Search Results (590)

Bacterial biofilms are structured microbial communities enclosed within a self-produced extracellular polymeric substance matrix composed of polysaccharides, proteins, extracellular DNA, and lipids. This matrix promotes adhesion, structural stability, and the development of heterogeneous microenvironments that restrict antimicrobial penetration and shield bacteria from host immune responses. As a result, biofilms are major contributors to chronic, recurrent, device-related, and difficult-to-treat infections, posing a major challenge for clinical management and antimicrobial stewardship. This review summarizes current understandings of biofilm biology, its clinical relevance, including the stages of biofilm development, the composition and protective roles of the matrix, and the physiological heterogeneity that arises during maturation. It also examines key mechanisms underlying biofilm tolerance and resistance, such as limited antibiotic diffusion, and sequestration, enzymatic inactivation, efflux pump upregulation, persister cell formation, and horizontal gene transfer. In addition, it highlights important clinical settings in which biofilms are implicated, including cystic fibrosis, chronic wounds, osteomyelitis, implant- or device-associated infections, and breast implant illness, in which persistent implant-associated biofilms and the resulting chronic inflammatory milieu have been hypothesized to contribute to local and systemic manifestations in a subset of patients. The review further discusses conventional and emerging approaches for biofilm detection alongwith real-time monitoring. Biofilm-associated infections remain difficult to eradicate because persistence is driven by multiple interconnected protective mechanisms. Effective management therefore requires integrated strategies that combine accurate detection with multifaceted therapies, including antibiotics alongside matrix-disrupting enzymes, quorum-sensing inhibitors, bacteriophages, metabolic reactivators, and nanotechnology-based delivery systems. Advances in multi-omics and system-level modeling will be essential for developing next-generation strategies to prevent, monitor, and treat biofilm-associated disease. Full article

Carbapenem-resistant Gram-negative infections have become one of the most formidable challenges in intensive care units (ICUs). Critically ill patients—often exposed to invasive procedures, prolonged hospitalization, and broad-spectrum antibiotics—are highly susceptible to infections by carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB). These pathogens are associated with mortality exceeding 40%, prolonged ICU stays, and increased healthcare costs. Therapeutic advances have reshaped management in recent years. New β-lactam/β-lactamase inhibitor combinations—ceftazidime–avibactam, meropenem–vaborbactam, imipenem–relebactam, and sulbactam–durlobactam—along with cefiderocol, have provided safer and more effective alternatives to previously used regimens. Yet, none are universally effective, particularly against carbapenemase-producing organisms, especially metallo-β-lactamase (MBL) producers, and resistance may still emerge during treatment. Rapid molecular and phenotypic diagnostics, when integrated into antimicrobial stewardship, have improved early therapy alignment and reduced unnecessary broad-spectrum use. Beyond antibiotics, colonization surveillance and infection control remain pivotal, as colonization often precedes invasive infection. Biofilm formation on devices such as endotracheal tubes and catheters further promotes persistence and relapse. Strategies targeting biofilm disruption, improved dosing guided by pharmacokinetic/pharmacodynamic optimization, and therapeutic drug monitoring are crucial in ICU practice. The future of managing these infections will depend on integrating precision tools—rapid diagnostics, mechanism-based therapy, and stewardship-guided decisions—with emerging treatments and adjunctive options such as immunomodulators, bacteriophages, and AI-driven decision support. Continued research in ICU-specific populations, especially regarding pharmacokinetics in patients on ECMO or CRRT, is urgently needed. In summary, while the therapeutic landscape for carbapenem-resistant Gram-negative infections has evolved substantially, sustained success will rely on a multifaceted strategy combining innovation, precision, and prevention to improve outcomes for the most vulnerable patients. Full article

Background: Continuous glucose monitoring (CGM) systems have significantly improved glycemic management in patients with type 1 diabetes mellitus and are generally considered safe. However, transcutaneous sensor insertion disrupts the skin barrier and, in susceptible individuals, may contribute to infectious complications. Severe soft tissue infections occurring in temporal association with CGM use are exceedingly rare. Case Presentation: We report a fatal case of necrotizing soft tissue infection in a 54-year-old male with long-standing type 1 diabetes mellitus occurring in temporal association with CGM use. The patient initially developed localized inflammation at a prior sensor insertion site that failed to fully resolve. Over subsequent weeks, he experienced progressive systemic symptoms and worsening local findings, culminating in advanced necrotizing infection. Despite emergency surgical debridement, broad-spectrum antimicrobial therapy, and intensive care support, the clinical course was complicated by septic shock and multiorgan failure, resulting in death. Discussion: This case highlights the role of patient-specific vulnerability, persistent insertion-site inflammation, and delayed clinical recognition in the progression from localized skin changes to life-threatening infection. Importantly, this report does not establish a direct causal relationship between CGM use and necrotizing soft tissue infection but underscores the need for heightened vigilance in high-risk individuals. Conclusions: Although CGM systems have a favorable safety profile, careful inspection of insertion sites, avoidance of sensor reapplication over incompletely healed tissue, and early evaluation of persistent or progressive symptoms are essential to minimize the risk of severe outcomes in susceptible patients. Full article

Infective endocarditis (IE) is a severe infectious disease affecting cardiac valves (either native or prosthetic) or implantable cardiac devices, and it is associated with high rates of morbidity and mortality. Recent data from the Global Burden of Disease study have shown a significant increase in both the incidence and mortality of IE. One-year mortality following diagnosis can reach up to 30%. IE can present with a wide range of clinical manifestations, and its course may be complicated by systemic embolic events or intracardiac complications such as abscess formation or prosthetic valve dehiscence. Echocardiography remains the first-line imaging modality; however, an integrated multimodality imaging approach is increasingly adopted in contemporary practice, incorporating both cardiac computed tomography and positron emission tomography. A multidisciplinary approach involving cardiologists, cardiac surgeons, internists, infectious disease specialists, and nuclear medicine physicians is often required to ensure accurate diagnosis and effective treatment of IE. The prognosis of infective endocarditis depends on early diagnosis, appropriate antimicrobial therapy, and timely surgical intervention when indicated. This review aims to summarize the current knowledge on IE, from pathophysiological insights to surgical strategies. It also focuses on practical recommendations to address the most pressing unmet clinical needs through a multidisciplinary approach. Full article

Background: Left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation who are at high risk of thromboembolic events or bleeding complications. Methods: In this single-center retrospective study, we analyzed 70 consecutive patients who underwent successful LAAC with the Watchman™ device between 2012 and 2024. Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements and mortality were evaluated. Mean follow-up duration was 1210 days. Results: Procedural success was achieved in 98.6% of cases with a low periprocedural complication rate. Ischemic stroke/transient ischemic attack occurred in 2.8% of patients; no hemorrhagic strokes or stroke-related deaths were observed. LAAC resulted in a significant reduction in both the number (144 vs. 56 events; 2.36 vs. 1.55 events per patient, p < 0.05) and severity of bleeding events. Nonetheless, 42.9% of patients required bleeding-related hospitalization after implantation, predominantly within the first 6 months during dual antiplatelet therapy. Overall mortality was 40% with a 12% yearly mortality rate; heart failure and infections were leading causes of death. Pre- and postprocedural transfusion requirements were independently associated with a six-fold increase in mortality risk (HR = 5.97). Conventional risk scores (CHA₂DS₂-VASc, HAS-BLED) failed to predict transfusion needs; atrial enlargement, right ventricular dysfunction, smoking and alcohol consumption were associated with higher risk. Conclusions: LAAC is a safe and effective alternative to long-term anticoagulation, significantly reducing bleeding burden without increasing thromboembolic mortality. Persistent postprocedural bleeding remains a major determinant of long-term prognosis, underscoring the need for individualized, multidisciplinary post-implant management. Full article

Staphylococcus epidermidis is a leading opportunistic pathogen in medical device-associated infections due to its ability to adhere to abiotic materials and develop biofilms that are difficult to eradicate. This study investigated the antibiofilm potential of an ethanolic extract of the red seaweed Gracilaria fisheri and its purified constituent, N-benzylcinnamamide, against S. epidermidis. Antibacterial activity was determined, and antibiofilm effects were assessed using the crystal violet assay and confocal laser scanning microscopy (CLSM). Early bacterial adhesion on glass and polyurethane (PU) surfaces was measured. The effect on catheter-associated biofilms was evaluated by scanning electron microscopy (SEM). Transcripts of biofilm- and quorum-sensing-associated genes (icaA and luxS) were assessed by semi-quantitative RT-PCR. Cytotoxicity was evaluated by MTT assay. At 200 µg/mL, biofilm biomass decreased to 48.21 ± 5.52% with the extract and to 36.65 ± 6.82% with N-benzylcinnamamide. CLSM time-course imaging showed delayed biofilm maturation and less consolidated, discontinuous structures. Surface exposure to the extract markedly reduced early attachment on both materials. On PU catheter segments, SEM demonstrated that N-benzylcinnamamide markedly reduced surface coverage and disrupted three-dimensional biofilm architecture. At the molecular level, transcription of icaA and luxS was reduced. Both the extract and N-benzylcinnamamide showed minimal cytotoxicity in HeLa cells. These findings support further evaluation of these marine-derived agents as candidates for antibiofilm surface treatments to reduce early medical device colonization. Full article

To map and describe the scientific evidence on germicidal ultraviolet C (UV-C) light for hospital surface disinfection, this scoping review examined device types, reported operational parameters, microbiological and clinical outcomes, and implementation aspects. Primary studies conducted in hospital settings and evaluating UV-C or ultraviolet germicidal irradiation on environmental surfaces were searched in four databases without date restrictions. Data were synthesized descriptively in tables and narrative form following JBI and PRISMA-ScR guidance. Eleven studies (2007–2025) met the inclusion criteria. Reported microbial reductions ranged from 1 to ≥5 log₁₀. Higher and more consistent reductions were predominantly observed under laboratory or controlled experimental conditions, whereas reductions in real-world hospital surface sampling were more variable and influenced by pathogen type, surface material, room geometry, and shadowing. Integration of UV-C with manual cleaning and multi-position irradiation cycles was associated with greater effectiveness. Reporting of key radiometric parameters (dose, exposure time, and distance) was frequently incomplete, limiting reproducibility and cross-study comparability. Clinical findings were heterogeneous: some interrupted time-series analyses suggested reductions in healthcare-associated infections, although effects were not uniform across microorganisms. Implementation reports described room-level cycle times compatible with turnover, variable staffing requirements, and limited economic evaluation. Overall, UV-C appears to be a promising adjunct to standard cleaning practices in hospital environments. However, standardized radiometric reporting, multicenter studies, and robust clinical and economic evaluations are necessary to support safe, reproducible, and sustainable large-scale implementation. Full article

In the 21st century, there have been radical changes in healthcare related to the transition from a universal approach to personalized medicine based on the unique characteristics of each patient. In large part, this has become possible due to the development and distribution of wearable medical devices that are capable of providing continuous monitoring of a variety of physiological parameters outside medical institutions. The most important of these devices are modern biosensors that allow real-time tracking of various biomarkers in the body, thereby opening up new opportunities for disease prevention, early diagnosis, and personalized treatment strategies. The most obvious example of the transformation is the implementation of wearable devices for continuous glucose monitoring (CGM), which has significantly facilitated the daily lives of millions of people with diabetes. Nevertheless, despite the examples of successful implementation of these devices, their large-scale distribution is associated with many challenges, such as the need for standardization, data transmission security, and the risks of immune responses to implantable devices or infections. This review examines all the current problems of wearable biosensors and possible ways to overcome them. Special emphasis will be placed on devices for continuous glucose monitoring as the most commercially successful representatives of this device class. Full article

Background/Objectives: The effective prevention and control of healthcare-associated infections (HAIs) require the active engagement of clinical staff, which depends on strong relationships between the Infection Prevention and Control Team (IPCT) and frontline healthcare personnel. The role of the Infection Control Physician (ICP) as a clinical leader is essential for supporting evidence-based practice and fostering collaboration. This study aimed to demonstrate the impact of leadership-oriented interventions—particularly the introduction of ICP consultations in hospital wards—on HAI surveillance quality. Methods: A retrospective observational quasi-experimental study was conducted in a single hospital in southern Poland between 2017 and 2024, excluding 2020–2021 due to the COVID-19 pandemic. HAI surveillance followed the ECDC HAI-Net methodology. The study included all hospitalized patients in wards where invasive medical devices or invasive procedures were used. The intervention consisted of expanding the IPCT, increasing managerial support, extending infection control nurses’ competencies, and implementing routine ICP medical consultations. Changes in HAI incidence rates between the pre-intervention (pre-IP) and post-intervention (post-IP) periods were analyzed for catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infections (CLABSI), expressed per 1000 device-days. Results: The overall device utilization increased from 0.44 to 0.54 per 1000 patient-days in the post-IP period. The utilization of microbiological diagnostic tests more than doubled, with marked increases in blood cultures (6.4% vs. 15.5%) and urine cultures (7.7% vs. 11.0%). No IPCT consultations occurred in the pre-IP period, while 874 consultations were recorded in the post-IP period. Th incidence rates for CAUTI and VAP increased (1.4 to 3.1 and 11.7 to 24.6 per 1000 device-days, respectively). The CLABSI incidence showed no significant overall change. Conclusions: Structural and functional changes in the IPCT, combined with the introduction of ICP consultations, substantially enhanced the quality and completeness of HAI surveillance in the analyzed hospital. The findings highlight the importance of leadership-driven engagement in improving infection prevention and control systems. Full article

Background: Stenotrophomonas maltophilia infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim–sulfamethoxazole (SXT) are needed, with cefiderocol (FDC) representing a promising option, but clinical evidence is limited; moreover, data to support the superiority of mono or combination therapy are lacking. Case presentation: We describe the case of a 55-year-old female patient with a tunneled hemodialysis central venous catheter (HD-CVC)-associated bloodstream infection caused by S. maltophilia that, after failure of a prolonged SXT monotherapy, was successfully treated by HD-CVC replacement followed by intravenous cefiderocol (FDC) and levofloxacin (LVX). Conclusions: FDC represents an interesting option for complex cases of S. maltophilia bloodstream infections, and the combination with LVX might add benefit in cases associated with biofilm formation on intravascular devices. Full article

Aim: Infections and multidrug-resistant (MDR) pathogens are concerns in pediatric palliative care (PPC) units, where children with life-limiting conditions undergo invasive procedures and prolonged hospitalization. This study evaluated clinical characteristics, microbiological profiles, and factors associated with MDR infections among pediatric patients hospitalized in a PPC unit. Methods: This retrospective observational study included 66 children aged 1 month to 18 years who were admitted to the PPC unit of our hospital due to infection between June 2023 and January 2024. Demographic data, comorbidities, device use, infection sites, and microbiological results were reviewed. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2 system and interpreted according to EUCAST. Results: The median age was 48 months (IQR 19–106); 63.6% were male. Lower respiratory tract infection was most common (68.2%), followed by sepsis (13.6%) and urinary tract infection (12.1%). Pseudomonas aeruginosa (36.4%) and Klebsiella pneumoniae (27.3%) predominated. MDR organisms represented 15.2% of isolates. MDR infections were significantly associated with percutaneous endoscopic gastrostomy or mechanical ventilation use (p = 0.033). Prolonged hospitalization and multiple comorbidities tended to increase the MDR risk but did not reach statistical significance. Conclusions: Gram-negative MDR infections constitute an important problem in PPC units. Frequent exposure to invasive devices and antibiotics increases susceptibility to resistant pathogens. Reinforcing infection prevention, optimizing antimicrobial stewardship, and monitoring device-related infections are essential to reduce morbidity and improve care quality in pediatric palliative care. Full article

Background/Objectives: Healthcare-associated infections (HAIs) remain an important cause of morbidity in coronary care units (CCUs). Although left ventricular ejection fraction (LVEF) is central to cardiovascular risk stratification, its relationship with infection susceptibility in CCU patients is poorly defined. We explored the association between LVEF and HAI incidence in a real-world CCU population. Methods: We performed a retrospective cohort study including 870 consecutive adult patients admitted to a tertiary CCU. Patients were stratified by LVEF into reduced (<40%) and preserved or mildly reduced (≥40%) groups. HAIs were defined using Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) criteria and required microbiological confirmation. Demographic data, comorbidities, exposure to invasive devices, colonization status and clinical outcomes were collected. Associations with HAIs were assessed using univariate and exploratory multivariable logistic regression. Results: Of the 870 patients, 235 (27.0%) had LVEF < 40%. The overall HAI incidence was 1.8% (16/870) and was significantly higher in patients with reduced LVEF compared with those with LVEF ≥ 40% (3.82% vs. 1.10%, p = 0.018). Patients with LVEF < 40% had greater exposure to invasive devices (OR 2.06, 95% CI 1.52–2.79, p < 0.001). The excess HAI burden was mainly driven by urinary tract infections (1.70% vs. 0.15%, p = 0.021). Colonization rates at admission were similar between groups. In univariate analysis, reduced LVEF was associated with higher HAI occurrence, but it did not remain independently associated after adjustment. Admission infection, malignancy, CPAP use, and CCU length of stay ≥5 days emerged as independent factors in the exploratory multivariable model (Nagelkerke R² = 0.247). Conclusions: Reduced LVEF is associated with higher HAI incidence in CCU patients, reflecting greater clinical severity, longer hospitalization, and increased exposure to invasive devices. Although not an independent predictor, LVEF appears to function as a clinically useful marker of vulnerability that may support early risk stratification and targeted infection-prevention strategies in CCU settings. Full article

Background: The Trichosporonaceae family includes genera such as Trichosporon, Apiotrichum, and Cutaneotrichosporon, which are components of the human microbiota but may cause infections under conditions such as immunosuppression, prolonged hospitalization, invasive procedures, and broad-spectrum antimicrobial use. Objectives: This study aimed to describe the clinical and epidemiological characteristics of hospitalized and outpatient individuals with positive cultures for Trichosporonaceae species in Juiz de Fora, Minas Gerais, Brazil, and to correlate these findings with antifungal susceptibility profiles. Methods: Clinical isolates collected between 2020 and 2023 were identified using the Vitek 2^® system, and antifungal susceptibility was assessed by disk diffusion. Clinical and epidemiological data were obtained from electronic health records. Results: Among 40 isolates, Trichosporon asahii predominated (92.5%). Most cases involved hospitalized individuals (83.8%), mainly from intensive care units (81.8%). Respiratory infections and acute renal failure were the most common reasons for admission. The mean hospital stay was 34.8 days, and overall mortality reached 51.6%. Most individuals were male (77.5%) and older than 61 years (57.5%). Urine was the most frequent specimen (52.5%), and invasive infections predominated (87.5%). Corticosteroid use and invasive devices were common, and prior antibiotic use occurred in most cases. Only 35.0% of patients received antifungal therapy, predominantly fluconazole. Conclusions: Trichosporonaceae infections, particularly those caused by T. asahii, are associated with critically ill patients and high mortality, highlighting the need for early diagnosis, appropriate therapy, and continuous surveillance. Full article

Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity characterized by a supine or semi-supine body position at splashdown, extreme forced hip abduction, asymmetric lower-limb positioning, and abrupt hydrodynamic deceleration. The high descent velocity, abrupt hydrodynamic deceleration, and forced hip abduction at water entry may combine to generate open-book-type pelvic injuries. Evidence guiding diagnosis and surgical management in this setting remains scarce. Materials and Methods: We retrospectively analyzed a consecutive series of adult patients sustaining waterslide-related anterior–posterior compression type II (APC2) pelvic ring injuries. Demographic data and the body mass index (BMI), fracture classification, surgical strategy, complications, and functional outcomes were reviewed. Only patients with complete imaging, operative records, and follow-up were included. Results: Four patients (38–72 years) met the inclusion criteria. All sustained rotationally unstable open-book pelvic injuries and were classified as APC2; three were AO/OTA 61B2.3 and one 61B3.3. All patients were overweight or obese (BMI 27.2–31.2). Pelvic binders provided an effective acute reduction in symphyseal diastasis; however, in one bilateral injury, CT imaging obtained with the binder in situ masked posterior ligamentous instability. Definitive surgical fixation was performed in all cases. Early mechanical failure occurred in two patients treated with short anterior symphyseal plate constructs. In the bilateral injury, isolated anterior fixation failed repeatedly until posterior sacroiliac stabilization was added. No deep infections or thromboembolic events occurred. Although two patients required short observational ICU stays, none were admitted for hemodynamic instability or pelvic bleeding. Conclusions: At 12-month follow-up, three patients achieved pain-free ambulation without assistive devices, while one patient required intermittent use of a single crutch; all patients regained independence in daily activities. Waterslide accidents represent a high-energy injury mechanism capable of producing severe APC2 pelvic disruptions, particularly in patients with an elevated BMI. Awareness of this mechanism and meticulous assessment of posterior stability are essential to avoid under-treatment and mechanical failure. Full article

Catheter-associated urinary tract infections are often caused by biofilm formation on device surfaces. This paper presents an antimicrobial catheter-coating hydrogel comprising p(HEMA) and carboxyl-functionalized p(HEMA-co-MA), loaded with benzalkonium chloride (BAC) to increase hydrophilicity, pH responsiveness, and antibiofilm activity. Hydrogels were prepared by free-radical polymerization, loaded with BAC via swelling, and their physicochemical properties were characterized. Furthermore, microbiological assessment focused on the detection of MIC/MBC/MFC, disk diffusion, biofilm assays, SEM imaging, and RT-qPCR sequencing were used to determine the impact on biofilm-related gene expression to evaluate antimicrobial activity against major catheter-associated urinary tract infection (CAUTI)-associated pathogens and identify the higher BAC loading p(HEMA) and enhanced hydrophilicity and pH-responsive swelling (p(HEMA-co-MA)). The two hydrogels exhibited a wide range of antimicrobial activity and provided lasting inhibition for up to 8 days. It is worth noting that the MA-functionalized hydrogel exhibited a high intrinsic antifouling property, and biofilm development was reduced by more than 85% in BAC-loaded formulations. SEM and gene-expression studies showed reduced microbial adhesion and substantial repression of virulence and biofilm-associated genes. In summary, BAC-loaded p(HEMA) and p(HEMA-co-MA) coatings exhibit strong antimicrobial and antiadhesive properties, and the incorporation of MA results in more effective biofilm suppression, which supports their future use as advanced catheter coatings to prevent the development of device-related infections. Full article