Background/Objectives: Multidrug-resistant (MDR) nosocomial infections remain a major challenge in intensive care units (ICUs), where delays in diagnosis and suboptimal antimicrobial therapy significantly impact outcomes. This narrative review synthesizes international literature and local epidemiological data from Western Romania to examine the role of rapid molecular diagnostics in the management of MDR infections and their integration with prevention and antimicrobial stewardship (AMS) strategies. Methods: Evidence was collected through a narrative literature review using PubMed, WHO, and ECDC sources published between 2010 and 2025. Key terms included “rapid molecular diagnostics,” “sepsis,” “ICU,” “UNYVERO,” “GeneXpert,” “BioFire,” and “carbapenem resistance.” Studies were selected based on clinical relevance to rapid diagnostics and MDR pathogens; no PRISMA-based systematic methodology was applied. Results: Diagnostic performance varies by platform and clinical syndrome. UNYVERO Hospitalized Pneumonia panel demonstrates a sensitivity range of 88.8–91.4% and specificity of 94.9–99.5% in respiratory infections, with a turnaround time of approximately 4–5 h. The GeneXpert Carba-R assay identifies major carbapenemases within 45–60 min with reported sensitivity 96–100% and specificity of 93–99%. BioFire^® Pneumonia and Blood Culture Identification panels similarly provide rapid syndromic results within 1 h, enabling earlier optimization of antimicrobial therapy. Local ICU data from Western Romania identified a substantial burden of carbapenem-resistant Acinetobacter baumannii, underscoring the need for rapid resistance detection to guide therapy. Conclusions: Rapid molecular diagnostics, when integrated with prevention bundles and AMS programs, facilitate earlier targeted therapy, support responsible antimicrobial use, and improve clinical decision-making in MDR infections. Their value is amplified in settings with high resistance prevalence. Wider implementation, combined with surveillance and access to novel antimicrobials, is essential to improve outcomes in critically ill patients.

Sedation and anesthesia are integral components of modern gastrointestinal endoscopy, enhancing patient comfort and procedural success while adding risks such as respiratory and cardiovascular complications. Accurate monitoring of sedation depth is essential to balance safety and procedural efficacy. This narrative literature review synthesizes current evidence on monitoring depth of anesthesia during endoscopic procedures, including clinical assessment scales, capnography, and processed electroencephalogram (pEEG)-based technologies. The effects of commonly used sedative agents on monitoring parameters and the impact of different monitoring strategies on clinical outcomes are also discussed. Current evidence indicates that clinical assessment remains the cornerstone of monitoring during moderate sedation, while capnography improves early detection of respiratory compromise during deep sedation. pEEG-based monitoring may provide additional value in selected high-risk or prolonged procedures but should complement, not replace, clinical evaluation. A multimodal monitoring approach tailored to sedation depth and patient risk profile is likely to be the most effective strategy for optimizing patient safety. Future research should focus on standardizing monitoring protocols and identifying populations most likely to benefit from advanced monitoring techniques.

Background/Objectives: Carbapenem-resistant Gram-negative (CR-GN) infections are associated with high mortality in intensive care units (ICUs), with limited therapeutic options. We aimed to evaluate microbiological and clinical outcomes associated with cefiderocol in critically ill patients with multidrug-resistant (MDR) Gram-negative infections. Methods: This retrospective, single-center case series included 25 critically ill patients with carbapenem-resistant or multidrug-resistant Gram-negative infections treated with cefiderocol between May 2024 and October 2025 in a mixed ICU of a tertiary hospital in Romania. Microbiological cure was defined as eradication of the designated target pathogen at the end of therapy. Clinical evolution was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, as well as inflammatory biomarkers including white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT). Results: Klebsiella pneumoniae was the predominant pathogen, identified in 23 of 25 patients (92%), followed by Acinetobacter baumannii (11/25, 44%) and Pseudomonas aeruginosa (6/25, 24%). As multiple pathogens were co-isolated in 16 patients (64%), percentages exceed 100% and are reported as proportions of patients rather than of total isolates. Microbiological cure was achieved in 68% of patients. Mortality was markedly higher in patients without microbiological eradication (88% vs. 35%). Higher baseline APACHE II (HR 1.18, 95% CI 1.02–1.37) and SOFA scores (HR 1.33, 95% CI 1.07–1.65) were associated with increased mortality. Early initiation of cefiderocol (≤10 days from ICU admission) was associated with improved microbiological and clinical outcomes compared to delayed treatment. Reductions in severity scores and inflammatory markers, including C-reactive protein (CRP) and procalcitonin (PCT), were observed during therapy. Pathogen type and combination therapy were not clearly associated with outcomes in this cohort. Conclusions: Cefiderocol was observed in association with clinically relevant rates of microbiological eradication and improvements in clinical parameters in critically ill patients with MDR Gram-negative infections. Outcomes appeared to be primarily determined by baseline disease severity, while earlier initiation of therapy was associated with more favourable microbiological and clinical outcomes, although causality cannot be established given the observational design and absence of a comparator group. These findings are hypothesis-generating and supportive of a potential role for cefiderocol as a salvage option in high-risk ICU populations, pending validation in larger, prospective, controlled studies.

Background: NT-proBNP is a mechanistically grounded biomarker of ventricular wall stress with established prognostic value in cardiac surgery, but its perioperative role in lung cancer resection remains incompletely characterised. Pulmonary resection imposes unique haemodynamic stressors—including one-lung ventilation-induced right ventricular afterload increase, permanent pulmonary vascular bed reduction, and ischaemia–reperfusion injury—that create a distinct biological context for natriuretic peptide elevation not represented in general surgical cohorts. Methods: A narrative review of the literature was conducted through systematic searches of PubMed, EMBASE/MEDLINE, and the Cochrane Library (January 2000–June 2026), supplemented by manual reference screening. Approximately 135 articles were included in the final synthesis. Results: Perioperative NT-proBNP elevation predicts postoperative atrial fibrillation, major adverse cardiovascular events, and long-term survival after lung resection, with effect sizes substantially exceeding those reported in general surgical populations. The PRESAGE trial established that NT-proBNP-guided prophylaxis reduces postoperative atrial fibrillation from 40% to 6% in high-risk patients. No thoracic surgery-specific NT-proBNP threshold has been prospectively validated in a multicentre setting, and approximately half the evidence base derives from BNP rather than NT-proBNP assays, precluding direct threshold synthesis. Surgical approach—particularly robot-assisted thoracoscopy—modulates postoperative biomarker elevation through OLV duration rather than inflammatory burden alone. The combination of NT-proBNP with high-sensitivity troponin identifies a dual-elevation subgroup with a MACE rate of 18.4%. Conclusions: NT-proBNP measurement is clinically actionable in thoracic surgery but requires assay-standardised, multicentre validation of population-specific thresholds stratified by resection extent and surgical approach. A dual biomarker strategy combining NT-proBNP with high-sensitivity troponin represents the most evidence-based perioperative risk stratification framework currently available.

Background: Multidrug-resistant Gram-negative infections remain a major challenge in critically ill patients, particularly when caused by carbapenem-resistant pathogens with limited therapeutic options. Although eravacycline has emerged as a potential salvage agent, real-world data in high-acuity intensive care populations remain scarce. Methods: We conducted a retrospective cohort study including adult ICU patients who received eravacycline as salvage therapy for multidrug-resistant Gram-negative infections between February 2024 and September 2025 in a tertiary-care center. Demographic, clinical, microbiological, and treatment-related variables were extracted from electronic records. Infection complexity was classified as monomicrobial single-site, monomicrobial multi-site, or polymicrobial. The primary outcome was in-hospital mortality; secondary outcomes included clinical response, microbiological eradication, and safety. Results: Forty critically ill patients were included (median age 58 years, IQR 47–69; mean APACHE II 16.4 ± 6.9; mean SOFA 5.5 ± 3.3). Pulmonary (62.5%) and intra-abdominal (55.0%) infections were most frequent. Klebsiella pneumoniae predominated (75.0%), followed by Acinetobacter baumannii (35.0%) and Pseudomonas aeruginosa (22.5%). Most patients received combination antimicrobial therapy. Microbiological eradication or presumed eradication was documented in 24 patients (60.0%), yet overall in-hospital mortality remained high (75.0%). Baseline disease severity and persistent inflammatory response were more strongly associated with unfavorable outcomes than treatment timing or duration. Conclusions: In this real-world ICU cohort, eravacycline-based salvage therapy was associated with moderate microbiological response but very high mortality, reflecting the severity of underlying critical illness. The dissociation between microbiological eradication and survival suggests that outcomes are more closely related to host factors and unresolved systemic inflammation than to pathogen clearance alone. Eravacycline remains one of the few agents active against MDR Gram-negative pathogens (with no activity against Pseudomonas aeruginosa), frequently used off-label; larger controlled studies are needed to establish efficacy beyond complicated intra-abdominal infections.

Background/Objectives: Anatomical lung resection removes part of the pulmonary vascular bed and may acutely alter right ventricular loading conditions. The magnitude and the clinical significance of these early changes remain incompletely characterized, and it is unclear whether early echocardiographic changes relate to postoperative complications. This study aimed primarily to characterize the perioperative echocardiographic response to lung resection, while associations with any postoperative complication and with a cardiopulmonary composite outcome were evaluated as a secondary, exploratory analysis. Methods: This prospective, single-center observational study included 40 adult patients undergoing lung resection for suspected or confirmed lung cancer. Transthoracic echocardiography was performed preoperatively and on the first postoperative day, and N-terminal pro–B-type natriuretic peptide (NT-proBNP) was measured preoperatively and at 24 h. Assessed parameters included left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PASP), peak tricuspid regurgitation velocity (TRV), the TAPSE/PASP coupling ratio and NT-proBNP. The primary outcome was the paired perioperative change in those measurements. Paired comparisons used the Wilcoxon signed-rank test with matched-pairs rank-biserial correlations and bootstrap confidence intervals; exploratory comparisons used Mann–Whitney U tests and areas under the receiver operating characteristic curve (AUC) with bootstrap confidence intervals. Multivariable modeling was not performed. Results: All six parameters changed significantly between the preoperative and postoperative assessments. PASP increased by a median of 4.0 mmHg (p < 0.001) and TRV max by 0.10 m/s (p < 0.001), while TAPSE decreased by 0.10 cm (p = 0.015) and LVEF by 2.0 percentage points (p = 0.001). The right ventricular–pulmonary arterial (RV–PA) coupling ratio declined from 0.717 to 0.526 mm/mmHg (p < 0.001) and NT-proBNP rose from 82.5 to 229.0 pg/mL (p < 0.001). Sixteen patients (40.0%) developed any complication and seven (17.5%) developed a cardiopulmonary complication. No echocardiographic parameter showed statistically supported discrimination for either outcome; all corresponding confidence intervals for the AUC included 0.50. NT-proBNP measured at 24 h and its perioperative change showed nominal associations with complication status, whereas the preoperative concentration did not. All recorded complications were documented before the 24-h blood draw. Conclusions: Anatomical lung resection was followed by statistically detectable changes in measured echocardiographic indices by the first postoperative day. The cohort-level increase in pulmonary pressures and the decline in RV–PA coupling were the most clearly supported findings, whereas the small changes in TAPSE and LVEF are of uncertain biological magnitude. No echocardiographic parameter showed statistically supported discrimination between patients who did and did not develop complications, as estimates were imprecise, with wide confidence intervals. The association with 24-h NT-proBNP was post-event and therefore cannot be interpreted as evidence of predictive value.