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Objectives: The emergence of mpox outbreaks in non-endemic areas, characterised by human-to-human transmission and unique clinical presentations, poses challenges in containment efforts. This study aimed to analyse the 2022 outbreak in Slovenia and characterise the country's response to the outbreak., Methods: A retrospective, observational study analysed all confirmed mpox cases in Slovenia between 1 January 2022 and 31 December 2023 and specific public health measures and responses in the country to contain the mpox outbreak. Data were collected from clinical facilities, public health institutions and civil society organisations and analysed accordingly., Results: Of 149 suspected cases tested, 49 were confirmed, all cisgender men, predominantly men who have sex with men (93%), exhibiting skin lesions, with 20% being HIV infected and 62% reporting recently having sex abroad. Hospitalisation was required in 14%, no specific treatment was needed, and no fatalities occurred. After the rapid spread of mpox from May to mid-July 2022, only occasional cases were detected afterwards until the outbreak's termination in early September. Slovenia's containment strategy started immediately after the first case detection, involving rapid diagnostics and active case search, centralised case management and targeted public health measures. The LGBTIQ+ (Lesbian, Gay, Bisexual, Trans, Intersex, Queer and other sexual identities) community civil society organisation Legebitra played a critical role by launching awareness campaigns and promoting easily accessible vaccination. Despite its late start in September 2022, by the end of 2023, the vaccination campaign achieved coverage of 309 individuals., Conclusions: Slovenia's response to the 2022 mpox outbreak highlights prompt multisectoral collaboration, community engagement and timely public health interventions. Rapid diagnostics, centralised case management and targeted outreach likely contributed to containment. While vaccination had limited impact during the outbreak, its importance for long-term prevention cannot be overstated. As the global threat of mpox persists, continuous surveillance, cross-border cooperation and proactive vaccination strategies are recommended activities to address future challenges., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.

Prevalence of HIV in Slovenia is low, and men who have sex with men (MSM) have the highest risk for infection. Rates of enrolment into HIV care, initiation of antiretroviral therapy and reaching an undetectable viral load in HIV-infected patients are very high. Prevention of HIV infection for MSM with PrEP is not formally available in Slovenia. The aim of this study was to demonstrate possible implementation of PrEP in Slovenia. Sixty-nine ( n = 69) MSM with increased risk for HIV received PrEP with oral tenofovir disproxil fumarate /emtricitabine and acquisition were followed for a mean of 566.6 days. They had 71 episodes of STIs (incidence 61.7 per 100 person-years). No one got acquired HIV infection. Estimated glomerular filtration rate (EGFR) was significantly lower 4 ( p = 0.014) and 19 ( p = 0.021) months after inclusion; however, there was no clinically significant renal failure (mean EGFR 110-115 mL/min). Self-reported body weight significantly increased after 7 months ( p < 0.05). Overall EGFR and self-reported body weight did not change significantly. No significant change in adherence (overall mean 81.0%; 95% CI 77.5%-84.6%; p = 0.728), condom use ( p = 0.077) and number of sexual partners (overall mean 2.36 per 30 days; 95% CI 2.06 to 2.65; p = 0.235) was found throughout the study. Participants reported 110 graded adverse effects (AE), 104 (94.5%) grade 1-2 and 6 (5.5%) grade 3-4. No participant discontinued PrEP due to AE. The study showed successful implementation of PrEP among MSM at high risk for HIV infection in Slovenia. Based on the results of our study, PrEP should be formally available in Slovenia.

Purpose. Increasing consumption of colistin as treatment for infections with multidrug-resistant (MDR) Gram-negative bacilli (GNB) has been accompanied by increasingly frequent reports of colistin-resistant (ColR) MDR GNB. Higher selective pressure creates a favourable environment that can facilitate the spread of ColR isolates. Monitoring of asymptomatic ColR GNB carriage can give us a better understanding of this emerging healthcare problem, particularly in wards with higher polymyxin selective pressure and prevalence of carbapenem-resistant GNB. Our aim was to assess the ColR GNB colonization rate in intensive care unit (ICU) patients and evaluate the performance of two surveillance protocols using a selective medium. Methodology. A prospective study included 739 surveillance samples (rectal swabs and tracheal aspirates) from 330 patients that were screened for ColR GNB carriage using SuperPolymyxin medium. Two approaches were used: direct sample plating and overnight pre-enrichment of samples followed by plating. Colistin resistance was confirmed with broth microdilution. ColR isolates were molecularly screened for plasmid-mediated mcr genes. Results. A total of 44/739 samples (45 ColR GNB isolates) were positive for ColR GNB, which included 31/330 (9.4 %) colonized patients; mcr genes were not detected. The direct plating method only identified 17/45 (37.8 %) isolates correctly, whereas the pre-enrichment protocol identified all 45 ColR GNB. Conclusion. The colonization rate among our ICU patients was 9.4  %. Based on our findings, the pre-enrichment step is necessary for the determination of ColR GNB carriage - even though the time to result takes an additional day, fewer than half of ColR GNB carriers were detected using the direct plating protocol.