Search Results (125)

Background/Objectives: The liver, the body’s primary detoxifying organ, is often affected by various inflammatory diseases, including hepatitis, cirrhosis, and non-alcoholic fatty liver disease (NAFLD), many of which can be exacerbated by secondary infections such as spontaneous bacterial peritonitis, bacteremia, and sepsis—particularly in patients with advanced liver dysfunction. The global rise in these conditions underscores the need for effective interventions. Natural products have attracted attention for their potential to support liver health, particularly through synergistic combinations of plant extracts. Epavin, a dietary supplement from Erbenobili S.r.l., formulated with plant extracts like Taraxacum officinale (L.), Silybum marianum (L.) Gaertn., and Cynara scolymus (L.), known for their liver-supporting properties, has been proposed as adjuvant for liver functions. The aim of this work was to evaluate of Epavin’s antioxidant, anti-inflammatory, and protective effects against heavy metal-induced toxicity. In addition, the antibacterial effect of Epavin against a panel of bacterial strains responsible for infections associated with liver injuries has been evaluated. Methods: The protection against oxidative stress induced by H₂O₂ was evaluated in HepG2 and BALB/3T3 cells using the dichlorofluorescein diacetate (DCFH-DA) assay. Its anti-inflammatory activity was investigated by measuring the reduction in nitric oxide (NO) production in LPS-stimulated RAW 264.7 macrophages using the Griess assay. Additionally, the cytoprotecting of Epavin against heavy metal-induced toxicity and oxidative stress were evaluated in HepG2 cells using the [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide] (MTT) and DCFH-DA assays. The antibacterial activity of Epavin was assessed by determining the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) against Gram-positive (Enterococcus faecalis ATCC 29212, and BS, Staphylococcus aureus 25923, 29213, 43300, and BS) and Gram-negative (Escherichia coli 25922, and BS, Klebsiella pneumoniae 13883, 70063, and BS) bacterial strains using the microdilution method in broth, following the Clinical and Laboratory Standards Institute’s (CLSI) guidelines. Results: Epavin effectively reduced oxidative stress in HepG2 and BALB/3T3 cells and decreased NO production in LPS-stimulated RAW 264.7 macrophages. Moreover, Epavin demonstrated a protective effect against heavy metal-induced toxicity and oxidative damage in HepG2 cells. Finally, it exhibited significant antibacterial activity against both Gram-positive and Gram-negative bacterial strains, with MIC values ranging from 1.5 to 6.0 mg/mL. Conclusions: The interesting results obtained suggest that Epavin may serve as a valuable natural adjuvant for liver health by enhancing detoxification processes, reducing inflammation, and exerting antibacterial effects that could be beneficial in the context of liver-associated infections. Full article

Background: Bacteremia is a life-threatening condition encountered in the emergency department (ED). Escherichia coli and Staphylococcus aureus are among the most common pathogens, but early differentiation is challenging. Identifying clinical predictors may help guide empirical treatment while awaiting culture results. Methods: This retrospective analytical study included adults aged 18 years or older who presented with bacteremia in the ED between 1 January 2016 and 31 December 2018 and had blood cultures positive for either S. aureus or E. coli. Clinical predictors of E. coli bacteremia were identified using multivariable logistic regression analysis. Results: Among 327 patients, 272 (83.2%) had E. coli bacteremia. Significant predictors of E. coli bacteremia included hypertension (adjusted OR 2.12; 95% CI: 1.03–4.39; p = 0.041), solid organ tumor (adjusted OR 3.72; 95% CI: 1.63–8.51; p = 0.002), and higher body temperature (adjusted OR 1.49 per °C; 95% CI: 1.15–1.93; p = 0.002). The model showed good fit (Hosmer–Lemeshow p = 0.326). Conclusions: Patients presenting with hypertension, solid organ tumor, or elevated body temperature at the ED are more likely to have E. coli bacteremia than S. aureus. These predictors may support early empirical antibiotic decision-making. Full article

Staphylococcus lugdunensis is a coagulase-negative staphylococcus known for its significant pathogenic potential, often causing severe infections such as endocarditis and bacteremia, with virulence comparable to S. aureus. Despite general susceptibility to most antibiotics, the emergence of oxacillin-resistant strains is increasingly concerning. This study conducted whole-genome sequencing on 20 S. lugdunensis isolates from Chang Gung Memorial Hospital to explore their genetic diversity, antimicrobial resistance mechanisms, and mobile genetic elements. The lugdunin biosynthetic operon, essential for antimicrobial peptide production, was present in multilocus sequence typing (MLST) types 1, 3, and 6 but absent in STs 4, 27, and 29. Additionally, IS256 insertion elements, ranging from 7 to 17 copies, were identified in four strains and linked to multidrug resistance. CRISPR-Cas systems varied across STs, with type III-A predominant in ST1 and ST6 and type IIC in ST4, ST27, and ST29; notably, ST3 lacked CRISPR systems, correlating with a higher diversity of SCCmec elements and an increased potential for horizontal gene transfer. Phage analysis revealed stable phage–host associations in ST1, ST6, and ST29, whereas ST4 displayed a varied prophage profile. Phenotypic resistance profiles generally aligned with genomic predictions, although discrepancies were observed for aminoglycosides and clindamycin. These findings highlight the complex genetic landscape and evolutionary dynamics of S. lugdunensis, emphasizing the need for genomic surveillance to inform clinical management and prevent the spread of resistant strains. Full article

Background: The opportunistic pathogen Staphylococcus aureus causes skin and soft tissue infections that are associated with biofilm formation, and in immunocompromised patients can progress to surgical site infections, pneumonia, bacteremia, sepsis, and even death. Most antibiotics actively damage living, dividing cells on the surface of the biofilm, where there is a high concentration of nutrients and oxygen, while in the depths, where these factors are scarce, slowly growing cells remain. Objectives: The aim of our study was to evaluate the antibiofilm potential of ethyl acetate roots (EtOAcR) and aerial parts (EtOAcAP) extracts from the perennial Bulgarian plant Geum urbanum L. against methicillin-resistant S. aureus (MRSA) NBIMCC 8327. Methods: The effects of both extracts on the expression of biofilm-related genes, icaA and icaD, were investigated. The cytotoxicity of EtOAcR and EtOAcAP on A-375 (human melanoma), A-431 (epidermoid skin cancer) and HaCaT (normal keratinocytes) cell lines, and the induction of apoptosis were determined. Finally, the in vivo skin irritation potential of the most active extract was studied. Results: Both tested extracts inhibited biofilm formation at concentrations that did not affect bacterial growth. Interestingly, the expression of icaA and icaD was upregulated, although the biofilm development was inhibited 72.4–90.5% by EtOAcAP and 18.9–20.4% by EtOAcR at sub-MICs. EtOAcAP extract showed a more favorable cytotoxic profile on non-tumorigenic cells and stronger antineoplastic activity (IC₅₀ = 6.7–14.68 µg/mL) as compared to EtOAcR extract (IC₅₀ = 8.73–23.67 µg/mL). Therefore, a skin irritation test was performed with the EtOAcAP extract at ten-times higher concentrations than the minimum inhibitory one, and, resultantly, the primary irritation index was equal to zero (no skin irritation observed). Conclusions: The EtOAcAP extract was proven to be an effective antistaphylococcal agent with favorable skin tolerance. The extract showed strong antineoplastic activity and antibiofilm effect at sub-MICs, which outlines new prospects for its development as a natural product for specific skin applications in medical practice. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) represents a major therapeutic challenge due to its multidrug-resistance and the associated clinical burden. Daptomycin (DAP), a cyclic lipopeptide antibiotic, has become a key agent for the treatment of severe MRSA infections owing to its rapid bactericidal activity and favourable safety profile. In this narrative review, we examine studies published between 2010 and April 2025. The data suggest that treatment with high-dose (8–10 mg kg⁻¹) DAP shortened the time to blood-culture sterilisation by a median of 2 days compared with standard-dose vancomycin without increasing toxicity when model-informed area-under-the-curve monitoring was employed. Particular attention is given to the synergistic effects of DAP combined with fosfomycin or β-lactams, especially ceftaroline and ceftobiprole, in overcoming persistent and refractory MRSA infections; this approach results in a reduction in microbiological failure relative to monotherapy. Resistance remains uncommon (<2% of isolates), but recurrent mutations in mprF, liaFSR, and walK underscore the need for proactive genomic surveillance. Despite promising preclinical and clinical evidence supporting combination strategies, further randomized controlled trials are necessary to establish their definitive role in clinical practice, as are head-to-head cost-effectiveness evaluations. DAP remains a critical option in the evolving landscape of MRSA management, provided its use is integrated with precision dosing, resistance surveillance, and antimicrobial-stewardship frameworks. Full article

Background/Objectives: This work aims to assess the evolution in the management of Staphylococcus aureus bacteremia (SAB) and the impact of the COVID-19 pandemic on it. SAB is associated with high morbidity and mortality, requiring structured management strategies. The COVID-19 pandemic led to major changes in hospital workflows, potentially affecting the quality of SAB care. Methods: We conducted a retrospective per-protocol analysis of SAB episodes at Costa del Sol University Hospital (Marbella, Spain) across three periods: pre-pandemic, pandemic, and post-pandemic. Patients with early mortality or early transfer were excluded. Clinical variables, adherence to recommended management bundles, and outcomes were compared. Demographic characteristics were similar across the analyzed periods. Results: The incidence of SAB increased over time, with a notable rise post-pandemic. Key management indicators such as the identification of infection source and appropriate antibiotic therapy showed adherence rates of above 90%, while echocardiography exhibited an adherence rate of above 75% throughout the study. Adherence to the full management bundle was suboptimal, with no significant differences between periods. However, an appropriate treatment duration significantly improved in the post-pandemic group (p = 0.038). Mortality at 14 and 30 days was highest during the pandemic period (10.3% and 17.6%, respectively), although differences were not statistically significant. Complications and mortality were more frequent in patients with complete adherence to the bundle (p = 0.031). Conclusions: Despite stable or improved adherence to certain SAB management measures during the pandemic, mortality and complication rates did not significantly decrease, likely reflecting increased patient severity or healthcare system overload. These findings highlight the need for sustained, multidisciplinary, bedside-based approaches to SAB care, even during public health emergencies. Further research is needed to explore modifiable factors and enhance adherence to evidence-based recommendations. Full article

Background/Objective: Coxitis is an inflammation of the hip joint, often resulting in pain and functional decline. It can be caused by various factors, including avascular necrosis, trauma, and infection. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat due to its resistance profile and destructive potential. To the best of our knowledge, there are limited studies on MRSA-induced purulent coxitis, specifically in patients with human immunodeficiency virus (HIV) and tetraplegia, making this case particularly valuable for expanding the understanding of this rare and complicated condition. The aim is to describe the clinical presentation, diagnostic workup, antimicrobial management, surgical intervention, and follow-up of a patient with an atypical hip joint infection. A brief literature review is also provided. Case Report: We report a case of suppurative coxitis caused by MRSA in a 38-year-old man with HIV disease and post-traumatic tetraplegia, which posed significant diagnostic and therapeutic challenges. The patient was diagnosed with MRSA bacteremia and suppurative coxitis after extensive work-up. Synovial fluid cultures were negative, likely due to previous antibiotic use. Targeted antimicrobial therapy was initiated based on blood culture and susceptibility testing. Surgical debridement and femoral head resection were performed. The patient showed progressive clinical and biochemical improvement with combined antimicrobial and surgical therapy. Conclusions: This case highlights the difficulty in diagnosing septic arthritis in patients with neurological disorders and immunosuppression, especially in the absence of classic symptoms. It emphasizes the importance of multidisciplinary care and early imaging in patients with persistent fever and unclear source of infection. Full article

Staphylococcus aureus is a Gram-positive bacterium living abundantly on our skin and mucous membranes. When there is an imbalance in microbiota, they are the main protagonists of various infections, such as soft tissue infections and bacteremia. However, Staphylococcus epidermidis also colonizes this microbiome, is able to compete with pathogenic bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and can contribute to treatments such as photodynamic inactivation (PDI) by inhibiting infection progression and restoring a healthy microbiota. In vitro photodynamic inactivation experiments were carried out using synthetic curcumin at a concentration of 5 μM as a photosensitizer and varying light doses (1, 2 and 5 J/cm²) at a wavelength of 450 nm, on pure cultures (S. aureus, S. epidermidis and MRSA) and mixed cultures, in which bacteria were placed together proportionally. This study revealed that pure cultures of these bacteria obtained statistically significant results with varying light doses of 2 and 5 J/cm². In addition, in an attempt to bring infections closer to reality, experiments were carried out on mixed cultures. The results were not only significant but also increased reduction of bacteria, including resistant bacteria. Study offers new perspectives on the importance of themicrobiota for treatment of infections caused by the Staphylococcus genus. Full article

Background: Bloodstream infections (BSIs) are both a primary cause and a severe complication of hospitalization. This retrospective study aims to analyze the epidemiology of BSIs at the University Hospital of Palermo from 2018 to 2024. Methods: We conducted a single-center, retrospective, observational study at the University Hospital Paolo Giaccone in Palermo, analyzing microbiological data from blood cultures collected between 1 January 2018 and 31 December 2024. Results: A total of 6345 blood culture isolates from 2967 patients were analyzed. Bacteremia-related mortality per 1000 patients rose from 5.1% in 2018 to 10.5% in 2024. The most isolated pathogens were non-aureus staphylococci (39.7%), followed by Klebsiella pneumoniae (12.1%) and Staphylococcus aureus (7.47%). Acinetobacter baumannii and Pseudomonas aeruginosa were more prevalent in ICUs. The number of K. pneumoniae, A. baumannii, S. aureus, and P. aeruginosa isolates per 1000 admitted patients increased significantly over time. Oxacillin resistance in S. aureus peaked at 49.0% in 2020 before declining, while among non-aureus staphylococci, it remained consistently high (>80%). Carbapenem-resistant K. pneumoniae peaked at 80% in 2022 before decreasing in 2024. Resistance to ceftazidime-avibactam and meropenem-vaborbactam was observed in 11.3% and 11.8% of K. pneumoniae, respectively. Multivariable analysis identified A. baumannii and K. pneumoniae BSIs as independent predictors of in-hospital mortality. Additionally, female sex, pneumonia, and central nervous system infections were significant risk factors for mortality. Conclusions: We observed an increasing trend in overall bacteremia-related mortality from 2018 to 2024. Microbiological data highlight the predominance of non-aureus staphylococci, K. pneumoniae, and S. aureus as leading pathogens of BSI, with A. baumannii emerging as a significant threat, particularly in ICUs. Rising antimicrobial resistance, especially among K. pneumoniae, underscores the urgent need for robust antimicrobial stewardship programs. K. pneumoniae and A. baumannii were associated with higher mortality. Full article

Background: The relationship between vegetation characteristics in Staphylococcus aureus infective endocarditis (IE) and blood culture time to positivity (TTP) has not been investigated. This study evaluates the correlation between vegetation length and TTP in patients with S. aureus IE. Methods: A retrospective cohort study was conducted that included 164 definite cases S. aureus IE. Vegetation length was determined by transesophageal echocardiography (TEE), and TTP was measured in hours from the initial time of blood culture incubation to positivity. Correlations between vegetation characteristics and TTP were analyzed using Spearman’s rank correlation coefficient. Results: A modest but statistically significant negative correlation was observed between vegetation length and TTP (Spearman ρ = −0.18, p = 0.020), suggesting that larger vegetations were associated with shorter TTP. No significant correlations were found for other vegetation characteristics (e.g., vegetation mobility, location, or number) and TTP. Conclusions: Larger vegetation size in S. aureus IE was associated with shorter TTP. These findings highlight the importance of vegetation size in the pathophysiology of S. aureus IE and its role in bacteremia dynamics. Full article

Staphylococcus spp. is a major nosocomial pathogen, particularly affecting immunocompromised patients and infants. It is associated with bacteremia, endocarditis, and co-infections. Methicillin-resistant Staphylococci (MRS) carry the mecA gene, encoding PBP2a, which confers resistance to beta-lactam antibiotics. The aim of this study is to investigate resistance profiles and develop a molecular method to identify nosocomial Staphylococcus spp. strains. A total of 64 strains from public hospitals in Rio de Janeiro were analyzed using phenotypic and molecular methods, with 17 classified as MDR. Different melting temperatures (Tm) were obtained through qPCR-HRM analysis, to identify S. aureus- (70.4 °C), S. haemolyticus- (79 °C), S. epidermidis- (74.1 °C) and mecA (70.5 °C)-positive strains (MRS). The mecA gene was detected in 51 strains, with 22 showing SCCmec type IV. The spread of MRSA and MDR Staphylococci, particularly MDR S. haemolyticus, is a growing concern. In our study, among 64 Staphylococci strains, only 11 were susceptible to methicillin, showing the continuous emergence of resistant strains. qPCR-HRM is a cost-effective, sensitive and fast method for rapid Staphylococcus spp. identification, aiding in nosocomial infection control. Full article

Background: Staphylococcus aureus bacteremia (SAB) is of great clinical relevance, as it is the most common type of bacteremia. Several studies show that the quality of care and thus the outcome can be positively influenced by the involvement of infectious disease specialists and structured programs like Antimicrobial Stewardship (AMS). In 2020, the SARS-CoV-2 pandemic occurred, which dominated the healthcare system and global events during this time. At the same time, a standard operational procedure (SOP) for SAB quality management (SABQM) was introduced in a German maximum-care hospital with 500 beds. Additionally, voluntary AMS team consultations were introduced in June 2021. This work addresses whether the introduction of SABQM has led to an improvement in the quality of care for SAB, despite the possible negative influences of the pandemic. Methods: Retrospective statistical analyses were conducted on all 145 cases coded as SAB at this hospital during the “pre-pandemic” period (2017 to 2019, 75 cases) and the pandemic period (2020 to 2022, 70 cases). Population parameters and quality management parameters were extracted from the clinical patient documentation. In a first analysis, the SARS-CoV-2 status served as a discriminatory parameter to determine its influence on the quality of care within the “pandemic period”. In a second analysis, the period served as a discriminatory parameter to determine its influence on the quality of care. In a third analysis, the use of AMS team consultation served as a discriminatory parameter to determine its influence on the quality of care in a subgroup of 42 cases from June 2021 to 2022. Results: The SARS-CoV-2 status had no influence on the population parameters or the quality management parameters. Between both analyzed periods, there was an improvement in the quality management parameters, with statistically significant higher rates of follow-up blood cultures, transthoracic echocardiography and adequate antibiotic therapy. AMS team consultation led to a relevant, but not statistically significant improvement in the quality management indicators. Conclusions: An SOP for SABQM leads to an improvement in the quality of care, even under the possible negative influences of a pandemic. AMS team consultations further strengthen this positive influence, even if this is not statistically significant due to the small number of cases in the subgroup analyzed. Full article

Background: Mycotic aneurysms of the subclavian artery are infrequent and pose significant diagnostic challenges, particularly in the context of recurrent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The concomitant presence of upper extremity deep vein thrombosis (UEDVT) further complicates the management of bleeding risk and the necessity for anticoagulation therapy. Methods: This report discusses a 75-year-old male patient with a medical history of lung and skin cancer undergoing immunotherapy who presented with a swollen and painful right arm. Ultrasound examination identified deep vein thrombosis in the right axillary and basilic veins, and blood cultures confirmed MRSA infection. Subsequent imaging revealed bilateral subclavian artery aneurysms with contained ruptures involving previously placed stent grafts. Emergent endovascular interventions were performed to prevent catastrophic hemorrhage. Results: Despite the initial interventions, concerns regarding infected stent grafts persisted due to ongoing MRSA bacteremia and the presence of an endoleak. The complexity of balancing anticoagulation for DVT with the risk of aneurysm rupture necessitated the patient’s transfer to a tertiary care center for potential open surgical debridement. Conclusions: This case underscores the diagnostic and therapeutic challenges associated with the simultaneous occurrence of vascular infection, thrombosis, and aneurysmal pathology. Although emergency endovascular repair provided temporary hemostatic control, definitive management may require graft removal if stent infection is confirmed. Optimal care in such complex clinical scenarios demands a multidisciplinary approach and may necessitate advanced surgical interventions. Full article

Background: In the US, 120,000 cases of Staphylococcus aureus bacteremia (SAB) occur annually. Apart from mortality, little is known about other unfavorable outcomes (UOs). We developed a multifaceted definition for UOs in SAB and examined their incidence and predictors. Methods: We conducted a multicenter (~300 hospitals) retrospective cohort study between 2020 and 2022 of adult hospitalized patients with at least one blood culture (BC) positive for S. aureus. UOs were any of the following: hospital mortality, antibiotic escalation, persistently positive BCs, prolonged post-infection length of stay (LOS), 30-day readmission, and disease worsening. We compared the group with UOs to favorable outcomes (FOs). Regression models identified predictors of UOs. Results: Among 4080 patients with SAB, 2427 (59.5%) experienced a UO, most commonly 30-day readmission (42.0%) and antibiotic escalation (37.7%). Those with UOs more frequently had septic shock at admission (5.7% vs. 1.2%), requiring the ICU (18.8% vs. 14.7%) and dialysis (4.4% vs. 1.9%) prior to SAB onset. Community-onset SAB predominated in both groups, with more complicated SAB in the UO group (39.8% vs. 22.3%). Vancomycin use was similar, while daptomycin was more common in the UO group (8.5% vs. 3.0%). Variables with the highest odds ratios predicting a UO were septic shock on admission (3.498, 95% CI 2.145, 5.704), empiric daptomycin (2.723, 95% CI 1.943, 3.821), and complicated SAB (2.476, 95% CI 2.047, 2.994). Conclusions: UOs occur frequently in the setting of SAB. A broader perspective exploring issues other than mortality demonstrates the substantial implications of SAB both for patients and healthcare systems. Select clinical variables are associated with UOs, some of which may not be modifiable. Full article

Background: Persistent methicillin-resistant Staphylococcus aureus (MRSA) endovascular infections present a significant clinical therapeutic challenge. Prophages are increasingly recognized as important genetic factors influencing the pathogenicity of S. aureus, yet their role in antibiotic persistence in MRSA remains underexplored. Our previous work demonstrated that prophage ϕSA169 promotes vancomycin (VAN) persistence in an experimental model of endocarditis caused by MRSA strains with a clonal complex (CC) 45 genetic background. However, it is unknown whether this persistence-promoting effect of ϕSA169 extends to other clinically relevant MRSA lineages. This study aims to elucidate the role of ϕSA169 in influencing VAN persistence across diverse MRSA genetic backgrounds. Methods: A pilot analysis of clinical data suggested that patients infected by MRSA containing ϕSA169-like prophage appear to have worse clinical outcomes. Thus, we lysogenized representative clinical resolving bacteremia (RB) MRSA strains with ϕSA169 and evaluated phenotypes closely associated with VAN persistence, including VAN susceptibility, biofilm formation, and the efficacy of VAN treatment in an experimental infective endocarditis (IE) model. Each ϕSA169 lysogenic strain was compared to its isogenic MRSA parental counterpart. Results: ϕSA169 lysogeny significantly promotes biofilm formation and enhances survival to VAN exposure under human-mimicking conditions for RB strains from CC5 and CC30. ϕSA169 lysogeny significantly reduces VAN effectiveness in the IE model due to RB lysogen from CC5 despite no detectable impact on VAN MICs. Conclusions: These results indicate that ϕSA169 promotes VAN persistence across clonal backgrounds, likely through biofilm formation and VAN tolerance. Targeting prophage could provide new strategies to combat persistent MRSA infections. Full article