Search Results (554)

Background: The movement of endemic diseases from tropical and disadvantaged areas is gradually spreading to developed countries as well. Amoebiasis, in particular, represents a significant threat to public health, amplified by globalization and increasing contact between humans and animals or vectors. In this way, atypical diseases may emerge in our country, also through an unusual mode of transmission—likely sexual, as “sexually transmitted enteric (STE) diseases”. Objective: We report and discuss the clinic approach to a rare case of dual human infestations by ecto- and endo-parasites with multiple liver abscesses presentation in a young truck driver residing in Northern Italy. Methods: The patient underwent a comprehensive screening with laboratory and microbiological tests, and CT images. Results: In July, the patient was admitted to our hepatology unit following the ultrasound identification of two hypoechoic lesions in the right lobe of the liver. In his medical history, in April, after a seemingly harmless infestation of body lice, effectively treated, he suffered from a prolonged and debilitating episode of acute diarrhea, lasting a month. This status was also accompanied by intestinal cramps, weight loss, and recurring fever episodes. Afterwards also appeared a Quincke’s-like angioedema involving the lips and mouth mucosa, with evening time exacerbation. Conclusions: The differential diagnosis of this complex and unusual clinical picture, together with the temporal evolution of the patient’s signs and symptoms, led us to hypothesize the presence of concomitant infections. These were most likely borreliosis and a STE disease, the latter ultimately diagnosed as amebiasis with hepatic invasion, allowing appropriate treatment and a favorable clinical outcome. Full article

Background/Objectives: Antimicrobial-resistant bacterial infections are frequent in intensive care units (ICUs), but the independent effect of multidrug resistance relative to infection with susceptible organisms remains uncertain. We compared clinical characteristics, microbiology, treatment intensity, and in-hospital mortality among patients with no documented bacterial infection, antimicrobial-susceptible infection, or multidrug-resistant (MDR) infection. Methods: We conducted a single-center retrospective cohort study of the first eligible ICU hospitalization for each patient at the University Clinical Hospital in Bialystok, Poland, from 1 January 2017 to 1 June 2023. Infection groups were assigned using clinical documentation, microbiological results, and local laboratory resistance-phenotype coding; patients with multiple isolates were classified according to the most resistant clinically relevant isolate. Multivariable logistic regression evaluated associations with in-hospital mortality. Results: Among 3326 patients, 1413 (42.5%) had a documented bacterial infection: 481 (34.0% of infected patients) had susceptible infection and 932 (66.0%) had MDR infection. Crude mortality was 45.5%, 46.8%, and 48.4% in the no-infection, susceptible-infection, and MDR-infection groups, respectively (p = 0.354), whereas mean ICU length of stay was 10.0, 15.5, and 25.2 days (p < 0.001). In the complete-case whole-cohort model (n = 678), MDR infection (adjusted OR 2.70, 95% CI 1.84–3.96) and susceptible infection (adjusted OR 2.16, 95% CI 1.26–3.69) were associated with in-hospital death versus no infection. Within the infected cohort (n = 352), MDR status was not independently associated with mortality versus susceptible infection (adjusted OR 1.09, 95% CI 0.61–1.93). Conclusions: MDR infection identified patients with prolonged ICU exposure and greater organ-support requirements but did not independently increase mortality relative to susceptible infection. Interpretation is limited by the retrospective single-center design, complete-case analysis, and absence of time-resolved MDR acquisition data. Full article

The analysis of non-blood biological fluids, including cerebrospinal fluid (CSF), serous effusions, and synovial fluid, plays a central role in laboratory medicine by providing essential diagnostic and prognostic information for neurological, infectious, inflammatory, and neoplastic diseases. However, the interpretation of these specimens remains challenging because it requires the integration of heterogeneous biochemical, cytological, microbiological, molecular, and clinical data, often in the absence of standardized analytical workflows. Artificial intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), is emerging as a powerful approach for extracting clinically relevant information from complex multidimensional datasets beyond the capabilities of conventional analytical methods. AI-driven Clinical Decision-Support Systems (CDSSs) can integrate laboratory findings with clinical, demographic, imaging, and multi-omics data, supporting diagnostic interpretation, patient stratification, and personalized clinical decision-making. At the same time, the convergence of AI with proteomics, metabolomics, metagenomics, and other omics technologies is accelerating biomarker discovery and advancing precision laboratory medicine. Current evidence indicates different levels of maturity across biological fluids. AI-assisted interpretation of CSF biomarkers and digital cytology of serous effusions currently show the strongest clinical evidence, whereas applications involving synovial fluid and integrated multi-omics remain largely exploratory. Although important technical, methodological, and regulatory challenges still limit widespread clinical implementation, AI has the potential to improve diagnostic accuracy, reduce interpretative variability, and support more integrated diagnostic workflows. This mini-review summarizes current and emerging AI applications in non-blood biological fluid analysis, with particular emphasis on biomarker discovery, CDSS, multi-omics integration, current evidence, existing limitations, and future perspectives for precision laboratory medicine. Full article

Background/Objectives: Staphylococcus argenteus is a recently recognized member of the Staphylococcus aureus complex that is almost identical to S. aureus phenotypically and by 16S rRNA gene sequences. Although genomic analyses demonstrate that S. argenteus is phylogenetically distinct from S. aureus, the two species exhibit more than 90% nucleotide identity and routine identification methods—including routine biochemical assays and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)—cannot reliably distinguish between the two. We develop and validate a MALDI-TOF MS-based model for accurate identification of S. argenteus. Methods: A multiplex PCR assay targeting crtM and NRPS genes served as the reference standard. MALDI-TOF MS spectra from 25 S. argenteus and 25 methicillin-susceptible S. aureus (MSSA) isolates were analyzed using ClinProTools to identify characteristic peaks and develop the identification model. The model was validated using 40 S. argenteus and 80 MSSA isolates, then applied to 130 randomly selected clinical isolates. Results: Five characteristic peaks—m/z values 5005, 5285, 5323, 6440, and 6526—were identified. Isolates exhibiting at least 4 of these 5 peaks were classified as S. argenteus; those exhibiting fewer than 4 were classified as S. aureus. The model achieved 100% specificity and 100% sensitivity in both the development and validation phases. In the clinical application phase, the model correctly classified all isolates, whereas conventional MALDI-TOF MS yielded several misidentifications. Conclusions: The identification model, and the simple peak-based rule it is based on, can accurately distinguish S. argenteus from MSSA, offering a practical diagnostic tool for clinical microbiology laboratories. Full article

Acute hepatitis B virus (HBV) infection is rare during infancy, and severe symptomatic HBV-associated hepatitis is even less common. We describe two siblings who developed severe HBV-associated liver injury during infancy, two years apart, but experienced markedly divergent clinical outcomes. Clinical, laboratory, virological, microbiological, imaging, therapeutic, and follow-up data were retrospectively reviewed. Household members were subsequently tested for HBV and HDV. The first infant, a 5-month-old girl, presented with HBsAg positivity, negative serological markers for HAV, HCV, and HEV, and severe acute liver injury with a fulminant clinical course that resulted in death. Because anti-HBc IgM, HBV DNA, repeat HBsAg testing, and follow-up serology were unavailable, acute HBV infection could not be confirmed, and the episode was therefore classified as presumed HBV-associated fulminant hepatitis. The rapidly fatal clinical course precluded a comprehensive etiological evaluation, and the available medical records did not fully document the diagnostic work-up. The second patient, a 4-month-old boy, presented with serological and molecular evidence of acute HBV infection, including low-level HBV DNA, total anti-HDV positivity of uncertain clinical significance, and positive CMV IgM/IgG serology. He also had a urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Without HDV RNA and CMV DNA testing, active HDV infection and clinically significant CMV disease could not be definitively confirmed, while passive transfer of maternal anti-HDV antibodies could not be excluded. The patient required prolonged hospitalization, during which he received supportive, replacement, and antimicrobial therapy. He recovered, and long-term follow-up demonstrated HBsAg clearance with undetectable HBV DNA. Testing of household members revealed chronic HBV infection in the mother and maternal grandmother, both of whom had detectable HDV RNA, consistent with ongoing HBV/HDV circulation within the family. However, without viral sequence data from the infants, the source, route, timing, and direction of transmission could not be established. These cases illustrate the potential severity of HBV-associated hepatitis during infancy and its highly variable clinical outcomes. They also underscore the importance of antenatal HBV screening, timely immunoprophylaxis, and cautious interpretation of suspected viral coinfections when molecular confirmation is unavailable. Full article

Joint aspiration remains the gold standard and an urgent step in the diagnosis of paediatric septic arthritis (SA). Unlike in acute haematogenous osteomyelitis, it has both diagnostic and therapeutic value. No previous review has specifically addressed when bacteriological sampling is essential and when it may reasonably be omitted. The bacteriological profile in children is highly age-dependent: Kingella kingae predominates before 4 years of age, whereas Staphylococcus aureus—including Panton–Valentine leukocidin (PVL)-producing and methicillin-resistant (MRSA) strains—predominates thereafter. We critically review the evidence through nine clinical questions and propose a conceptual risk-stratified framework in which the sampling approach is tailored to age and clinical context. In children younger than 4 years with a positive oropharyngeal K. kingae PCR and a mild clinical presentation—defined as CRP < 20 mg/L, absence of fever, and preserved weight-bearing—non-invasive confirmation may be sufficient. This proposal is explicitly hypothesis-generating: it is derived from observational data, it has not been validated prospectively, and it is not endorsed by current PIDS/IDSA or ESPID guidance. A positive oropharyngeal PCR alone is never sufficient, given the 10–12% asymptomatic carriage rate and the limited reliability of the Kocher–Caird criteria in this age group; the decision requires a cluster of concordant findings together with mandatory clinical and laboratory reassessment at 48–72 h and a low threshold for escalation to arthrocentesis. In children older than 4 years, arthrocentesis under general anaesthesia remains the standard approach, with pathogen identification and antimicrobial susceptibility testing as the primary microbiological determinants of therapy and toxin profiling as an adjunctive investigation in selected cases. Full article

Background/Objectives: Polymethyl methacrylate (PMMA) is widely used in medical and dental applications because of its favorable mechanical properties and ease of processing. However, its clinical performance is limited by low surface hardness, hydrophobicity, and susceptibility to microbial colonization and biofilm formation. This study aimed to investigate the effects of amorphous titanium dioxide (TiO₂) nanolayers deposited by atomic layer deposition (ALD) on the surface morphology and antibacterial properties of PMMA-based materials. Methods: Amorphous TiO₂ coatings were deposited on bone cement PMMA and dental PMMA substrates using ALD with TiCl₄ and H₂O precursors at 80 °C. The low deposition temperature enabled the conformal of thermally sensitive polymer substrates. Surface characterization was performed using atomic force microscopy (AFM) and scanning electron microscopy (SEM) to evaluate coating morphology and nanoscale topography. Antibacterial activity was assessed against S. aureus and P. aeruginosa through planktonic growth and biofilm formation assays, with additional evaluation of ultraviolet (UV) activation and surface polishing. Results: AFM analysis revealed that amorphous TiO₂ coating on standardly laboratory practice-polished PMMA increased the arithmetical mean roughness (Ra) from 1.82 nm to 14.60 nm, and maximum height (Rmax) from 36.20 nm to 298.00 nm. Polishing before coating significantly increased surface roughness and height variation, resulting in complex micro- and nanotopography. Microbiological analyses demonstrated variable antibacterial effects depending on bacterial species and surface characteristics. Comparison of planktonic growth, biofilm formation and OD590 ratio showed that amorphous TiO2 coating on polished PMMA reduced biofilm formation and planktonic growth in P. aeruginosa with a decreased OD ratio, while S. aureus biofilm formation was reduced. S. aureus had a consistently higher OD590 than P. aeruginosa. UV treatment alone did not produce consistent antibacterial enhancement. Conclusions: The study findings suggest that the surface topography had a greater role than UV treatment in determining bacterial adhesion. Surface roughness was strongly associated with S. aureus adhesion., whereas P. aeruginosa showed minimal response to the tested surface modifications. These findings suggest that TiO₂ coating after standard polishing alone may not provide consistent antibacterial activity under the tested conditions and point to the importance of nanoscale surface design in developing antimicrobial polymer biomaterials. Full article

Nontuberculous mycobacteria (NTM) pose significant diagnostic challenges in high tuberculosis (TB)-burden settings, particularly when routine molecular assays suggest multidrug-resistant TB (MDR-TB). Current diagnostic algorithms in high TB-burden settings are primarily designed to detect members of the Mycobacterium tuberculosiscomplex (MTBC) and may inadequately distinguish NTM when discordant laboratory findings are encountered. The value of this case lies not in demonstrating that whole-genome sequencing (WGS) should guide real-time treatment, but in illustrating how diagnostic uncertainty can arise when routine MTBC-focused tests fail to identify NTM and how genomic surveillance can contribute to species-level characterization in such settings. We report a complex case which was initially diagnosed as rifampicin- and isoniazid-resistant MTBC and subsequently managed according to programmatic MDR-TB guidelines. Persistent acid-fast bacilli positivity in the presence of negative MTBC antigen testing during follow-up raised suspicion of NTM involvement. Whole-genome sequencing (WGS), performed retrospectively on a follow-up isolate, identified an NTM belonging to the Mycobacterium avium complex (MAC) which was phylogenetically closest to genomes provisionally designated Mycobacterium europaeum_A and distinct from Mycobacterium europaeum sensu stricto, a member of the Mycobacterium simiae complex. The identification of a MAC-associated NTM provided an explanation for the observed diagnostic discordance but could not determine whether the organism represented colonization, sequential infection, or concurrent infection. Although WGS did not inform clinical management, it provided high-resolution species identification and highlighted important limitations of MTBC-focused diagnostic workflows when discordant microbiological findings are encountered. This case underscores the need for the targeted investigation of NTM in patients with acid-fast bacilli-positive cultures and negative MTBC antigen testing and supports the use of genomic surveillance to improve species-level identification and understanding of NTM epidemiology in high TB-burden settings such as Limpopo Province, South Africa. Full article

Distinguishing tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) remains difficult when presentation is non-specific, blood cultures are negative, or initial biopsy is non-diagnostic. The two entities differ substantially in antimicrobial strategies, resistance testing requirements, public health interventions, and surgical thresholds, yet diagnostic delay is associated with neurological deficits, spinal instability, and permanent deformity. This narrative review maps the non-imaging evidence most useful for frontline differentiation between TS and PS across five domains: epidemiology and risk stratification, clinical presentation, laboratory markers, tissue acquisition and histopathology, and molecular diagnostics. PubMed/MEDLINE was searched from inception to 31 March 2026 using pre-specified Boolean search terms; a secondary Scopus search identified no additional eligible records. Following screening, approximately 90 records were included in this synthesis. Priority was given to comparative TS-versus-PS cohorts, biopsy-yield and culture-negative studies, pathology series, pediatric data, and recent molecular diagnostics literature. Epidemiological TB (tuberculosis) risk, longer symptom duration, constitutional symptoms, deformity, and a less intense acute-phase response increase the probability of TS, whereas healthcare exposure, bacteraemia, recent spinal procedures, and brisk neutrophilic inflammation favor PS. In stable patients, the highest-yield strategy is early blood cultures followed by image-guided biopsy with parallel tissue allocation for bacterial culture, mycobacterial studies, histopathology, and selected molecular assays. No single laboratory marker reliably distinguishes TS from PS without tissue confirmation. Per a 2023 systematic review and meta-analysis, image-guided percutaneous biopsy achieves microbiological confirmation in approximately one-third of cases. Histopathology demonstrating caseating granulomatous inflammation supports TS, although a substantial minority of confirmed cases lack classic features. Supported by cohort prospective data, Xpert MTB/RIF Ultra has the clearest first-line molecular role when TS is plausible and should be requested at the time of first biopsy rather than reserved for salvage testing; broader or targeted next-generation sequencing is best reserved for selected unresolved cases. Imaging differentiation is addressed in the companion manuscript, Part II. Full article

Acute infectious gastroenteritis (AIG) is caused by diverse bacterial and viral enteric pathogens with overlapping clinical presentations, limiting conventional pathogen-directed workflows. This retrospective before–after study evaluated the diagnostic, microbiological, operational, and economic impact of multiplex molecular syndromic testing for AIG within a regional hub-and-spoke laboratory network in Italy. Two 19-month periods were compared: a pre-implementation period based on conventional diagnostics and a post-implementation period using multiplex syndromic panels as first-line tests. Diagnostic investigations totalled 25,574 before and 24,509 after implementation. Overall test positivity increased from 5.43% to 11.59% (p < 0.001), with significant increases for bacterial and viral targets. Pathogen detection events increased from 1388 to 2839, including broader detection of Campylobacter spp., Shigella spp./enteroinvasive Escherichia coli (EIEC), Yersinia enterocolitica, Aeromonas spp., Astrovirus, Sapovirus, and Norovirus genogroups. Mean turnaround time decreased from 63 to 47 h from sample collection and from 56 to 41 h from laboratory check-in. Although direct diagnostic costs increased moderately, total laboratory costs decreased when personnel costs were included, and cost per diagnostic detection declined from €233.80 to €120.86. Multiplex syndromic testing improved microbiological detection, diagnostic efficiency, turnaround time, and laboratory organisation in routine AIG diagnosis. Full article

Pseudomonas aeruginosa is an important opportunistic pathogen increasingly associated with multidrug resistance (MDR) and therapeutic failure. Data on MDR community-associated P. aeruginosa in southern Morocco remain limited. This study evaluated the contribution of urban diagnostic laboratories to the surveillance of MDR P. aeruginosa in this underrepresented region. A retrospective multicenter study was conducted between January and December 2024 using data collected from urban medical diagnostic laboratories in southern Morocco. Clinical isolates of P. aeruginosa recovered from community-associated patients were identified using standard microbiological methods, and antimicrobial susceptibility testing was performed according to EUCAST guidelines. MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial classes according to the international criteria. Associations between MDR status and demographic variables were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05. Among the 49 P. aeruginosa isolates included, 29 (59.2%, 95% CI: 45.4–72.0%) were classified as MDR. High resistance rates were observed for several β-lactams, whereas most isolates remained susceptible to amikacin and selected β-lactam/β-lactamase inhibitor combinations. No statistically significant association was found between MDR status and demographic variables. These findings highlight the circulation of MDR P. aeruginosa in southern Morocco and suggest that urban diagnostic laboratories may provide valuable complementary data for community-level antimicrobial resistance surveillance. Full article

Neurosurgical devices provide clinical benefits that are undermined by the incidence of device-related infections. This study examined the microbiological and clinical characteristics of central nervous system (CNS) infections associated with cerebrospinal fluid (CSF) shunts and drains in neurosurgery patients during August 2022–July 2024. Upon suspicion of CNS infection, CSF samples were submitted for cytology, biochemical analysis, and culture. Identification and susceptibility testing were performed by VITEK-2 and VITEK-MS PRIME (bioMérieux); susceptibility to colistin was determined by broth microdilution (Bruker). The results were interpreted according to EUCAST guidelines. An infection definition was based on IDSA’s guidelines, and the outcome was considered positive upon successful therapeutic intervention. Out of 825 CSFs, 178 showed microbial growth in culture; they corresponded to 102 patients. Neurosurgical devices were implanted in 68 patients and, among them, 29 presented with a CNS infection. The infections attributed to drains and shunts were 72% versus 28%, respectively. Polymicrobial or consecutive infections occurred in 6/29 patients. Overall, 40 pathogens were isolated. The predominant causative agents were Acinetobacter baumannii (40%), Klebsiella pneumoniae (12.5%), coagulase-negative-Staphylococci (12.5%), and Pseudomonas aeruginosa (10%). Neurosurgical devices are easily contaminated and may cause CNS infections, regardless of the device type. The infections’ outcome is multifactorial; timely diagnosis and intervention are of utmost importance. Full article

Background: Monkeypox (MP) is an emerging disease with the capacity for worldwide dissemination, endangering all nations. Healthcare workers (HCWs) frequently act as the initial point of contact for MP patients; therefore, evaluating their understanding of the disease and their perspectives on MP immunisation is crucial for effective prevention and control. This study aimed to assess HCWs’ knowledge of and attitudes toward MP and associated vaccines. Methods: A cross-sectional study was performed, focusing on HCWs in Makkah, Saudi Arabia. Data were collected through a standardised, self-administered online questionnaire provided in both English and Arabic. The questionnaire gathered the participants’ sociodemographic information and assessed their knowledge, opinions, and attitudes concerning MP infection and vaccination. The questionnaire included multiple-choice items with response possibilities such as “Yes”, “No” and “Don’t know”. Results: In total, 428 HCWs participated in this study; 60.7% had adequate knowledge of MP, while 39.3% had inadequate knowledge. Some knowledge of specific aspects of the disease was reported to be variable, with 67.5% correctly identifying MP as a viral infection, 55.1% aware of the endemic nature of the disease in parts of Western and Central Africa, and 65.0% recognising skin rash as a common symptom. In terms of attitudes towards MP vaccination, 47.9% had a positive attitude, while 52.1% had a negative attitude. In total, 65.7% of the respondents indicated that vaccination is essential to controlling MP, while only 23.1% (95% CI: 19.1–27.1%) had received vaccination. Furthermore, 57.0% reported concerns about potential adverse effects. Educational level was significantly associated with knowledge of MP (p = 0.001), while job title (p = 0.008) and years of work experience (p = 0.018) were significantly associated with attitudes towards MP vaccination. Age group was significantly associated with MP vaccination status (p = 0.002), while gender, educational level, job title, and years of work experience were not significantly associated with vaccination status. Conclusions: HCWs demonstrated an adequate level of knowledge about MP; however, important knowledge gaps and negative attitudes towards MP vaccination remained. Despite recognising the importance of vaccination, vaccine uptake was low. Educational level was associated with knowledge about MP, while job title and years of work experience were associated with attitudes towards MP vaccination, and age group was associated with MP vaccination status. Targeted educational interventions and evidence-based awareness programmes may enhance knowledge, improve preparedness for future MP outbreaks, and decrease vaccine hesitancy among HCWs. Full article

Diagnostic failure in invasive fungal infections (IFIs) remains a relevant and underrecognized cause of mortality, morbidity, delayed therapy, unnecessary antifungal exposure, and pharmacological selective pressure. Although major advances have been achieved in biomarkers, rapid diagnostic tests, molecular methods, imaging studies, and microbiological identification, timely diagnosis continues to be influenced by the interaction among host factors, pathogen-related factors, diagnostic tools, and healthcare system–related factors. This narrative review analyzes diagnostic failure in IFIs as a dynamic process that includes delayed, incorrect, and incomplete diagnosis. It examines its determinants and consequences in high-risk populations—critically ill patients, patients with hematologic diseases or hematopoietic stem cell transplant recipients, and neonates—as well as in invasive candidiasis, aspergillosis, mucormycosis, cryptococcosis, endemic mycoses, and infections caused by rare or emerging fungi. It also reviews how delayed sampling, decontextualized interpretation of biomarkers, incomplete microbiological identification, absence of antifungal susceptibility testing when clinically relevant, and fragmentation between clinical and laboratory teams contribute to adverse outcomes. Finally, it proposes a diagnostic-centered antifungal stewardship framework (AFSP-Dx) based on syndromic bundles, population-specific diagnostic algorithms, 48–72 h reassessment, and auditable indicators intended to support earlier recognition, more precise therapeutic decisions, and rational antifungal use. Full article

Background: Healthcare-associated bloodstream infections remain a significant cause of morbidity and mortality in hospitalized children, particularly in intensive care settings. Carbapenem-resistant Gram-negative bacterial (CR-GNB) bloodstream infections and fungemia may present with overlapping clinical features. This can complicate empirical treatment decisions in resource-limited settings. This study evaluated baseline clinical and laboratory characteristics associated with CR-GNB bloodstream infections and fungemia among high-risk pediatric patients. Methods: This retrospective observational cohort study included pediatric patients aged 0–18 years who were evaluated at the time of clinical deterioration and blood culture collection for suspected healthcare-associated bloodstream infection before empirical antifungal therapy initiation for the index episode. Patients who subsequently received empirical antifungal therapy between May 2023 and September 2025 were retrospectively screened. Of the 240 screened patients, 103 met the inclusion criteria and were classified into CR-GNB (n = 56) and fungemia (n = 47) groups based on blood culture results. Clinical, laboratory, and microbiological data were analyzed using univariate and multivariable statistical methods. Results: Observed 90-day all-cause mortality was higher in the CR-GNB group than in the fungemia group (50.0% vs. 29.8%, p = 0.038). Central venous catheter use was more frequent (91.1% vs. 48.9%, p = 0.006), and platelet counts were lower (median: 120 × 10⁹/L vs. 259 × 10⁹/L, p = 0.011) in patients with CR-GNB bloodstream infections. In multivariable analysis, thrombocytopenia (OR: 4.22, 95% CI: 1.35–13.17; p = 0.013) and central venous catheter use (OR: 5.53, 95%: CI 1.89–16.26; p = 0.002) were independently associated with CR-GNB bloodstream infections. The model showed moderate discrimination (AUC = 0.786). Conclusion: In this selected high-risk cohort, thrombocytopenia and central venous catheter use were associated with CR-GNB bloodstream infections. Observed mortality was higher in the CR-GNB group, but this finding should be interpreted with caution as adjusted mortality analysis and standardized severity assessment were not performed. These findings are hypothesis-generating and require validation in larger prospective studies before guiding empirical treatment decisions. Full article