Gorana Nedin Ranković

Introduction: Continuous prospective surveillance is considered the reference method for monitoring healthcare-associated infections (HAIs), but it requires substantial personnel and organizational resources. Point prevalence surveys provide a simpler alternative, although they primarily measure prevalence rather than incidence. The aim of this study was to evaluate the validity of the estimation of cumulative incidence of healthcare-associated infections (HAIs) from a point prevalence survey (PPS) across different hospital wards. Methods: A HAI PPS was conducted between 14 November and 2 December 2022, at the University Clinical Center Nis, Serbia, using the European Centre for Disease Prevention and Control (ECDC) protocol. Data from 774 patients were analyzed. Prevalence data from the Surgical Intensive Care Unit (SICU) and the Orthopedics and Traumatology department were converted into estimated cumulative incidence using the Rhame and Sudderth formula. These estimates were compared against the actual 2022 cumulative incidence obtained via continuous surveillance. Results: The overall HAI prevalence was 3.6% (28 HAIs among 27 patients; 95% CI: 2.5–5.2%). In the SICU, the formula-derived calculated incidence (5.3 per 100 admissions) demonstrated an excellent fit with the observed continuous surveillance incidence (5.54 per 100 admissions; ratio: 0.96), falling well within its 95% CI (4.24–7.22%). Conversely, in the Orthopedics department, the formula significantly overestimated the true incidence by a factor of 10.7 (2.6 vs. 0.24 per 100 admissions), lying far above the upper limit of the observed 95% CI (0.09–0.62%). Conclusions: Converting prevalence data into cumulative incidence estimates is an accurate tool for estimating HAI incidence in stable, high-risk environments like intensive care units. However, it should be applied with extreme caution in low-prevalence specialty wards, where small sample sizes and individual outliers can lead to profound misestimation.

Background and Objectives: Surgical treatment of breast cancer is commonly associated with a pronounced inflammatory and metabolic stress response, which may adversely affect postoperative recovery. The erector spinae plane block (ESPB) is an ultrasound-guided regional anesthesia technique that has been suggested to influence perioperative stress responses through effective analgesia and reduced opioid requirements. This study aimed to evaluate the effects of ESPB on early postoperative inflammatory and metabolic parameters in patients undergoing breast cancer surgery. The present study represents a secondary exploratory analysis of a previously reported clinical cohort. The central hypothesis was that the addition of ESPB to general anesthesia (GA) would be associated with different early postoperative patterns of inflammatory and metabolic parameters compared with GA alone. Materials and Methods: This secondary exploratory analysis included 48 female patients (aged 50–65 years) scheduled for modified radical mastectomy. They were sequentially allocated in an alternating manner into two groups: one receiving only GA (n = 24) and the other GA with ESPB (n = 24). Inflammatory markers (interleukin-6, leukocyte count, neutrophil-to-lymphocyte ratio, C-reactive protein, and fibrinogen) and blood glucose levels were measured preoperatively and in the immediate postoperative period. Statistical analysis was conducted using t-tests, Mann–Whitney tests, and repeated measures ANOVA. Results: Patients who received ESPB in addition to GA had significantly lower immediate postoperative CRP levels (p < 0.001), while leukocyte and neutrophil counts showed significantly different patterns of change over time between the groups (time × group interaction: p = 0.005 and p = 0.003, respectively). While IL-6 levels did not differ significantly between the groups, immediate postoperative blood glucose levels were significantly lower in the ESPB group (p < 0.001), indicating a more favorable early postoperative glycemic profile. Conclusions: In patients undergoing breast cancer surgery, the addition of ESPB to general anesthesia was associated with different patterns of change in selected inflammatory parameters and lower blood glucose levels during the immediate postoperative period compared with general anesthesia alone. The present findings are limited to this early postoperative time point and do not establish a sustained anti-inflammatory or metabolic effect.

Background: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection in mechanically ventilated preterm infants and is increasingly caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative organisms. Tigecycline, a glycylcycline with broad activity against many such pathogens, is not approved below 18 years of age and carries a boxed warning for excess mortality that is most pronounced in hospital-acquired and ventilator-associated pneumonia. Its role, if any, in preterm infants with VAP is undefined. Objectives: To systematically identify and appraise all human evidence on the efficacy (clinical cure, microbiological eradication, survival) and safety (adverse events, mortality) of tigecycline used to treat VAP or nosocomial pneumonia during mechanical ventilation in preterm infants and neonates. Methods: A PRISMA 2020 structured search of PubMed/MEDLINE, Cochrane CENTRAL, Scopus, trial registries, regulatory documents, Google Scholar and reference lists was designed without language or date restrictions. Eligible reports described tigecycline treatment of pneumonia/VAP in neonates or young infants; pediatric case series and syntheses were retained as contextual evidence. Because only case reports and small non-comparative series were anticipated, a narrative synthesis was pre-specified; JBI tools and GRADE were planned for appraisal and certainty. Results: No randomized controlled trial, controlled observational study, or study dedicated to tigecycline for VAP in preterm infants was identified. Direct evidence meeting the full eligibility criteria (preterm neonate, VAP specifically, separately extractable outcomes) was limited to two case reports of extremely preterm neonates with VAP successfully weaned after tigecycline-based salvage combination therapy. Six further neonatal/young-infant reports initially considered were, on full-text re-review, reclassified as contextual (not index) evidence because they described non-VAP infections (sepsis, or CNS infections such as ventriculitis/meningitis), non-preterm ages, or mixed-infection series without separable VAP data. Reported outcomes were generally favorable in published cases but are subject to severe selection and publication bias; thrombocytopenia, hypofibrinogenemia and hepatic enzyme elevation were the principal adverse signals, against a class-level mortality signal concentrated in VAP. Quantitative pooling was not appropriate. The overall certainty of evidence was very low. Conclusions: There is no direct, credible efficacy or safety evidence supporting tigecycline for VAP in preterm infants. Available data neither establish benefit nor exclude harm. Based on this very-low-certainty evidence and on regulatory/class-level safety data rather than on demonstrated efficacy, tigecycline warrants consideration only as a last-resort, combination salvage option for culture-confirmed pan- or extensively drug-resistant pathogens when no safer alternative exists, with intensive monitoring and, ideally, within a registry or trial. Adequately designed neonatal pharmacokinetic and comparative safety studies are urgently needed. Registration: PROSPERO CRD420261450972 (registered 14 July 2026).

Background: Patients with malignant diseases receiving chronic opioid therapy are particularly susceptible to drug–drug interactions because of extensive polypharmacy, multimodal anticancer treatment, supportive care, and comorbidities. This study aimed to determine the prevalence of potentially clinically relevant drug–drug interactions and to identify factors associated with their occurrence. Methods: This exploratory observational cross-sectional pilot study included 49 adult oncology patients receiving chronic opioid therapy. Complete medication regimens were screened using the Medscape Drug Interaction Checker and Lexicomp. Lexicomp category D and X interactions were analysed descriptively. Because category D interactions were nearly universal and category X interactions were rare, the presence of at least one Medscape “Serious—Use Alternative” interaction was used pragmatically as the binary outcome for regression modelling. Potential predictors were assessed using univariable binary logistic regression and a parsimonious adjusted model with covariates selected using a clinically informed approach. Because of quasi-complete separation, Firth’s penalized-likelihood logistic regression was used as the primary adjusted analysis. Results: Lexicomp category D interactions were identified in 48 of 49 patients (98.0%), whereas category X interactions were present in 2 patients (4.1%). Medscape serious interactions were detected in 33 patients (67.3%). In the Firth-adjusted model, female sex was associated with lower odds of a Medscape serious interaction (adjusted OR 0.12, 95% CI 0.02–0.52), while cardiovascular disease was associated with higher odds (adjusted OR 5.16, 95% CI 1.27–26.31). Stage IV disease showed a positive but statistically non-significant association, and total medication count was not independently associated with the outcome in sensitivity analysis. Because of the small pilot sample and the resulting wide confidence intervals, these findings should be interpreted as exploratory and hypothesis-generating. Conclusions: Oncology patients receiving chronic opioid therapy had a high burden of potentially clinically relevant drug–drug interactions, predominantly Lexicomp category D interactions, warranting consideration of therapy modification and individualized monitoring rather than absolute avoidance. Regular medication review, use of complementary interaction databases, and individualized clinical assessment may improve pharmacotherapy safety in this vulnerable population.