Stefano Di Bella, MD
stefanodibella.it
Stefano Di Bella, MD
@stefanodibella.it
Infectious diseases physician & researcher 🦠 University of Trieste
TBE · antimicrobial resistance · rare infections
📜 How infections shaped history, art & fashion
Papers, clinical cases & curiosities #IDSky
Not all antibiotics are equal in the eyes of C. difficile. 🦠

Choice and duration both matter: late-gen cephalosporins, some quinolones and carbapenems top the risk scale.

Stewardship = limiting collateral damage. 🌿

📖 doi.org/10.1128/cmr.00135-23

#CDiff #AMS #IDSky #Microbiome #Antibiotics
October 31, 2026 at 10:59 AM
⏱️ Can cefiderocol really run for 24h? In our case: yes.

6 g/24h continuous infusion by elastomeric pump, 62 days, NDM-producing K. pneumoniae otomastoiditis.
TDM: 100% fT>4–6×MIC. No adverse events.

📄 doi.org/10.1093/jacamr/dlaf066

#IDSky #AMR #OPAT #Cefiderocol #Klebsiella #PKPD #MedSky
October 29, 2026 at 6:59 AM
🧬 Albumin vs streptolysin O

Human serum albumin binds SLO, the pore-forming toxin of S. pyogenes, via domain II: membranes stay intact, haemolysis drops.

A natural buffer against bacterial toxins? 🤔

#IDSky #MicroSky #MedSky #ImmunoSky #StrepA #iGAS #BacterialToxins #InnateImmunity #Streptococcus
October 28, 2026 at 6:40 AM
🦠 When the spinal implant stays, the biofilm stays too.

Our CID letter with Filippo Mearelli & Milo Gatti: retained hardware → think antibiofilm, not just MIC.
Rifampin, fosfomycin, ceftobiprole, daptomycin, delafloxacin.

📄 doi.org/10.1093/cid/ciaf064

#IDSky #MedSky #AMR #Biofilm #OrthoSky
October 27, 2026 at 6:33 AM
Can maggots become an antimicrobial stewardship tool? 🪰

Sterile larvae debride necrotic tissue, and their secretions are antibacterial, anti-biofilm and synergistic with antibiotics.

From battlefield medicine to the AMR era.

📄 doi.org/10.53854/liim-3302-11

#IDSky #AMR #WoundCare #histmed
October 25, 2026 at 8:46 PM
🔎 Clinical Challenge #9
Look carefully at the skin. And then at the eyebrows.
56-year-old man: diffuse erythematous lesions and sensory abnormalities.
What is your diagnosis?
👉 stefanodibella.it/clinical-challenge-9/
#ClinicalChallenge #IDsky #MedSky #DermSky #MedEd
October 25, 2026 at 5:17 PM
📏 BMI isn't the whole story.

In 397 hospitalized #COVID19 patients, a larger neck was associated with 2.5× higher adjusted 30-day mortality hazard, independent of BMI.

doi.org/10.3390/idr1...

#IDSky #InfectiousDisease #MedSky #EpiSky #CriticalCare #Obesity #PublicHealth
October 22, 2026 at 5:40 AM
French soldiers. Algeria. 19th century. 🗃️
Malaria, dysentery… and absinthe. 🦟💚
Military medicine had some rather unconventional ideas.

www.mdpi.com/2413-4155/7/...

#IDSky #Malaria #histmed #HistSTM #MedSky
October 20, 2026 at 8:51 AM
Aspirin isn’t an antibiotic. But Klebsiella may still dislike it. 💊🦠

In lab studies, salicylate reduced capsular polysaccharide production by up to 70%, increasing susceptibility to phagocytosis.

Intriguing mechanism, not clinical proof.

Our review: doi.org/10.3390/biom...
October 19, 2026 at 5:52 AM
💊 Temocillin for UTIs: first Italian multicentre real-world data.

30 patients, a high-risk mix:
🔹 ESBL 56.7%
🔹 Bacteraemia 40%
🔹 Sepsis 50%

✅ Clinical success: 93.3%

A carbapenem-sparing option worth more attention.

📄 www.mdpi.com/2079-6382/15/10/1034

#IDSky #AMR #AntimicrobialStewardship
October 18, 2026 at 6:50 AM
🚪 E. faecalis: the door is usually open.
🏰 E. faecium: expect a fortress.
11 Italian hospitals - 4,858 enterococcal blood isolates.
Ampicillin resistance:
🔹 E. faecalis: 6.8%
🔸 E. faecium: 89.1%
doi.org/10.1089/mdr....
#Enterococcus #AntimicrobialResistance #Microbiology #AntimicrobialStewardship
October 15, 2026 at 9:10 PM
🧫 Mycoplasma & Ureaplasma are not one resistance phenotype.
🇮🇹 5-year data:
Ureaplasma spp. → ciprofloxacin R 39.5%
M. hominis → azithromycin R 60.5%
Species identification matters.
📄 doi.org/10.1089/mdr....
#IDSky #AMR #ClinMicro #MedSky
October 5, 2026 at 11:08 AM
🔎 Any idea what this strange blue object was used for?
The “Blue Henry” (Blauer Heinrich) was a portable sputum flask used by tuberculosis patients.
It even appears in Thomas Mann’s The Magic Mountain, set in a tuberculosis sanatorium.
🎨 Artwork by Anna Dumitriu.
#IDSky #Tuberculosis
October 4, 2026 at 7:25 AM
🦴 Spondylodiscitis with neurological deterioration: decompression does not necessarily mean stabilization.
In selected patients, decompressive laminectomy was associated with neurological recovery, pain relief, and no delayed arthrodesis.
📄 doi.org/10.3390/jpm1...
October 4, 2026 at 7:15 AM
Sweet syndrome beyond the skin.

Ulcerated cutaneous lesions with extensive oral involvement in classical Sweet syndrome—an uncommon presentation with a broad differential diagnosis.

Ragonesi S et al., Dermatology Reports, 2026
doi.org/10.4081/dr.2...
September 13, 2026 at 9:26 PM
A tongue tremor can be a clue to tick-borne encephalitis.

In TBE, tongue tremor has been reported in ~30% of patients during the neurological phase. This short video shows the finding in a woman with TBE from northeastern Italy.

Paper: doi.org/10.1136/pn-2...

#IDSky #TBE
September 13, 2026 at 8:50 PM
Can fosfomycin rescue temocillin activity against KPC-K. pneumoniae?

In KPC-Kp isolates, temocillin + fosfomycin showed 91% synergy.

In 97% of temocillin-resistant isolates, fosfomycin restored temocillin susceptibility

The combination also improved survival in animal model.

👉 lnkd.in/d8fZQ3Y9
September 13, 2026 at 8:33 PM
🧠🦠 Tick-borne encephalitis (TBE) is more than meningitis or encephalitis.

Clinical manifestations, diagnosis, epidemiology, treatment and prevention — with a focus on emerging neurological features.

📄 Read our review:
www.infezmed.it/media/journa...

#TBE #TickBorneEncephalitis #InfectiousDiseases
September 2, 2026 at 4:58 PM
Syphilis changed fashion. Yes, really. 👀

Wigs could hide hair loss, while facial patches may have concealed scars or skin lesions.

From syphilis to plague, TB, HIV/AIDS and COVID-19, infections have shaped fashion through history.

📖 rosa.uniroma1.it/rosa01/medic...
August 8, 2026 at 10:02 AM
🚨 Campylobacter spp. bacteremia 🦠🩸
Happy to share our new systematic review & meta-analysis 📊✨
✅ 25 studies
✅ 2,480 patients
✅ case-fatality risk: 5%
Higher mortality was associated with:
🧫 C. fetus
🛡️ immunocompromised status
🟤 chronic liver disease
📖 lnkd.in/duJQgHR4
June 30, 2026 at 4:34 PM
🦠 Ecthyma gangrenosum: don’t miss it

A small necrotic skin lesion in a neutropenic patient can be the only sign of a life-threatening infection.

Think Pseudomonas aeruginosa → act fast with empirical therapy.

🚀 Early recognition saves lives.

📄 Read more: rdcu.be/fbuu1
April 3, 2026 at 9:34 AM
🚨 This “skin cancer” in a kidney transplant recipient turned out to be something very different.

We report a rare cutaneous Scedosporium infection that clinically mimicked post-transplant malignancy — a potentially dangerous diagnostic pitfall.

doi.org/10.1016/j.di...
March 12, 2026 at 10:38 AM
European Journal of Pharmacology (2026)

We explore the therapeutic potential of butyrate supplementation in sepsis: gut barrier protection, immune modulation, metabolic reprogramming.

Nice preclinical evidence; clinical translation remains an open challenge.

DOI: 10.1016/j.ejphar.2026.178594
January 26, 2026 at 10:14 PM