Search Results (613)

Background and Objectives: Infective endocarditis (IE) remains a major clinical challenge. It carries high morbidity and mortality, despite advances in diagnostic and therapeutic methods. This study aimed to evaluate the epidemiological profile, microbiological characteristics, complications, and predictors of adverse outcomes among patients with IE treated at a tertiary cardiovascular center in Romania over 5 years. Materials and Methods: We conducted a retrospective study including 156 patients diagnosed with IE between January 2020 and December 2024. We analyzed demographic data, comorbidities, microbiological findings, treatment strategies, complications, and in-hospital outcomes. Results: The cohort was predominantly male (76.3%), with a mean age of 58.5 years. Native valve endocarditis was the most frequent form (80.1%). Streptococci were the most commonly identified pathogens, followed by enterococci and staphylococci. Complications occurred in 74.4% of patients. Heart failure (70.5%), acute kidney injury (37.2%), and embolic events (32.7%) were most frequent. Healthcare-associated infective endocarditis (HAIE) was seen in 10.3% of patients. Additional healthcare-associated infections (HAIs) occurred in 26.9% of patients and were associated with longer hospital stays (21.7 vs. 13.5 days; p < 0.001). Use of a central venous catheter independently predicted HAI development (adjusted OR, 3.89; 95% CI, 1.08–14.06; p = 0.038). The in-hospital mortality rate was 16.7%. Acute kidney injury and sepsis were the strongest factors associated with in-hospital mortality. Conclusions: IE remains associated with a high burden of complications and in-hospital mortality. HAIs complicate the clinical course and are closely linked to invasive device use. Mortality is mainly driven by systemic disease severity, especially acute kidney injury and sepsis. These findings highlight the importance of infection prevention, prompt risk stratification, and coordinated multidisciplinary care to improve outcomes in patients with IE. Full article

Background: Spasticity is a major contributor to pain, impaired mobility, contractures, and caregiver burden in children with cerebral palsy. Intrathecal baclofen (ITB) is an established treatment for severe generalized spasticity when rehabilitation, oral medications, and focal interventions are insufficient or poorly tolerated. Methods: This critical review synthesizes current evidence on ITB in children with cerebral palsy, focusing on patient selection, screening, rehabilitation goals, functional outcomes, complications, and long-term management. Results: Available evidence consistently demonstrates substantial and sustained tone reduction with ITB, with associated improvements in comfort, positioning, ease of care, pain, and selected quality-of-life domains. However, gains in gross motor function are variable and depend on baseline motor phenotype, individualized treatment goals, and careful dose titration. Device-related complications, infections, catheter dysfunction, overdose, and withdrawal remain clinically significant risks requiring specialized multidisciplinary follow-up. Compared with selective dorsal rhizotomy and botulinum toxin injections, ITB provides a reversible and programmable option particularly suited to children with severe, generalized spasticity and high caregiving needs. Conclusions: ITB represents an important component of comprehensive, goal-directed spasticity management in appropriately selected children. Further high-quality longitudinal and comparative studies are needed to define long-term functional and cost-effectiveness outcomes better. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is of great concern because of the difficulties encountered in the management of infections it may cause. This study aims to identify possible difficulties in the management of K. pneumoniae infections in the current context of antibiotic resistance, particularly regarding carbapenem resistance. Methods: This is a retrospective, cross-sectional study that analyses epidemiological, clinical and bacteriological features identified in all patients with CRKP infections/colonization admitted during 2024 in an infectious diseases hospital. Results: Carbapenemase-producing K. pneumoniae isolates were co-harboring NDM+OXA-48 in 55.2% of cases. NDM+OXA-48-producing K. pneumoniae (116 isolates, 55.2%) was correlated with high resistance to aztreonam (100%, p = 0.01), ceftazidime–avibactam (100%, p < 0.01), trimethoprim–sulfamethoxazole (99.1%, p < 0.01), gentamycin (94.8%, p < 0.01), amikacin (93.8%, p < 0.01), colistin (79.8%, p < 0.01). OXA-48-producing K. pneumoniae (29 isolates, 13.8%) was correlated with lower resistance to ceftazidime–avibactam (11.5%, p < 0.01), amikacin (48.1%, p < 0.01), colistin (51.7%, p = 0.01), and gentamycin (65.5%, p < 0.01). We found in vitro synergistic effects of ceftazidime/avibactam + aztreonam for 32/32 CRKP isolates and of colistin + tigecycline for 12/14 CRKP isolates. Higher recurrence of CRKP infections was recorded in patients with urinary tract conditions (RR = 11.58, 95%CI: 1.58–81.91) and upper urinary tract devices (RR = 3.53, 95% CI: 1.72–7.22). In this study, adequate antibiotic treatment, compared to excessive antibiotic treatment in CRKP infections, was associated with shorter treatment duration (p = 0.02) and shorter length of hospitalization (p = 0.04). Conclusions: In our study, CRKP is frequently coharboring NDM+OXA-48, having limited treatment options. Implementing new treatment strategies, testing antibiotic synergies for older antibiotics in order to identify alternative treatment options and avoiding unnecessary carbapenem consumption are essential for decreasing the burden of CRKP infections. Full article

Breast implants are among the most frequently used long-term implantable medical devices in aesthetic and reconstructive surgery. In addition to correcting anatomical deficits, they have significant psychosocial effects, influencing body image, self-esteem, and quality of life, particularly in patients undergoing postmastectomy reconstruction. This review provides a comprehensive overview of the historical development, biological interactions, material characteristics, and clinical outcomes of breast implants. Early reconstructive attempts using foreign materials and injectable substances were associated with severe complications, underscoring the need for safer technologies. The introduction of silicone gel implants in the 1960s marked a pivotal advancement, followed by the development of saline-filled devices and highly cohesive silicone gels with enhanced mechanical stability. Key surgical considerations, including incision type and implant placement plane (subglandular, submuscular, dual-plane, and subfascial), are discussed in relation to aesthetic outcomes and complication risk. Emphasis is placed on the implant–tissue interface and the foreign body response (FBR), a process involving protein adsorption, immune cell activation, fibrous capsule formation, and potential chronic inflammation. Persistent inflammatory stimulation, often associated with bacterial biofilm formation, contributes to capsular contracture, the most common long-term complication. Additional adverse events include implant rupture, silicone gel bleed, granulomatous reactions, infection, hematoma, implant malposition, and rare but clinically significant conditions such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The review also summarizes implant classification according to construction, filling material, shape, and surface topography, highlighting the influence of surface characteristics on host response and clinical outcomes. Advances in biomaterials, cohesive gel formulations, and surface engineering aim to enhance biocompatibility and long-term safety, supported by standardized mechanical and biological testing protocols. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before–after, controlled before–after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies. Full article

Background/Objectives: Central line-associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units (ICUs). This study evaluated changes in CLABSI incidence following the implementation of a multimodal infection control intervention in the ICU. Methods: We conducted a quasi-experimental study in the adult ICUs of a referral hospital from January 2023 to December 2025. The interventions included staff education, performance feedback, infection control-led rounds, optimization of catheter practices, and reinforcement of environmental hygiene. The primary outcome was CLABSI incidence per 1000 central line-days. An interrupted time-series analysis using segmented Poisson regression with robust standard errors was used to assess temporal trends. Results: A total of 17 CLABSI cases occurred during the pre-intervention period, and 25 during the post-intervention period. There was no significant difference in CLABSI incidence between the two periods (incidence rate ratio, 1.07; 95% confidence interval, 0.58–1.98). However, interrupted time-series analysis demonstrated a significant decreasing trend in CLABSI incidence following the intervention (rate ratio, 0.89 per month; 95% confidence interval, 0.81–0.97; p = 0.01). This trend was observed despite the higher patient severity and increased use of advanced supportive therapies in the post-intervention period. The device utilization ratio and monthly blood culture rate remained unchanged. Avoidance of femoral venous access increased, and adherence to catheter-handling protocols significantly improved. Conclusions: A staged, multimodal intervention was associated with a significant decreasing trend in CLABSI incidence over time, suggesting a potential benefit of comprehensive infection prevention strategies in ICU settings. Full article

Background/Objectives: External ventricular drains (EVDs) are widely used in the management of intracranial hemorrhage and hydrocephalus; however, they carry a significant risk of device-related central nervous system infections, including ventriculitis and meningitis, which are associated with increased morbidity, mortality, and prolonged intensive care stays. We conducted a systematic review and meta-analysis to evaluate whether prolonged EVD duration (>10 days) is associated with an increased risk of ventriculostomy-related infection compared with shorter duration (≤10 days), and to explore the association with cerebrospinal fluid (CSF) leak where data were available. Methods: A comprehensive literature search of PubMed, Google Scholar, Web of Science, and Cochrane CENTRAL was performed from database inception through September 2025, including English-language clinical trials, cohort studies, and case–control studies reporting infection outcomes related to EVD management factors. Two reviewers independently screened studies and extracted data. A random-effects meta-analysis was conducted to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: Sixteen studies comprising approximately 5500 patients met the inclusion criteria. Shorter EVD duration (≤10 days) was associated with a significantly lower risk of infection (pooled OR 0.45, 95% CI 0.30–0.68; p = 0.0002), corresponding to a 55% reduction in the odds of ventriculostomy-related infection. Prolonged EVD duration was consistently associated with increased infection risk across studies. Conclusions:These findings suggest that minimizing EVD duration may reduce infection risk and support early removal when clinically feasible. However, given the observational nature of the included studies, the results should be interpreted with caution. Further research is warranted to evaluate additional modifiable risk factors, including CSF leakage and sampling practices. Full article

Chronic wounds represent a major complication of underlying conditions such as diabetes mellitus, arterial ischemia, surgical wound and burns. This study aimed at the phenotypic and molecular characterization of antimicrobial resistance for a selection of bacterial isolates, originating from wounds harvested from patients hospitalized in the Vascular Surgery and Plastic Surgery wards. The microbiological diagnosis of wound infections was established according to the laboratory’s working protocol. PCR screening of antibiotic resistance genes was performed using a real-time PCR, while the microtiter plate assay was used to determine the biofilm-forming capacity. Testing of biofilm susceptibility to meropenem and amikacin was performed on Calgary biofilm device. Of the 88 bacterial isolates studied, 78.40% were Gram-negative bacilli (GNB)—Klebsiella pneumoniae (K.P), Pseudomonas aeruginosa (P.A), Proteus mirabilis (P.M), Acinetobacter baumannii (A.B), while the remaining 21.60% were Gram-positive cocci (GPC)—Staphylococcus aureus (S.A). All A.B isolates and 92.59% of K.P were carriers of β-lactamase- and carbapenemase-encoding genes, while 57.89% of S. aureus isolates were carriers of mecA (methicillin-resistant). Strong biofilm-forming isolates (B+++) were more frequent in P.A than in K.P (p = 0.002) and P.M (p = 0.02), with a frequency comparable to that of A.B strains (p = 0.212). When analyzing the biofilm reaction to meropenem, a significantly lower susceptibility was detected in the biofilm for K.P isolates, compared to the planktonic ones. Most GNB have been extensively multidrug-resistant, particularly K.P and A.B. Isolates from chronic wounds are major biofilm-formers. A strong and statistically significant association has been identified in the case of K.P and P.M between the presence of resistance genes and the biofilm-forming capacity. These findings highlight the need for a customized therapeutic approach for each chronic wound, considering the mechanisms underlying treatment resistance. These include bacterial virulence factors and the wound microenvironment colonized by the biofilm and the relative contribution of each to the overall resistance profile. Full article

Invasive fungal respiratory infections (IFRIs) remain a major cause of morbidity and mortality among immunocompromised patients, yet diagnosis continues to be hindered by nonspecific clinical features, limited sample accessibility, and the poor sensitivity or specificity of conventional tests. Microfluidic and microelectromechanical systems (MEMS)-based biosensing platforms have emerged as promising alternatives, enabling rapid, minimally invasive, and highly specific detection of fungal pathogens and host responses. Microfluidic nucleic acid and antigen assays allow on-chip amplification and immunodetection with reduced sample volumes and turnaround times, while CRISPR-enhanced systems further improve analytical sensitivity. Parallel advances in host response profiling—including transcriptomic, proteomic, and cytokine-based signatures—have demonstrated feasibility for integration into lab-on-a-chip platforms. MEMS-based technologies extend this potential by facilitating real-time analysis of exhaled volatile organic compounds, mechanical biosensing of fungal DNA and antigens, and in situ monitoring of device-associated biofilms. Translational studies highlight potential applications across intensive care, hematology–oncology, and transplant settings, as well as in outpatient monitoring of high-risk populations. However, several challenges remain, including limited multicenter validation, matrix-related biofouling effects, and a lack of standardization in fungal biomarker panels. Future directions include AI-driven interpretation of multianalyte data, multiplexed integration of host and pathogen markers, and development of fully cartridge-based systems for near-patient deployment. Collectively, these innovations may shift fungal diagnostics toward earlier, more precise, and patient-tailored interventions, improving outcomes in vulnerable populations. Full article

Healthcare-associated infections (HAIs) are clinically relevant complications in critically ill stroke patients, particularly in neurological intensive care settings, where severe neurological injury, dysphagia, immobilization, invasive device exposure, and prolonged hospitalization increase infection susceptibility. Romanian data focused on deceased stroke patients admitted to neurological intensive care units remain limited. This retrospective descriptive single-center hospital-based study, supported by focused literature contextualization, was conducted in the Neurological Intensive Care Unit of the Brașov County Emergency Clinical Hospital, Romania. Adult stroke patients who died during hospitalization over a six-year observation period were included. Clinical data were extracted from a working hospital database and analyzed descriptively after data cleaning and harmonization. The final cohort comprised 190 deceased stroke patients; ischemic stroke was documented in 69.5% and hemorrhagic stroke in 28.9%. Hypertension (73.7%) and ischemic heart disease and/or previous myocardial infarction (60.0%) were the most frequently recorded comorbidities. Pneumonia was the dominant documented infectious complication, recorded in 52.6% of patients, followed by urinary tract infection (11.6%), pressure sore-related infection (4.7%), and sepsis-related coding (6.8%). The median in-hospital survival interval was 6 days (IQR 3.0–10.75). Because year-by-year stratification was not sufficiently robust, the temporal component was interpreted only in aggregate form. These findings provide a descriptive hospital-based profile of documented infectious complications in a fatal stroke ICU cohort and support the need for more standardized infection documentation and better linkage between clinical and microbiological data in neurocritical care settings. Full article

Background and Objectives: Healthcare-associated infections (HAIs) remain a relevant complication in coronary care units (CCUs), particularly among patients with cardiac dysfunction requiring invasive monitoring and prolonged hospitalization. In this setting, infection occurrence may reflect the cumulative interaction between baseline biological vulnerability and care-related exposure. This study aimed to explore whether a simple cumulative framework integrating these components can describe patterns of HAI occurrence and support early identification of patients at risk for severe infectious complications and sepsis. Materials and Methods: The retrospective cohort study included 870 consecutive adult patients admitted to a tertiary-care CCU. A four-component cumulative framework was constructed using reduced left ventricular ejection fraction (LVEF < 40%), diabetes mellitus, urinary catheterization, and CCU length of stay > 5 days. Each component contributed one point (range 0–4). HAIs were defined according to CDC/NHSN criteria and required microbiological confirmation. Associations between cumulative burden and infection occurrence were assessed using trend analysis and exploratory modeling. Results: HAI occurrence increased progressively across cumulative framework levels, demonstrating a stepwise pattern from low to higher vulnerability strata (p for trend < 0.001). A substantial proportion of infections clustered in patients with higher cumulative values, despite representing a minority of the cohort. Increasing cumulative burden was accompanied by higher observed infection occurrence, supporting a graded association between cumulative vulnerability and infection occurrence. Conclusions: In CCU patients, HAI occurrence appears to reflect the accumulation of biological vulnerability and care-related exposure during hospitalization. A simple cumulative framework may support early identification of patients requiring closer preventive attention and contribute to improved awareness of severe infectious complications in cardiac critical care. Prospective validation is warranted. Full article

Fungal infections are an escalating health threat, especially in hard-to-treat biofilm-associated infections. Candida species are the most widespread drivers of wound biofilm and biomedical device-associated infections. In this study, biodegradable nanoemulsions (BNEs) were fabricated by encapsulating active components of three different essential oils—carvacrol (C-BNE), geraniol (G-BNE), and eugenol (E-BNE)—in a polymeric scaffold with a biodegradable crosslinker. The antibiofilm efficacy of BNEs was assessed against 2-day-old biofilms of multiple Candida species. C-BNE showed maximum effectiveness against all fungal biofilms as compared to G-BNE and E-BNE. Confocal microscopy further demonstrated that C-BNE efficiently penetrated the biofilm and killed the fungal cells by compromising cell membrane integrity. Overall, this study highlights the potential of essential oil-loaded nanoemulsions against drug-resistant biofilm-associated fungal infections. Full article

Microorganisms can aggregate and organise into structured communities embedded within an exopolysaccharide-based matrsix, which serves as a protective barrier and a functional environment around microbial cells. The formation of biofilms is widely recognised as a pivotal factor in bacterial virulence, impeding the efficacy of antimicrobial agents and hindering immune responses, whilst concomitantly contributing to the development of antimicrobial resistance and the onset of persistent infections. Biofilm formation is a tightly regulated and dynamic process, controlled by quorum-sensing mechanisms and profoundly influenced by environmental factors and nutrient availability. The objective of this review is to elucidate the significance of biofilms in clinical settings, with a particular focus on their role in the pathogenesis of infectious diseases. Particular attention is devoted to biofilm-associated infections and infections related to invasive medical devices, with a particular emphasis on the most prevalent microbial pathogens, which include S. aureus, S. epidermidis, P. aeruginosa, E. coli, K. pneumoniae, A. baumannii and various species of Candida. Furthermore, the present review encompasses biofilm-associated chronic infections, conditions manifesting in predisposed patients, including individuals affected by cystic fibrosis. This review further examines the most recent strategies for combating antibiotic resistance in bacterial biofilms. This review focuses on recent biofilm pathogenesis advancements, with a focus on diagnosis challenges and the need for new ways to disrupt biofilm integrity. Full article

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology. Full article