Introduction: Mpox virus (MpoxV), an emerging zoonotic pathogen, has recently caused global concern due to increasing outbreaks beyond its traditional endemic regions. While transmission primarily occurs via close contact, fomites are also suspected of contributing. This study aims to evaluate the effectiveness of UV-C irradiation on MpoxV-contaminated surfaces. Methods: the virucidal activity of UV-C (254 nm) irradiation on MpoxV applied to plastic, glass, and stainless-steel surfaces was assessed. Using a viral stock of 2.49 × 105 TCID50/mL, the samples were exposed to increasing UV-C doses. Viral titers were quantified through TCID50 and plaque assays. Results: A UV-C dose of 6.34 mJ/cm2 achieved a >2-log reduction of viral load, below the detection limit (31.6 TCID50/mL), on all tested surfaces. EC90 values were determined as 3.33 mJ/cm2 (plastic), 0.81 mJ/cm2 (stainless steel), and 1.98 mJ/cm2 (glass). No viable virus was detectable post-treatment at these doses on plastic and stainless steel while the titer was significantly reduced on glass. Conclusions: UV-C irradiation at low doses effectively inactivated MpoxV on various fomites. These findings support UV-C as a rapid and effective environmental disinfection strategy in healthcare and community settings to prevent indirect transmission of MpoxV.

OBJECTIVE:Assessment of real-life effectiveness of an intervention for smoking cessation in people living with HIV (PLWH) in long-term follow-up. SETTING:Multicenter cohort prospective study, involving PLWH from Italian Infectious Disease Centers. METHODS:During routine HIV care, clinicians usually promote smoking cessation implementing the European AIDS Clinical Society guidelines. We analyzed smoking cessation for 9 years of follow-up. The brief counseling intervention was defined "standard" when delivered in at least half follow-up visits, "soft" if less than half. We excluded from the analysis 85 patients lost at follow-up. The main outcome was definitive smoking interruption at the last follow-up visit (smoking abstinence for >6 months and no recurrence). Abstinence predictors were evaluated using a Cox-proportional hazard regression model [adjusted hazard ratio (aHR), and 95% confidence interval (CI)]. RESULTS:Out of 1002 PLWH with prolonged follow-up, 510 were current smokers at baseline (median observation time was 7.4 years, interquartile range 6.9-8.0). The standard intervention was performed in 340 smokers (66.7%) and soft intervention in the remaining 170 (33.3%). At the last visit, 66 (12.9%) PLWH achieved self-reported definitive smoking cessation, 59 (17.4%) in standard and 7 (4.1%) in soft intervention. At the multivariate analysis, Fagerström score (by -1, aHR 1.16, 95% CI: 1.05 to 1.29), stage of change (preparation/action aHR 3.33, 95% CI: 1.81 to 6.12), and standard intervention (aHR 2.45, 95% CI: 1.08 to 5.58) were predictors of smoking cessation. CONCLUSIONS:The brief intervention led to self-reported definite smoking cessation in 12.9% of PLWH. The standard intervention was more effective: thus, adherence to intervention emerged as a critical factor for the effectiveness.

We evaluated the levels of plasma biomarkers of central nervous system (CNS) injury in people with HIV and four-class drug resistance (heavily treatment-experienced, HTE), and in virally suppressed, non-HTE controls. Biomarkers included NFL, t-Tau, GFAP, and UCH-L1. No evidence was found for higher biomarker levels in HTE individuals. Age, comorbidities, and CD4+ cell count were stronger predictors of higher biomarker levels than HTE status or viral replication. Effective management may mitigate CNS injury despite long-term HIV infection and treatment resistance.

Infective endocarditis (IE) due to methicillin-susceptible Staphylococcus aureus (MSSA) still represents a clinical and therapeutic issue. Discrepancies between guidelines, clinical studies and clinical practice have already been highlighted, especially regarding daptomycin use in MSSA cases. The aim of this study was to evaluate daptomycin’s impact on outcomes in this setting. This was a retrospective observational study. We enrolled all patients with MSSA IE admitted from 2015 to 2023. Patients were divided into two groups according to daptomycin administration. We enrolled 76 patients, with 49 in group A (standard treatment) and 27 in group B (treated with daptomycin). The in-hospital crude mortality was 14.3% and 29.6% in group A and B, respectively (p = 0.191). Only heart failure was significantly associated with negative outcome in the univariate and multivariate analyses (OR 6.424, 95% CI, 1.680–24.559; p = 0.007). In this study population, daptomycin treatment for IE due to MSSA was not associated with a reduced mortality rate. Heart failure was the only independent risk factor associated with in-hospital mortality.

New beta-lactam/beta-lactamase inhibitor combinations (BL/BLICs) are licensed for Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections. However, data regarding their efficacy against bacterial biofilms and the potential of synergistic combinations remain limited. This study evaluated their efficacy on planktonic and biofilm forms of KPC-Kp isolated from catheter-related bloodstream infections (CRBSIs), correlating findings with genomic and clinical data. Twelve KPC-3-harboring isolates (ST512, n = 7; ST307, n = 3; ST101, n = 2) were characterized via whole-genome sequencing. Ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), and imipenem/relebactam (IMI/REL) were tested alone or combined with fosfomycin (FOS), cefepime (FEP), meropenem (MEM), or imipenem (IMI) using checkerboard assays. All BL/BLICs alone showed significant, comparable efficacy against biofilm-producing strains. However, combination testing revealed heterogeneous synergistic profiles. CAZ/AVI combined with MEM, IMI, or FEP achieved 100% synergy in both planktonic and biofilm states. MEM/VAB-based combinations demonstrated consistent synergy (50-100%), whereas IMI/REL showed higher synergistic rates in biofilm than in planktonic forms. Conversely, FOS-based regimens were significantly less effective against biofilms. These findings provide a clinical rationale for selecting optimized dual regimens to eradicate biofilms, offering a critical therapeutic strategy to preserve vascular devices when catheter removal is unfeasible.

Background:Antibiotic resistance represents a great concern worldwide with increasing related morbidity and mortality. Multidrug resistant microorganisms are going to be detected more and more frequently even in the community setting. Therefore, patients could be colonised even at the admission to the hospital. Objective:The aim of this study is to evaluate colonisation at admission to an intensive care unit (ICU) and the acquisition of new colonisation during the ICU stay and the related risk factors. Secondly, healthcare-associated infections and surgical prophylaxis efficacy were also evaluated. Methods:Retrospective observational study. All the patients admitted to the post-cardiosurgical ICU from 01 January to 30 June 2021 were enrolled. Colonisation was evaluated by rectal and nasal swab at admission or at the pre-hospitalisation visit and then every 7 days during the hospital stay. Results:80 out of 183 patients were colonised at admission, 46 by non-susceptible microorganisms (NSM). An antibiotic treatment in the previous 3 months was identified as risk factor for NSM colonisation. According to these isolates, about one third of the surgical prophylaxis could be ineffective. During the hospital stay, 36 patients acquired new colonisations; antibiotic treatment and length of hospital stay were recognised as risk factors. At least one (≥1) healthcare-associated infection (HAI) was detected in 54 patients (68 episodes); HAIs were significantly more frequent in the colonised patients. Moreover, in 35/68 HAIs aetiology was consistent with the colonisation. Discussion:Knowing patients' colonisations could be fundamental to tailor antibiotic treatments and prophylaxis and to avoid NSM spread.

INTRODUCTION:A reliable quantification of hepatitis D virus (HDV) RNA is of paramount importance for monitoring patients under antiviral therapy. This quality control study compares the diagnostic performances of quantitative HDV-RNA assays used in clinical practice. METHODS:Two HDV-RNA sample panels were quantified in 30 centers by RoboGene (N = 9 laboratories), EurobioPlex (N = 7), RealStar (N = 4), AltoStar (N = 1), Bosphore (N = 3), Bosphore-on-InGenius (N = 1), Dia.Pro (N = 2), Nuclear-Laser-Medicine (N = 1) and 3 in-house assays. Panel A and B comprised 8 serial dilutions of WHO/HDV standard (range: 0.5-5.0 log10 IU/ml) and 20 clinical samples (range: 0.5-6.0 log10 IU/ml), respectively. The following parameters were determined: sensitivity by 95 % LOD (limit of detection), precision by intra- and inter-run CV (coefficient of variation), accuracy by the differences between expected-observed HDV-RNA, linearity by linear regression analysis. RESULTS:95 % LOD varied across assays and centers underlining heterogeneous sensitivities: AltoStar had the lowest 95 % LOD (3 IU/ml) followed by RealStar (10 [min-max: 3-316] IU/ml), Bosphore-on-InGenius (10 IU/ml), RoboGene (31 [3-316] IU/ml), Nuclear-Laser-Medicine (31 IU/ml) and EuroBioplex (100 [100-316] IU/ml). Moreover, 6 assays (RoboGene, EurobioPlex, RealStar, AltoStar, Nuclear-Laser-Medicine and In-house) showed <0.5 log10 IU/ml differences between expected and observed HDV-RNA for all dilutions while other assays had >1 log10 IU/ml underestimations. RealStar, Bosphore-on-InGenius and EurobioPlex had the highest precision (mean intra-run CV < 20 %). Inter-run CV was higher for all assays, with CVs < 25 % for RealStar, AltoStar, Nuclear-Laser-Medicine and EurobioPlex. Seven assays (RoboGene/AltoStar/RealStar/EurobioPlex/Nuclear-Laser-Medicine/In-house) showed a good linearity (R2 > 0.90), but for HDV-RNA < 1000 IU/ml only Bosphore-on-InGenius, AltoStar, RealStar and Robogene showed a R2 > 0.85. CONCLUSIONS:This study underlines heterogeneous sensitivities (inter- and intraassays), that could hamper proper HDV-RNA quantification, particularly at low viral loads. This raises the need to improve the diagnostic performance of most assays for properly identifying virological response to anti-HDV drugs.

The purpose of the study was to evaluate the therapeutic success and adverse events (AEs) of dalbavancin on-label and off-label use in clinical practice. This was a retrospective, observational, multicentre study that enrolled consecutive patients treated with dalbavancin from January 2017 to May 2024 in the Italian SUSANA cohort. Therapeutic success was defined as clinical cure or infection control if chronic suppressive therapy was performed. Risk factors for treatment failure were evaluated using a logistic regression model. A total of 281 patients were enrolled in the study. On-label administration occurred in 162 (57.6%) cases and off-label in 119 (42.6%). The main off-label prescriptions included 29 cases of osteomyelitis and 25 cases of prosthetic joint infections. Dalbavancin was used mainly as empirical therapy (70.4% of cases) in the on-label group, while in the off-label group as targeted therapy for methicillin-resistant Staphylococcus aureus (29.4%). The therapeutic success rate was similar in both groups (82.7% on-label versus 84.0% off-label). Only one adverse event caused discontinuation of treatment in the on-label group. In addition, one grade-3 AE was observed in each cohort, without treatment interruption. Dalbavancin was widely used in clinical practice for on-label and off-label indications with a comparable success rate of 82.8% and 84.0%, respectively, and a good safety profile.

The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients. Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality. Among 185 patients, 84 (45.4

OBJECTIVE:Both vancomycin (VAN) and teicoplanin (TEI) augment the risk of acute kidney injury (AKI) when combined with piperacillin-tazobactam (TZP). We aimed to compare the risk of AKI among patients receiving TZP-VAN vs. TZP-TEI. METHODS:This was a prospective, multinational, multicentre cohort study conducted in 12 centres from Turkiye, Italy, and Spain between 1 June 2022, and 31 December 2023. The primary outcome was the occurrence of AKI between the first day of antibiotic treatment and the third day after completing therapy, according to the Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression and propensity-score match analyses were employed to adjust for confounding variables. Stratified Kaplan-Meier analysis was used to assess the time-to-AKI between the comparison groups. RESULTS:Of 187 patients (TZP-TEI, n = 102; TZP-VAN, n = 85), the AKI occurred in 21 patients (24.7%) who received TZP-VAN and in 15 patients (14.7%) with TZP-TEI (unadjusted odds ratio [OR], 1.90; 95% CI: 0.91-3.97; P = 0.087). After adjusting for confounding variables with multivariable analysis, TZP-VAN was not associated with increased odds of AKI compared with TZP-TEI; with an adjusted OR of 2.24 (95% CI: 0.78-6.42; P = 0.133). In propensity-score matched analysis (n = 49 pairs), the AKI risk was similar between the two groups (OR, 2.10; 95% CI: 0.67-6.50; P = 0.199). The stratified Kaplan-Meier analysis indicated no difference between the treatment groups in terms of time-to-AKI (log-rank test, P = 0.107). CONCLUSIONS:The risk of AKI in TZP-VAN was similar to that in TZP-TEI. These results should be confirmed in randomized controlled trials.

We aim to assess the state-of-the-art of Infection Prevention and Control (IPC) practices and their results in Italian healthcare facilities 6 years after the kick-off of the new National Plan for the Control of Antibiotic Resistance (PNCAR). This was a multicenter, cross-sectional, observational study conducted between January 1st, and December 31st, 2023, among Italian hospitals. Survey questions were readapted from the WHO IPC assessment framework (IPCAF), PNCAR and INSIEME group proposals, resulting in 155 questions grouped into six sections: IPC program, surveillance, control activities for healthcare-associated infections, antimicrobial stewardship (AMS) strategies, IPC training and education, and monitoring indicators. Thirty-eight acute care Hospitals completed the survey (response rate: 30%): 26.3% of hospitals did not define an annual program and 34.2% an AMS task force. Periodic microbiology reports were available for 57.9%, hospital alcohol-based hand rubs consumption per 1000 bed-days in 42.1% and defined daily dose of antimicrobials per 100 bed-days in 55.3% hospitals with a significant difference between Northern and Southern regions (90.9% vs 22.2%; P = 0.006). Active monitoring of hand hygiene and contact isolation compliance was implemented in only half of the hospitals. Structured HAI surveillance systems were implemented in fewer than 20% of hospitals. Components on IPC implementation activity, such as no-touch sanitizing systems, checklist for environmental cleaning, informatic flags, bundles for pathogens revealed the lowest score. The appropriateness of antibiotic therapy prescribing was assessed in 73.7% of facilities. Only 42.1% of hospitals had budget goals. This survey provides a baseline assessment and identifies key barriers to the implementation of IPC programs across Italian acute care hospitals. The findings highlight priority areas for intervention and will inform the next phase of the INSIEME project, which aims to develop and implement tailored strategies that address the specific needs of healthcare workers and institutions nationwide.

Background: Intra-abdominal infection (IAI) is a challenging condition that needs both medical and surgical treatment and it is still associated with high morbidity and mortality rates. Fosfomycin is approved for use in combination therapy for IAIs. The aim of this study was to evaluate the impact of intravenous fosfomycin addition in a combination regimen for IAI treatment in an intensive care setting. Methods: We performed a retrospective, observational, monocentric study. We enrolled patients admitted to the ICU with IAIs from April 2022 to June 2024. Patients were divided into two groups: Group A, standard treatment; and Group B, combination therapy including fosfomycin. Primary endpoints were clinical response at 7 days and in-hospital mortality; moreover, a risk factor analysis for mortality was also performed. Results: In total, 104 patients were enrolled, 85 in Group A, and 19 in Group B. Groups were homogenous in regard to demographics, but clinical condition was slightly worst in Group B. Source control < 24 h was performed in 69.6% and 33.3% cases in Group A and Group B, respectively (p = 0.017). Clinical response on day 7 (81.2% vs. 73.7%, p = 0.675) and in-hospital mortality (27.1% vs. 47.2%, p = 0.145) were comparable. Univariate and multivariate analysis highlighted Charlson Comorbidity Index (CCI) (p = 0.04) and septic shock (p = 0.029) as risk factors, and effective empirical therapy (p = 0.04) as the protective factor; fosfomycin was not directly associated with outcome improvement. Conclusions: The outcome was comparable between groups; clinicians preferred to administer a combination regimen including fosfomycin in patients with statistically significant greater severity of illness and without early source control.

Since early 2022 the Omicron variant has rapidly spread worldwide, becoming the dominant variant to date. The study aimed to investigate the clinical and epidemiological characteristics of COVID-19 patients and reconstruct the genomic epidemiology of main SARS-CoV-2 Omicron sublineages in Italy in 2022. A total of 8970 SARS-CoV-2 samples were studied, and phylogenetic analyses were focused on BA.1, BA.2, and BA.5 subvariants. More than half of subjects received three doses of vaccine and experienced a reinfection. A significant larger proportion of unvaccinated subjects presented reinfection compared with vaccinated. Clusters presented a tMRCA between September-November 2021 (BA.1), November 2021-January 2022 (BA.2), and October 2021-May 2022 (BA.5). Re values showed the highest level between September-October, January-February 2022, and May 2022 for BA.1, BA.2 and BA.5, respectively. Limited number of studied variant sequences are included in clusters. The spread rate of the studied variant exceeded its evolutionary rate. No single sublineage had sufficient time to differentiate into large clusters, but only into small and fragmented groups sharing the same recent ancestor. These analyses dissect the epidemiological dynamics of Omicron sublineages in Italy over a period of great epidemiological changes in the COVID-19 epidemic.

BACKGROUND AND AIM:Ceftobiprole, an advanced-generation cephalosporin with broad bactericidal activity, is approved for community-acquired and hospital-acquired pneumonia (excluding ventilator-associated pneumonia). We aimed to evaluate, in a real-world setting, the safety profile of ceftobiprole in patients with risk conditions (severe renal impairment, hepatic impairment, and immunocompromised status), groups excluded from clinical trials. METHODS:In this retrospective study (NCT04170309), 396 consecutive charts of patients treated with ceftobiprole during 2016-2022 in 15 centres in France, Italy, and Spain were analysed: 62 had severe renal impairment, 51 had a hepatic impairment, 120 were immunocompromised, and 203 had no predefined risk condition (controls). RESULTS:Ceftobiprole was used for off-label indications in 110/396 (27.8%) patients; 46/396 (11.6%) patients received a higher-than-recommended dose. Treatment-emergent adverse events (TEAEs) considered as ceftobiprole-related occurred in 44 patients, more frequently in the risk groups compared to controls (severe renal impairment: 8/62 [12.9%]; hepatic impairment: 7/51 [13.7%]; immunocompromised: 19/120 [15.8%]; controls: 15/203, [7.4%]); in 7/44 patients, these events were serious. Compared to controls, liver-related AEs occurred more frequently in the impaired hepatic function (17/51 [33.3%] vs. 22/203 [10.8%], odds ratio [OR:]: 4.11; 95% confidence interval [CI]: 1.98-8.55) and immunocompromised (30/120 [25.0%] vs. 22/203 [10.8%], OR: 2.74; 95% CI: 1.50-5.02) groups. Hyponatremia was also more frequent in immunocompromised patients than controls (14/120 [11.7%] vs. 9/203 [4.4%], OR: 2.85; 95% CI: 1.19-6.80). Underlying disease, concomitant medications and the poor health status of the patients likely affected these imbalances. CONCLUSION:Overall, no new safety concerns related to ceftobiprole use in real-world patients with severe renal impairment, hepatic impairment or immunocompromised status were identified.

Objective:The study aimed to assess the impact of smoking exposure on major clinical events (MCEs) in a real-life setting of people with HIV (PWH).Design:An observational, longitudinal, multicenter cohort study from Italy.Methods:Consecutive 983 PWH were enrolled in "STOP Smoking in HIV people" (STOPSHIV) projects and followed from July 2014 until September 2023. The observed MCE defined as cardiovascular events, neoplastic diseases, or death for any reason was assessed according to smoking status and related variables (number of cigarettes smoked daily, pack-years, Fagerstr & ouml;m test) in participants. The association between exposure variables and the event was evaluated using the Cox proportional hazard model [hazard ratios, and 95% confidence interval (95% CI)].Results:Over 6997.6 person-years of follow-up (PYFU), we found a total of 49 cardiovascular events, 61 neoplastic events, and 47 deaths. The overall incidence rate of MCE was 17.6 /1000 PYFU (95% CI 14.7-21.0). All-cause death rate was 6.7 (95% CI 5.0-8.9)/1000 PYFU. In a multivariate analysis, older age (hazard ratio 1.07, CI 1.05-1.09), high Fagerstr & ouml;m Test for Nicotine Dependence (hazard ratio 1.09, CI 1.03-1.15), a low nadir CD4+ cell count less than 200 cells/mu l (hazard ratio 1.63, CI 1.10-1.41), history of previous neoplasm (hazard ratio 2.41; CI 1.34-4.43), and IDU as a risk factor for HIV infection (hazard ratio 2.36; CI 1.52-3.68) were independent predictors of any MCE.Conclusion:Non-AIDS clinical conditions are the most observed clinical events in PWH from Italy. Smoking exposure significantly increases the risk of MCE in PWH, and a high Fagerstr & ouml;m Test for Nicotine Dependence is a predictor of MCE.