Background: Large-scale public health emergencies, such as pandemics, can significantly disrupt human behavior and social dynamics. This study aimed to examine how containment measures against COVID-19 may be correlated with animal bite rates. Method: A retrospective analysis of animal bite reports from 2015 to 2022 in Ilam Province, Iran, was conducted. Bite data were compared with confirmed COVID-19 case counts and analyzed for trends relative to the pandemic timeline. Correlation and regression analyses evaluated associations between bite incidents and COVID-19 case rates over time. Results: A total of 7036 animal bites and 122,342 COVID-19 cases were included. A significant negative correlation was observed, with periods of greater viral transmission coinciding with relatively fewer reported bites. Bite occurrences generally increased as restrictions eased, but were highest in 2022 after case rates declined. Logistic regression indicated that bite risk was 69% greater in 2021 than in 2020 during the peak of the pandemic. Conclusion: Reduced mobility and public health restrictions during periods of high COVID-19 activity may have contributed to a lower reported animal bite incidence, and exposure during short-term but prolonged isolation was unsustainable. Balanced long-term strategies promoting responsible ownership through education are warranted. Further studies accounting for underreporting and additional contextual factors are needed, but this analysis provides insights into how animal bite patterns may inversely correlate with large-scale public health events in Iran. Policymakers should promote responsible pet ownership through public education on vaccination, supervision, and bite first aid. Targeted campaigns tailored to periods of increased risk, such as the summer season, could help optimize resource allocation.
Canaliculitis is an uncommon lacrimal drainage disorder often presenting with persistent discharge and misdiagnosed as conjunctivitis or dacryocystitis. We describe a case of a 39-year-old woman with a 6-month history of mucopurulent discharge and discomfort in the left eye. Clinical examination revealed inflammation of the lower punctum and yellow granular discharge. Curettage of the canaliculus under local anesthesia extracted yellow granules, raising a strong suspicion of actinomycetes canaliculitis. Cytological examination confirmed the diagnosis of Actinomyces canaliculitis. This case highlights the significance of clinical diagnosis in canaliculitis and the importance of prompt surgical and medical management even in the absence of laboratory reports.
Introduction: Liver transplant (LT) recipients are at high risk of infections due to chronic immunosuppression, complex perioperative factors, and preexisting malnutrition. These infections significantly contribute to increased morbidity, mortality, and health care utilization. This study aimed to evaluate the burden and impact of infections on in-hospital outcomes among LT recipients. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2022 to identify LT recipients. Patients were stratified into 2 groups based on the presence of infections. Demographic characteristics, underlying liver disease, liver-related decompensations, comorbidities, and clinical outcomes were analyzed. Multivariate logistic and linear regression models were used to assess the independent impact of infections on outcomes. Results: Among 247,955 LT recipients, 84,660 (34.1%) developed infections during hospitalization. The most frequently observed infections were pneumonia (12.8%), urinary tract infections (10.7%), and skin and soft tissue infections (5.2%). After adjustment for potential confounders, infections were significantly associated with increased odds of in-hospital mortality (adjusted odds ratio: 2.17; 95% CI: 1.93 to 2.43; P < 0.001), prolonged length of stay (adjusted coefficient: 2.34 d; 95% CI: 2.15 to 2.53; P < 0.001), and higher total hospitalization charges (adjusted coefficient: $25,424.53; 95% CI: $22,068.63 to $28,780.42; P < 0.001). Conclusion: Infections remain a common and clinically significant complication in LT recipients, leading to worse hospital outcomes. These findings highlight the importance of early identification, preventive strategies, and optimized management to improve posttransplant outcomes and reduce health care burden.
Background: Bloodstream infections (BSI) due to carbapenem-resistant gram-negative bacilli (CR-GNB), especially Klebsiella pneumoniae carbapenemase (KPC) and New-Delhi metallo-β-lactamase (NDM) producers, are associated with high morbidity and mortality. We aimed to compare the outcomes, specifically 30-day and overall in-hospital crude mortality, among patients with BSIs from KPC-producing or NDM-producing GR-GNB, in a tertiary-care, Greek hospital. Materials and Methods: We conducted a single-center, retrospective, observational study from January 1 to December 31, 2023. All consecutive adult patients with confirmed BSI due to KPC-producing or NDM-producing CR-GNB during the period were included in the study. The primary outcome was the 30-day in-hospital crude mortality rate. Results: We recorded 133 episodes of BSIs in 118 unique patients; 79 episodes were due to KPC-producing and 54 to NDM-producing CR-GNB (incidence 0.49 and 0.31 episodes per 1000 patient-days, respectively). We found high 30-day crude mortality rates for patients with BSIs due to KPC-producing CR-GNB (26.4%) and NDM-producing CR-GNB (37%). Bacteremias due to NDM-producing Pseudomonas aeruginosa had the highest 30-day (47.1%) and overall (70.6%) in-hospital, crude mortality. Treatment with beta-lactam/beta-lactamase inhibitors as monotherapy or in combination with other active agents (ie, colistin and/or tigecycline) was associated with improved survival rates among patients with KPC-producing GNB ( P =0.009). Conclusions: In conclusion, we found a high incidence of BSIs due to NDM-producing and KPC-producing CR-GNB, associated with high in-hospital mortality, especially among patients with NDM-producing P. aeruginosa .
External ventricular drainage (EVD) is a common neurosurgical intervention in pediatric patients but carries a significant risk of ventriculitis, especially during prolonged catheterization and in the presence of multidrug-resistant (MDR) pathogens. We report 2 pediatric siblings who developed prolonged EVD-associated ventriculitis caused by MDR Acinetobacter baumannii during overlapping hospitalizations for different neurological conditions. Both patients required multiple catheter revisions and combined systemic and intrathecal antibiotic therapy because systemic treatment alone was not enough. One sibling was found to have low antibody levels (hypogammaglobulinemia) and needed immunoglobulin replacement, whereas the other had a normal immune workup. These cases highlight the complex relationship between device-related risks, antibiotic resistance, and the patient’s own immune defenses. Individualized, team-based decision-making, early consideration of intrathecal therapy, and thorough immune testing are all key to managing these difficult infections in critically ill children.
Increasingly difficult-to-treat (DTR) Pseudomonas aeruginosa ( P. aeruginosa) remains a common cause of serious infections. Newer beta-lactam agents such as ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (C/A) offer extended antimicrobial spectrums preferred for addressing this problem. The objective of this systematic review is to evaluate the efficacy and safety of ceftolozane/tazobactam and ceftazidime/avibactam compared to best available therapy, primarily carbapenems, for the treatment of either complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), or nosocomial pneumonia (NP) caused by P. aeruginosa . A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards on PubMed, Embase, and Cochrane Central for all available data through June 2025. Randomized controlled trials (RCTs) with participants 18 years of age or above that compared the efficacy and safety of either C/A or C/T for cUTIs, cIAIs, or NP caused by P. aeruginosa were included. A total of 439 studies were screened, and 8 RCTs were included. Treatment with C/T or C/A showed similar results when compared primarily to carbapenems for cUTIs, cIAIs, or NP caused by P. aeruginosa . Such results encompassed clinical response or cure, microbiological response or eradication, and safety outcome measures. While our findings demonstrate efficacious similarity comparing C/T or C/A to the best available therapy, current in vitro and head-to-head observational data show potential benefit in utilizing C/T over C/A. Additional robust randomized trials are needed to validate definitive therapy.
We report a case of methicillin-resistant Staphylococcus aureus (MRSA) right coronary artery (RCA) aneurysm in a 56-year-old male with poorly controlled diabetes and recent complex MRSA bacteremia originating from a skin source. Two months prior, he was treated for multifocal MRSA bacteremia with prostatic abscesses, pulmonary septic emboli, and right-sided endogenous endophthalmitis. He received 8 weeks of appropriate therapy then re-presented with fever and pleuritic chest pain. CT imaging revealed a large complex pericardial effusion and enlarging saccular aneurysm of the RCA with rim enhancement. His course was complicated by cardiac tamponade with evidence of shock, and pericardial window revealed purulent effusion that grew MRSA. He was also found to have multivessel coronary artery disease and underwent ligation of the aneurysm with coronary artery bypass grafting. This case highlights mycotic coronary artery aneurysm as a rare but important complication of MRSA bacteremia.
Background: Sepsis remains a leading cause of morbidity and mortality in the US, and early recognition improves outcomes. Traditional diagnostic tools such as systemic inflammatory response syndrome (SIRS) criteria have limited specificity, prompting interest in biomarkers like procalcitonin (PCT). However, PCT interpretation may be affected by comorbidities including renal dysfunction and cancer. Methods: We conducted a retrospective observational review of inpatients ≥10 years old from 2014 to 2015 who had both a PCT level and blood cultures drawn. We assessed diagnostic accuracy of PCT, SIRS criteria, and white blood cell count for bacteremia, infection-related mortality, and all-cause mortality. Subgroup analyses examined patients with impaired renal function and active cancer. Diagnostic test characteristics, receiver operating characteristic curves, and logistic regression were used to compare performance. Results: We included 1014 patients. PCT at a cutoff of 0.5 ng/mL demonstrated superior specificity (65.1%) and sensitivity (66.0%) for bacteremia compared to SIRS criteria (53.0% and 50.9%, respectively). Substituting leukocytosis in SIRS with PCT improved specificity for bacteremia and infection-related mortality. In patients with renal impairment (estimated glomerular filtration rate <30 mL/min/1.73m 2 ), PCT was higher and PCT had markedly higher sensitivity (93.9%) but reduced specificity (36.9%). Cancer did not significantly alter PCT performance but reduced specificity of white blood cell count. No test reliably predicted all-cause or infection-related mortality. Conclusions: PCT at 0.5 ng/mL improves diagnostic accuracy for bacteremia over traditional SIRS criteria, both alone and in combination with SIRS, but adjustment for renal function is needed. Incorporating PCT into sepsis diagnostic pathways may improve early identification while acknowledging specific limitations.
Low and middle-income countries are confronting a significant public health challenge in the form of cervical cancer (CC). Disruptions in the cervicovaginal microbial community, especially reduced Lactobacillus dominance, have been linked with persistent human papillomavirus infection and heightened CC risk. Aim of our review is to systematically evaluate the association between the cervicovaginal microbiome, human papillomavirus persistence, and cervical neoplasia from existing systematic reviews and meta-analyses, while critically appraising their methodological quality. We conducted an overview of systematic reviews and meta-analyses examining associations between the cervicovaginal microbiome, HPV infection, and cervical neoplasia. Literature search was conducted across various databases, including Scopus, Clarivate, PubMed, and Google Scholar, systematically spanning the period from June 2010 to June 2025, to identify eligible systematic reviews and meta-analyses. The study protocol was prospectively registered in PROSPERO (CRD420250533647). The study included 23 systematic reviews and meta-analyses. According to the AMSTAR-2 assessment, most reviews had low methodological quality; 5 were rated critically low, the majority were low, while 2 were rated moderate. Heterogeneity in study design, sequencing platforms, population characteristics, and analytical methods limited comparability and precluded causal inference. Current evidence suggests a consistent association between cervicovaginal dysbiosis and HPV persistence or cervical lesion progression; however, the predominance of low-quality reviews and substantial methodological heterogeneity reduces confidence in the strength and direction of these associations. This study is the first comprehensive overview of systematic reviews and meta-analyses, guiding future priorities in microbiome research on cervical carcinogenesis. Well-designed longitudinal studies and standardized methodologies for the microbiome are needed to clarify temporality.
GATA2 deficiency is a rare immunodeficiency and bone marrow failure syndrome characterized by loss of monocytes, dendritic cells, B cells, and NK cells, predisposing patients to disseminated nontuberculous mycobacteria, invasive fungi, severe herpesviruses, and human papillomavirus (HPV)-related disease. We present 2 cases illustrating the infectious spectrum of this disorder. Case 1 is a 21-year-old woman with GATA2-associated myelodysplastic syndrome, who progressed to acute myeloid leukemia, who developed recurrent Staphylococcus epidermidis bacteremia, invasive fungal sinusitis, Epstein-Barr viremia, and hemophagocytic lymphohistiocytosis following allogeneic-hematopoietic stem cell transplant. Case 2 is an 81-year-old man with GATA2 deficiency and follicular lymphoma evolving to T-cell large granular lymphocytic leukemia (T-LGLL) and CD30-positive peripheral T-cell lymphoma (PTCL), who developed chronic SARS-CoV-2 infection and multidrug-resistant bacterial pneumonia. Both patients died despite aggressive management. Case 2 represents one of the oldest reported GATA2 patients and the first reported association with follicular lymphoma, T-LGLL, and PTCL.
Many patients were admitted to the intensive care unit (ICU) as a result of the COVID-19 pandemic. Family members were frequently separated from their loved ones, which could lead to unpleasant experiences and psychological distress. Particularly during this delicate and challenging period for patients and family members, the family plays vital roles in supporting the patient’s recovery. Therefore, strategies to address families’ needs holistically must also be considered. Understanding the experiences of family members of COVID-19 patients in the ICU unit is the objective of this review. by means of an organized and qualitative meta-synthesis. This systematic review of qualitative studies and meta-synthesis will be conducted based on searches of the academic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, PsycINFO, ScienceDirect, Cochrane Library, Theses and Dissertations Global, Google Scholar, See-in-the-Dark (Scintific Information Database), and Magiran. Two research team members will be involved in all screening, review, data extraction, and quality assessment of studies. A third reviewer will consult with the research team and arbitrated with the two teams. Thematic synthesis steps will include acquiring familiarity with data, development of a thematic framework, indexing the data to identify themes and codes, charting the data, and mapping and interpreting the data. The Critical Appraisal Skills Programme (CASP) checklist will be used to appraise the quality of the included studies. Confidence in the meta-synthesis findings will be assessed by applying the GRADE-CERQual approach. The review will be reported in accordance with the ENTREQ guidelines.
Persistent bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality rate. While combination parenteral antibiotic regimens have shortened duration of bacteremia in some trials, they were also associated with increased nephrotoxicity and did not improve clinical outcomes. We cared for a patient with MRSA bacteremia that persisted for nearly 3 weeks. Due to medical ethical complexities, intravenous therapy could not be administered after day 6, so oral linezolid was started. On day 20 of persistent bacteremia, we attempted a "hail Mary" intensification by adding oral moxifloxacin and rifampin. On day 21, blood cultures cleared. Causality from the intensification cannot be presumed, but the temporal association was intriguing. Nevertheless, an oral regimen successfully cleared persistent S. aureus bacteremia, calling into question the necessity to wait until clearance of bacteremia before initiation of oral therapy. These results support the future study of all-oral therapy for S. aureus bacteremia.
Staphylococcus pseudintermedius , a coagulase-positive Staphylococcal species, colonizes the skin and mucosal surfaces of almost all dogs, and to a lesser extent, cats. A member of the Staphylococcus intermedius group of coagulase-negative staphylococci, it is known to cause opportunistic infections in these animals. After the initial reports of wound and skin infections in humans, S. pseudintermedius is now considered to be a potential zoonotic pathogen. The mounting number of human-dog interactions, coupled with its similar phenotypic, pathogenic, and resistance characteristics to S. aureus , has made S. pseudintermedius an emerging public health concern. We present a case of a 74-year-old woman with breast cancer who presented with a complicated post-mastectomy surgical wound infection involving S. pseudintermedius . Her infection was believed to have been acquired through close contact with her pet dog. Apropos this case, we review the microbiological identification, pathogenesis, antimicrobial resistance, and epidemiologic aspects of this increasingly recognized Staphylococcal species to call attention to its role as a human pathogen, particularly in individuals having close contact with canine companion animals.
Hantavirus infections remain rare but clinically significant zoonotic diseases associated with high morbidity and mortality. Despite ongoing research, no FDA‑approved pharmacotherapies exist, and management is largely supportive. This review summarizes current evidence on hantavirus pathophysiology, clinical presentation, diagnostic strategies, and investigational treatments, with a focus on the potential role of ribavirin and other emerging therapies. Although early studies suggested that ribavirin may reduce mortality when administered within the first 5 days of symptom onset, subsequent trials have shown no consistent clinical benefit, and its use remains controversial. Importantly, these data apply to hemorrhagic fever with renal syndrome (HFRS), not hantavirus pulmonary syndrome (HPS), for which ribavirin has not demonstrated therapeutic benefit. Supportive care, including hemodynamic stabilization, respiratory support, and management of complications, continues to be the cornerstone of therapy. Pharmacists play a critical role in the interdisciplinary management of hantavirus infection by providing evidence‑based pharmacotherapy recommendations, guiding antimicrobial stewardship, monitoring laboratory parameters, identifying adverse drug reactions, and supporting clinical decision‑making during multidisciplinary rounds. Their expertise is essential in optimizing supportive care, ensuring safe medication use, and educating health care teams on disease recognition, prevention strategies, and discharge planning. In the absence of definitive antiviral therapy, pharmacists remain integral to improving patient outcomes through clinical vigilance, therapeutic optimization, and active participation in collaborative care models. Continued research is needed to clarify the role of antiviral agents and to develop targeted treatments for this high‑risk infection.
Endocarditis remains associated with high morbidity and mortality despite advances in antimicrobial therapy and surgical management. Some patients are poor candidates for surgery due to comorbidities, extensive vegetations, or right-sided disease. AngioVac-assisted aspiration has emerged as a minimally invasive option for mechanical vegetation debulking in selected cases. We conducted a systematic review in accordance with PRISMA guidelines to identify published case reports describing the use of the AngioVac system for endocarditis. PubMed was searched from inception through September 2025. Data extracted included patient characteristics, vegetation location and size, microbiology, indications for AngioVac use, procedural details, complications, and clinical outcomes, with descriptive analyses performed. A total of 25 studies comprising 28 patients were included. The mean age was 46 years, with a balanced sex distribution. Right-sided endocarditis predominated, most commonly involving the tricuspid valve (78.6%). Large vegetations were frequent, with over half measuring ≥3.0 cm. Staphylococcus aureus was the most commonly identified pathogen. Indications for AngioVac use included septic pulmonary emboli, large vegetation burden, and persistent bacteremia despite antimicrobial therapy. Successful or partial vegetation debulking was achieved in 96.4% of cases, most commonly in right-sided disease, with low reported short-term mortality (3.6%). AngioVac-assisted aspiration appears to be a feasible and effective adjunctive strategy for carefully selected patients with infective endocarditis who are poor surgical candidates, particularly those with right-sided disease and large vegetations. While short-term outcomes are favorable, available evidence is limited, underscoring the need for prospective studies to better define long-term outcomes and optimal patient selection.
Background: Health care–associated infections (HCAIs) and antimicrobial resistance (AMR) remain major threats to global patient safety. Targeted infection prevention and antimicrobial stewardship are crucial. This study aimed to enhance patient safety by reducing HCAIs and AMR through structured interventions. Methods: An action research study was conducted at Ayatollah Taleghani Hospital, Tehran, Iran, from January 10, 2024, to July 30, 2025, using a planning, implementation, observation, and reflection cycle. Participants included physicians and nurses. Interventions comprised antibiotic stewardship, a hand hygiene compliance program, and active infection surveillance. Demographic and clinical data from 136 patients with positive cultures were analyzed, comparing pre- and postintervention outcomes. Results: The patients’ mean age was 30.52 (SD 20.63) years; the mean length of stay was 23.94 (SD 18.83) days; and the mean time to infection onset was 12.42 (SD 15.49) days. Hand hygiene compliance significantly improved ( P < 0.05). While infection rates and mortality showed a decreasing trend postintervention, the reductions were not statistically significant ( P > 0.05). Conclusions: Antibiotic stewardship, hand hygiene promotion, and active surveillance may improve patient safety and reduce HCAIs. Sustained, multifaceted infection control interventions are needed to significantly decrease infection-related morbidity and mortality.
