A Possible Outbreak by Serratia Marcescens: Genetic Relatedness between Clinical and Environmental Strains

Serratia marcescens (SM) is a Gram-negative bacterium that is frequently found in the environment. Since 1913, when its pathogenicity was first demonstrated, the number of infections caused by SM has increased. There is ample evidence that SM causes nosocomial infections in immunocompromised or critically ill patients admitted to the intensive care units (ICUs), but also in newborns admitted to neonatal ICUs (NICUs). In this study, we evaluated the possible genetic correlation by PFGE between clinical and environmental SM strains from NICU and ICU and compared the genetic profile of clinical strains with strains isolated from patients admitted to other wards of the same hospital. We found distinct clonally related groups of SM strains circulating among different wards of a large university hospital. In particular, the clonal relationship between clinical and environmental strains in NICU and ICU 1 was highlighted. The identification of clonal relationships between clinical and environmental strains in the wards allowed identification of the epidemic and rapid implementation of adequate measures to stop the spread of SM

Biphenotypic sinonasal sarcoma: European multicentre case-series and systematic literature review

Objective. Biphenotypic sinonasal sarcoma (BSNS) is a rare low-grade cancer that was included from the 4th edition of WHO classification of head and neck tumours. The purpose of this study is to analyse clinical behaviour, pattern of recurrences and survival outcomes of this neoplasm. Methods. Retrospective review of patients affected by BSNS who were treated via an en-doscopic-assisted approach in 6 European tertiary-care referral hospitals. Cases of BSNS described in literature since 2012 to date were fully reviewed, according to PRISMA guide-lines. Results. A total of 15 patients were included. Seven patients were treated via an endoscopic endonasal approach, 4 with endoscopic transnasal craniectomy, and 4 via a cranio-endoscopic approach. Adjuvant treatment was delivered in 2 cases. After a mean follow-up of 27.3 months, systemic metastasis was observed in 1 case; the 5-year overall survival and disease-free survival rates were 100% and 80 ± 17.9%, respectively. Conclusions. BSNS is a locally aggressive tumour with a low recurrence rate and encour-aging survival outcomes if properly treated with surgical resection and free margins fol-lowed by adjuvant radiotherapy for selected cases. Endoscopic-assisted surgery is safe and effective as an upfront treatment within a multidisciplinary care protocol

High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary Study

In critically ill patients with otherwise untreatable nosocomial infection due to gram-negative bacteria susceptible only to colistin, a high-dose, extended-interval colistin dosing regimen is, according to the pharmacokinetic/pharmacodynamic behavior of the drug, associated with low renal toxicity and high efficacy

Orbital abscess as a complication of acute sinusitis: a case report.

Orbital complications are the most common complication of acute sinusitis and can determine a severe condition, leading to permanent blindness if not treated promptly and accurately. It is essential to be witting of and to suspect them to manage the complication in the fastest way possible and to minimize the patient’ risks. Prompt clinical evaluation and following medical treatment are fundamental but imaging (computed tomography [CT-scan] and magnetic resonance imaging [MRI]) plays a crucial role since it assesses the status of disease and the necessity of surgical intervention. In this case-report, we present a case of massive superior orbital abscess because of acute rhinosinusitis in a 23-year-old-young man who presented at our attention with an important left eye proptosis, diplopia, associated to severe pain and swelling of the left eyeball, just 3-days after medical treatment and endoscopic surgery performed elsewhere. Imaging (CT-scan and MRI) displayed a left orbital abscess and guide the urgency of the intervention. Due to patient’s important symptoms and therapeutic unresponsiveness, surgical management and revision were decided. The massive orbital abscess was drained combining external and endoscopic approach to the widening inflammatory tissue and sinus surgery, focusing on frontal sinus, was performed to remove the focus of infection. After surgical intervention, patient kept following medical treatment based on corticosteroids, local and systemic antibiotics. A rapid relief of the major symptoms was observed in the postoperative period and up to now, no recurrence occurred. This evidence confirms a correct transnasal endoscopic procedure performed in well-experienced hands could be the right solution