The emergence of antimicrobial resistance (AMR) is of great concern to global public health. Treatment of multi-drug resistant (MDR) infections is a major clinical challenge: the increase in antibiotic resistance leads to a greater risk of therapeutic failure, relapses, longer hospitalizations, and worse clinical outcomes. Currently, there are no validated treatments for many MDR or pandrug-resistant (PDR) infections, and preventing the spread of these pathogens through hospital infection control procedures and antimicrobial stewardship programs is often the only tool available to healthcare providers. Therefore, new solutions to control the colonization of MDR pathogens are urgently needed. In this narrative review, we discuss current knowledge of microbiota-mediated mechanisms of AMR and strategies for MDR colonization control. We focus particularly on fecal microbiota transplantation for MDR intestinal decolonization and report updated literature on its current clinical use.

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Invasive group A streptococci infections are increasing worldwide, mainly due to the emm1 lineage M1_UK emergence. Although this variant has recently been described in adult Italian patients, its circulation in children has not yet been established. Characterizing by whole genome sequencing 6 invasive group A streptococci strains isolated between 2022 and 2023, we highlighted M1_UK lineage circulation in pediatric patients in Italy.

Infections represent a severe complication of extracorporeal membrane oxygenation (ECMO). Aim of the present study was to describe the epidemiology of infections acquired during ECMO in a tertiary care children's hospital. Retrospective analysis of clinical records of patients undergoing ECMO between January 2009 and December 2016. For each patientdata were collectedonclinical characteristics, modality of ECMO support, site and etiology of documented infections, survival within one week after ECMO weaning and/or at pediatric intensive care unit discharge. These data were employed to evaluate overall infection prevalence, infection rate (IR) expressed as episodes/1000 days of support and cumulative risk estimates of infections occurring during ECMO. During the study period a total of 46 ECMO procedures were performed. The overall prevalence of documented infections was 33%, with an IR of 27.22 and a CR of 55%. Bloodstream infection represented the most frequently documented (53%), followed by pneumonia (40%). Coagulase negative staphylococci and P.aeruginosa were prevailed as isolated pathogens. Overall survival was 59%, and 46% among those developing infections during ECMO. ECMO is a procedure at high risk for infections. Our data, limited to one center, represent a recent benchmark for further investigations.