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Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents. [ABSTRACT FROM AUTHOR]

Fosfomycin in intravenous (IV) formulation has re-emerged as a valuable tool in the treatment of multi-drug resistant (MDR) and extensively drug-resistant (XDR) infections because of its broad spectrum of antibacterial action and pharmacokinetic characteristics. This retrospective study aimed to evaluate how fosfomycin was used in patients admitted to the Polyclinic of Palermo between January 2017 and July 2022. Clinical indications, therapeutic associations, clinical outcomes, and any side effects were analyzed. Intravenous fosfomycin was used in 343 patients, 63% male, with a mean age of 68 years (range 15–95). Urinary tract infections (UTIs) and hospital-acquired pneumonia (HAP) were the main indications for treatment (19% and 18% of the total cases, respectively), followed by skin and soft tissue infections and sepsis. IV fosfomycin was administered in combination with other antibacterial agents, the most common of which were ceftazidime/avibactam (35%), meropenem (17%), and colistin (14%). Nineteen patients received it as monotherapy for UTIs. About 66% had resolution of the infectious process with clinical remission (cure or discharge). Electrolyte disturbances occurred in 2.6% and gastrointestinal symptoms occurred in 2.9%. The data showed that IV fosfomycin is a safe and effective therapeutic option in the treatment of infections with multidrug-resistant microorganisms. [ABSTRACT FROM AUTHOR]

Introduction: We investigated 170 HBsAg-positive immigrants living in Italy for 1-7 years to ascertain whether they may have become infected in the host country.Methods: Of 2032 adult immigrants interviewed, 1727 (85%) voluntarily adhered to a screening program for bloodborne or sexually transmitted infections. HBsAg was detected in 170 (9.8%) screened immigrants who completed the diagnostic, clinical and therapeutic process at the nearest clinic of infectious diseases. HBV molecular biology was performed applying a homemade technology. Phylogenetic signal of the datasets was obtained by a likelihood-mapping analysis using TreePuzzle.Results: Of the 170 HBsAg-positive immigrants, 133 were inactive carriers, 29 had chronic hepatitis and 8 compensated cirrhosis. HBV genotype was identified in 109 of the 113 HBV-DNA-positive immigrants and HBV-genotype-E predominated (68.9%). Of these 109, 6 (5.5%) subjects showed an HBV genotype absent or extremely rare in their native country: HBV-genotype-E in three from Eastern Europe and in one from Sri Lanka, possibly acquired from other immigrants from sub-Saharan countries, HBV-genotype-D1 in one from Burkina Faso and one from Senegal, possibly acquired in Italy.Conclusion: The data suggest that immigrants may acquire HBV infection in Italy and, therefore, HBV vaccination programs should be extended to all immigrants living in Italy. [ABSTRACT FROM AUTHOR]

Ceftobiprole is approved in Europe for treatment of community-acquired pneumonia and non-ventilator-associated hospital-acquired pneumonia (HAP) in adults. Real-world data are limited. This multi-centre, observational, ambispective investigator-initiated study was undertaken in Italy from January 2018 to December 2019 in order to evaluate the use of ceftobiprole in a real-world setting. Overall, 195 patients from 10 centres were evaluated (68% retrospectively). Male sex was prevalent (n =121, 62%). Median age was 67 [interquartile range (IQR) 53–75] years. Median Charlson Comorbidity Index score was 5 (IQR 3–7). The most common indication was pneumonia (151/195, 77%), especially HAP. Other uses were skin and soft tissue infections (5%), endocarditis (4%) and bone infections (4%). Ceftobiprole was usually an empiric choice (65%), in combination with other drugs (66%) and as second-line therapy (58%). A causative agent was found in 39% of cases. A diagnosis of sepsis was made in 59 cases (30%). Success in the clinically evaluable population (excluding 12 cases due to isolation of pathogens outside ceftobiprole's spectrum of activity) was obtained in 79% of cases, with all-cause mortality of 20%. On multi-level analysis, three predictors were positively associated with clinical success: male gender, pneumonia and detection of causal agent. Sepsis was a negative predictor. Nine factors were independently associated, favourably or unfavourably, with fatal outcome. Ceftobiprole is a safe and effective therapeutic choice, even in a real-world setting. More data are needed to establish its efficacy in patients with sepsis. [ABSTRACT FROM AUTHOR]

Aim: Diabetic foot ulcer infections are one of the mostly seen presentations of diabetic hospitalizations. However, as damaging but more mortal is diabetic hand infections and ulcers. The diabetic hand often presenting with silent infectious parameters, results in minor amputations and sometimes death very fast. Diabetic infections should be treated promptly, to avoid catastrophizing complications. Method: Nineteen diabetic patients with only upper extremity infections and ulcers are enrolled in this study. The operation rates, the amputation levels, hospitalization periods and various complications (nephropathy and sepsis) were reviewed retrospectively. Results / Discussion: All of the diabetic patients with hand infections and ulcers required operations. The operations were frequently debridements, and graft application. Ulcers seemed to localize however fasciitis were usually beyond at least 1 joint communicating. Minor amputations and fasciotomies were among other operations. Tendons were frequently exposed and flap surgery was required. Overall the hospitalization periods were longer than the diabetic foot ulcer patients (27 days compared to 13,5 days). One patient was lost 7 days after hospitalization. Due to the sophisticated structure of the hand musculature the intrinsic and extrinsic muscles are in communication with each other through various tunnels and compartments. This a little bit different from the leg which has 3 compartments with quite bigger muscles than hand. Hand infections are easily spread to the forearm. Conclusion: We think that especially health professionals are aware of the leg ulcers however very few are known about hand ulcers of diabetic patients. Both patients and professionals underestimate its importance and morbidity and mortality which is higher than leg ulcers. [ABSTRACT FROM AUTHOR]

Aim: Soft skin infection with Vibrio vulnificus could result in sepsis and necrotizing fasciitis if incision and tension reduction are not performed promptly. Biofilms are major contributors to multiple chronic inflammatory diseases. It greatly delay wound healing. In this case, we successfully rescuing an imperilled skin grafting of Vibrio vulnificus infected wound of survivor. Method: The 41-year male patient, who presented lower extremity edema and skin rupture, then developed septic shock. Survivor not only treated with hemodialysis and aggressive management of septic state, but also 5 times surgical wound management which including debridement, negative pressure wound therapy. However, we found exudate after the wound is closed by suture. During the next operation, the suture was removed and it was found that bacterial biofilm colonized at the wound base, manifested as shiny and slippery surface, with exudate and slough. PHMB [1] was used to rinse the wound before negative pressure wound therapy. The skin grafting was performed afterwards. When dressing change, it was found that the skin graft did not adhere or turn color and it was easily removed from the wound. PHMB gel was continued to use in every dressing change. Results / Discussion: The skin graft expanded quickly after it attached to the wound. 12-month postoperative result showed no sign of relapsed infection. Conclusion: Because the difficulties of visualizing biofilm, we should always consider its presence when failure in wounds. The principles of managing biofilm is to reduce the burden and prevent reconstruction of biofilm by barrier dressing and sequential topical antimicrobials. Changing to a different antimicrobial if there is lack of progress is an emerging choice. [ABSTRACT FROM AUTHOR]

Aim: Presentation of challenging wound treatment following necrotizing soft tissue infection and multiple bowel perforations after liposuction procedure. We present a complex case which resulted in a 5-month long hospitalization, multidisciplinary wound healing and numerous surgeries -- 4 laparotomies, and 13 free skin grafts. Method: A 43-year-old female patient presented to the ER with severe skin necrosis, covering her entire abdomen and most of her anterior thighs, 5 days after an abdominal wall and both thighs liposuction. She presented with septic shock that required vasopressor support and mechanical ventilation, accompanied by acute renal failure which required admission to the intensive care unit. A CT scan revealed free air in the abdomen, air and fat stranding in the soft tissue of the abdominal wall and thighs. Extensive skin and abdominal wall necrosis, with pockets of pus and enteric content was found throughout. The entire necrotic fascia and skin were resected, leaving no abdominal wall and massive tissue loss on both thighs. Results / Discussion: The management of extensive ulcers was determined by a nurse specialist with multidisciplinary team support. Alginogel enzyme and Silver Stream solution were the main intervention therapy devices that allowed wound bed preparation for skin graft. Following long hospital stay and slow recovery the patient was discharged home after 5 month -- 3 month of which in the ICU. Conclusion: We believe that this complication is under-reported in the literature. A systemic literature review published by Skorochod et al, found 49 cases of abdominal visceral perforation. Alongside internal complications this condition can lead to additional morbidity like extensive skin damage. [ABSTRACT FROM AUTHOR]

Aim: To investigate, based on the available evidence, the prevalence rate of skin infection among adult homeless individuals who are intravenous drug users (IVDU). Method: A systematic review following PRISMA guidelines. CINAHL, Medline and Embase were searched between 5th-9th January 2022. The PEO mnemonic (Population, Exposure, and Outcome) was utilised to form the review question. Quality appraisal of studies included was conducted using the evidence-based librarian (EBL) critical appraisal checklist. Data are presented using a narrative synthesis. Results / Discussion: Of 1552 potential studies identified, 15 met the criteria. A 51% (n= 7303/14301) prevalence of Skin and Soft Tissue Infection (SSTI) among homeless IVDUs was identified. The most common specific type of wound-related complications was abscess (53.3%), cellulitis (26.7%), abscess and cellulitis (13.3%), and secondary bacteraemia (6.7%). Furthermore, there is an increasing number of SSTI on the hand and upper extremity infections among IVDUs. Conclusion: Worryingly, 51% of IVDUs present to the emergency department with an SSTI. These results indicate the urgent need for wound-related care services for specific skin infections due to injecting drug use. However, the results are not entirely conclusive. There is also insufficient variety and quality of primary research studies related to this topic. Therefore, this systematic review has been fundamental for determining the need for further research. [ABSTRACT FROM AUTHOR]

The genus Myroides comprises aerobic, yellow-pigmented, non-motile, non-fermenting gram-negative rods formerly classified as Flavobacterium odoratum. Members of the genus are widely distributed in the environment, especially in water, and usually behave as low-grade opportunistic pathogens, having been found to cause urinary tract infection, endocarditis, ventriculitis, and cutaneous infections in severely immunocompromised patients. We report a case of soft tissue infection, septic shock, and pneumonia due to M. odoratimimus in an immunocompetent male. To our knowledge, this is the first description of life-threatening infection caused by this organism in an immunocompetent host. We have also reviewed the medical literature on the genus Myroides. [ABSTRACT FROM AUTHOR]

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamination from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found as an opportunistic pathogen in immunocompromised patients. It is not rare to find reports of bacteremia and sepsis from contamination of intravenous fluid, parenteral nutrition, blood products and anesthetic agents—that is, through contamination of medical devices and products. We reported a bacterial infection epidemic occurred in 2011 in a hospital in middle Italy which involved different hospital wards; Pantoea agglomerans was isolated from blood cultures of all infected patients and the source of infection was identified in contaminated parenteral nutrition prepared from the local pharmacy. [ABSTRACT FROM AUTHOR]

Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016-September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.