Search Results (494)

Background/Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in children and represent a leading indication for antibiotic prescribing across inpatient, emergency department, and outpatient settings. Despite the availability of multiple international guidelines, prescribing practices for pediatric UTI frequently deviate from evidence-based recommendations in antibiotic selection, route of administration, and duration of therapy. These suboptimal practices contribute to the emergence of resistant uropathogens, including extended-spectrum β-lactamase-producing organisms, and highlight the need for a comprehensive stewardship approach specific to this population. Methods: A literature search was performed using PubMed and MEDLINE from January 2000 to May 2026 using the following search terms: urinary tract infection, children, pediatrics, antibiotic stewardship, antimicrobial resistance, diagnosis, treatment, duration, prophylaxis, and intravenous-to-oral transition. Thirteen active international guidelines published between 2011 and 2025 were identified and evaluated with specific emphasis on the integration of antibiotic stewardship principles. Clinical trials, systematic reviews, meta-analyses, and quality improvement studies addressing stewardship-relevant outcomes in pediatric UTI were included. Case reports were excluded. Results: Comparative analysis of 13 international UTI treatment guidelines demonstrated substantial variation in diagnostic criteria, treatment duration, and prophylaxis recommendations, with most guidelines predating the SCOUT, STOP, and INDI-UTI randomized controlled trials. Diagnostic stewardship interventions targeting urine collection methods, urinalysis-guided treatment decisions, and avoidance of antibiotic treatment for asymptomatic bacteriuria represented high-impact opportunities to reduce unnecessary antibiotic exposure. Oral antibiotic therapy was as effective as intravenous therapy for most children with pyelonephritis, and early intravenous-to-oral transition was supported by consistent randomized controlled trial evidence. A 5-day oral course may be reasonable for uncomplicated febrile UTI in children demonstrating clinical improvement, supported by the STOP trial, although the SCOUT trial did not meet its noninferiority margin despite a low absolute failure rate; 3 to 5 days was appropriate for uncomplicated cystitis. Antibiotic prophylaxis was not indicated in children with a normal urinary tract following a first febrile UTI and should be reserved for specific high-risk subgroups, with nitrofurantoin as the preferred agent. Formal antibiotic stewardship programs combining prospective audit and feedback, electronic health record integration, and prescriber education demonstrated measurable improvements in prescribing appropriateness for pediatric UTI. Gepotidacin, a first-in-class oral antibiotic approved in 2025 for uncomplicated UTI in female patients aged 12 years and older and weighing at least 40 kg, represented a limited option for eligible adolescents with resistant infections. Conclusions: Antibiotic stewardship for pediatric UTI addresses the full clinical pathway from diagnostic stewardship through prophylaxis rationalization. Evidence-based interventions targeting urine collection, urinalysis-guided decision-making, early intravenous-to-oral transition, duration optimization, and selective prophylaxis use can collectively reduce unnecessary antibiotic exposure without compromising patient outcomes. A dedicated stewardship-oriented pediatric UTI guideline, standardized resistance surveillance, and multicenter stewardship program evaluations with patient-centered outcomes are critical research priorities. Full article

Introduction: Upper urinary tract infections (UUTIs) are among the most common serious infections during pregnancy and may be associated with maternal and fetal complications. The increasing prevalence of multidrug-resistant pathogens has led to the use of broader-spectrum antibiotics, including meropenem. However, data regarding the safety and efficacy of meropenem in pregnant women remain limited. The aim of this study was to evaluate the indications, efficacy, and safety of meropenem treatment in pregnant women with UUTIs and its impact on maternal and fetal outcomes. Methods: We conducted a retrospective study over a 12-year period including pregnant women hospitalized with UUTIs who received meropenem. The control group consisted of pregnant women with UUTIs who were treated with ceftriaxone during the same period. Results: Pregnant women treated with meropenem were more frequently diagnosed in the third trimester of pregnancy (p = 0.01) and were more often multiparous (p = 0.006). Sepsis and septic shock occurred significantly more frequently in the study group (p < 0.01), and multivariate analysis identified them as the main indications for meropenem administration (OR 10.54, 95% CI 3.30–33.70 for sepsis; OR 3.28, 95% CI 1.01–10.62 for septic shock). Patients in the study group had a higher rate of transfer to the obstetrics clinic (p = 0.032), a longer duration of antibiotic therapy (p = 0.031), and a longer hospital stay (p < 0.01). No maternal deaths were reported in either group. The rate of adverse pregnancy outcomes was similar between the two groups, except for the Apgar score, which was lower in the meropenem group (p = 0.007). Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens in both groups. Conclusions: Meropenem therapy in pregnant women with UUTIs was mainly indicated in cases of sepsis and septic shock and was associated with favorable maternal clinical evolution, even in patients with severe infections. The rate of adverse pregnancy outcomes was similar between the two groups, although a lower Apgar score was observed in the meropenem group; the severity of illness in the meropenem group should be considered when interpreting the lower Apgar scores. Further prospective multicenter studies are needed to better evaluate the safety and clinical effectiveness of meropenem during pregnancy. Full article

Background and Objective: Perioperative antibiotics are widely used in pediatric surgical practice; however, inappropriate selection and prolonged use may contribute to antimicrobial resistance and unnecessary exposure. Appropriate use of perioperative antibiotics is essential to prevent surgical site infections while minimizing antimicrobial resistance, adverse drug reactions, and unnecessary healthcare costs. Despite existing international recommendations, deviations from guideline-based practice remain frequent in pediatric surgical settings. This study aimed to describe patterns of perioperative antibiotic use and assess the appropriateness of prescribing practices in a tertiary care setting, and to identify factors associated with inappropriate antibiotic use. Methods: A retrospective pharmacoepidemiological study was conducted by reviewing medical records of pediatric patients admitted to a tertiary care hospital in Kosovo between January 2022 and December 2025 (data lock: December 2025). A total of 650 patients aged 0–18 years who underwent surgical interventions and received perioperative antibiotics for prophylaxis or empirical treatment (defined as antibiotic therapy initiated in the presence of suspected infection) were included. Data collected comprised demographic characteristics, surgical diagnoses, type of surgery, antibiotics prescribed, weight-adjusted dosing, route of administration, timing of initiation, and duration of therapy. Appropriateness of antibiotic use was evaluated based on available documentation and compliance with WHO (2018) and CDC (2017) guidelines regarding indication, antibiotic selection, dosage, timing, and duration. Statistical analyses included descriptive statistics, chi-square tests, and multivariable logistic regression to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs), with statistical significance set at p < 0.05. Results: Among the 650 patients, 378 (58.2%) were male and 272 (41.8%) were female, with a mean age of 6.8 ± 4.3 years. The most common types of surgery were abdominal (35.7%), otorhinolaryngological (29.4%), urological (19.1%), and orthopedic (15.8%). Perioperative antibiotics were administered predominantly for prophylaxis (91.5%), while 8.5% of patients received empirical treatment. The most frequently prescribed antibiotics were cefazolin (42.6%), ceftriaxone (34.8%), ampicillin/sulbactam (12.3%), and gentamicin (6.1%). Notably, ceftriaxone was frequently prescribed for prophylactic purposes despite international recommendations generally favoring narrow-spectrum first-line agents for perioperative prophylaxis. Intravenous administration was used in 87.9% of cases. Antibiotic duration was ≤24 h in 61.2% of patients, whereas 38.8% received antibiotics for more than 24 h. Overall, appropriate antibiotic use was identified in 62.9% of cases, while 37.1% were classified as inappropriate. Prolonged antibiotic use beyond 24 h (adjusted OR = 3.87; 95% CI: 2.68–5.58; p < 0.001) and ceftriaxone use (adjusted OR = 2.41; 95% CI: 1.63–3.55; p < 0.001), were independently associated with inappropriate antibiotic use. Conclusions: Perioperative antibiotic use in pediatric tertiary care is highly prevalent, with more than one-third of prescriptions not fully aligned with international recommendations. Prolonged antibiotic duration and the preferential use of broad-spectrum agents, particularly ceftriaxone, were the factors most strongly associated with inappropriate prescribing patterns. These findings highlight the need for improved adherence to guideline-based perioperative antibiotic protocols; however, causal inferences regarding stewardship interventions cannot be drawn from this retrospective study. The findings should be interpreted within the limitations inherent to retrospective observational studies. Full article

Background: Pulpitis is a common cause of dental pain in children and is primarily an inflammatory condition that can be effectively managed with local operative treatment. Although antibiotics are indicated only in cases of systemic involvement or infection spread, they are frequently overprescribed in dental practice. This misuse contributes to antimicrobial resistance and adverse health outcomes. This systematic review aimed to evaluate antibiotic prescribing practices for pulpitis in pediatric patients and to assess adherence to current clinical guidelines. Methods: A systematic review was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261342269). A comprehensive search was performed in PubMed/MEDLINE, Scopus, and Embase up to March 2026. Observational studies assessing antibiotic prescribing practices among pediatric dentists were included. A meta-analysis of proportions was conducted using a random-effects model. Risk of bias was assessed using the Joanna Briggs Institute Checklist, and certainty of evidence was evaluated using the GRADE approach. Results: Five cross-sectional studies were included. Antibiotic prescribing rates for pulpitis ranged from 0.6% to 50.0%. The pooled prevalence of antibiotic prescribing was 14.0% (95% CI: 5.0–33.5%), with high heterogeneity across studies (I² = 95%). Amoxicillin and amoxicillin–clavulanic acid were the most commonly prescribed first-line antibiotics, while clindamycin was the most frequently reported alternative in patients with penicillin allergy. Treatment duration was generally consistent, ranging from 5 to 7 days. Conclusions: Although pediatric dentists tend to prescribe antibiotics more conservatively than general practitioners, inappropriate use remains prevalent, particularly in conditions such as pulpitis where antibiotic therapy is not indicated. These findings highlight a persistent gap between evidence-based recommendations and clinical practice and underscore the need for targeted antimicrobial stewardship strategies to optimize antibiotic use in pediatric dentistry. Full article

Background: Otogenic lateral sinus thrombosis (OLST) is a rare but potentially life-threatening intracranial complication of middle-ear infection. Despite advances in imaging, antimicrobial therapy and otologic surgery, optimal management—particularly anticoagulation—remains controversial, and no standardized clinical guideline is available. Methods: A structured narrative review was conducted using PubMed for English-language human studies published between 1 January 2015 and 31 January 2025. The search was repeated and documented during revision on 12 May 2026. Four searches were run separately; retrieved records were manually merged, and duplicate record occurrences were removed using PMID. The searches retrieved 83 records before deduplication; after removal of 19 duplicates, 64 unique records remained for title and abstract screening. Single case reports and review articles were excluded from the primary descriptive synthesis. SANRA principles guided review quality and transparency. Seven eligible studies comprising 140 confirmed OLST patients were analyzed descriptively; selected clinically relevant but non-comparable publications were retained for contextual discussion. Results: Most included cohorts were pediatric; one study included both pediatric and adult patients. Clinical presentation was heterogeneous and often attenuated by prior antibiotic exposure. Contrast-enhanced CT was frequently used initially, whereas MRI/MRV was most informative for confirming thrombus extent and follow-up. Broad-spectrum intravenous antibiotics and surgical source control represented core treatment. Anticoagulation was reported in six studies, most often with low molecular weight heparin, but indications and duration varied substantially. Outcomes were generally favorable, although visual impairment, hearing loss, behavioral sequelae and incomplete radiological recanalization were reported. Conclusions: OLST management should be individualized according to disease severity, thrombus extent, septic status, and patient-specific risk factors. Antibiotics and source control are essential, while anticoagulation should be considered selectively. A practical management algorithm is proposed, but prospective multicenter data are needed. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is of great concern because of the difficulties encountered in the management of infections it may cause. This study aims to identify possible difficulties in the management of K. pneumoniae infections in the current context of antibiotic resistance, particularly regarding carbapenem resistance. Methods: This is a retrospective, cross-sectional study that analyses epidemiological, clinical and bacteriological features identified in all patients with CRKP infections/colonization admitted during 2024 in an infectious diseases hospital. Results: Carbapenemase-producing K. pneumoniae isolates were co-harboring NDM+OXA-48 in 55.2% of cases. NDM+OXA-48-producing K. pneumoniae (116 isolates, 55.2%) was correlated with high resistance to aztreonam (100%, p = 0.01), ceftazidime–avibactam (100%, p < 0.01), trimethoprim–sulfamethoxazole (99.1%, p < 0.01), gentamycin (94.8%, p < 0.01), amikacin (93.8%, p < 0.01), colistin (79.8%, p < 0.01). OXA-48-producing K. pneumoniae (29 isolates, 13.8%) was correlated with lower resistance to ceftazidime–avibactam (11.5%, p < 0.01), amikacin (48.1%, p < 0.01), colistin (51.7%, p = 0.01), and gentamycin (65.5%, p < 0.01). We found in vitro synergistic effects of ceftazidime/avibactam + aztreonam for 32/32 CRKP isolates and of colistin + tigecycline for 12/14 CRKP isolates. Higher recurrence of CRKP infections was recorded in patients with urinary tract conditions (RR = 11.58, 95%CI: 1.58–81.91) and upper urinary tract devices (RR = 3.53, 95% CI: 1.72–7.22). In this study, adequate antibiotic treatment, compared to excessive antibiotic treatment in CRKP infections, was associated with shorter treatment duration (p = 0.02) and shorter length of hospitalization (p = 0.04). Conclusions: In our study, CRKP is frequently coharboring NDM+OXA-48, having limited treatment options. Implementing new treatment strategies, testing antibiotic synergies for older antibiotics in order to identify alternative treatment options and avoiding unnecessary carbapenem consumption are essential for decreasing the burden of CRKP infections. Full article

Cystitis is a common condition in dogs and an important driver of antimicrobial prescription in small animal practice. Although international guidelines provide recommendations for diagnosis and management, their implementation in clinical settings remains variable. This survey-based study investigated the diagnostic and therapeutic approaches to canine cystitis among Italian veterinarians and explored differences between work settings. An anonymous online questionnaire was distributed nationwide between February and March 2024, yielding responses from 359 veterinarians. Of these, 63.2% worked in small clinics, 25.6% in large clinics, and 11.1% in veterinary hospitals. Diagnosis was most commonly based on the combination of symptoms, bloodwork, urinalysis, and abdominal ultrasound (45.1%) or on symptoms and urinalysis alone (43.7%). Urine culture and sensitivity testing (UCS) was performed in more than 50% of cases by 34.4% of small clinics, 55.4% of large clinics, and 72.5% of veterinary hospitals (p < 0.00001). Financial constraints, delayed results, and difficulty in urine collection were the main barriers. Overall, 56.2% of respondents included antibiotics as first-line therapy. Overall, antibiotic use did not differ among workplace categories, whereas fluoroquinolone prescription differed significantly (p = 0.021), being lower in veterinary hospitals than in small and large clinics. The most common treatment durations were 7 days (43.7%) and 10–14 days (43.2%). Management of subclinical bacteriuria was heterogeneous: probiotics (46.2%) and D-mannose (41.5%) were most frequently recommended, while 19.5% prescribed antibiotics and 19.8% opted for no therapy. These findings indicate variability in clinical practice, underuse of UCS, particularly in smaller clinics, and prescribing practices exceeding guideline recommendations. Full article

Background: Pulmonary actinomycosis is a rare chronic infection that frequently mimics lung malignancy, often leading to delayed diagnosis due to its non-specific clinical and radiological presentation. Given the diagnostic challenges associated with this condition, the aim of this study was to evaluate the clinical presentation, diagnostic pathways, treatment strategies, and outcomes of patients diagnosed with pulmonary actinomycosis in a single center. Methods: We retrospectively reviewed patients diagnosed with pulmonary actinomycosis at our institution between January 2014 and December 2022. Diagnosis was established based on compatible clinical and radiological findings together with microbiological identification of Actinomyces by culture or polymerase chain reaction. Results: Twenty-two patients were included in the final analysis. The median age was 61.5 years and males were more frequently affected (59%). The median time from initial hospitalization to definitive diagnosis was 70 days. Actinomyces odontolyticus was the most frequently identified species. All patients received antibiotic therapy, with a median treatment duration of 45.5 days. Thirteen patients underwent surgical intervention, performed either for diagnostic purposes or for treatment of complications. Complete disease eradication through surgical management was achieved in six cases. During follow-up (median 24 months), overall survival at three years was 78%, with one death directly related to pulmonary actinomycosis. Conclusions: Pulmonary actinomycosis remains a diagnostic challenge due to its non-specific clinical presentation and low microbiological yield. Early clinical suspicion and a combined diagnostic approach including bronchoscopy and microbiological testing are essential for timely diagnosis. Surgical intervention may play an important diagnostic and therapeutic role in selected patients. Full article

Background: Inappropriate antibiotic prescribing in dentistry contributes to antimicrobial resistance, a major global health concern. In pediatric dentistry, antibiotics are frequently prescribed despite guidelines discouraging their use in localized conditions such as apical periodontitis (AP). This systematic review aimed to evaluate patterns, indications, and adherence to clinical guidelines in antibiotic prescribing for AP and acute periapical abscess (APA) in children and adolescents. Methods: A systematic review was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261342269). The review question was structured using the CoCoPop framework. A comprehensive search was performed in PubMed/MEDLINE, Scopus, and Embase up to March 2026. Observational studies assessing antibiotic prescribing practices among pediatric dentists were included. Risk of bias was assessed using the Joanna Briggs Institute checklist, and certainty of evidence was evaluated using the GRADE approach. Results: Six cross-sectional studies were included. Adherence to prescribing guidelines ranged from 38.4% to 68.2%. Antibiotic prescribing rates ranged from 22.9% to 71.0% for AP and from 41.1% to 78.0% for APA. Pooled prevalence estimates increased from 36.0% (95% CI: 18.0–58.9%) for AP to 60.7% (95% CI: 46.1–73.5%) for APA. Amoxicillin was the most commonly prescribed antibiotic, followed by amoxicillin–clavulanic acid, and treatment duration was typically 5–7 days. Substantial variability in prescribing practices was observed. Conclusions: Antibiotic prescribing in pediatric dentistry remains inconsistent, with inappropriate use persisting in conditions where antibiotics are not indicated. Strengthening antimicrobial stewardship and improving adherence to evidence-based guidelines are essential to optimize antibiotic use. Full article

Background: Christensenella minuta (C. minuta) is a promising next-generation probiotic linked to reduced body weight, inhibition of obesogenic processes, and enhanced metabolic profiles. However, the extent and persistence of these effects, particularly under varying dietary conditions, remain uncertain. Objective: This study aimed to examine the effects of intrarectal administration of C. minuta on body weight regulation in vivo under different dietary patterns, with or without antibiotic pretreatment, both during the intervention and over the long term. Particular emphasis was placed on exploring the interactions between C. minuta supplementation, dietary background, caloric intake, and body weight gain. Methods: A total of 180 CD1 mice (both sexes equally) were allocated into nine experimental groups based on diet, with and without C. minuta supplementation, and with and without antibiotic pretreatment. The bacterial suspension was administered intrarectally once a week for three consecutive weeks in the treatment groups. Body weight was monitored weekly, and food intake was recorded biweekly over the 12-week study period. Visceral fat mass was measured postmortem. Results: Groups treated with C. minuta with antibiotic pretreatment exhibited significantly lower body weight gain than the control groups during the intervention phase in both sexes, irrespective of caloric intake and dietary pattern, indicating that the reduced weight gain was attributable to the effect of C. minuta. Regarding long-term effects following the cessation of administration, sexual dimorphism was observed: while no lasting impact was found in males, the body weight gain inhibiting effect of C. minuta treatment persisted in females. Furthermore, females treated with C. minuta exhibited the lowest levels of visceral fat among all groups. Caloric intake was not significantly associated with body weight gain at any time point in this study. Conclusions: C. minuta exerts a transient, caloric intake-independent inhibitory effect on body weight gain. The absence of sustained effects highlights the necessity for continuous or optimized administration protocols to ensure the attainment of long-term benefits in the future. The results of this study support the hypothesis that C. minuta can act as a modulator of host metabolism and body composition, underscoring the significance of treatment duration in this process. Full article

Background: Urinary tract infections (UTIs) are a leading cause of urine testing and antibiotic prescribing across healthcare settings. Despite established clinical guidelines, inappropriate practice such as unnecessary urine cultures, treatment of asymptomatic bacteriuria, suboptimal antibiotic selection, and excessive treatment duration remain common. These practices contribute to antimicrobial resistance, adverse drug events, and increased healthcare costs. Methods: This narrative review synthesises evidence from PubMed-indexed studies, including systematic reviews, randomised controlled trials, and implementation studies, to evaluate the impact of antibiotic and diagnostic stewardship interventions on UTI management. Studies assessing outcomes related to urine testing practices, antibiotic utilisation, and clinical safety were included. Discussion: The literature demonstrates that integrated stewardship interventions effectively reduce inappropriate urine testing and antibiotic use without negatively affecting patient outcomes. Diagnostic stewardship strategies such as limiting urine cultures to patients with appropriate clinical indications, implementing reflex testing algorithms, and improving result interpretation reduce downstream antibiotic overuse. When combined with antibiotic stewardship approaches including clinical decision support, audit-and-feedback, and bundled interventions, these strategies lead to sustained improvements in prescribing behaviour and care quality. Conclusions: Antibiotic and diagnostic stewardship are synergistic and essential components of optimal UTI management. Interventions targeting both diagnostic decision-making and antibiotic use can safely reduce unnecessary testing and treatment. Future stewardship efforts should prioritise integrated, multidisciplinary approaches supported by clinical decision support tools to enable real-time, sustainable improvements in UTI care across clinical settings. Full article

Background/Objectives: Intraoperative assessment guides the immediate postoperative management of acute appendicitis, whereas histopathological confirmation becomes available only after key clinical decisions have been made. This study evaluated the agreement between intraoperative and histopathological grading of acute appendicitis and compared their associations with postoperative outcomes, particularly length of hospital stay (LOS) and duration of antibiotic therapy. Methods: This retrospective single-center study included pediatric and adult patients who underwent appendectomy for suspected acute appendicitis at the University Hospital of Split between 1 January 2020 and 31 December 2025. After exclusion criteria were applied, 2279 patients were included. Agreement between intraoperative and histopathological classifications was assessed using Cohen’s kappa and weighted kappa. Associations with postoperative outcomes were examined using Kendall’s tau correlation, bootstrap comparison between age groups, Kruskal–Wallis testing with Bonferroni-adjusted post hoc analyses, adjusted negative binomial regression for length of hospital stay, zero-inflated negative binomial regression for total antibiotic duration, and Firth penalized logistic regression for binary outcomes. Results: Overall concordance between intraoperative and histopathological grading was 74.0%. Agreement was moderate by unweighted Cohen’s kappa (0.539) and substantial by weighted kappa (0.643), with intraoperative grading more often overestimating than underestimating histopathological severity. Intraoperative severity showed stronger correlations than histopathological severity with LOS (τ = 0.347 vs. 0.207) and total duration of antibiotic therapy (τ = 0.331 vs. 0.224). Both outcomes showed a non-linear pattern, with patients with a negative appendix having a longer hospital stay and greater antibiotic exposure than those with phlegmonous appendicitis, while advanced disease was associated with the greatest treatment burden. Thirty-day readmission was uncommon and not associated with severity. Conclusions: Agreement between intraoperative and histopathological grading was moderate to substantial. Intraoperative grading showed stronger associations with immediate postoperative outcomes than histopathological grading, reflecting its role as the primary driver of clinical decision-making in the immediate postoperative period. These findings do not diminish the diagnostic value of histopathological examination, which remains essential for confirmation and detection of unexpected pathology. Full article

Background/Objectives: Eravacycline is a fluorocycline antibiotic increasingly used for drug-resistant or difficult-to-treat infections, including off-label indications, with limited real-world clinical data. This study aimed to characterize the effectiveness, safety, and overall risk-benefit profile of eravacycline using an adapted Desirability of Outcome Ranking (DOOR) framework. Methods: We conducted a retrospective, single-center observational study of adult patients who received ≥48 h of eravacycline at an academic medical center between May 2022 and October 2023. Clinical response was assessed at the end of therapy, alongside 30-day all-cause mortality. Treatment-emergent adverse events (TEAEs) were recorded and normalized per 100 eravacycline-days. An adapted DOOR framework integrated efficacy, toxicity and mortality into an ordinal composite outcome, with analyses stratified by pathogen and site of infection. Results: A total of 140 patients contributed 151 eravacycline courses. Intra-abdominal (41.7%) and lower respiratory tract infections (27.8%) were the most common indications. Treatment success was observed in 69.5% of courses, while 30-day all-cause mortality was 23.6%. TEAEs occurred in 52.3% of courses and frequently led to eravacycline discontinuation. Exposure-normalized TEAE rates were highest in shorter courses, with gastrointestinal intolerance predominating early, while hepatoxicity and coagulation abnormalities were more frequent with intermediate treatment durations. DOOR analysis demonstrated highly desirable outcomes in 48.3% of courses, with more favorable profiles observed in carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE) and nontuberculous mycobacteria (NTM) infections. Bloodstream infections were associated with less desirable outcomes. Conclusions: Eravacycline demonstrated meaningful real-world activity across complex infections but was limited by frequent toxicity. The DOOR framework provided a patient-centered context for organism- and site-specific risk-benefit assessment. Full article

Background/Objectives: This study aimed to assess complications after endoscopic radial artery harvest, evaluate patient satisfaction, and assess the feasibility of a questionnaire interview. The primary aim was to assess neurological damage after endoscopic radial artery harvest (ERAH), and the secondary aim was to assess the feasibility of a newly constructed questionnaire in Danish. Methods: From June 2010 through October 2012, 108 patients underwent endoscopic radial artery harvest for coronary artery bypass grafting (CABG) at our institution. A total of 100 patients were interviewed by phone between one and two years after the operation. The interviews included questions about infection, bleeding, neurological damage, vascular perfusion of the hand, re-intervention, and general satisfaction with the procedure. Results: The described cohort was mainly male (88.9% 95% confidence interval (CI) 90.5–98.4%) with a mean age of 60.8 years (standard deviation (SD) 9.0). The self-reported incidence of postoperative antibiotic treatment was 7.0% (95% CI 3.1–14.4%), sensory deficit 18.0% (95% CI 11.3–27.2%), pain 8.0% (95% CI 3.8–15.6%), motoric deficit 4.0% (95% CI 1.3–10.5%) and cold or pale fingers 9.0% (95% CI 4.5–16.8%). At a follow-up time with a mean of 1.40 years (range 0.97–2.37 years, SD 0.36), all incisions were healed satisfactorily, 12.0% (95% CI 6.6–20.4%) reported sensory deficit, 7.0% (95% CI 3.1–14.4%) reported pain, 2.0% (95% CI 0.3–7.7%) reported motoric deficit, and none had a tendency towards cold fingers. The mean duration of antibiotic treatment was 8.7 days ± 2.3. When asked to rate the endoscopic procedure points of satisfaction from 0 (worst) to 10 (best), the mean was 9.7 ± 0.7. Conclusions: This study reports the occurrence of surgical complications immediately after ERAH, with an occurrence of self-reported neurological deficits of 18%. A questionnaire was feasible in a cohort of postoperative patients receiving radial artery harvest. Full article

Background: Antimicrobial resistance coupled with the lack of new antibiotics calls for the responsible use of antibiotics, including old antimicrobials. Aminoglycosides are effective against bacteria in acute appendicitis, a common intra-abdominal infection. Their use has been discouraged recently, but their place in therapy is based on studies performed in the era of lower resistance rates, and with multiple dosing regimens. Methods: In a prospective randomized open-label study, we compared the efficacy and safety of gentamicin in one daily dose and metronidazole (GTM+MZ) to ertapenem (ETP) and to cefuroxime with metronidazole (CXM+MZ) in adult patients surgically treated for acute appendicitis. Efficacy was assessed via the duration of antibiotic treatment and hospital stay, c-reactive protein (CRP) dynamics, and post-operative complications. Nephrotoxicity was assessed with urine biomarkers. Statistical analysis comprised mixed-model analysis of variance (ANOVA) with the missing-data-imputation method and linear mixed model (LMM). Results: One hundred-and-sixty-six patients were included in this study. There were no significant differences among the three groups in the durations of treatment and lengths of stay (p = 0.093, p = 0.222). CRP level was the lowest (p = 0.003) in the ETP group. There were five complications during hospitalization, with two of them classified as infectious. Both occurred in the GTM+MZ group; however, the difference was not statistically significant (p = 0.330). No difference was found in complications in the month following the operation (p = 0.763). Biomarkers indicating kidney injury showed the same trend in all three groups. Conclusions: Our results suggest the use of once-daily dose of gentamicin following an appendectomy for acute appendicitis. Gentamicin may be used to decrease selective pressure of other antimicrobials. Full article