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Dalbavancin is a lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). The aim of the study was to evaluate the efficacy and safety in all patients who received at least one administration of dalbavancin., Methods: We carried out a retrospective study of the use of dalbavancin in 55 patients at the Azienda Ospedaliera Ospedali Riuniti Umberto I (Ancona, Italy) from February 2017 to May 2020 and compared "on label" and "off label" use of dalbavancin in ABSSSI and non-ABSSSI., Results: A total of 55 patients were included in the study. The median age was 61 years; 51% had ABSSSI; 24% had prosthetic joint infections, and 14% had osteomyelitis. A total of 53% received a single 1500 mg infusion of dalbavancin, and 18% received a second dose 14 days later; 24% of patients received further doses at 14-day intervals. In 91% of cases, patients achieved clinical objectives with dalbavancin: 96% of patients with ABSSSI and 69% of those with prosthetic joint infections., Conclusions: Dalbavancin was shown to have an excellent tolerability profile and to be a highly successful therapeutic approach even in those cases treated "off-label".

The optimal management of cranioplasty infections remains a matter of debate. Most authors have suggested that the infected bone/implant removal is mandatory, combined with prolonged antibiotic therapy before reconstruction. However, failures can occur, even with 12-18-month intervals between the surgeries. Longer wait times before cranial reconstruction increase the risks of socioeconomic burdens and further complications, as observed in decompressed patients hosting shunts. In our department, we treated 48 cranioplasty infections over a period of 8 years, divided into two groups. For Group A (n = 26), the treatment consisted of cranioplasty removal and debridement, followed by a delayed reconstruction. Group B (n = 22) received 2 weeks of broad-spectrum antibiotics, followed by an "aggressive" field debridement and immediate cranioplasty. All patients received a minimum of 8 weeks of post-operative antibiotic therapy and were scheduled for clinic-radiological follow-ups for at least 36 months. Significant differences were observed between Groups A and B with respect to the number of failures (respectively 7 versus 1), the global operative time (significantly longer for Group B), germ identification (respectively 7 versus 13), and the overall length of hospital stay (on average, 61.04 days in Group A versus 47.41 days in Group B). Three shunted patients in Group A developed sinking flap syndrome. Shunt resetting allowed symptom control until cranioplasty in one subject, whereas two did not improve, even after reconstruction. In selected patients, an aggressive field debridement, followed by the immediate replacement of an infected cranioplasty, may represent a safe and valuable option.

We studied the prevalence of Giardia intestinalis in five patients risk groups including institutionalised psychiatric of elderly subjects, HIV-positive immunocompromised patients, immigrants from developing countries and travellers to tropical countries. Stool specimens of 1319 subjects were studied. Stools were collected in triplicate from each subject. The presence of bacteria, viruses and parasites was evaluated. A direct smear examination from fresh faecal specimens and after concentration with formalin-ethylacetate was performed for parasite examination. Smears were also stained by a modified acid fast method and then examined for the presence of Cryptosporidium spp. and other coccidia. Cryptosporidium parvum and G. intestinalis were also detected by immunofluorescent assay. Contemporaneously a microbiological investigation was performed with standard culture, biochemical techniques and viral detection. Clinical data about each subject were provided by standardised questionnaires. G. intestinalis was detected in the stools of 41 subjects (3.5%). The immigrants (5.5%), the institutionalised psychiatric patients (5.0%) and HIV immunocompromised patients (4.6%) showed the highest prevalence. By contrast, travellers showed the lowest prevalence (2.5%). G. intestinalis was the pathogen most frequently detected. The cohorts with the presence of more risk factors showed the highest prevalence. The low prevalence of the parasite among travellers demonstrated the significance of health education before travelling and of the most important role of bacterial etiopathogenesis in "traveller's diarrhoea". Epidemiologically, G. intestinalis remains a protozoon of evident importance and is significantly present in Italy.

Aging and HIV have parallelism in immunodeficiency status because of the appearance of infections or relapse leading to death in both conditions. HIV-RNA is predictor for HIV progression correlated with CD4+ depletion. CD4+ and plasma zinc levels (zincaemia) may be predictors for infections relapse in aging because of zinc relevance for normal immune efficiency against infections and for CD4+ growth. Moreover, zincaemia decreases in aging and infection. A total of 67 elderly subjects affected by infections resistant to antibiotic therapy were recruited. A total of 28 HIV+ subjects with HAART therapy were also used. CD4+ depletion (507 mm3) and zincaemia deficiency (76 microg/dl), as compared to CD4+ (700-1100 mm3) and zincaemia (85-100 microg/dl; age 40-75 years) normal ranges, are possible limits (Cox hazard regression) for severe infections relapse, such as chronic obstructive bronchitis and bronchopneumonia by bacteria or Candida complication, in aging. CD4+ and zincaemia values are within the lower limits of normal range in urinary tract infections. Zincaemia and HIV-RNA or CD4+ are inversely correlated (r = 0.57 and r = 0.72, respectively) in HIV+ HAART treated subjects. Consequently there is no appearance of opportunistic infections. Parallelism between aging and HIV may exist because of the resemblance in marked zinc deficiency and CD4+ depletion with high scores in relative risks for severe infections relapse. Supplementing zinc (12 mg Zn++/day) for one month in infected elderly subjects and HAART therapy in HIV+ subjects reduces risk scores in CD4+ and zincaemia deficiencies for infections relapse, suggesting that the zinc beneficial effect may be independent either by HIV-virus or pathogen agents involved. While HAART may reduce the occurrence of opportunistic infections in HIV by means of also major zinc bioavailability, supplementing zinc can be recommended in elderly people as resistance to infections. Since zinc deficiency is correlated with CD4+ depletion, this latter may also be good diagnostic marker to detect 'clear immunodeficiency' in aging, as in HIV condition.