New Microbiologica最新文献

Malaria remains a significant global health challenge, disproportionately affecting Sub-Saharan Africa. Pregnant women represent one of the most vulnerable populations. Despite numerous advances in malaria control measures, lost-to-follow-up (LTFU) in antenatal care (ANC) programs poses a critical barrier to achieving optimal maternal and neonatal outcomes and the success of public health interventions. The factors driving LTFU, particularly in rural, high-burden settings, are not completely understood. This study investigates the determinants of LTFU among pregnant women receiving malaria screening in the context of the ERASE-Rise Against Malaria project in Northern Uganda. An observational retrospective cohort study was conducted on 1,558 women, recruited from July 2022 to June 2024, during the operational research held to assess the impact of antimalarial resistance on malaria care among pregnant women in three healthcare facilities in Oyam and Kole districts. Data on individual level (sociodemographic and clinical) and health care-related factors were analyzed using a multilevel logistic regression model to identify predictors of LTFU, defined as the absence of cohort outcome data 30 days after the expected delivery date. Efforts to recover missing data included delivery register consultation, active phone calls, and contact tracing by village health team workers. 871 (55.9%) of the 1,558 women were LTFU. Recovery strategies reduced the missing data rate to 29.1% (n=454). Protective factors against LTFU included higher education (aOR=0.75, 95% CI: 0.54-1.03, p=0.0798), being primigravida (aOR=0.73, 95% CI: 0.56-0.97, p=0.0275), and experiencing malaria during pregnancy (aOR=0.61, 95% CI: 0.48-0.78, p<0.0001). Women attending Aboke Health Center IV (n=385) were over five times more likely to be LTFU than those at Aber Hospital (n=955) (aOR=5.57, 95% CI: 4.08-7.71, p<0.0001), highlighting significant geographic and structural barriers. The high rate of LTFU in malaria screening programs underscores the need for targeted interventions addressing individual, systemic and structural barriers. Strengthening community-level support, improving healthcare infrastructures, and integrating malaria prevention into broader maternal health services are crucial for enhancing retention in care. Addressing determinants of LTFU, systematically, through further qualitative and quantitative research, is essential to improving maternal and neonatal health outcomes and achieving malaria eradication goals in high-burden settings.

Persistent low-level viremia (LLV) in heavily treatment-experienced (HTE) people with HIV (PWH) harboring multidrug-resistant virus remains a challenging clinical scenario. We report two cases from the PRESTIGIO Registry of individuals with longstanding HIV infection, high cumulative genotypic resistance, and sustained LLV despite no current adherence issues. In both cases, a regimen confidently containing ≥2 fully active agents was not achievable without incorporating entry and/or capsid inhibitors. Through these cases, we highlight diagnostic and therapeutic uncertainties in the management of LLV, including: the unfeasibility of RNA-based genotyping, the limited availability of data on resistance assessment by DNA-based genotypic testing, and the possibility that such viremia stems from clonal viral production rather than active replication. Although both individuals maintained a stable immune profile and low transmission risk, these cases underscore the need for tailored guidance in managing LLV in HTE PWH.

Fungal infections pose a growing threat in hospital settings, particularly among critically ill or immunocompromised patients. A multidisciplinary consensus among fifteen clinical experts from Northern Italy examined the increasing challenge of invasive fungal infections, especially in patients with high-risk complications and in critical settings. The report emphasizes early diagnostic integration through clinical assessment, biomarker evaluation, and the essential role of therapeutic drug monitoring in optimizing outcomes. This consensus aims to consolidate clinical strategies for timely diagnosis, personalized pharmacologic intervention, and antifungal stewardship. Azoles are identified as first-line treatment options. Isavuconazole emerged as a preferred therapeutic agent due to its favorable pharmacokinetic profile, safety in renal impairment, and lack of QT interval prolongation. This consensus supports integrated strategies combining early recognition, rapid diagnostics, individualized pharmacology, and antifungal stewardship to improve outcomes, particularly in critical care settings.

Objectives: This retrospective observational study assesses adherence to antiretroviral therapy before and after the transition to pharmacy-based treatment dispensation.

Methods: Two 14-month periods were identified: before (P1) and after (P2) the transition to pharmacy-based provision of antiretrovirals. P2 also coincided with the SARS-CoV-2 pandemic. Adherence was assessed using a mathematical index to estimate the delay in refilling medication (delay index Di).

Results: 1,266 people with HIV were included. Higher values of Di were found to be associated with P2 (ß 0.17, 95%CI 0.04-0.07), primarily driven by a significant delay in the initial months of the SARSCoV-2 pandemic in Italy, with Di +0.051 ± 0.13 from March to May 2020 vs. Di +0.048 ±0.12 in the rest of P2. Higher Di was also associated with multi-tablet regimens (ß 0.06, 95%CI 0.006-0.03), whereas switching regimens was associated with lower Di (ß -0.06, 95%CI -0.07-0.04). The odds of HIV RNA>50 copies/mL were higher with higher Di (OR 2.78; 95%CI 1.14-6.75), but lower in P2 compared to P1 (OR 0.38; 95%CI 0.27-0.53).

Conclusions: Despite an apparent adherence decline due to delays in treatment refills during the first months of the SARS-CoV-2 pandemic, the transition to pharmacy-based antiretrovirals supply was associated with lower frequency of uncontrolled HIV replication.

Stenotrophomonas maltophilia is an emerging, multidrug-resistant pathogen increasingly associated with nosocomial infections, particularly in immunocompromised patients such as those undergoing allogeneic hematopoietic stem cell transplantation or affected by oncological diseases. Therapeutic options are limited due to intrinsic and acquired resistance mechanisms, including β-lactamases and efflux pumps. Although minocycline and trimethoprim-ulfamethoxazole are standard treatments, recent evidence suggests that eravacycline, a novel fluorocycline, may be effective in vitro, though clinical data remain scarce. Two cases of S. maltophilia bloodstream infection (BSI) in immunocompromised patients were reviewed. Both patients received eravacycline as part of combination therapy, following microbiological identification of the pathogen. Clinical course, microbiological outcomes, and antibiotic regimens were analyzed. Both patients, affected by acute myeloid leukemia and cholangiocarcinoma, developed S. maltophilia BSI after prolonged exposure to broad-spectrum antibiotics. Eravacycline (1 mg/kg every 12 hours) was included in both regimens. Blood cultures cleared within 48 hours in both cases. One patient died due to fungal complications, but S. maltophilia BSI was microbiologically controlled in both. These findings suggest a potential role for eravacycline in treating S. maltophilia BSI when standard options are limited. Further clinical studies are needed to establish efficacy and appropriate therapeutic use.

We report a rare case of tertiary syphilis in a pregnant woman, presenting with cutaneous gumma and ocular involvement. This case highlights the diagnostic challenges of atypical syphilitic lesions and emphasizes the importance of considering syphilis in the differential diagnosis of facial skin lesions during pregnancy.

Pseudomonas aeruginosa infections in cystic fibrosis (CF) often present therapeutic challenges due to acquired resistance. This study analyzed 178 strains from adult CF patients at a single French university hospital. High in vitro activity was observed for newer antibiotics such as ceftolozane-tazobactam (83% susceptibility), ceftazidime-avibactam (85% susceptibility), and cefiderocol (89% susceptibility). Delafloxacin also showed promising activity, with 93% of the isolates exhibiting MICs below the EUCAST epidemiological cut-off value. Results emphasize the potential utility of these agents.

The emergence and global dissemination of carbapenem-resistant Klebsiella spp. have seriously threatened global public health. Few genomic analyses of ceftazidime-avibactam-resistant and carbapenem-resistant Klebsiella spp. (CAR-CRKS) have been performed to date. This was a retrospective study of 12 CAR - CRKS isolates from 99 Klebsiella spp. collected in a Chinese tertiary hospital between 2018 and 2020. K. pneumoniae (eight cases, 66.67%), K. variicola (two cases, 16.67%), and K. quasipneumoniae (two cases, 16.67%) were identified in these isolates. Most of these patients had underlying hepatobiliary diseases or a history of receiving interventional procedures, and were hospitalised recurrently. The isolates were sensitive to amikacin, tigecycline, and polymyxin. blaIMP-4 was detected in six isolates, whereas blaNDM-1, blaNDM-5 and blaNDM-9 were detected in three, two, and one isolates, respectively. Only one strain harboured the rmpA, and exhibited a hypermucinous phenotype. The aerobactin (iucABCD) and yersiniabactin genes were absent in most of the strains. The strains containing blaIMP-4 exhibited higher virulence. These findings are of great significance for understanding the characteristics of CAR - CRKS and developing treatment strategies.

In this narrative review, inspired by the observation of changes in clinical practice implemented at our centre (IRCCS San Gerardo dei Tintori), we describe the evolution of care for pregnant women living with HIV (WLWH) and the current issues regarding ARV therapy, delivery, prophylaxis and breastfeeding. Over the years, advances in the care of HIV in pregnancy have significantly reduced the risk of perinatal transmission, making the experience of motherhood in WLWH comparable to that of people without HIV infection. However, some issues remain to be overcome to separate the real risks of transmission from the perceived fears and reduce the medicalization of pregnancy in WLWH. Notably, the rate of caesarean section remains higher than that of the general population, highlighting the need to further promote vaginal birth for WLWH in clinical practice and to reassure both women and physicians on its safety. Moreover, certain areas remain uncertain or subject to conflicting guidelines, such as the use of post-exposure prophylaxis for low-risk neonates and breastfeeding.

This study assessed HIV and sexual health knowledge among undergraduate medical students in Milan, Italy. An anonymous online survey with nine multiple-choice questions was distributed by email to students at Vita-Salute San Raffaele University in November 2024. Of 1004 respondents, 48% reported comprehensive and 44% partial knowledge of HIV. Awareness of PrEP, PEP, and "U=U" was 47%, 45%, and 46%, respectively. HIV stigma persisted, with 36% considering it a taboo subject. Knowledge was significantly associated with prior sexual health education, highlighting the need for strengthened sexual health training to address gaps and reduce stigma.