Sepsis is a life-threatening organ dysfunction that leads to 11 million annual global deaths. It is characterized by severe immune dysregulation, with gasdermin D (GSDMD)-driven pyroptosis recognized as a key pathogenic mechanism. After exposure to pathogen-associated molecular patterns (PAMPs)/damage-associated molecular patterns (DAMPs), GSDMD, activated via the canonical (caspase-1) and non-canonical (caspase-4/5/11) pathways, forms plasma membrane pores, induces cell lysis, and triggers multi-organ injury. Specifically, GSDMD pores trigger lung inflammation via alveolar macrophage pyroptosis, induce hepatic high mobility group box 1 protein (HMGB1) release, perpetuate bacteremia, cause renal microthrombosis, and disrupt the blood-brain barrier. GSDMD drives both the hyperinflammatory phase (via cytokine storm, NETosis) and the immunosuppressive phase (via lymphocyte apoptosis, T-cell exhaustion), thereby defining hyperinflammatory (GSDMD-NT >120 ng/mL) and immunosuppressive (intestinal barrier failure) endotypes. Promising therapeutic agents include disulfiram (blocking Cys191 oligomerization), anti-GSDMD mAb26.5 (decreasing mortality to 30%), and the combination of imipenem and disulfiram. Clinical translation faces challenges in terms of biomarker validation, organ-specific delivery, and phase-adapted intervention. Future research directions include AI-based drug design, exosome-mediated CRISPR knockout, clinical trials on drug repurposing, and single-cell omics-integrated stratified immunotherapy.

We performed a retrospective study in patients with febrile neutropenia between 2005 and 2020 to assess the impact of time-to-antibiotics (TTA) on mortality. We included 1089 patients (58% males) aged 58 [46-67] years with hematological malignancies (62% acute leukemias, 20% lymphomas). TTA was 132 [68-271] minutes and hospital mortality was 9.1%. Hourly TTA was not associated with mortality in multivariate logistic regression. Hospital mortality was lower in patients with TTA ≤4 h (8.0% versus 11.9%, p = 0.04) and after propensity score matching based on comorbidities, vital signs and biological parameters at the time of fever, TTA ≤4 h remained associated with decreased mortality (odds ratio 0.55, 95% CI 0.31-0.96, p = 0.038). These findings were not confirmed in subgroups of patients with sepsis or bacteremia. Our study confirmed that TTA >4 h was associated with increased mortality but does not support recommendations of TTA ≤1 h in febrile neutropenia.

Disseminated intravascular coagulation (DIC) is a critical complication of systemic illness, and its diagnosis can be especially challenging in patients with cirrhosis, where baseline liver-related coagulopathy may mask the development of superimposed consumptive coagulopathy. In the setting of sepsis and liver dysfunction, DIC may progress to purpura fulminans (PF), a rare, life-threatening condition characterized by dermal necrosis and microvascular thrombosis. We present the case of a 54-year-old man with alcoholic cirrhosis and untreated hepatitis C who developed DIC and PF following methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and toxic shock syndrome (TSS). Despite treatment with antibiotics, transfusions, intravenous immunoglobulin (IVIG), and hemodialysis, he developed multiorgan failure. This case highlights that in patients with sepsis and cirrhosis, acutely worsening coagulation parameters, falling fibrinogen, and evolving purpuric or necrotic skin lesions should not be attributed to liver disease alone but should instead prompt urgent evaluation for DIC and PF. The early recognition of this distinction is essential to guide timely multidisciplinary intervention in this rare but devastating complication.

Stenotrophomonas maltophilia bacteremia is an opportunistic infection associated with high mortality among intensive care unit (ICU) patients, largely due to intrinsic antimicrobial resistance and the severe underlying conditions of affected hosts. This study aimed to identify independent predictors of 28-day mortality, evaluate the prognostic value of laboratory biomarkers, and assess the impact of source control in ICU patients with S. maltophilia bacteremia. A retrospective single-center case-control study was conducted over a five-year period, including 148 ICU patients with S. maltophilia bacteremia and 1:1 matched non-S. maltophilia controls. Demographic, clinical, and laboratory data were analyzed using multivariate logistic regression to determine independent predictors of mortality, while receiver operating characteristic (ROC) analysis assessed the prognostic performance of selected biomarkers. Multivariate analysis identified shock (OR = 6.01; 95% CI: 3.13-11.56; p < 0.001), underlying malignancy (OR = 4.31; 95% CI: 1.44-12.96; p = 0.009), higher Sequential Organ Failure Assessment (SOFA) score (OR = 1.28; 95% CI: 1.16-1.41; p < 0.001), and elevated procalcitonin levels (OR = 1.014; 95% CI: 1.002-1.026; p = 0.019) as independent predictors of mortality. A multivariable prediction model incorporating age, SOFA score, shock, malignancy, procalcitonin, and lactate demonstrated good discriminative performance for predicting 28-day mortality (AUC = 0.817; p < 0.001). Source control was significantly associated with improved survival. These findings suggest that hemodynamic instability, malignancy, and severe organ dysfunction are major determinants of mortality in ICU patients with S. maltophilia bacteremia, and that multidimensional risk assessment models integrating clinical severity scores and biomarkers may facilitate early identification of high-risk patients and support targeted clinical management.

Clostridium tertium is an emerging opportunistic pathogen typically associated with immunocompromised hosts, yet it can also cause serious infections in non-neutropenic individuals. We present a case of postoperative peritonitis and bacteremia caused by C. tertium in a non-neutropenic 75-year-old woman following emergency obturator hernia repair. Diagnosis was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and successful treatment was achieved with piperacillin-tazobactam combined with levornidazole alongside surgical source control. A review of 128 cumulative cases (including ours) revealed two distinct patterns: bacteremia in severely neutropenic patients versus a broader spectrum of localized and bloodstream infections in non-neutropenic hosts, often linked to intestinal barrier disruption. Mortality was largely driven by underlying comorbidities and polymicrobial sepsis. These findings indicate that C. tertium infection should be considered in non-neutropenic patients with postoperative or gastrointestinal barrier-disruptive infections, especially when there is a poor response to initial empiric therapy. Consequently, in such clinical scenarios, empirical therapy should be guided by its unique resistance pattern, favoring carbapenems, vancomycin, or piperacillin-tazobactam, often combined with a nitroimidazole, alongside urgent source control.

Background: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is increasingly recognized as a thromboinflammatory disorder involving coagulation, innate immunity, endothelial dysfunction, and vascular homeostasis. Emerging evidence suggests that gut microbiome-related inflammatory and metabolic signals may influence pathways potentially relevant to VTE through intestinal barrier dysfunction, microbial translocation, and microbiome-derived metabolites. This review critically examines the direct and indirect evidence relating gut dysbiosis to mechanisms potentially relevant to venous thrombogenesis. Methods: A structured literature search of PubMed, Scopus, and Web of Science was conducted from database inception to February 2026. Observational, translational, experimental, preclinical, and selected genetic studies were narratively synthesized across heterogeneous evidence types. Results: Available evidence suggests that intestinal barrier dysfunction and microbial translocation may increase systemic exposure to lipopolysaccharide and other microbial products, potentially contributing to inflammatory signaling and procoagulant responses. Proposed downstream effects include tissue factor (TF) activation, platelet reactivity, neutrophil extracellular traps (NETs) formation, complement signaling, endothelial perturbation, and impaired balance of anticoagulant and fibrinolytic pathways. Microbiome-derived metabolites, including trimethylamine N-oxide (TMAO), phenylacetylglutamine (PAGln), bile acids, and short-chain fatty acids (SCFAs), have been linked, mainly in experimental or non-VTE settings, to thrombosis-related biology. However, most evidence remains indirect, associative, or experimental, whereas direct human VTE-specific evidence is limited and heterogeneous. Conclusions: The gut microbiome-VTE axis is biologically plausible and supported mainly by mechanistic and indirect evidence, but current data are insufficient to support strong causal conclusions. Further longitudinal, well-phenotyped, mechanistically informed studies are needed to determine whether microbiome-related pathways have measurable clinical relevance in human VTE.

Background: The global demographic shift towards an aging population has driven a steady, exponential increase in the utilization of cardiac implantable electronic devices (CIEDs). Consequently, device-related infectious complications have emerged as a leading cause of morbidity and healthcare expenditure. Patients in their eighth decade of life-octogenarians (aged 80-90 years)-represent an exceptionally high-risk demographic due to the compounding factors of physiological frailty, immunosenescence, and complex multi-morbidity. Despite this growing demographic, their specific clinical presentations, microbiological profiles, and procedural outcomes following infection remain poorly defined in the current literature. This study aimed to comprehensively compare the clinical characteristics, pathogen distribution, and in-hospital outcomes of CIED infections in an octogenarian cohort against a younger patient population. Methods: We conducted a robust retrospective cohort analysis of 383 consecutive patients treated for confirmed CIED infections at one major tertiary referral center (Heidelberg University Hospital) between January 2002 and December 2022. The cohort was stratified by age into octogenarians (n = 76) and a younger control group (n = 307). We systematically extracted and compared data regarding baseline clinical presentation, chronic comorbidities, detailed microbiological cultures (pocket, blood, and extracted leads), and definitive in-hospital outcomes, primarily mortality and length of stay. Results: The octogenarian cohort exhibited a significantly heavier comorbidity burden, notably higher rates of coronary artery disease (51.3% vs. 29.6%, p < 0.001), systemic hypertension (55.3% vs. 38.1%, p = 0.007), and chronic obstructive pulmonary disease (7.9% vs. 1.6%, p = 0.003). Furthermore, therapeutic systemic anticoagulant use was substantially more prevalent in the elderly group (60.5% vs. 45.0%, p = 0.015). Octogenarians presented overwhelmingly with localized generator pocket infections (73.0% vs. 30.0%, p < 0.001) but paradoxically also demonstrated higher rates of systemic bacteremia and sepsis (26.3% vs. 15.0%, p = 0.019). Microbiological analysis revealed a unique pathogen profile, with Staphylococcus capitis found with significantly higher frequency in the generator pockets of the elderly cohort. Remarkably, despite possessing a higher average lead burden (2.1 vs. 1.2 leads) and extreme comorbidity profiles, octogenarians demonstrated no statistically significant differences in in-hospital mortality (3.9% vs. 4.2%, p = 1.000) or overall length of hospital stay (14.7 vs. 17.2 days, p = 0.386) when compared to the younger cohort. Conclusions: Octogenarians suffering from CIED infections display highly distinct clinical and microbiological profiles, characterized predominantly by elevated rates of localized pocket infections, specific opportunistic pathogens, and a severe underlying comorbidity burden. Crucially, our findings indicate that with the application of modern extraction and management protocols, advanced age alone does not intrinsically correlate with increased in-hospital mortality. Future prevention and perioperative management strategies tailored to this rapidly expanding demographic must heavily prioritize the mitigation of pocket-related complications, particularly considering the high prevalence of concurrent anticoagulation therapy.

Sepsis is a life-threatening syndrome driven by dysregulated immune activation and multi-organ dysfunction, with limited effective therapies. Oxylipins are endogenous lipid mediators that promote the resolution of inflammation and tissue repair, yet their therapeutic potential in systemic inflammatory diseases remains incompletely understood. In this study, we evaluated the effects of two oxylipins, 10-epi-Protectin DX (10-epi-PDX) and Resolvin D5n-3 DPA (RvD5n-3 DPA), in a lipopolysaccharide (LPS)-induced murine endotoxemia model. Given that this model recapitulates key features of systemic inflammation and multi-organ injury relevant to sepsis-associated conditions, oxylipin effects were assessed across major organs implicated in systemic inflammatory pathology. Administration of either oxylipin significantly reduced systemic tissue injury and inflammatory damage in the lungs, kidneys, and liver. These protective effects were accompanied by suppression of inflammatory responses and marked improvements in histopathological outcomes. These findings indicate that 10-epi-PDX and RvD5n-3 DPA possess organ-protective, anti-inflammatory properties in endotoxemia and support further investigation of their potential as therapeutic candidates for limiting systemic inflammatory injury.

Parabiotics (also termed paraprobiotics) are defined as non-viable microbial cells or their components, including peptidoglycans, teichoic acids, surface proteins, that confer health benefits without requiring viability which distinguishes them from traditional probiotics. Their non-viable nature eliminates risks such as microbial translocation, bacteremia, and sepsis, making them suitable for vulnerable populations including immunocompromised, critically ill, paediatric and elderly individuals. In addition, parabiotic exhibit improved thermal stability, extended shelf life, and easier incorporation into functional foods, nutraceuticals, and pharmaceutical formulations without cold-chain requirements. Mechanistically, parabiotics retain immunomodulatory, anti-inflammatory and have barrier-enhancing activities through interactions with host pattern recognition receptors, including Toll-like receptors, modulation of cytokine responses, and reinforcement of gut epithelial integrity. Preclinical and clinical studies support their therapeutic potential such as in case of heat-killed Lactobacillus acidophilus LB (L. acidophilus) has shown efficiency in managing acute paediatric diarrhoea, while heat-inactivated Lacticaseibacillus paracasei PS23 (Lcb. paracasei) has demonstrated improvements in muscle strength and inflammatory markers, including reduced C-reactive protein and interleukin-6 and increased interlukin-10 in elderly individuals. Similarly, inactivated Lactiplantibacillus plantarum (Lpb. plantarum) and Bifidobacterium strains have been associated with benefits in irritable bowel syndrome, atopic dermatitis, respiratory infections, visceral fat reduction, and antibiotic-associated dysbiosis. Synergistic combinations with prebiotics, postbiotics and related bioactives further enhance therapeutic outcomes in inflammatory, metabolic and infectious conditions. Advances in metagenomics, next-generation sequencing, proteomics, metabolomics, CRISPR-Cas systems, and synthetic biology are accelerating strain characterization, functional evaluation, and scalable production. Despite ongoing challenges in standardization and regulated harmonization, parabiotics represent a safe and effective approach for microbiome-targeted interventions. This review synthesizes current evidence on their therapeutic applications, technological advancements, and translational potential, highlighting their role in precision health and next-generation functional nutrition.