Background: Purpureocillium lilacinum (P. lilacinum) is an emerging filamentous fungus known to cause opportunistic infections, particularly in immunocompromised patients. Formerly known as Paecilomyces lilacinus, this pathogen is widespread in the environment and can lead to a range of infections, from superficial skin lesions to invasive diseases. This article presents a case of deep cutaneous hyalohyphomycosis caused by P. lilacinum in a liver transplant patient, followed by a review of the literature focusing on new antifungal agents. Methods: We reported a brief case description followed by a narrative review of the literature regarding P. lilacinum cutaneous and lymphangitic infections in immunocompromised patients. Results: We conducted a review of the literature over the past 20 years, focusing on the clinical features, diagnostic challenges, and therapeutic outcomes of cutaneous and lymphangitic P. lilacinum infections in immunocompromised hosts. Conclusions: This review highlights the critical importance of early diagnosis through the analysis of biopsy samples using standard microbiological and histological techniques, complemented by innovative molecular biology methods. We also emphasise the role of appropriate antifungal treatment, despite the absence of an established standard of care, particularly in high-risk patients. Furthermore, we review and discuss the current lack of a standardised therapeutic regimen and the potential of novel antifungal agents as promising treatment options for P. lilacinum infections.
Vascular graft infections are rare but serious complications of vascular surgery. Listeria monocytogenes represents an exceedingly rare yet potentially life-threatening cause. We present a narrative review according to the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, summarizing the existing literature regarding Listeria vascular graft infections. Moreover, we have revised novel potential antibiotics against Listeria spp. A systematic search identified 23 studies involving 39 patients. Most infections affected abdominal aortic grafts (50%), with a median interval of 28 months from graft implantation to infection. Common comorbidities included hypertension (30.8%) and diabetes (18%), with 24% of patients being immunocompromised. Diagnosis was supported by blood cultures (45%) and imaging, particularly computed tomography (CT, 90%) and positron emission tomography CT (PET-CT) in selected cases. Surgical intervention was performed in 55% of patients, while 45% were treated medically. Ampicillin, often combined with an aminoglycoside, was the most common first-line therapy. Median treatment duration was 51 days, with some patients requiring lifelong suppressive antibiotic therapy. Mortality was low (one patient), and no recurrences were reported. This review underscores the diagnostic complexity and evolving management strategies in Listeria spp. vascular graft infections.
10 February 2025 in Infectious Diseases & Immunity
Antimicrobial resistance (AMR) in Gram-negative pathogens represents a critical global health challenge. Combining cefepime with novel β-lactamase inhibitors (enmetazobactam, taniborbactam, zidebactam, and nacubactam) revitalizes the role of this fourth-generation cephalosporin in contemporary therapy. We present a narrative review according to the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, summarizing the existing literature regarding new cefepime combinations with β-lactamase inhibitors. Based on 68 identified studies, data were structured by molecule. Each section explores in vitro activity, preclinical in vivo data, PK/PD parameters, clinical evidence, and dosage. Findings demonstrate that these inhibitors successfully restore cefepime’s efficacy against diverse resistance mechanisms, notably ESBLs, AmpC, KPC, OXA-48, and metallo-β-lactamases. “Cefepime 2.0” therapies expand the therapeutic armamentarium against severe multidrug-resistant infections, offering vital carbapenem-sparing strategies. Because they possess distinct microbiological spectra, these agents serve complementary rather than interchangeable roles. Their clinical success demands targeted integration into antimicrobial stewardship programs to optimize efficacy and safely reduce carbapenem dependence.
Background and Clinical Significance: Corynebacterium striatum is an emerging multidrug-resistant pathogen increasingly implicated in infections among immunocompromised patients and patients with indwelling medical devices. Case Presentation: We report the probable first case of pseudomembranous inflammation associated with C. striatum infection in a 53-year-old male with an implanted left ventricular assist device (LVAD) awaiting heart transplantation. The patient experienced recurrent episodes of C. striatum bacteremia despite multiple courses of targeted antibiotic therapy, including vancomycin, linezolid, tedizolid, teicoplanin, and dalbavancin. During urgent heart transplantation, pseudomembranous tissue surrounding the LVAD driveline was observed, and cultures confirmed C. striatum device infection. Histopathological analysis revealed necrotic elements and Gram-positive organisms consistent with pseudomembranous inflammation. Conclusions: The case describes the diagnosis and treatment of this rare infection, highlighting the pathogenic potential of C. striatum, its role in device-related infections, and the histopathological evidence of pseudomembrane formation.