Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the aortic native and prosthetic mitral valve, highlighting the clinical characteristics, treatment, and complications of this condition.

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12–24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.

Colistin has re-emerged as a last-resort antibiotic for treating infections caused by multidrug-resistant (MDR) Gram-negative bacilli (GNB). However, increasing resistance threatens its efficacy. This study aimed to evaluate colistin resistance trends among clinical isolates of Gram-negative bacilli isolated over a five-year period at a large Emergency Hospital in North-Eastern Romania. A total of 23,143 GNB strains were isolated during the study period, including 14,531 Enterobacterales and 8294 non-fermenting Gram-negative bacilli. The percentage of colistin-resistant strains among those analyzed was 3.98%. Species-specific analysis focused on Klebsiella spp., Escherichia coli, Enterobacter spp., Citrobacter spp., Pseudomonas spp., and Acinetobacter spp. Klebsiella spp. exhibited the highest prevalence of colistin resistance, accounting for over 80% of all colistin-resistant strains, with annual resistance rates fluctuating between 12.97% and 21.64%. Colistin resistance among E. coli was low (0.18–1.25%). Citrobacter spp. showed no resistance in the last three years of the study, and Enterobacter spp. maintained relatively stable resistance (3–5%). Resistance in Pseudomonas spp. remained below 1%, while Acinetobacter spp. showed a resistance rate of 5.43%. Several distinct resistance phenotypes were identified among Klebsiella spp., Pseudomonas spp., and Acinetobacter spp. strains, reflecting both endemic and sporadic circulation patterns. The study highlights a persistent presence of colistin resistance, especially in Klebsiella spp., underlining the importance of ongoing surveillance. Despite low resistance in other species, the emergence of resistant strains underscores the need for robust antimicrobial stewardship and infection control policies.

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.