Search Results (1,326)

Background/Objectives: Sepsis is a leading cause of hospital mortality and represents a time-sensitive medical emergency. Current diagnostic strategies rely on clinical assessment, severity scores, biomarkers, and blood cultures. However, blood cultures require 24–72 h for pathogen identification and demonstrate limited sensitivity, while biomarkers such as procalcitonin and C-reactive protein lack optimal specificity. These limitations support the widespread empirical use of broad-spectrum antibiotics and highlight the need for rapid, sensitive, and culture-independent diagnostic tools. Methods: A narrative literature review was conducted using PubMed and Google Scholar, including 28 studies published over the past 10 years, encompassing observational and preclinical investigations. Current evidence on the application of Raman spectroscopy in sepsis was summarized, with a dual focus on pathogen identification and the assessment of the host response. Results: Raman spectroscopy has demonstrated the ability to detect early molecular alterations in circulating immune cells and mitochondrial redox status, potentially preceding conventional biomarkers. For pathogen identification, Raman techniques have achieved diagnostic accuracies comparable to automated systems, but with significantly shorter turnaround times. Integration with microfluidics, optical tweezers, and deep learning algorithms has further enhanced performance, although these applications remain largely experimental. Conclusions: Despite these promising results, the lack of methodological standardization, spectral overlap among phylogenetically related species, limited large-scale validation, and challenges in interpreting certain spectral signatures remain unresolved. Most available evidence originates from preclinical, single-center, and controlled studies, underscoring the need for prospective multicenter trials and harmonized protocols. Full article

Neonatal meningitis-associated Escherichia coli (NMEC) is a formidable pathogen in veterinary medicine. The emergence of atypical, multidrug-resistant (MDR) variants complicates disease control. An Escherichia coli (E. coli) strain was isolated from the brain tissue of a deceased calf with acute meningitis. Comprehensive characterizations were performed, including whole-genome sequencing (WGS), multi-locus sequence typing (MLST), antimicrobial susceptibility testing (AST), murine pathogenicity assays, and RT-qPCR evaluation of neuroinflammatory cytokines. Results: The isolate (O18ab:H14) was identified as a capsule-deficient NMEC strain belonging to phylogroup A and sequence type ST1434. WGS showed that the genome size of this strain is 5.1 Mb, containing 73 strictly defined antimicrobial resistance genes and 202 virulence factors. These may be involved in the compensatory mechanism for capsule deficiency, and further functional verification is required. Phenotypically, it exhibited a robust MDR profile. In the murine model, the strain demonstrated high lethality, and induced severe multi-organ lesions characteristic of both meningitis and systemic sepsis. While intraperitoneal injection bypasses natural colonization routes, the brain-specific bacterial persistence and neuronal pathology imply neurotropic potential. Furthermore, RT-qPCR confirmed a severe neuroinflammatory response, marked by the significant upregulation of IL-1β, IL-6, and TNF-α in the infected brains. This study characterizes a novel, highly virulent, and MDR capsule-deficient NMEC/SEPEC hybrid strain. The findings emphasize the urgent need for continuous genomic surveillance of atypical E. coli pathotypes in livestock. Full article

Necrotizing enterocolitis (NEC) and sepsis/late-onset sepsis (LOS) are significant contributors to preterm infant morbidity and mortality, with prematurity and low birth weight representing major risk factors for these interconnected conditions. Although the pathogenesis of NEC and LOS is not fully understood, there is a clear association with an immature intestinal mucosal barrier, which may enable bacterial invasion and translocation, resulting in an inflammatory cascade. Increasing recognition of the gut microbiome as a marker for health and disease has driven interest in probiotics, particularly Bifidobacterium spp. and Lactobacillus spp., as potential adjunctive agents for the prevention and management of NEC and LOS in preterm infants, which is the area of focus of this review. The focus of this paper was to analyze clinical studies using different probiotic strains, and compare single-strain versus multi-strain probiotic formulations. Several studies support that probiotic supplementation in preterm infants has the potential to decrease NEC incidence and, to a lesser extent, sepsis/LOS. Nonetheless, inconsistent results due to strain differences and clinical heterogeneity limit the widespread adoption of this mode of therapy, as do safety concerns in this vulnerable population. Further high-quality standardized studies are necessary to establish consistent guidelines for probiotic use in preterm infants. Full article

Background: Malnutrition is highly prevalent among critically ill patients and has been associated with worse clinical outcomes, particularly in sepsis. Several nutritional risk scores have been proposed to identify patients at increased risk of mortality in the intensive care unit (ICU). This study aimed to evaluate the prognostic value of three commonly used nutritional indices—modified Nutrition Risk in the Critically Ill (mNUTRIC), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT)—for predicting mortality in septic ICU patients. Methods: In this prospective observational cohort study conducted at two ICUs, 155 critically ill patients at nutritional risk were evaluated, including 105 patients with sepsis and 50 without sepsis. The primary endpoint was ICU mortality. Nutritional risk scores (mNUTRIC, PNI, and CONUT) were calculated at ICU admission. Survival analysis was performed using Kaplan–Meier (KM) curves and log-rank tests to compare survival probabilities across nutritional risk categories. Cox proportional hazards regression analysis was used to assess the association between nutritional scores and ICU mortality. Of note, only 24 mortality events were recorded in the septic cohort, which limits the statistical power of the findings. Results: KM analysis revealed significantly reduced survival among patients with severe malnutrition, as measured by the PNI score (log-rank p = 0.044). Patients with high mNUTRIC scores showed a tendency toward lower survival probability compared with those with low nutritional risk, approaching statistical significance (log-rank p = 0.059). No significant survival differences were observed between CONUT categories (log-rank p = 0.380). In univariate Cox regression analysis, the mNUTRIC score was significantly associated with ICU mortality (HR 1.67, 95% CI 1.17–2.38, p = 0.005). Conclusions: In this selected cohort, mNUTRIC demonstrated the strongest univariate prognostic signal for ICU mortality; however, this association was attenuated and did not reach statistical significance after limited multivariable adjustment. These findings are exploratory and apply specifically to a cohort of septic ICU patients with confirmed nutritional risk and therefore should not be generalized to the broader population of critically ill septic patients. Full article

This study aimed to investigate the protective effects of fenofibrate against sepsis-induced acute lung injury using a feces-induced peritonitis (FIP) rat model, with particular emphasis on the modulation of HSP70 and Nrf2 as key cellular defense mechanisms. The FIP model was employed to mimic colon-origin abdominal sepsis, frequently encountered in general surgery, including conditions such as colonic perforation and anastomotic leakage. Thirty male Wistar albino rats were randomly assigned to control, FIP, and FIP + fenofibrate groups. Sepsis was induced by intraperitoneal injection of a fecal-saline suspension. Fenofibrate (100 mg/kg) was administered intraperitoneally after the FIP procedure. After 24 h, lung tissues and blood samples were collected. Assessments included histopathology (H&E staining), thoracic CT imaging, arterial blood gas analysis, ELISA-based quantification of plasma cytokines (IL-6, IL-1β, TNF-α), MDA for oxidative stress, and lung tissue levels of HSP70 and Nrf2. Feces-induced peritonitis caused severe acute lung injury, evidenced by increased histopathological damage (p < 0.001), impaired gas exchange (PaO₂ and PaCO₂, p < 0.01), elevated inflammatory cytokines (IL-6, IL-1β, TNF-α; p < 0.001), increased oxidative stress (MDA, p < 0.001), and suppressed lung Nrf2 and HSP70 expression (p < 0.001). Fenofibrate significantly attenuated lung injury, improved gas exchange (p < 0.05), reduced inflammation (p < 0.01–p < 0.001), decreased MDA (p < 0.001), and increased Nrf2 (p < 0.001) and HSP70 (p < 0.01). Fenofibrate attenuates sepsis-induced acute lung injury by reducing inflammation and oxidative stress while preserving HSP-70 and Nrf2-mediated cytoprotective pathways. These findings are clinically relevant to general surgery, as septic lung injury commonly arises from colon-origin abdominal sepsis, including colonic perforation and anastomotic leakage. Full article

Background: The global demographic shift towards an aging population has driven a steady, exponential increase in the utilization of cardiac implantable electronic devices (CIEDs). Consequently, device-related infectious complications have emerged as a leading cause of morbidity and healthcare expenditure. Patients in their eighth decade of life—octogenarians (aged 80–90 years)—represent an exceptionally high-risk demographic due to the compounding factors of physiological frailty, immunosenescence, and complex multi-morbidity. Despite this growing demographic, their specific clinical presentations, microbiological profiles, and procedural outcomes following infection remain poorly defined in the current literature. This study aimed to comprehensively compare the clinical characteristics, pathogen distribution, and in-hospital outcomes of CIED infections in an octogenarian cohort against a younger patient population. Methods: We conducted a robust retrospective cohort analysis of 383 consecutive patients treated for confirmed CIED infections at one major tertiary referral center (Heidelberg University Hospital) between January 2002 and December 2022. The cohort was stratified by age into octogenarians (n = 76) and a younger control group (n = 307). We systematically extracted and compared data regarding baseline clinical presentation, chronic comorbidities, detailed microbiological cultures (pocket, blood, and extracted leads), and definitive in-hospital outcomes, primarily mortality and length of stay. Results: The octogenarian cohort exhibited a significantly heavier comorbidity burden, notably higher rates of coronary artery disease (51.3% vs. 29.6%, p < 0.001), systemic hypertension (55.3% vs. 38.1%, p = 0.007), and chronic obstructive pulmonary disease (7.9% vs. 1.6%, p = 0.003). Furthermore, therapeutic systemic anticoagulant use was substantially more prevalent in the elderly group (60.5% vs. 45.0%, p = 0.015). Octogenarians presented overwhelmingly with localized generator pocket infections (73.0% vs. 30.0%, p < 0.001) but paradoxically also demonstrated higher rates of systemic bacteremia and sepsis (26.3% vs. 15.0%, p = 0.019). Microbiological analysis revealed a unique pathogen profile, with Staphylococcus capitis found with significantly higher frequency in the generator pockets of the elderly cohort. Remarkably, despite possessing a higher average lead burden (2.1 vs. 1.2 leads) and extreme comorbidity profiles, octogenarians demonstrated no statistically significant differences in in-hospital mortality (3.9% vs. 4.2%, p = 1.000) or overall length of hospital stay (14.7 vs. 17.2 days, p = 0.386) when compared to the younger cohort. Conclusions: Octogenarians suffering from CIED infections display highly distinct clinical and microbiological profiles, characterized predominantly by elevated rates of localized pocket infections, specific opportunistic pathogens, and a severe underlying comorbidity burden. Crucially, our findings indicate that with the application of modern extraction and management protocols, advanced age alone does not intrinsically correlate with increased in-hospital mortality. Future prevention and perioperative management strategies tailored to this rapidly expanding demographic must heavily prioritize the mitigation of pocket-related complications, particularly considering the high prevalence of concurrent anticoagulation therapy. Full article

Background: The landscape of paediatric oncology has undergone a remarkable transformation over recent decades. Advances in both oncological and supportive therapies have dramatically improved survival in children with haematological malignancies and solid tumours, with current survival rates exceeding 80% for many childhood cancers. However, this therapeutic success has brought with it an unexpected consequence: the intensification of treatment protocols has led to a parallel increase in life-threatening complications requiring intensive care support. Current evidence indicates that up to 40% of paediatric oncology patients will require admission to a Paediatric Intensive Care Unit (PICU) at some point during their disease trajectory. Objectives: This comprehensive review synthesises current evidence to provide an updated framework for PICU admission decision-making in oncology haematology patients. We have integrated the most recently published international guidelines, including the groundbreaking Phoenix 2024 sepsis criteria and the updated PALICC-2 2023 recommendations for paediatric acute respiratory distress syndrome. Beyond establishing admission criteria, we critically analyse the efficacy of advanced support strategies and examine emerging therapeutic approaches in this uniquely vulnerable population. Methods: Our methodology encompassed a systematic review of the literature published between 2011 and 2024, complemented by a detailed analysis of current international guidelines and expert consensus statements. We included randomised controlled trials, observational studies, meta-analyses, and consensus conference proceedings specifically addressing the intensive care management of paediatric patients with oncological or haematological conditions. Main Results: Several key findings emerge from our analysis. The Phoenix 2024 criteria represent a fundamental reconceptualisation of paediatric sepsis diagnosis, validated through an unprecedented dataset encompassing more than 3 million paediatric encounters. In the realm of respiratory support, early implementation of non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) has demonstrated remarkable efficacy, reducing the need for invasive mechanical ventilation by 45% (RR 0.45, 95% CI 0.26–0.78) when applied to appropriately selected patients. Extracorporeal membrane oxygenation (ECMO), whilst increasingly utilised, shows survival to decannulation ranging from 52% to 64%, though survival to hospital discharge remains less encouraging at 36–42%. Continuous renal replacement therapy (CRRT) has proven highly effective for tumour lysis syndrome, achieving metabolic correction in 90% of severe cases. Perhaps most promisingly, emerging biomarkers—particularly interleukin-6, interleukin-10, and procalcitonin—have substantially enhanced our ability to stratify infection risk, demonstrating sensitivity exceeding 85% for bacteraemia detection. Conclusions: The evidence unequivocally supports several core principles for optimising outcomes in this population. Early identification of deterioration through validated scoring systems enables timely intervention before irreversible organ failure develops. Prompt implementation of non-invasive respiratory support, when appropriately applied, can obviate the need for mechanical ventilation with its attendant complications. Perhaps most critically, centralisation of care in centres with dedicated expertise and comprehensive support capabilities fundamentally improves survival. These findings argue compellingly for the establishment of a formal national network of reference centres, implementing standardised protocols and structured care pathways specifically designed for critically ill paediatric oncology haematology patients. Full article

Postoperative complications in gastrointestinal (GI) cancer patients remain a significant challenge for physicians. It leads to increased morbidity, prolonged hospital stays, and higher healthcare costs. Enteral immunonutrition (EIN) has emerged as a promising add-on treatment to modulate immune response following surgery. In fact, it reduces inflammation and promotes patients’ recovery. Indeed, the literature data on its real clinical impact for the patients are inconsistent and, yet, poorly investigated. Thus, the aim of this review was to narratively assess the current evidence for the use of EIN in postoperative GI cancer patients, evaluating the effect on clinical and immunological outcomes of patients. Therefore, a literature search was conducted using the following keywords and associations: enteral immunonutrition, gastrointestinal cancer, immune response, inflammation, and postoperative complication. GI cancers, mainly esophageal and gastric cancer, represent a significant global health burden, characterized by high incidence and mortality rates. The complex interplay between tumor progression, systemic inflammation, and host nutritional status profoundly impacts patient outcomes. Traditional cancer treatments are effective and often lead to severe side effects. The latter includes malnutrition and immunosuppression and can significantly affect patients’ recovery. In recent times, the concept of immunonutrition has emerged as a promising add-on therapy able to consensually modulate immune response and improve nutritional status. Several studies and meta-analyses suggest that EIN can reduce postoperative infections (e.g., wound infections and sepsis incidence), shorten hospital stays, and improve overall outcomes in GI cancer surgery patients vs. standard enteral feeding. EIN is a promising add-on approach for the management of postoperative GI cancer patients. It can significantly reduce postoperative complications and enhance their recovery. However, the result seems consistent for gastric but not yet esophageal cancer patients. EIN shows high tolerance and a high safety profile. Full article

Background: End-stage renal disease (ESRD) is an immunocompromised state that confers a high risk of infection. We aimed to integrate bioinformatics analyses with a clinical cohort to explore the association between ESRD and sepsis. Methods: We retrieved transcriptomic data from the Gene Expression Omnibus and used computational tools, including Gene Set Enrichment Analysis, the eXtreme Gradient Boosting algorithm, and Mendelian randomization, to characterize gene expression changes, biological pathways, and genetic features in ESRD and sepsis. A multicenter retrospective cohort of patients with sepsis due to carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia in intensive care units (ICUs) was used to compare clinical presentation and outcomes between patients with and without ESRD. Results: Differential gene expression analysis showed widespread transcriptomic dysregulation in ESRD, and functional enrichment analysis revealed perturbations in immune signaling and vesicular transport pathways. Both the innate and adaptive immune systems appeared compromised, with marked depletion of lymphoid lineages in ESRD. An XGBoost machine-learning model derived from immune cell enrichment scores demonstrated a similar immune microenvironment in ESRD and sepsis. Mendelian randomization analysis supported an association between genetic variants predisposing to ESRD and an increased risk of sepsis, using genome-wide association study datasets. In the clinical cohort, patients with ESRD had significantly higher Sequential Organ Failure Assessment (SOFA) scores and in-hospital mortality than patients with normal renal function. Conclusions: ESRD shares similar immune microenvironmental features and genetic signatures with sepsis. These shared characteristics may contribute to the greater sepsis severity and poorer outcomes observed in patients with ESRD. Full article

Background: Postoperative hemorrhage is a severe complication after pancreatic surgery. While bleeding related to pancreatic fistula is well characterized, hemorrhage secondary to biliary leakage remains poorly understood. This study investigates the incidence, associated factors, clinical course, and outcomes of hepaticojejunostomy insufficiency-associated arterial hemorrhage (HIAA). Methods: This retrospective single-center study included 1413 patients who underwent pancreatic surgery with hepaticojejunostomy between 2004 and 2014. Demographics, underlying disease, surgical procedures, postoperative complications, management strategies, and outcomes were analyzed. Results: HIAA occurred in 13 patients (0.9%), accounting for one third of all erosion-related hemorrhages. The median onset was 16 days postoperatively, and 77% were preceded by sentinel bleeding. Completion pancreatectomy and sepsis were significantly associated with HIAA. The right hepatic artery was the most frequent bleeding source. Primary interventional angiography achieved hemostasis in 62.5% of patients, while 61.5% required surgical revision. Thirty- and ninety-day mortality rates were 15.4% and 30.8%, respectively, compared with 2.1% and 3.7% in the overall cohort. Conclusions: HIAA is a rare but highly lethal complication after pancreatic surgery. It represents a distinct clinical entity characterized by delayed onset, frequent sentinel bleeding, an association with sepsis and completion pancreatectomy, and markedly increased mortality. Early recognition, prompt imaging, and an interventional-first strategy are essential to improve outcomes. Full article

Context/Objectives: In patients with COPD (chronic obstructive pulmonary disease), SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection represents an overlap of viral injury on a lung already affected by pathological mucus, altered mucociliary clearance, chronic inflammation, and impaired antiviral immunity. Methods: A focused narrative review (2020–2025) was conducted using clinical, experimental, and consensus evidence. The evidence was synthesized qualitatively, with priority given to cohort studies, meta-analyses, and mechanism-focused studies with clinical relevance. Results: Mucus obstruction (“mucus plugs”) is frequent in COPD (41–67%) and is associated with unfavorable outcomes. COPD also increases the risk of post-COVID respiratory sequelae. Bacterial coinfection at presentation is uncommon (3–5%), whereas secondary bacterial infections are more frequent (14–18%), especially in severe disease requiring intensive care, where VA-LRTI/VAP (ventilator-associated lower respiratory tract infection/ventilator-associated pneumonia) become predominant. Sepsis, whether viral or mixed, reflects disease severity and may contribute to functional decline and susceptibility to reinfections; however, the concept of a post-acute “sepsis legacy” in COPD after COVID-19 should currently be regarded as a clinically plausible but still emerging hypothesis rather than an established COPD-specific outcome. During recovery, acute exacerbation risk rises to 5.6% versus 3.9%, peaking in the first 30 days after severe disease (aHR ≈ 8.14). Persistent dyspnea and reduced DLCO (diffusing capacity for carbon monoxide) suggest ARDS-related injury, tissue remodeling, and microvascular dysfunction. Conclusions: In COPD, post-COVID respiratory sequelae result from the interaction of mucus, immunity, and infectious/sepsis-related complications. The first post-discharge month is a critical period requiring careful risk stratification and targeted follow-up. Full article

Background and Clinical Significance: Cirrhosis-associated immune dysfunction (CAID) is characterized by impaired innate and adaptive immune responses, gut dysbiosis, and increased bacterial translocation, predisposing patients to severe and atypical infections. While spontaneous bacterial peritonitis and other intra-abdominal infections are well-recognized complications of cirrhosis, extraintestinal infectious manifestations related to bacterial translocation are less commonly described. A tubo-ovarian abscess (TOA) typically arises from ascending pelvic infections associated with pelvic inflammatory disease and is rarely reported in patients with cirrhosis without gynecologic risk factors. Thus, recognizing unusual infectious presentations in cirrhotic patients is important given their functionally immunocompromised state. Case Presentation: We report a 46-year-old woman with previously undiagnosed alcohol-related cirrhosis who presented with sepsis and abdominal pain. She had no prior gynecologic history or known risk factors for pelvic inflammatory disease. Contrast-enhanced computed tomography (CT) demonstrated bilateral tubo-ovarian abscesses. Image-guided percutaneous drainage was performed, and cultures from both ascitic fluid and bilateral adnexal collections grew Enterococcus faecium, supporting a shared intra-abdominal source of infection and suggesting transperitoneal dissemination via infected ascitic fluid as a plausible mechanism, although an ascending genital tract source cannot be fully excluded. The patient was treated with targeted intravenous antibiotics and drainage with subsequent clinical improvement. Conclusions: This case highlights bilateral tubo-ovarian abscesses as a rare infectious complication of cirrhosis-associated immune dysfunction. In cirrhotic patients presenting with sepsis and intra-abdominal pathology, clinicians should consider atypical infection pathways related to bacterial translocation among the differential mechanisms of spread. Thus, recognizing cirrhosis as a functionally immunocompromised state is essential for the timely diagnosis and management of unusual infections. Full article

Background: Early identification of patients at risk for adverse outcomes after cardiac surgery remains a major clinical challenge. While preoperative risk scores are widely used, the prognostic value of early postoperative ICU severity scores and functional performance measures has not been fully clarified. Methods: This prospective observational study included 195 patients undergoing cardiac surgery between 2018 and 2024. Predictive performance of EuroSCORE II, the SOFA score, the APACHE II score, Karnofsky performance status, handgrip strength, and phase angle was assessed for postoperative complications and mortality. Receiver operating characteristic (ROC) curves with 95% confidence intervals were calculated, and pairwise comparisons between ROC curves were performed. Major postoperative complications were analyzed using a composite endpoint including stroke, prolonged intubation, sepsis, and reoperation, excluding systemic inflammatory response syndrome (SIRS). Results: Major postoperative complications occurred in 46 patients (23.6%). For prediction of major postoperative complications, SOFA demonstrated the highest discrimination (AUC = 0.881, 95% CI 0.819–0.928), followed by APACHE II (AUC = 0.826, 95% CI 0.753–0.888) and EuroSCORE II (AUC = 0.695, 95% CI 0.602–0.785). In-hospital mortality occurred in 19 patients (9.7%). SOFA showed the strongest predictive performance (AUC = 0.915, 95% CI 0.851–0.968), followed by APACHE II (AUC = 0.869, 95% CI 0.781–0.939) and EuroSCORE II (AUC = 0.742, 95% CI 0.595–0.870). During follow-up, 54 patients (27.7%) died. Predictive performance was comparable between SOFA (AUC = 0.710, 95% CI 0.618–0.793), APACHE II (AUC = 0.695, 95% CI 0.606–0.782), and EuroSCORE II (AUC = 0.680, 95% CI 0.599–0.757). Conclusions: Early postoperative ICU severity scores, particularly SOFA and APACHE II, demonstrated strong predictive ability for major postoperative complications and in-hospital mortality following cardiac surgery and outperformed preoperative risk scores. Full article

The increasing prevalence of multidrug-resistant (MDR) pathogens, particularly avian pathogenic Escherichia coli (APEC) and methicillin-resistant Staphylococcus aureus (MRSA), poses a severe threat to the breeding industry and human health. To develop novel antibiotic alternatives, we adopted a “converting virulence into therapy” strategy by leveraging the type VI secretion system (T6SS) of the APEC strain ACN17-20. Guided by the structural analysis of T6SS Protein 00145, we rationally designed a series of amphipathic α-helical polypeptides. Among them, polypeptide A7 emerged as a lead candidate, exhibiting potent broad-spectrum antibacterial activity with negligible cytotoxicity against mammalian cells. Mechanistic studies revealed that A7 exerts a rapid bactericidal effect through a dual mode of action: physical disruption of bacterial membrane integrity leading to cytoplasmic leakage, and induction of lethal oxidative stress via reactive oxygen species (ROS) accumulation. Furthermore, A7 demonstrated excellent efficacy in eradicating pre-formed bacterial biofilms, addressing the challenge of persistent infections in breeding environments. In a mouse sepsis model induced by APEC and MRSA, A7 treatment significantly improved survival rates (60–80%), reduced bacterial loads in vital organs, and attenuated the systemic cytokine storm (TNF-α and IL-1β), thereby alleviating immune-mediated tissue damage. In conclusion, this study identifies polypeptide A7 as a safe therapeutic agent with a dual mechanism of action, providing a promising strategy to combat MDR infections and reduce antibiotic dependence. Full article

Background/Objectives: Abdominal sepsis remains a major contributor to morbidity and mortality among surgical and critically ill patients worldwide. Timely diagnosis is frequently hindered by the overlapping clinical and biochemical features of postoperative inflammatory responses and evolving intra-abdominal infections, which may resemble systemic sepsis. Conventional biomarkers, including C-reactive protein (CRP) and procalcitonin (PCT), are widely implemented in clinical practice but demonstrate suboptimal specificity in differentiating infectious from sterile inflammatory conditions in the early postoperative phase. Presepsin (soluble CD14 subtype, sCD14-ST), a circulating fragment released during monocyte–macrophage activation in response to bacterial endotoxins, has emerged as a biomarker reflecting innate immune engagement. This review aims to critically evaluate the current evidence regarding the diagnostic accuracy, prognostic relevance, and potential clinical role of presepsin in abdominal sepsis. Methods: A comprehensive narrative review of the biomedical literature was performed using MEDLINE (via PubMed) and supplementary academic sources. Studies assessing the diagnostic performance, prognostic associations, and clinical applicability of presepsin in abdominal infections, postoperative infectious complications, and sepsis were systematically examined. Where available, comparative analyses with established biomarkers such as CRP and PCT were evaluated to contextualize its incremental value within existing diagnostic frameworks. Results: The accumulated evidence indicates that presepsin concentrations increase early during bacterial infections and correlate with validated severity indices, organ dysfunction scores, and mortality outcomes. Across multiple surgical and intensive care settings, presepsin demonstrated moderate-to-high diagnostic performance, frequently comparable to and occasionally exceeding that of traditional inflammatory biomarkers, particularly in distinguishing septic from non-septic inflammatory states. Moreover, dynamic changes in circulating levels appear to provide additional prognostic information and may support longitudinal clinical assessment. Nonetheless, substantial heterogeneity in study design, patient populations, sampling strategies, and reported cut-off values limits direct cross-study comparability and constrains definitive clinical recommendations. Conclusions: Presepsin represents a biologically plausible and clinically promising biomarker for the early identification and risk stratification of abdominal sepsis. Although current findings are encouraging, further large-scale, methodologically standardized prospective investigations are required to define optimal diagnostic thresholds and to clarify their role within multimodal biomarker strategies in contemporary sepsis management. Full article