The reemergence of Streptococcus pyogenes in skin and soft tissue infections: a review of epidemiology, pathogenesis, and management strategies.

Purpose Of Review: To discuss skin and soft tissue infections (SSTIs) caused by group A Streptococcus (GAS) by focusing on their pathogenesis, clinical manifestations, and management strategies.

Recent Findings: GAS is responsible for a wide range of infections from mild disease to severe fatal invasive infections with high mortality rates. Invasive GAS (iGAS) infections affect both young and old individuals and account for 1.

Automated extraction of standardized antibiotic resistance and prescription data from laboratory information systems and electronic health records: a narrative review.

Antimicrobial resistance in bacteria has been associated with significant morbidity and mortality in hospitalized patients. In the era of big data and of the consequent frequent need for large study populations, manual collection of data for research studies on antimicrobial resistance and antibiotic use has become extremely time-consuming and sometimes impossible to be accomplished by overwhelmed healthcare personnel. In this review, we discuss relevant concepts pertaining to the automated extraction of antibiotic resistance and antibiotic prescription data from laboratory information systems and electronic health records to be used in clinical studies, starting from the currently available literature on the topic.

Impact of Fluconazole Resistance on the Outcomes of Patients With Candida parapsilosis Bloodstream Infections: A Retrospective Multicenter Study.

Background: This study assesses the impact of fluconazole resistance on 30-day all-cause mortality and 1-year recurrence in patients with Candida parapsilosis bloodstream infections (BSI).

Methods: A multicenter retrospective study was performed at 3 hospitals in Italy and Spain between 2018 and 2022. Adult patients with positive blood cultures for C.

Posaconazole for Prevention of COVID-19-Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: A European Multicentre Case-Control Study (POSACOVID).

Background: This study investigated the impact of posaconazole (POSA) prophylaxis in COVID-19 patients with acute respiratory failure receiving systemic corticosteroids on the risk for the development of COVID-19-associated pulmonary aspergillosis (CAPA).

Methods: The primary aim of this prospective, multicentre, case-control study was to assess whether application of POSA prophylaxis in mechanically ventilated COVID-19 patients reduces the risk for CAPA development. All consecutive patients from centre 1 (cases) who received POSA prophylaxis as standard-of-care were matched to one subject from centre 2 and centre 3 who did not receive any antifungal prophylaxis, using propensity score matching for the following variables: (i) age, (ii) sex, (iii) treatment with tocilizumab and (iv) time at risk.

Omadacycline for the treatment of skin and soft tissue infections.

Purpose Of Review: To evaluate the current evidence on the use of omadacycline for the treatment of skin and soft tissue infections (SSTIs).

Recent Findings: This narrative review examines the available data on the pharmacology, clinical efficacy, safety profile, and comparative effectiveness of omadacycline in treating SSTIs, with a focus on its potential role in everyday clinical practice.

Summary: Omadacycline is a viable option for outpatient therapy and early discharge in patients with SSTIs, particularly in frail populations and those undergoing chronic polypharmacotherapy.

Comparative efficacy and safety of treatment regimens for Pneumocystis jirovecii pneumonia in people living with HIV: a systematic review and network meta-analysis of randomized controlled trials.

Background: Pneumocystis jirovecii pneumonia (PCP) is a serious opportunistic infection in people living with HIV (PWH) who have low CD4 counts. Despite its side effects, trimethoprim-sulfamethoxazole (TMP-SMX) is currently considered the primary treatment for PCP.

Objectives: The objectives of this study are to compare the efficacy (treatment failure and mortality) and tolerability (treatment change) of PCP treatment regimens with a frequentist network meta-analysis.

Mycobiome analyses of critically ill COVID-19 patients.

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a life-threatening complication in patients with severe COVID-19. Previously, acute respiratory distress syndrome in patients with COVID-19 has been associated with lung fungal dysbiosis, evidenced by reduced microbial diversity and colonization. Increased fungal burden in the lungs of critically ill COVID-19 patients is linked to prolonged mechanical ventilation and increased mortality.

Rezafungin acetate for the treatment of candidemia and invasive candidiasis: a pharmacokinetic evaluation.

Introduction: Rezafungin, formerly SP3025 and CD101, is a next-generation echinocandin, chemically related to anidulafungin, with differentiated pharmacokinetic characteristics, including a prolonged half-life allowing extended-interval dosing.

Areas Covered: Herein, we discuss the role of rezafungin in the treatment of candidemia and invasive candidiasis, with a specific focus on pharmacokinetics considerations.

Expert Opinion: Rezafungin exhibits potent in vitro activity against most wild-type and azole-resistant species, including .

COVID-19 throughout pandemic waves and virus variants: a real-life experience in an Italian hospital.

New therapies and vaccines changed the management of COVID-19. The aim of this retrospective study was to describe characteristics, in-hospital mortality and its predictors in patients with moderate/severe COVID-19, considering the 4 different pandemic waves and viral variants' prevalence from February 2020 to January 2022. Among 1135 patients included, 873 (77%) had at least one comorbidity, 177 (16%) were immunocompromised.

Artificial intelligence and prescription of antibiotic therapy: present and future.

Introduction: In the past few years, the use of artificial intelligence in healthcare has grown exponentially. Prescription of antibiotics is not exempt from its rapid diffusion, and various machine learning (ML) techniques, from logistic regression to deep neural networks and large language models, have been explored in the literature to support decisions regarding antibiotic prescription.

Areas Covered: In this narrative review, we discuss promises and challenges of the application of ML-based clinical decision support systems (ML-CDSSs) for antibiotic prescription.

New antibiotics in clinical pipeline for treating infections caused by metallo-β-lactamases producing Gram-negative bacteria.

Purpose Of Review: To discuss novel antibiotics under clinical development, focusing on agents showing in-vitro activity against metallo-β-lactamases (MBL)-producing carbapenem-resistant Gram-negative bacteria (CR-GNB).

Recent Findings: Currently, only a few approved agents show activity, alone or in synergistic combinations, against MBL-producing CR-GNB. If approved by regulatory agencies in case of favorable results from ongoing (and, for some agents, already completed) phase-3 studies, some novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations could become available in the next few years as additional important options for treating MBL-producing CR-GNB infections.

Prediction of candidemia with machine learning techniques: state of the art.

In this narrative review, we discuss studies assessing the use of machine learning (ML) models for the early diagnosis of candidemia, focusing on employed models and the related implications. There are currently few studies evaluating ML techniques for the early diagnosis of candidemia as a prediction task based on clinical and laboratory features. The use of ML tools holds promise to provide highly accurate and real-time support to clinicians for relevant therapeutic decisions at the bedside of patients with suspected candidemia.

Optimizing Antifungal Treatment Strategies to Prevent Invasive Pulmonary Aspergillosis Infection-Related Deaths in Intensive Care Unit Patients: The Need for Standardization of Research Definitions.

The clinical spectrum of invasive pulmonary aspergillosis (IPA) has expanded in recent decades. A large group of patients admitted to intensive care units (ICU) is indeed susceptible to the development of IPA. Although timely diagnosis and antifungal therapy of IPA in this expanding population is crucial to prevent IPA-related deaths, the magnitude of the favorable prognostic impact of antifungal therapy is difficult to measure precisely.

Interpreting the results of rapid molecular diagnostic tests for carbapenem-resistant Enterobacterales infection: current clinical perspective while waiting for further evidence.

Introduction: Carbapenem-resistant Enterobacterales (CRE) causing severe infections in humans have represented an important challenge for clinicians worldwide during the past two decades.

Areas Covered: Novel β-lactams and β-lactam/β-lactamase inhibitor combinations have led to a shift in the first-line approach to the treatment of severe CRE infections from polymyxin-based regimens to treatment with less toxic agents. This new scenario offers the opportunity to apply rapid molecular diagnostic tests for CRE infection to identify different types of carbapenemases.

Attributable mortality of candidemia - Results from the ECMM Candida III multinational European Observational Cohort Study.

Introduction: Despite antifungal advancements, candidaemia still has a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes of candidaemia for better understanding and management of these infections.

Methods: In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with blood culture-proven candidemia.

Treating influenza with neuraminidase inhibitors: an update of the literature.

Introduction: Influenza affects individuals of all ages and poses a significant threat during pandemics, epidemics, and sporadic outbreaks. Neuraminidase inhibitors (NAIs) are currently the first choice in the treatment and prevention of influenza, but their use can be hindered by viral resistance.

Areas Covered: This review summarizes current NAIs pharmacological profiles, their current place in therapy, and the mechanisms of viral resistance and outlines possible new indications, ways of administration, and novel candidate NAIs compounds.

Towards the automatic calculation of the EQUAL Candida Score: Extraction of CVC-related information from EMRs of critically ill patients with candidemia in Intensive Care Units.

Objectives: Candidemia is the most frequent invasive fungal disease and the fourth most frequent bloodstream infection in hospitalized patients. Its optimal management is crucial for improving patients' survival. The quality of candidemia management can be assessed with the EQUAL Candida Score.

Cefepime-taniborbactam and CERTAIN-1: Can we treat carbapenem-resistant infections?

Wagenlehner and colleagues demonstrated non-inferiority and superiority with respect to a primary endpoint of composite success (microbiological plus clinical) of cefepime/taniborbactam vs. meropenem in treating complicated urinary tract infections and acute pyelonephritis caused by carbapenem-susceptible gram-negative bacteria in adults. A major area of interest in real-world application of cefepime/taniborbactam is its potential role in treating carbapenem-resistant infections, which deserves further investigation.

Explainable and Interpretable Machine Learning for Antimicrobial Stewardship: Opportunities and Challenges.

There is growing interest in exploiting the advances in artificial intelligence and machine learning (ML) for improving and monitoring antimicrobial prescriptions in line with antimicrobial stewardship principles. Against this background, the concepts of interpretability and explainability are becoming increasingly essential to understanding how ML algorithms could predict antimicrobial resistance or recommend specific therapeutic agents, to avoid unintended biases related to the "black box" nature of complex models. In this commentary, we review and discuss some relevant topics on the use of ML algorithms for antimicrobial stewardship interventions, highlighting opportunities and challenges, with particular attention paid to interpretability and explainability of employed models.