Decoding virulence and resistance in Klebsiella pneumoniae: Pharmacological insights, immunological dynamics, and in silico therapeutic strategies

Klebsiella pneumoniae (K. pneumoniae) has become a serious global health concern due to its rising virulence and antibiotic resistance. As one of the leading members of ESKAPE pathogens, it plays a major role in a wide range of infections that cause pneumonia, urinary tract infections, and bacteremia, especially in immunocompromised and hospitalized patients. The recent increase in multidrug-resistant (MDR) and hypervirulent (hvKP) strains due to the production of extended-spectrum beta-lactamases (ESBLs) and carbapenemases, has greatly limited therapeutic options that highlights the need for novel approaches to combat the pathogen. This review outlines the virulence mechanisms, profiles of antibiotic resistance, and immune evasion strategies in K. pneumoniae. Also, it points out the role of capsular polysaccharides, lipopolysaccharides, and fimbriae in host colonization and immune evasion. Additionally, the review discusses the emerging therapeutic strategies of vaccine development, computational drug discovery, and the use of artificial intelligence (AI). The progress achieved in reverse vaccinology and structural biology enables the identification of new drug and vaccine targets, whereas AI and machine learning (ML) stand out as powerful candidates for high-throughput screening and drug design. However, challenges with antigenic variability, safety, and the need to collaborate globally still exist. This review focuses on the need for interdisciplinary approaches involving molecular biology and immunology with computational sciences to address K. pneumoniae infections and provide appropriate therapies in the era of antibiotic resistance.

Structural studies on ribosomes of differentially macrolide-resistant Staphylococcus aureus strains

Antimicrobial resistance is a major global health challenge, diminishing the efficacy of many antibiotics, including macrolides. In Staphylococcus aureus, an opportunistic pathogen, macrolide resistance is primarily mediated by Erm-family methyltransferases, which mono- or dimethylate A2058 in the 23S ribosomal RNA, reducing drug binding. Although macrolide-ribosome interactions have been characterized in nonpathogenic species, their structural basis in clinically relevant pathogens remains limited. In this study, we investigate the impact of ermB-mediated resistance on drug binding by analyzing ribosomes from S. aureus strains with varying levels of ermB expression and activity. Using cryo-electron microscopy, we determined the high-resolution structures of solithromycin-bound ribosomes, including those with dimethylated A2058. Our structural analysis reveals the specific interactions that enable solithromycin binding despite double methylation and resistance, as corroborated by microbiological and biochemical data, suggesting that further optimization of ketolide-ribosome interactions could enhance macrolide efficacy against resistant S. aureus strains.

Vitamin K (Menaquinone) from marine Kocuria sp. RAM1: optimization, characterization and potential in vitro biological activities

BACKGROUND

Menaquinone (MK), which is also known as vitamin K2, is a kind of lipoquinone that, unlike humans, is biosynthesized in bacteria through a series of steps as a necessary component of their respiratory chain for electron transport among various components of the bacterial cell membrane. MKs are receiving increasing attention as they play several essential biological roles in humans.

RESULTS

In this study, MK was obtained from Kocuria sp. RAM1, characterized using UV absorbance, and validated using nuclear magnetic resonance spectroscopy (NMR) and liquid chromatography-electrospray ionization-quadrupole time-of-flight mass spectrometry (LC-ESI-QTOF-MS). The chemical characterization revealed a total of six MK analogues that were identified and confirmed as MK-1, MK-3, MK-5 (H2), MK-7 (H6), MK-8 (H2), and MK-9. Subsequent to the execution of a significant optimization model, a total KMs of 394.69 µg/ml was obtained, with the MK-1 analog being the dominant one. The antibacterial, anti-inflammatory, antioxidant, anticancer, antidiabetic, and wound-healing activities of MKs were evaluated in vitro. As a result, we discovered that MKs have promising findings on the tested in vitro activities.

CONCLUSIONS

Our study was made to evaluate MKs obtained from the Red Sea Kocuria sp. RAM1 to emphasize their significant role in different biological applications. Therefore, from a therapeutic and medicinal perspective, the extracted MKs are interesting for additional in vivo studies.

Epidemiological Trends and Drug Resistance Patterns of Carbapenem-Resistant Gram-Negative Bacteria: A Retrospective Study in a Tertiary Hospital in China (2019-2024)

Objective

To elucidate the distribution characteristics and drug resistance of carbapenem-resistant gram-negative bacteria (CR-GNB) within a general hospital setting from 2019 to 2024.

Methods

The distribution characteristics of CR-GNB and antimicrobial resistance patterns among inpatients from 2019 to 2024 were investigated. The detection rate, departmental distribution, annual trends, and drug susceptibility profiles of key carbapenem-resistant bacterial species were compared.

Results

A total of 34, 370 patients infected with GNB were investigated, with 2967 cases identified as CR-GNB. Among these, the nosocomial infection rate of carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were 33.11%, 44.02%, and 22.87%, respectively. The positivity rate for CR-GNB among male patients was 72.94%, with the vast majority of these infected patients (71.88%) aged 65 and above. In 2021, notable shifts in hospital infection control concerning CR-GNB were observed, with a reduction of over 40% in CRAB infection rates and a decline of over 35% in CRPA infection rates. The top three clinical departments with CR-GNB detection were the intensive care unit (ICU), intensive rehabilitation ward (HDU), and emergency ward. CR-GNB accounted for the largest proportion of respiratory infections (73.49%). Clinically isolated CR-GNB exhibited pan-resistance to commonly used clinical antimicrobial drugs, with only cefoperazone/sulbactam, amikacin, and tigecycline demonstrating high sensitivity. Analysis of carbapenemase production revealed a significant prevalence of Ambler class A enzymes.

Conclusion

The detection of CR-GNB in this hospital from 2019 to 2024 indicates a widespread distribution across clinical departments and infection sites, coupled with a high rate of resistance to commonly used antimicrobials. Local hospitals should prioritize the distribution patterns of CR-GNB to develop personalized prevention strategies, strengthen hospital public health and infection prevention and control measures, and promote rational use of antibiotics to effectively curb the spread of CR-GNB infections.

Assessment of Methicillin-Resistant Staphylococcus aureus (MRSA) knowledge and awareness among healthcare workers in South-Lebanon

Background

Methicillin-Resistant Staphylococcus aureus (MRSA) is a well-known cause of hospital acquired infections (HAIs), associated with high rates of morbidity and mortality. In healthcare settings, MRSA can spread via contaminated surfaces and direct contact.

Objective

This study aims to assess the knowledge and awareness of MRSA risks, prevention methods (such as hand hygiene), proper antibiotics use, and multidrug resistance among various groups of healthcare workers (HCWs) in Southern Lebanon.

Methods

A total of 244 HCWs, including those in medical services (MS), paramedical services (PS), and non-medical services (NMS), were conveniently selected for this study. Data was gathered using a structured, validated questionnaire that explored their knowledge and awareness of MRSA risks, prevention measures, hand hygiene practices, and multidrug resistance.

Results

The findings revealed that 68% of HCWs were aware of the origin of MRSA infection, and 61.5% and 51.6% were familiar with its treatment and transmission, respectively. Only 24.2% of HCWs were able to differentiate between hospital-acquired and community-acquired MRSA, 14.7% were aware of the institution's written MRSA control protocols, and 17.6% had heard of MRSA infections. Notably, knowledge and hand hygiene practices were significantly better among MS HCWs than PS and NMS groups (P<0.0001). While all HCWs were familiar with antibiotic usage and drug resistance, NMS HCWs were more likely to use antibiotics without a prescription compared to MS and PS groups (P<0.003).

Conclusion

HCWs in South-Lebanon demonstrated a knowledge gap regarding MRSA risks and prevention guidelines. These findings underscore the need for targeted educational intervention on MRSA, as well as coordinated efforts by healthcare authorities and centres to control MRSA infections.

Chemical composition, antibacterial and antioxidant activities of Piper betle and Anethum graveolens essential oils against Methicillin-resistant Staphylococcus aureus clinical isolates

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of infection worldwide due to its antimicrobial resistance. Plant-derived essential oils (EOs) have undergone extensive observational and clinical research to explore their antimicrobial properties. The present study aimed to check mec A positive MRSA isolates using sequencing analysis, determination of chemical composition using gas chromatography-mass spectroscopy (GC-MS), antioxidant, and antimicrobial activity of Anethum graveolens and Piper betle EOs against the infectious agent MRSA. The result demonstrates a significant antibacterial activity of both essential oils against MRSA clinical isolates. GC-MS analysis of Piper betle showed (41.06%) 3-Allyl-6-methoxyphenol (Eugenol) as the major compound, whereas Anethum graveolens exhibited o-cymene (14.01%) abundantly. Piper betle essential oil retained appreciable levels of total phenolic (39.5 ± 10.9 mg/g of gallic acid equivalents) and flavonoid content (216 ± 145 mg quercetin equivalent/g), when compared to Anethum graveolens essential oil. A strong correlation was observed between antioxidant activity (DPPH, FRAP, and ABTS), total phenolic, and total flavonoid content in the Piper betle and displayed using principal component analysis (PCA) and a scatter matrix plot. Parallelly, clear morphological bacterial alterations were visualized by scanning electron microscopy after treating it with essential oils. MRSA showed malformed cell surfaces or broken cells with pore formation and septae. These findings imply that both essential oils are potential natural sources of antimicrobials against the MRSA superbug. They can also be used in combination therapies with other plant EOs or with traditional antibiotics to combat the rise of bacteria resistance.

Factors associated with core competencies of infection prevention and control practitioners in 511 hospitals: a large cross-sectional survey in Guizhou, south-west China

OBJECTIVE

To examine the determinants that influence the level of core competencies of infection prevention and control practitioners (IPCPs) in different hospitals in Guizhou Province, south-west China.

METHODS

This study conducted a cross-sectional survey of IPCPs from April to June 2022, using a competency self-assessment scale for IPCPs that encompassed four core dimensions, 11 sub-dimensions and 47 measurement items.

RESULTS

The mean ± standard deviation (SD) self-assessed competency score of 1083 IPCPs from 511 hospitals was 4.891 ± 1.204. Among the four core dimensions, the lowest mean ± SD self-assessed score was for professional development ability at 4.494 ± 1.291, and among the 11 sub-dimensions, the lowest score was for comprehensive knowledge at 3.748 ± 1.578. The core competencies of different hospitals showed that traditional Chinese medicine hospitals had the highest score (5.306 ± 1.071). Linear regression analysis showed that the independent factors influencing self-assessed competency were age [B=0.487, 95% confidence interval (CI) 0.189-0.785], years of practical experience of infection prevention and control (IPC) (B=0.216, 95% CI 0.050-0.382), professional title (B=-0.395, 95% CI -0.693 to -0.097), monthly income (B=-0.296, 95% CI -0.484 to -0.107), experience in front-line epidemic response (B=0.236, 95% CI 0.098-0.382), proficiency in office software applications (B=-0.747, 95% CI -0.898 to -0.596), and cultural atmosphere of hospital IPC (B=-0.406, 95% CI -0.799 to -0.013).

CONCLUSIONS

The core competencies of IPCPs in China require enhancement. Differences in the core competencies of IPCPs in different hospitals were identified, providing substantial evidence for further development of competency-based training programmes.

Successful management of Lomentospora prolificans septic arthritis and osteomyelitis in an immunocompetent child: A case report

Available online We report a case of limb-threatening Lomentospora prolificans elbow infection in a 3-year-old immunocompetent boy following a closed fracture. Resolution of infection was achieved following combined aggressive debridement, combined antifungal therapy, voriconazole-loaded bone cement, and antiseptic joint irrigation. This highlights the need for early diagnosis and multi-modal surgical, medical and other novel adjunctive therapies in managing these difficult-to-treat infections. Increased research and improved access to novel antifungal drugs are essential to enhance treatment options for intrinsically multidrug-resistant fungal infections.

A shared approach to managing urinary tract infections in nursing homes improved perceived care quality, workload, and collaboration - a qualitative study

BACKGROUND

In 2019, around 4.95 million global deaths were linked to bacterial antimicrobial resistance (AMR). Managing urinary tract infections (UTIs) in nursing homes involves prevention, diagnosis, and treatment. This is often complex and cause excessive antibiotic use, increasing AMR. Infection prevention and antimicrobial stewardship (AMS) are complementary strategies for reducing AMR. Studies show that nursing home staff can safely reduce antibiotic prescriptions for UTIs using these strategies and that cross-sectoral collaboration with general practice is important in UTI management. However, the impact of combining infection prevention with AMS and general practice is unknown.

OBJECTIVE

To explore the perceived impact of a new cross-sectorial intervention combining prevention and AMS on UTI management in nursing homes.

METHODS

The intervention included a 3-h seminar for general practice and nursing home staff, and a reflection sheet to assess residents. We held 9 seminars in the Capital Region of Denmark in 2022 and conducted 15 semi-structured online and phone interviews with participants.

RESULTS

Our findings indicate that the intervention clarified workflows, encouraged nursing staff to adhere to agreements, and increased trust and respect between nursing homes and general practice. A reflection sheet was essential in linking planned changes to actual implementation. The sheet helped restructure UTI management, leading to perceived improved patient assessment and fewer UTI-related inquiries to general practice.

CONCLUSION

Our findings suggest that the intervention had a positive impact on experienced care quality, workload, and cross-sector collaboration. However, physical attendance at the seminar limits the large-scale implementation of the intervention.

SAGES white paper on antibiotic omission in the management of acute uncomplicated diverticulitis: why, when, who, and most importantly, how

BACKGROUND

Historically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America. The purpose of this SAGES White Paper was to review the available evidence on antibiotic omission in uncomplicated diverticulitis and to explore methods of safe implementation.

METHODS

A task force within the SAGES Colorectal Surgery Committee was formed to work on this White Paper. The committee and its leadership approved an outline that would focus on the following topics: (1) Defining the problem with unnecessary antibiotic exposure; (2) Evaluating the evidence on antibiotic omission in uncomplicated diverticulitis; (3) Identifying the appropriate patient for antibiotic omission; (4) Outlining how to counsel patients who are treated without antibiotics; (5) Reviewing methods to safely implement this practice in both the hospital and community setting. These topics were divided up among members of the task force who performed a structured literature search in preparation for their assignments.

RESULTS

Antibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.

CONCLUSION

The existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.

Antimicrobial resistance: Linking molecular mechanisms to public health impact

BACKGROUND

Antimicrobial resistance (AMR) develops into a worldwide health emergency through genetic and biochemical adaptations which enable microorganisms to resist antimicrobial treatment. β-lactamases (blaNDM, blaKPC) and efflux pumps (MexAB-OprM) working with mobile genetic elements facilitate fast proliferation of multidrug-resistant (MDR) and exttreme drug-resistant (XDR) phenotypes thus creating major concerns for healthcare systems and community health as well as the agricultural sector.

OBJECTIVES

The review dissimilarly unifies molecular resistance pathways with public health implications through the study of epidemiological data and monitoring approaches and innovative therapeutic solutions. Previous studies separating their attention between molecular genetics and clinical outcomes have been combined into our approach which delivers an all-encompassing analysis of AMR.

KEY INSIGHTS

The report investigates the resistance mechanisms which feature enzymatic degradation and efflux pump overexpression together with target modification and horizontal gene transfer because these factors represent important contributors to present-day AMR developments. This review investigates AMR effects on hospital and community environments where it affects pathogens including MRSA, carbapenem-resistant Klebsiella pneumoniae, and drug-resistant Pseudomonas aeruginosa. This document explores modern AMR management methods that comprise WHO GLASS molecular surveillance systems and three innovative strategies such as CRISPR-modified genome editing and bacteriophage treatments along with antimicrobial peptides and artificial intelligence diagnostic tools.

CONCLUSION

The resolution of AMR needs complete scientific and global operational methods alongside state-of-the-art therapeutic approaches. Worldwide management of drug-resistant infection burden requires both enhanced infection prevention procedures with next-generation antimicrobial strategies to reduce cases effectively.

Real-time FT-IR typing of Klebsiella pneumoniae: a flexible and rapid approach for outbreak detection and infection control

BACKGROUND

Expansion of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) is driven by within-hospital transmission, requiring timely typing data for effective infection control.

OBJECTIVES

We evaluated real-time performance and flexibility of our previously developed Fourier-transform infrared (FT-IR) spectroscopy workflow (spectra acquisition and analysis by machine-learning model).

METHODS

All CP-Kp infection isolates (n = 136) identified at a northern Portuguese hospital (April 2022-March 2023) were tested from Columbia agar with 5% sheep blood, identified by FT-IR (KL-type/sublineage) and confirmed by reference methods (wzi sequencing, MLST and/or WGS).

RESULTS

FT-IR typing from Columbia agar with 5% sheep blood showed 73% sensitivity, 79% specificity and 74% accuracy. Our method correctly identified 94% of typeable isolates, 87% of which were communicated in <24 h. Non-typeable isolates belonged to new KL-types to the model (40%) or non-recognized KL-types (60%), most of which (66%) were correctly predicted when retested from Mueller-Hinton agar. Accuracy was then higher (88%) when results from both culture media were considered, and the model retrained to incorporate new sublineages. Three K. pneumoniae sublineages (ST147-KL64, ST15-KL19, ST268-KL20) were predominant and 86% of the isolates were correctly identified. During the study, an outbreak by ST268-KL20 in the neonatal ICU was quickly recognized, and solved in 23 days. Most isolates (98%) produced KPC-3.

CONCLUSIONS

We demonstrate that FT-IR spectroscopy meets high performance standards in real-time and adaptability to clonal dynamics, and we provide practical guidance for integrating FT-IR into daily microbiology practices. The unique time to response (same day as bacterial identification) enables early and effective infection control interventions.

Analysis of rectal carbapenem-resistant Enterobactericeae colonization results first report in Istanbul/Turkiye: Klebsiella pneumoniae co-producing blaKPC + blaNDM + blaOXA-48 in a single strain

BACKGROUND

Carbapenemase-Producing Enterobacteriaceae (CPE) are known to be on the rise globally and are a major concern. Rapid screening of at-risk patients and implementation of infection control measures can prevent colonization from becoming a source of infection.

OBJECTIVE

We investigated the incidence of carbapenem-resistant Enterobacteriaceae (CRE) colonization, CRE-producing Enterobacteriaceae species, carbapenemase gene types and prevalence in patients subjected to CRE screening tests in rectal swab samples using the CHROMAgar culture method and real-time Polymerase Chain Reaction (PCR) method in a tertiary hospital in Istanbul, Turkiye. In addition, we investigated the effectiveness of diagnosis with PCR and CHROMAgar methods by examining whether meropenem-resistant infection foci developed in patients with CRE colonization from hospitalization to discharge.

MATERIALS AND METHODS

This study was conducted retrospectively in the Microbiology Laboratory of 3953 patients at Başakşehir Çam and Sakura City Hospital in Istanbul between January 2021 and December 2023. All data, including CRE colonization screening test results using CHROMAgar and PCR methods, age, gender, requesting clinic, and meropenem-resistant Enterobacteriaceae culture results in infection foci that developed during hospitalization, were obtained from the hospital automated system.

RESULTS

In all 3953 patients included in the study, CRE colonization was screened by CHROMAgar culture method on rectal swab samples and by real-time PCR method in 500 patients. The mean age of the patients was 42.9 ± 30.1 and 58.1% were male. There was no difference in age and gender distribution between the Upon admission to the hospital and during hospitalization groups (p > 0.05). Rectal CRE colonization was detected in 9.7% of all patients with the CROMAgar method and in 9.2% with the PCR method and in 16.2%. The most statistically significant increase was seen in intensive care units with the CHROMAgar method (p < 0.05). Among Enterobacteriaceae species, Klebsiella pneumoniae (69.6%) was most frequently grown, followed by Escherichia coli (13.7%). There was no statistically significant difference between the groups in terms of CRE growth status and microorganism distribution in rectal swab samples of patients during hospitalization and hospital admission (p > 0.05). Among the CRE genes detected by PCR, single genes were the most common. While OXA-48 positivity was detected in 113 (16.40%) of the patients, blaNDM was detected in 31 (4.50%), blaKPC was detected in 5 (0.73%) and bla VIM/IMP gene was detected in 5 (0.73%) of the others. Double gene positivity was observed in a single strain in 6 patients and blaKPC, blaNDM and blaOXA-48 genes were positive together in a single strain in 3 patients. Infection developed in one or more foci resistant to carbapenem in 159 of the patients colonized with CRE during their hospitalization. The rate of infection development was lower in patients colonized by PCR compared to chromogenic agar.

CONCLUSION

The CRE colonization rate is high and should be closely monitored with infection control precautions. Although the detection rate of CRE colonization was higher with PCR, the rate of progression to infection in any focus during hospitalization was found to be lower detected with the CHROMAgar method. This situation showed that rapid detection of CRE colonization with PCR, early diagnosis and isolation are important. Klebsiella pneumoniae colonization was the most common causative agent. Co-production of 3 CRE genes (blaKPC + blaNDM + blaOXA-48) in 3 patients in our hospital highlighted the importance of concerns about multi-resistant Enterobacteriaceae.

A comparison of frequentist and Bayesian approaches to the Personalised Randomised Controlled Trial (PRACTical)-design and analysis considerations

BACKGROUND

Multiple treatment options frequently exist for a single medical condition with no single standard of care (SoC), rendering a classic randomised trial comparing a specific treatment to a control treatment infeasible. A novel design, the personalised randomised controlled trial (PRACTical), allows individualised randomisation lists and borrows information across patient subpopulations to rank treatments against each other without comparison to a SoC. We evaluated standard frequentist analysis with Bayesian analyses, and developed a novel performance measure, utilising the precision in treatment coefficient estimates, for treatment ranking.

METHODS

We simulated trial data to compare four targeted antibiotic treatments for multidrug resistant bloodstream infections as an example. Four patient subgroups were simulated based on different combinations of patient and bacteria characteristics, which required four different randomisation lists with some overlapping treatments. The primary outcome was binary, using 60-day mortality. Treatment effects were derived using frequentist and Bayesian analytical approaches, with logistic multivariable regression. The performance measures were: probability of predicting the true best treatment, and novel proxy variables for power (probability of interval separation) and type I error (probability of incorrect interval separation). Several scenarios with varying treatment effects and sample sizes were compared.

RESULTS

The Frequentist model and Bayesian model using a strong informative prior, were both likely to predict the true best treatment (P best ≥ 80 % ) and gave a large probability of interval separation (reaching a maximum ofP IS = 96 % ), at a given sample size. Both methods had a low probability of incorrect interval separation (P IIS < 0.05 ), for all sample sizes ( N = 500 - 5000 ) in the null scenarios considered. The sample size required for probability of interval separation to reach 80% ( N = 1500 - 3000 ), was larger than the sample size required for the probability of predicting the true best treatment to reach 80% ( N ≤ 500 ).

CONCLUSIONS

Utilising uncertainty intervals on the treatment coefficient estimates are highly conservative, limiting applicability to large pragmatic trials. Bayesian analysis performed similarly to the frequentist approach in terms of predicting the true best treatment.

Antibacterial and antibiofilm efficacy of eugenol, carvacrol, and cinnamaldehyde against colistin-resistant Klebsiella pneumoniae

BACKGROUND

Colistin-resistant Klebsiella pneumoniae (CR K. pneumoniae) is considered one of the bacteria with the highest levels of antibiotic resistance, necessitating the discovery of alternative therapeutic strategies. This study aimed to evaluate the ability of eugenol, carvacrol, and cinnamaldehyde to inhibit CR K. pneumoniae and the biofilm community of this bacterium.

METHOD

The minimum inhibitory concentration (MIC) and antibiofilm effects of compounds were assessed using broth macrodilution and microtiter plate assays, respectively. Time-kill assays determined the bactericidal effects of natural compounds on CR K. pneumoniae isolates. Protein and nucleic acid leakage were examined to assess metabolic disruption and cell membrane integrity. Real-time PCR was used to evaluate the effect of natural compounds on the expression of biofilm-related genes (mrkA, treC, and luxS).

RESULTS

In the disk diffusion test, the inhibition zones of eugenol, carvacrol, and cinnamaldehyde were 15 ± 1, 29 ± 2, and 30 ± 1 mm, respectively. The MIC of eugenol, carvacrol, and cinnamaldehyde were 260, 119, and 128 µg/mL, respectively. The time-kill assay demonstrated the rapid bactericidal effects of eugenol, carvacrol, and cinnamaldehyde at 2× MIC, with kill times of 6, 2, and 3 h, respectively. At the MIC, the kill times were 12, 10, and 12 h, respectively. These compounds significantly released proteins and nucleic acids from the treated bacteria. They also inhibited biofilm formation and disrupted mature biofilms. Furthermore, mrkA and treC expression levels were significantly reduced in the presence of eugenol and cinnamaldehyde.

CONCLUSION

These natural compounds demonstrated significant antibacterial and antibiofilm activity against CR K. pneumoniae, emerging as a promising natural alternative for treatment.

Unveiling Therapeutic Powers of Indigenous Flora: Antimicrobial, Antioxidant, and Anticancer Properties of Horwoodia dicksoniae

Background:Horwoodia dicksoniae Turrill. (Brassicaceae) and Stipa capensis Thunb. (Poaceae) are commonly grown in the eastern region of Saudi Arabia. Methods: This study evaluated the antibacterial and antifungal potential of these plants. H. dicksoniae extract was further subjected to antioxidant, anticancer, GC-MS, LC-MS/MS, and in silico analyses. Results: H. dicksoniae extract presented a higher antimicrobial efficiency than S. capensis extract by effectively inhibiting the growth of Staphylococcus aureus, Escherichia coli, Proteus vulgaris, Bacillus subtilis, and Candida albicans. H. dicksoniae ethanolic extract also demonstrated promising antioxidant and anticancer properties against the human colon cancer cell line HCT-116. GC-MS analysis revealed the presence of 12 natural compounds in the H. dicksoniae extract, whereas LC-MS/MS analysis revealed 19 different compounds in negative ion mode and 25 in positive ion mode. Furthermore, the presence of bioactive compounds in the H. dicksoniae extract, such as flavonoids (acacetin and hesperetin) and caffeic acid, confirmed the observed antibacterial, antifungal, antioxidant, and anticancer activities. Molecular docking revealed promising interactions between various bioactive compounds and target proteins associated with antimicrobial, antioxidant, and anticancer activities. Conclusions: This study is the first to report GC-MS and LC-MS/MS analyses of H. dicksoniae ethanolic extract. The findings provide valuable insights into the potential mechanisms and therapeutic applications of the identified bioactive compounds. Thus, the present work can serve as a platform for the isolation of natural compounds from H. dicksoniae extract, which may play a significant role in the discovery and design of new drugs for the treatment of human diseases.

Management of multidrug-resistant gram-negative bacilli infections in adult solid organ transplant recipients: GESITRA-IC/SEIMC, CIBERINFEC, and SET recommendations update

Multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections in solid organ transplant (SOT) recipients continue to pose a significant threat despite advances in diagnostics and treatments. The last international consensus guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the management of MDR GNB in adult solid organ transplant (SOT) recipients were published in 2018, underscoring the need for an update to incorporate recent advances, particularly the availability of new drugs that may improve the current standard of care. A working group consisting of members from the Study Group of Infection in Transplantation and Immunocompromised Hosts (GESITRA-IC) of SEIMC, the Center for Biomedical Research Network in Infectious Diseases (CIBERINFEC) and the Spanish Society of Transplantation (SET) developed consensus-based recommendations for managing MDR GNB infections during the transplant procedure. Recommendations were categorized based on evidence quality and strength, utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.

Effect of host microenvironment and bacterial lifestyles on antimicrobial sensitivity and implications for susceptibility testing

Bacterial infections remain a major global health issue, with antimicrobial resistance (AMR) worsening the crisis. However, treatment failure can occur even when bacteria show antibiotic susceptibility in diagnostic tests. We explore factors such as phenotypic resilience, bacterial lifestyles such as biofilms, and differences between laboratory tests and real infection sites, highlighting the need for improved platforms to better predict treatment outcomes, and reviewing emerging technologies aimed at improving susceptibility testing.

Stool multiplex PCR assay versus conventional stool tests for detecting gastrointestinal infection as a cause for flare of inflammatory bowel disease

BACKGROUND

In inflammatory bowel disease (IBD), a flare can be due to natural history of disease or due to gastrointestinal infection. Infection is conventionally diagnosed by stool microscopy and culture. Stool multiplex polymerase chain reaction (PCR) assay or Biofire® FilmArray® GI Panel is a sensitive and rapid test for detecting infection, but is expensive; its impact on management and cost-effectiveness has not been studied in IBD.

AIMS

To compare stool PCR assay and conventional tests during IBD flare for detection of infection, impact of detection on treatment and cost-effectiveness of the tests.

METHODS

Sixty-five patients with IBD flare underwent conventional stool tests (microscopy, culture and Clostridioides difficile toxin assay) and stool PCR assay simultaneously.

RESULTS

We prospectively enrolled 65 consecutive patients presenting with disease flare: ulcerative colitis (58 patients, 28 women, mean age 41.1 years) and Crohn's disease (seven patients; three women; mean age 36.1). Stool PCR detected organisms in 36 (55.4%) patients as compared to six (9.2%) by conventional tests (p < 0.0001). The organisms detected by the PCR assay were enteroaggregative (EAEC) (22 patients), enteropathogenic (EPEC) (12), enterotoxigenic Escherichia coli (ETEC) (5), Plesiomonas shigelloides (4), C. difficile (3), norovirus (3), enteroinvasive E. coli (2), rotavirus (2) and G. lamblia, cryptosporidia, cyclospora, Sapovirus, adenovirus and Entamoeba histolytica (one each). PCR organism detection resulted in management change in 13 (20%) patients as compared to five (7.6%) by conventional tests (p < 0.02). Cost to achieve one positive result on stool PCR that led to management change was INR 60,000 (USD 690, EUR 638) as compared to Indian Rupees (INR) 54,600 (United States Dollar [USD] 627, EUR 580) for conventional tests. The incremental cost-effective ratio (ICER) was INR 63,375 (USD 728, EUR 674).

CONCLUSION

In an IBD flare, stool PCR or Biofire® FilmArray® GI Panel detected more organisms and led to more frequent management change as compared to conventional tests. The ICER was INR 63,375 (USD 728, EUR 674). This test should be considered first-line investigation in an IBD flare.

Synurus deltoides Alleviates Anti-Depressive Like Behavior Dysfunction Induced by Chronic Unpredictable Mild Stress via Stress-Related CRF/TLR Pathway

This study was aimed at assessing the protective effect of the 80% ethanolic extract of Synurus deltoides (EESD) on chronic unpredictable mild stress (CUMS)-induced depressive-like behavior dysfunction. The bioactive compounds of S. deltoides were identified as quinic acid, chlorogenic acid, rutin, 1,3-dicaffeoylquinic acid, and dicaffeoylsuccinoylquinic acid. EESD and bioactive compounds in EESD significantly protected corticosterone-induced hippocampal cellular death and reactive oxygen species (ROS) contents compared to vitamin C in HT22 cells. By conducting the sucrose preference test, forced swimming test, open field test, and tail suspension test, EESD was found to significantly suppress depression-like behavior. EESD effectively reduced mitochondrial dysfunction by regulating cerebral ROS levels, mitochondrial membrane potential, and ATP contents. EESD showed a considerable regulatory effect by regulating serum stress hormones including corticosterone, norepinephrine, serotonin, 5-hydroxyindoleacetic acid, and melatonin. In addition, EESD significantly suppressed stress-related CRF pathway, inflammatory TLR pathway, and apoptotic signal in cerebral tissues. These results suggest that EESD might be a natural plant substance that improves CUMS-induced behavior abnormality by regulating inflammation and hormonal changes in brain tissue. In the future, additional clinical trials or efficacy evaluations of individual compounds of EESD will be needed to confirm the bioactivity ability and usability of EESD.

Advances in understanding therapeutic mechanisms of probiotics in cancer management, with special emphasis on breast cancer: A comprehensive review

The increasing global prevalence of cancer, particularly breast cancer, necessitates the development of innovative therapeutic strategies. Probiotics, proficient in promoting gut health, have emerged as promising candidates for cancer treatment due to their immunomodulatory and potential anticancer properties. This review focuses on the therapeutic mechanisms of probiotics in breast cancer, examining their anticancer efficacy through metabolic, immune, and molecular mechanisms. Probiotics enhance cancer therapies, minimize side effects, and offer new adjuvant approaches in oncology. Recent advancements discussed in the review include the utilization of probiotics as oncolytic gene expression systems and drug delivery vectors, as well as personalized probiotic interventions aimed at optimizing cancer therapy. Clinical studies are critically evaluated, highlighting both the outcomes and limitations of probiotic use in cancer patients, particularly those suffering from breast cancer. Additionally, the review explores factors influencing anticancer effects of probiotics, focusing on their role in modulating the tumor microenvironment. Challenges in translating preclinical findings to clinical practice are discussed, along with future research directions, focusing on the relationship between probiotics, the microbiome, and cancer treatment. Ultimately, this review advocates for further investigation into the therapeutic potential of probiotics in breast cancer, aiming to harness their benefits in oncology.

Short- and long-read metagenomics uncover the mobile extended spectrum β-lactamase (ESBL) and carbapenemase genes in hospital wastewater in Sri Lanka

The antibiotic resistance issue in low- and middle-income countries has drawn global concern. This study presents the first metagenomic investigation of antibiotic resistance genes (ARGs) in hospital and municipal wastewater treatment plants (WWTPs) in Sri Lanka, using Illumina short-read and Nanopore long-read sequencing. Samples from three representative WWTPs receiving hospital and/or municipal wastewater (domestic generated) were collected from four districts in Sri Lanka, and as a comparison, wastewater directly discharged without treatment was also taken. ARG abundance was significantly higher in hospital wastewater (7.22 copies/cell) than in municipal wastewater (2.33 copies/cell), and greatly decreased by 82 % and 93 % after treatment processes, respectively. Similar trends were observed for mobile genetic elements. The prevalent subtypes of clinically relevant extended spectrum β-lactamase (ESBL) and carbapenemase genes in hospital wastewater were blaOXA, blaGES, blaVEB and blaTEM, whereas blaCTX-M and blaNDM were less dominant, which indicated the potential unique distribution pattern of ESBL and carbapenemase genes in Sri Lanka. Using long-read metagenomics, bacterial host range and genetic locations (plasmid or chromosome) of ARGs in sludge samples were predicted. Diverse pathogenic host taxa (Pseudomonas, Streptococcus, Salmonella and Escherichia) and a higher plasmid proportion were identified in the hospital WWTP (39.8 % vs. 21.5 % in the municipal WWTP). Detected mobile genetic contexts in this study, IS6100-sul1-blaOXA-329-blaGES-5-blaGES-5-intI1 and ISKpn6-blaKPC-2-ISKpn7-ISPsy42, were also common in antibiotic-resistant plasmids in Enterobacteriaceae from different countries. These data will serve to expand the inventory of global ARG epidemiology. Also, the finding emphasizes that the wastewater treatment projects, especially in healthcare facilities, are vital for reducing clinically relevant ARG discharge to the environment. Further monitoring using advanced meta-omics approaches is crucial to assess potential ARG risks and optimize control strategies for improving human and ecosystem health in Sri Lanka.

The role of antimicrobial prophylaxis in brachytherapy for prostate, breast and gynaecological cancer: a narrative review

Proper antimicrobial prophylaxis is critical for reducing the risk of infection during interventional procedures. Brachytherapy, a highly effective radiation therapy for various malignancies, allows for precise radiation delivery; however, the use of foreign material as instrumentation for brachytherapy potentially increases the risk of infection. Understanding infectious complications and proper antimicrobial use in this case is essential for successful outcomes and patient safety. The aim of this review is to provide insights and summarize existing information on the infectious complications of brachytherapy in prostate, breast and gynaecological (cervical and endometrial) cancer, as well as on the potential benefit, if any, of administering antimicrobial prophylaxis. Infectious complication rates in prostate, breast and gynaecological cancer brachytherapy remain low with diverse prophylactic regimens, emphasizing the need to identify risk factors for tailored practices. The choice of the antimicrobial regimen, type of device and modality influences the probability of infectious complications. There is minimal overlap of existing brachytherapy guidelines with surgical prophylaxis guidelines. Infectious outcomes and antimicrobial resistance are underreported, and guidance for antimicrobial-resistant organisms is scarce. When indicated, prophylaxis for less than 24 h is efficient. More studies oriented towards antimicrobial prophylaxis on this specific population are needed.

Severe community-acquired pneumonia (sCAP): advances in management and future directions

Severe community-acquired pneumonia (sCAP) is a major global health challenge, with high morbidity and mortality, especially among patients requiring intensive care. Despite advancements in antimicrobial therapies and supportive care, sCAP remains a significant threat, particularly for those needing invasive mechanical ventilation or vasopressor support. Recent progress in diagnostics, therapeutics and management strategies offers hope for improved outcomes. Pathogen-specific management is now central to sCAP care, with molecular diagnostics enhancing pathogen detection accuracy and enabling tailored antimicrobial therapy. These tools help combat antimicrobial resistance by reducing unnecessary broad-spectrum antibiotic use.Host immune responses in sCAP vary widely and significantly impact outcomes. Some patients face an overwhelming pathogen burden, while others experience excessive immune responses, such as acute respiratory distress syndrome. This distinction is vital for guiding immunomodulatory therapies, as immunosuppression may benefit hyperinflammatory states but harm those overwhelmed by infection. Corticosteroids, though controversial, show potential benefits in select populations but carry risks like secondary infections and hyperglycaemia, requiring a nuanced approach.Non-invasive respiratory support strategies, such as high-flow nasal oxygen, have transformed care by improving oxygenation and reducing the need for invasive ventilation. However, their efficacy depends on timing, patient tolerance and disease severity, necessitating careful monitoring.Global disparities in sCAP management, particularly in low-income and middle-income countries, highlight the need for region-specific guidelines and scalable solutions. Limited access to advanced diagnostics and critical care resources exacerbates poor outcomes, underscoring the importance of investments in affordable diagnostics, infection control and multidisciplinary training. Emerging technologies, such as artificial intelligence and advanced imaging, promise to revolutionise sCAP management by enabling precision medicine and real-time insights into disease severity. A holistic, multidisciplinary approach integrating these advancements is essential to improving outcomes and advancing personalised care for this life-threatening condition.

Therapeutic effect and concomitant toxicity of hydrargyrum chloratum compositum on chronic difficult-to-heal wounds in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Hydrargyrum chloratum compositum(Hcc) is a traditional Chinese medicine for external use, with the efficacy of 'transforming corrosion and pulling out toxins, removing corrosion and regenerating muscles'. The main components are mercuric chloride (HgCl2) and mercurous chloride (Hg2Cl2), which have antibacterial, corrosive and tissue repairing effects. However, the therapeutic mechanism and toxicity risk of its topical application for treating difficult-to-heal wounds have not been clearly explained.

AIMS OF THE STUDY

To investigate the therapeutic mechanism of Baishuidan on chronic non-healing wounds in rats and to assess the risk of mercury toxicity.

METHODS

The antimicrobial activity of Hcc against Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, and Streptococcus-β haemolyticus was assessed by the circle of inhibition assay, Minimum inhibitory concentration(MIC) and Minimum bactericidal concentration(MBC) assay and 24-h inhibition curve. SD rats were used to establish a chronic difficult-to-heal wound model. The efficacy of C. albicans and its effects on inflammatory and angiogenic factors were assessed by wound healing rate, histopathological analysis, immunohistochemical staining, and Elisa assay. The pathological effects of Hcc on the principal organs of rats and the accumulation of mercury ions were detected by hematoxylin-eosin (H&E) staining and atomic absorption spectrophotometry (AAS).

RESULTS

Hcc showed different degrees of bacteriostatic effects on Staphylococcus aureus, Streptococcus-β haemolyticus, Pseudomonas aeruginosa, and Candida albicans. Among them, the most significant inhibitory effect was on S. aureus (MIC 4 μg/mL, MBC 8 μg/mL). Hcc significantly promoted the healing of skin wounds in rats, with the best effect in the middle-dose group. Pathological analysis showed that collagen fibre production and neocapillary formation increased and inflammatory cell infiltration decreased in the treatment group. Hcc improved the microenvironment of wounds by decreasing the level of the pro-inflammatory factor IL-6 and increasing the level of the anti-inflammatory factor IL-10. By activating the Pi3k - Akt and Notch1 - Vegfa signalling pathways, Hcc promotes cell proliferation and angiogenesis, accelerating wound healing. Hcc did not cause significant pathological damage to the major organs of rats at the therapeutic dose. However, a significant accumulation of mercury ions was detected in the kidneys, suggesting that long-term use may cause damage to renal function.

CONCLUSION

This study is the first to systematically investigate the multi-target, multi-pathway mechanism of action of Hydrargyrum Chloratum Compositum (Hcc) in treating chronic hard-to-heal wounds and to comprehensively assess its potential mercury toxicity risk. Through in vitro antimicrobial assays, animal models, histopathological analyses, protein expression and mercury ion accumulation assays, the present study revealed the unique mechanisms of Hcc in promoting wound healing, including inhibition of bacterial growth, modulation of immune-inflammatory responses, promotion of angiogenesis, and activation of key signalling pathways (Pi3k-Akt and Notch1-Vegfa pathways). In addition, this study is the first to evaluate the accumulation of mercury ions in Hcc in different organs, especially the significant accumulation in the kidney, which provides important safety data for clinical application. Compared with the existing literature, the present study verified the antimicrobial activity of Hcc, and revealed its specific mechanism in promoting wound healing, providing a scientific basis for the clinical use of Hcc.

Terbinafine Resistance in Trichophyton rubrum and Trichophyton indotineae: A Literature Review

BACKGROUND/OBJECTIVES

Terbinafine has been the gold standard for the management of superficial fungal infections. The etiological agent generally is Trichophyton rubrum (T. rubrum); however, there has been increased reporting of a new terbinafine-resistant strain of the T. mentagrophytes complex (T. mentagrophytes ITS genotype VIII otherwise known as T. indotineae). Here, we review the epidemiology, clinical features, diagnosis, and treatment of T. rubrum and T. indotineae infections.

METHODS

We conducted a systematic literature search using PubMed, Embase (Ovid), and Web of Science, resulting in 83 qualified studies with data summarized for clinical features, antifungal susceptibility, and terbinafine resistance mechanisms and mutations.

RESULTS

Dermatophytosis is most commonly caused by T. rubrum; however, in certain parts of the world, especially in the Indian subcontinent, T. indotineae infections have been reported more frequently. The majority of T. rubrum isolates remain susceptible to terbinafine (over 60% of isolates show MIC50 and MIC90 < 0.5 µg/mL). In contrast, for T. indotineae, 30% of isolates exhibit MIC50 ≥ 0.5 µg/mL and 80% exhibit MIC90 ≥ 0.5 µg/mL. Frequently detected squalene epoxidase (SQLE) mutations in T. rubrum are Phe397Leu/Ile (41.6%) and Leu393Phe (20.8%); in T. indotineae, these include Phe397Leu (33.0%) and Ala448Thr (24.5%). Other potential terbinafine resistance mechanisms in T. rubrum and T. indotineae are discussed.

CONCLUSIONS

T. rubrum generally remain susceptible in vitro to terbinafine in contrast to T. indotineae. The essential components of an effective antifungal stewardship emphasize accurate clinical and laboratory diagnosis, susceptibility testing, and appropriate antifungal therapy selection with a multidisciplinary approach.

Establishing Core Competencies for Antimicrobial Stewardship Teams: A Consensus Development Using the Modified Delphi Technique; an ESGAP position paper

OBJECTIVES

This study aimed to identify and develop a standard set of competencies needed for members of an AMS team.

METHODS

A panel of experts in AMS utilized a survey based on a modified Delphi technique to establish consensus on AMS competencies.

RESULTS

The authors identified 88 competencies covering 15 domains with strong agreement by 58 international experts. The identified domains were: the objectives of AMS; management of infection; microbiology diagnostics; pharmacology of antimicrobial agents; general principles of antibiotic use; the structure and the position of AMS; antimicrobial stewardship interventions; AMS in special settings; surveillance and monitoring; behavior change and communication; infection prevention and control; quality management and patient safety; IT support; communication with patients and general public and governance/policy framework. The consensus-based list of competencies was ratified by ESGAP Executive Committee.

CONCLUSIONS

The identified competencies can be used as a tool in planning of AMS training and to develop and optimize AMS programmes worldwide.

Exploring Interindividual Variability in Resilience to Stress: Social Support, Coping Styles, and Diurnal Cortisol in Older Adults

The psychobiological response to stress is known to be a key factor affecting health at any age, but especially in older adults. It involves the hypothalamic-pituitary-adrenal (HPA) axis, a hormonal circuit whose product is the activation of cortisol. We sought to explore the relationships leading to resilience to stress, as exemplified by the model of aging, stress, and resilience, in a sample of older adults at risk for mental health problems. Specifically, we examined the concurrent effects of individual age-related determinants, social support, and coping style on the cortisol awakening response (CAR), the cortisol area under the curve (AUC) with respect to ground, and the rate of change of cortisol from the awakening peak to bedtime. Our results showed an association between life impairment and health problems on the three indicators of HPA disturbance. An higher AUC was also observed in older age and in individuals reporting more major life events. Less use of avoidance coping was also associated with greater levels of CAR and AUC. Although significant, the measured determinant explained only a small part of the total interindividual variability in our three cortisol indices. Other factors, such as same-day stressors especially in older populations at risk for psychological distress, should be considered in future studies.

Identification of drug combinations to reduce the risk of pioglitazone-related bladder cancer using the FDA adverse event reporting system database

BACKGROUND

Emerging studies have uncovered the innovative pharmacological characteristics of pioglitazone (PLZ). However, concerns regarding the potential link to an increased risk of bladder cancer (BC) had constrained its clinical application.

RESEARCH DESIGN AND METHODS

BC reports associated with PLZ and drug combinations containing PLZ from 1 January 2004 to 30 September 2024 were identified from the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Reporting odds ratio (ROR) and Bayesian confidence propagation neural network (BCPNN) method was applied to mine adverse drug event signals.

RESULTS

Of 144 combinations, 15 showed an IC025 greater than 3, denoting a strong signal; 44 had an IC025 between 1.5 and 3, indicating moderate signal intensity; 36 had an IC025 between 0 and 1.5, pointing to a weak signal; and 49 had an IC025 less than 0, suggesting no apparent related signal. Importantly, the IC025 values for all drug combinations did not surpass the value observed when PLZ was used as monotherapy.

CONCLUSIONS

Through comprehensive data mining, 14 PTs associated with BC were identified, indicating that specific medication combinations might mitigate the risk of PLZ-related BC. Our findings offer valuable insights for guiding decisions on PLZ combination therapies.

Factors affecting treatment adherence in people with HIV - A single-Centre Descriptive Study from Turkey

BACKGROUND

Treatment adherence is extremely important for virological suppression and a good clinical outcome in HIV. People with good adherence to treatment are less likely to experience treatment failure and have a better clinical course of the infection. In this study, we aimed to elucidate the factors affecting treatment adherence in people with HIV in a single centre from Turkey.

METHODS

The study was conducted at Tepecik Training and Research Hospital between September 2022 and December 2022. People with HIV over the age of 18 years who had been on ART for at least 6 months were included. Researchers designed a questionnaire by reviewing the literature to include factors that may affect treatment adherence.

RESULTS

A total of 306 people participated in the study (non-response rate: 30%), of which 86% were male. Among the individual factors, feeling depressed (19.5%), treatment fatigue (18.5%), and anxiety about not being able to have a healthy child (18.2%) were prominent. Major HIV/AIDS-related factors were the presence of AIDS-related opportunistic infection/cancer/comorbidity (20.9%) and lack of cure with current treatment (20.5%). Concern about side effects (14.6%) and drug-drug interaction (13.6%) were the most frequently mentioned ART-related factors. Main healthcare facility-related barriers for adherence were insufficient counselling (15.2%) and inability to reach the HIV physician (15.1%). Only a few patients stated factors related to the health system.

CONCLUSION

In our study, the most significant factors affecting treatment adherence appeared to be individual and HIV/AIDS-related. It is important to be aware of these factors and to spend time on tailored counselling during initial diagnosis and follow-up visits.

The gastrointestinal mycobiome in inflammation and cancer: unraveling fungal dysbiosis, pathogenesis, and therapeutic potential

The gastrointestinal mycobiome, comprising diverse fungal species, plays a significant role in gastrointestinal carcinogenesis and inflammatory bowel disease (IBD) pathogenesis. Recent studies have demonstrated that dysbiosis of the gut mycobiome, characterized by an overrepresentation of pathogenic fungi such as Candida albicans and Aspergillus, correlates with increased inflammation and cancer risk. For instance, C. albicans has been shown to induce colonic inflammation through the activation of pattern recognition receptors and the release of pro-inflammatory cytokines, exacerbating IBD symptoms and potentially facilitating tumorigenesis. Additionally, metagenomic analyses have revealed distinct fungal signatures in colorectal cancer tissues compared to adjacent healthy tissues, highlighting the potential of fungi as biomarkers for disease progression. Mechanistically, gut fungi contribute to disease through biofilm formation, mycotoxin secretion (e.g., aflatoxins, candidalysin), pro-inflammatory cytokine induction (e.g., IL-1β, IL-17), and disruption of epithelial barriers-creating a tumor-promoting and inflammation-prone environment. Furthermore, the interplay between fungi and the bacterial microbiome can amplify inflammatory responses, contributing to chronic inflammation and cancer development. Fungal interactions with bacterial communities also play a synergistic role in shaping mucosal immune responses and enhancing disease severity in both cancer and IBD contexts. As research continues to elucidate these complex fungal-host and fungal-bacterial interactions, targeting the gut mycobiome may offer novel therapeutic avenues for managing IBD and gastrointestinal cancers, emphasizing the need for integrated, mechanistically informed approaches to microbiome research.

Cognition and behavior in neurofibromatosis type 1: report and perspective from the Cognition and Behavior in NF1 (CABIN) Task Force

Individuals with neurofibromatosis type 1 (NF1) are prone to the evolution of neurodevelopmental symptomatology including motor delays, learning disabilities, autism, and attention deficits. Caused by heterozygous germline mutations in the NF1 gene, this monogenic condition offers unique opportunities to study the genetic etiologies for neurodevelopmental disorders and the mechanisms that underlie their formation. Although numerous small animal models have been generated to elucidate the causes of these alterations, there is little consensus on how to align preclinical observations with clinical outcomes, harmonize findings across species, and consolidate these insights to chart a cohesive path forward. Capitalizing on expertise from clinicians; human, animal, and cellular model research scientists; and bioinformatics researchers, the first Cognition and Behavior in NF1 (CABIN) meeting was convened at the Banbury Center of Cold Spring Harbor Laboratory in October 2024. This Perspective summarizes the state of our understanding and a proposed plan for future investigation and exploration to improve the quality of life of those with NF1.

Trends in surgical site infection and periprosthetic joint infection after primary total hip arthroplasty in two national health registers 2013-2022

BACKGROUND

This study aimed to assess trends in surgical site infection (SSI), re-operations for SSI, and re-operations for periprosthetic joint infection (PJI) following primary total hip arthroplasty (THA) in Norway from 2013 to 2022. Two national health registers were used to compare their abilities as surveillance tools for PJI after primary THA.

METHODS

The Norwegian Surveillance System for Healthcare-Associated Infections (NOIS) was evaluated for 30-day incidence and risk of SSI and reoperations for SSI after THA. Reporting to NOIS is mandatory. The Norwegian Arthroplasty Register (NAR) was assessed for 30-day and 1-year incidence and risk of re-operation due to PJI after THA. Reporting to NAR is based on patient consent. Descriptive statistics and adjusted Cox regression analyses, accounting for sex, age and American Society of Anesthesiology class, were performed.

RESULTS

A total of 87,923 primary THAs were included in NOIS, with 1393 (1.6%) reported as 30-day SSIs. The 30-day re-operation rate for SSI in NOIS was 0.9% (N = 765), with 96% completeness of 30-day follow-up. In NAR, out of 91,194 THAs, the 30-day re-operation rate for PJI was 0.8% (N = 725) and the 1-year rate was 1.2% (N = 1019). The completeness of 30-day re-operation for PJI in NAR compared with re-operation for SSI in NOIS was 95%. Annual risk factors were similar across registers. There was a corresponding decline in SSI [adjusted hazard rate ratio (aHRR) 0.92, 95% confidence interval (CI) 0.90-0.93] and reoperations for SSI (aHRR 0.95, 95% CI 0.92-0.97) in NOIS, and reoperations for PJI (30 days: aHRR 0.96, 95% CI 0.94-0.99; 1 year: aHRR 0.95, 95% CI 0.95-0.99) in NAR.

CONCLUSION

There has been a corresponding decline in SSI and re-operation for PJI between 2013 and 2022. The 95% completeness of 30-day re-operation for PJI in the patient-consent-based NAR, compared with the mandatory NOIS, is considered excellent. The findings indicate a genuine reduction in the incidence of SSI and PJI after primary THA.

The impact of climate change on travel-related vector-borne diseases: A case study on dengue virus transmission

INTRODUCTION

Climate change significantly affects global health, particularly through the increased transmission of vector-borne diseases like dengue fever. This study examines how climate change influences the geographical spread of Aedes aegypti mosquitoes, the main carriers of dengue, highlighting its implications for public health worldwide.

MATERIALS AND METHODS

This study employed a comprehensive approach to evaluate the effect of climate change on dengue transmission dynamics. It included environmental data analysis, mosquito population surveys, and dengue case reports. Remote sensing data was used to track changes in temperature, precipitation, and humidity in dengue-prone areas. Field surveys measured mosquito density, while molecular techniques assessed viral load in Aedes mosquitoes. Additionally, mathematical modeling predicted dengue's future spread under various climate scenarios.

RESULTS

The findings indicate a significant correlation between rising temperatures, changing rainfall patterns, and the expansion of Aedes aegypti habitats, resulting in increased mosquito populations in previously non-endemic areas. This ecological shift is linked to a rise in dengue incidence in regions affected by climate change. Projections suggest a 25 % increase in dengue spread by 2050, especially in Southeast Asia, sub-Saharan Africa, and parts of South America.

DISCUSSION

The study highlights the significant effects of climate change on mosquito distribution and the increasing rates of dengue fever. Warmer temperatures and altered rainfall patterns enhance mosquito growth and virus transmission, while global travel aids the spread of the virus. It emphasizes the necessity for early intervention strategies, including better surveillance, vector control, and adaptations to climate changes, to tackle future dengue transmission issues.

Risk factors for neurosyphilis in HIV patients: A retrospective cohort study

INTRODUCTION

Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, asymptomatic neurosyphilis patients are not rare in the HIV population and other risk factors should be defined to guide screening.

METHODS

We performed a retrospective cohort to evaluate risk factors related to neurosyphilis in HIV patients. Adults with HIV infection and laboratory confirmed syphilis between 2011 and 2021 were included. Patients with no record of syphilis treatment, VDRL titers ≤ 1:4, other neurologic diseases or non-HIV related immunological impairment were excluded. The patients were followed for 2-years after syphilis diagnosis.

RESULTS

One-hundred and forty patients (190 syphilis episodes) were included, with mean age of 45.0 ± 9.2-years-old, 111 (79.3 %) were male, 48 (25.8 %) had CD4 count ≤ 350 cells/mm3 at syphilis diagnosis (median: 522.5 cells/mm3; IQR: 315.5‒703.5), 127 (66.8 %) of 172 had a HIV viral load ≤ 400 copies/mm3 and median serum VDRL titer was 1:64 (IQR: 1:16‒1:128). In multivariate analysis, serum VDRL titers ≥ 1:32 and the presence of neurologic symptoms were associated with neurosyphilis, while HIV viral load ≤ 400 copies/mm3 was a protective factor.

DISCUSSION

In addition to the presence of neurological symptoms, HIV viral load > 400 copies/mm3 and VDRL titers ≥ 1:32 were shown to be risk factors for neurosyphilis in this study and diagnostic lumbar puncture should be considered in these cases.

Surveillance of device-associated infection rates at adult intensive care units in the VINCat program (2010-2022)

INTRODUCTION

Surveillance is an essential part of the control of device-related nosocomial infections (NI) in intensive care units (UCIs). The aim of this study was to analyze the evolution of device-related infection rates in ICUs over the last 13 years, including ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI).

MATERIAL AND METHODS

Patients admitted to the 44 ICUs at 43 participating hospitals of the VINCat Program from 2010 to 2022 were included, taking into account three periods: first period (2010-2013), second period (2014-2017) and third period (2018-2022). Hospitals were classified into three groups according to their size: small (<200 beds), medium (200-500 beds) and large (>500 beds). Complexity was assessed based on the use of invasive mechanical ventilation. The incidence rate of VAP, CRBSI and CAUTI was recorded at least during three consecutive months/year in each unit by an intensivist with extensive experience.

RESULTS

The device utilization ratio (DUR) of mechanical ventilation was 0.39, varying between 0.38 in large hospitals and 0.42 in small hospitals. The DUR of central venous catheter was 0.6, ranging from 0.59 (large hospitals) to 0.64 (small). The DUR of urinary catheter was 0.66, with a range of 0.65 (large hospitals) to 0.68 (small). The complexity of the different ICUs influenced the DUR of the different devices and the infections associated with them. The average rates of VAP, CRBSI, and CAUTI were 6.4, 1.9, and 3.4 episodes per 1000 device days respectively.

CONCLUSIONS

Surveillance systems provide information on intra-ICU infections. ICU complexity, measured in terms of the use of mechanical ventilation, influences device-associated infections.

Risk Factors for Infections Caused by Extended-spectrum Beta-Lactamase Producing and Carbapenem-resistant Enterobacterales in Pediatric Critical Care Settings: A Case-control Study

BACKGROUND

Infections due to Gram-negative resistant bacterial pathogens are a major concern in intensive care units (ICUs). Risk factors for extended-spectrum beta-lactamase (ESBL)-producing enterobacterales (ESBL-PE) and carbapenem-resistant enterobacterales (CRE) infections in pediatric critical care settings remain unclear.

METHODS

This was a retrospective case-control study of infections due to ESBL-PE and CRE during a 5-year period (2016-2021). Control cases were matched for age, infection site and year of infection, but their cultures grew enterobacterales that were non-ESBL or carbapenemase producers.

RESULTS

A total of 57 patients with ESBL-PE or CRE infections (cases) and 59 control patients were included. The majority of organisms were Escherichia coli and Klebsiella species recovered from the respiratory tract. There was no difference in prior hospital admission, pediatric ICU, or neonatal ICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (P > 0.3). Risk factors evaluated by univariate analysis included the history of antibiotic use in the last 6 months, antibiotic treatment with cephalosporins including cefepime, cephalosporins treatment duration ≥7 days, treatment with trimethoprim/sulfamethoxazole and carbapenems and vancomycin use ≥ 7 days. However, multivariate logistic regression analysis showed that cefepime use ≥ 7 days was the single best predictor for cases with an odds ratio of 2.205-fold (95% confidence interval, 1.403-3.466; P < 0.001).

CONCLUSIONS

Cefepime use ≥ 7 days was the most predictive risk factor of ESBL-PE and CRE acquisition. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.

Multi-drug-resistant bacteria on household textiles: characteristics, transmission and low-temperature washing

The aim of this study was to analyse how the properties of reference-resistant bacterial strains and textiles affect the transmission of bacteria, the antibacterial potential of detergents and disinfectants and how this can be implemented in low-temperature washing. Bacterial cells were characterised by a hydrophobicity test, and textiles were characterised by roughness and surface energy. Transmission and suspension tests were then carried out, followed by an evaluation of the wash. The results show that cotton has the highest roughness, polyester is the most hydrophobic and MRSA (methicillin-resistant Staphylococcus aureus) is the most hydrophobic bacterium. It was observed that resistant bacteria can be transmitted to a considerable extent via household textiles. The suspension test showed that the 0.5% European Colourfastness Establishment (ECE) reference detergent did not achieve a sufficient reduction (>5 log colony forming units - CFU) for any of the strains tested, whereas the addition of 3% hydrogen peroxide or 4% quaternary ammonium silicone compound did so for all of them. Washing at 60 °C reduced the textile contamination sufficiently (>4 log CFU) for all strains tested, while the criteria for cross-contamination and wash water were not met (<1.1 CFU/mL). However, the addition of disinfectants to the detergent at 30 °C met all hygiene requirements with the complete elimination of all tested bacteria on all textiles. Washing home textiles contaminated with resistant bacteria at low temperatures was only possible if a disinfectant was added. Otherwise, textiles can be an important vehicle for the transmission of resistant bacteria in domestic facilities.

Rethinking Antibiotic Prophylaxis for Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: First, Do No Harm

Antibiotic prophylaxis for spontaneous bacterial peritonitis (SBPPr) in patients with cirrhosis has been considered the standard of care since the 1990s and is currently recommended by several major gastroenterological societies. However, the evidence that supports this practice is weak, and there is no clear mortality benefit. The unintended consequences of this strategy are not insignificant, both at the patient and population levels. Recent evidence suggests that SBPPr may even cause harm. Since the widespread implementation of SBPPr 3 decades ago, our overall approach to antibiotic use has shifted. We now recognize the growing threat of antimicrobial resistance, the potential harms of antibiotics, and the vital role of antimicrobial stewardship. In light of recent developments and evidence, there is an urgent need for infectious diseases, antimicrobial stewardship, and hepatology leaders to collaborate in development of an updated and cohesive approach to SBPPr.

Acceptability of the gonorrhoea human challenge model to accelerate vaccine development in UK men

BACKGROUND

281 million people worldwide were diagnosed with a bacterial sexually transmitted infection (STI) in 2020. Antimicrobial therapy for bacterial STIs is a key contributor to antimicrobial resistance (AMR) and multidrug resistant gonorrhoea is an urgent global health threat. Development of an efficacious gonorrhoea vaccine is a global health priority to address AMR. The controlled human infection model for gonorrhoea (GC-CHIM) could accelerate gonorrhoea vaccine development. This work sought to assess the acceptability of the urogenital model to UK men.

METHODS

A mixed-methods study of UK men aged 18-35 years old was undertaken to assess acceptability of the urogenital GC-CHIM to UK men and attitudes to STI research, vaccines and AMR. Participants completed an online survey indicating their agreement with a series of statements using a Likert scale. Semi-structured interviews were performed on a subset of participants to gain insight into their survey responses.

RESULTS

Survey responses from 72 participants and 13 interviewees highlighted stigma associated with STIs as a key barrier to, and perceived risk of, participation in STI research and GC-CHIM studies. Financial reimbursement was an important motivator, and some felt this should include compensation for intimate procedures, potential embarrassment and sexual abstinence. Individuals willing to participate in a GC-CHIM study were more likely to have personal experience of STIs, be educated to postgraduate level and describe their sexuality as gay or bisexual than those who were ambivalent or opposed to participation.

CONCLUSIONS

Recruitment of participants to UK urogenital GC-CHIM studies is feasible. Sexual abstinence can be a significant inconvenience for individuals that could be recognised via reimbursement. Care should be taken generalising results from STI vaccine research where participants may not be representative of the general population. Investigators in STI research should recognise stigmatisation as a potential risk for participants and promote their STI research sensitively as a means to counter misinformation and stigma.

Memory T Cells in Respiratory Virus Infections: Protective Potential and Persistent Vulnerabilities

Respiratory virus infections, such as those caused by influenza viruses, respiratory syncytial virus (RSV), and coronaviruses, pose a significant global health burden. While the immune system's adaptive components, including memory T cells, are critical for recognizing and combating these pathogens, recurrent infections and variable disease outcomes persist. Memory T cells are a key element of long-term immunity, capable of responding swiftly upon re-exposure to pathogens. They play diverse roles, including cross-reactivity to conserved viral epitopes and modulation of inflammatory responses. However, the protective efficacy of these cells is influenced by several factors, including viral evolution, host age, and immune system dynamics. This review explores the dichotomy of memory T cells in respiratory virus infections: their potential to confer robust protection and the limitations that allow for breakthrough infections. Understanding the underlying mechanisms governing the formation, maintenance, and functional deployment of memory T cells in respiratory mucosa is critical for improving immunological interventions. We highlight recent advances in vaccine strategies aimed at bolstering T cell-mediated immunity and discuss the challenges posed by viral immune evasion. Addressing these gaps in knowledge is pivotal for designing effective therapeutics and vaccines to mitigate the global burden of respiratory viruses.

A Cross-Sectional Study Assessing Antibiotic Resistance Awareness Among University Students in Samborondón, Greater Guayaquil, Ecuador

Background/Objectives: Education on antibiotic use has the potential to positively shape the practices and perspectives of future professionals. Assessing awareness levels of antibiotic resistance among university students is, therefore, critical, as they represent a vital demographic capable of influencing public health outcomes, especially in low- and middle-income countries. Methods: This cross-sectional study employed the World Health Organization's Antibiotic Resistance: Multi-Country Public Awareness Survey, which examines demographics, antibiotic use, knowledge, perspectives, and sources of information. A total of 922 surveys were collected from students across various disciplines at two universities in Greater Guayaquil. Results: Most participants reported obtaining antibiotics through healthcare professionals, adhering to proper usage instructions, and purchasing them primarily from pharmacies. However, only 56% of the responses were correct, with many students incorrectly associating antibiotic use with conditions where they are typically ineffective. Despite these gaps, the students expressed positive attitudes toward proposed measures to address antibiotic resistance. While the participants demonstrated familiarity with terms related to antibiotic resistance and identified doctors and educators as their main sources of information, educational campaigns were not widely recognized as important. Conclusions: These findings evidence knowledge gaps among an essential group, suggesting the need for targeted health programs, preventive strategies, and educational initiatives to combat misinformation regarding antimicrobial resistance.

Questionnaire-Based Survey Regarding the Rational Usage of Antimicrobial Agents in Food-Producing Animals in Romania

The annual rise in antimicrobial resistance (AMR) is a major public health concern. This Romanian questionnaire-based survey aimed to evaluate the appropriateness of routine antimicrobial use by veterinary practitioners in food-producing animals and to gauge their concerns about AMR. To gather data, an online questionnaire with 28 questions was developed and distributed nationwide to veterinarians via the Google Drive network and Google Forms. Despite this increased awareness, deviations in antimicrobial administration persist, often due to insufficient knowledge about AMR and the mechanisms of antimicrobial action. This study underscores the urgent need for prudent antimicrobial use in livestock production in Romania.

Association Between Epicardial Adipose Tissue and Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

Background

Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. The relationship between EAT and CI-AKI remains unclear. This study aims to explore the relationship between EAT and the incidence of CI-AKI after PCI in STEMI patients.

Methods

Patients diagnosed with STEMI were continuously included, all patients underwent PCI within 12 hours of onset. EAT volume was measured and obtained by chest CT. Logistic regression analysis was used to analyze possible risk factors for CI-AKI. Restricted cubic splines (RCS) were utilized to explore the dose-response relationship involving EAT and CI-AKI.

Results

The incidence of CI-AKI was 8.9% (57/638). Compared with the Non-CI-AKI group, the EAT volume was significantly higher (p<0.005). After adjusting for confounding factors, multivariate regression analysis showed FBG, NT-proBNP, LVEF, and EAT volume were the independent predictors for CI-AKI. RCS analysis indicated a linear dose-response relationship between EAT volume and CI-AKI. The integration of EAT volume could significantly improve ability of the model for CI-AKI (NRI 0.4071, 95% CI 0.231 ~ 0.583, p < 0.001; IDI 0.1356, 95% CI 0.091 ~ 0.180, p < 0.001).

Conclusion

Higher EAT volume was an independent risk factor for CI-AKI in STEMI patients. Integration of EAT volume could significantly improve the risk model for CI-AKI.

Catheter-associated urinary tract infections in the intensive care unit during and after the COVID- 19 pandemic

BACKGROUND

Urinary tract infections (UTIs) acquired in hospitals, particularly among patients in intensive care units (ICUs), are prevalent and represent a significant clinical issue as they are associated with increased patient morbidity, prolonged hospital stays, elevated healthcare costs, and antimicrobial resistance development.

METHODS

This study was conducted in the ICU of the University Hospital in Wrocław, Poland, from January 1, 2020, to June 30, 2024, and included 2,751 patients. The aim was to evaluate the incidence, epidemiological, and microbiological characteristics, mortality rates, and prevention strategies of UTIs during and after COVID-19 pandemic.

RESULTS

Catheter-Associated Urinary Tract Infection (CAUTI) (48 hours after admission) was recorded in 243/2751 (8.83%) patients, whereas UTI at admission was found in 63/2751 (2.3%). The mean CAUTI incidence rate (per 1,000 patient-days) was 6.99, 95% CI (6.13-7.85), whereas the mean CAUTI incidence density (per 1,000 urinary catheter days) was 7.04, 95% CI (6.18-7.91). CAUTI was significantly more frequent in females (12.32%) than in males (6.85%), p = 0.0000008, and in internal-medical patients (14.07%) compared to surgical patients (6.45%), p < 0.000001. The mean CAUTI density during the pandemic equaled 8.03, 95% CI (6.46-9.60) and was greater than in the post-pandemic period 6.25, 95% CI (5.34-7.17), p = 0.051. No statistically significant difference was observed in CAUTI incidence between COVID-positive 27/264 (10.23%) and COVID-negative 83/904 (9.18%) patients, p = 0.942. The most frequently identified pathogen in CAUTI was Klebsiella pneumoniae ESBL/MBL, whereas in UTI at admission, it was Escherichia coli. The percentage of alert pathogens among CAUTI etiological factors was significantly higher during the pandemic 72/116 (62.07%), compared to the post-pandemic period 62/143 (43.36%), p = 0.002. There was no statistically significant difference in mortality between CAUTI patients 56/207 (27.05%) and patients without CAUTI 810/2,544 (31.84%), p = 0.119.

CONCLUSION

Although there were no statistically significant differences observed in CAUTI incidence between COVID-positive and COVID-negative patients, CAUTI remains a significant challenge in the ICU setting, with particularly elevated risks among female and internal-medical patients. Consistent monitoring of CAUTI, implementation, evaluation of preventive measures, and ongoing assessment are essential for improving clinical outcomes.

Prognosis of Cancer Patients with Severe Hyponatremia in the Emergency Department: A Retrospective Study from the National Cancer Center of China

AIM

The aim of this study was to analyze the clinical characteristics and prognostic factors of profound hyponatremia in solid cancer patients admitted to the oncologic emergency department.

METHODS

We gathered data retrospectively from cancer patients who visited the emergency department of the National Cancer Center of China between October 2019 and February 2023 with a serum sodium (Na) level of less than 125 mmol/L. The demographic and clinical characteristics, medical history, admission symptoms, laboratory parameters, and outcomes of the patients were recorded.

RESULTS

This study comprised 307 patients with severe hyponatremia in total. With 39.4% of all tumors being lung cancer (n = 121), nausea and vomiting were the most common admission symptoms for patients with severe hyponatremia. The 30-day mortality rate of profound hyponatremia cancer patients in the emergency department was 13.4%. The albumin level (p < 0.001), the hemoglobin level (p = 0.033), the TNM stage (p = 0.004), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score (p < 0.001), hypocalcemia (p = 0.006), renal insufficiency (p = 0.035), and the efficacy of sodium supplementation (p = 0.006) were significantly associated with 30-day mortality. Binary logistic regression analysis showed that a lower albumin level (OR 0.924, 95% CI 0.861-0.991, p = 0.028) and higher ECOG score (OR 8.443, 95% CI 3.568-19.976, p < 0.001) were independent risk factors for 30-day mortality. The overall survival of emergency cancer patients with severe hyponatremia was also examined. The results of the COX regression analysis demonstrated that the efficacy of sodium supplementation (OR = 2.643, 95% CI 1.593-4.386, p < 0.001), a low albumin level (OR = 0.654, 95% CI 0.463-0.923, p = 0.016), the TNM stage (OR = 4.606, 95% CI 2.846-7.455), and a higher ECOG score (OR = 1.738, 95% CI 1.292-2.338, p < 0.001) were independent risk factors for overall survival.

CONCLUSIONS

The clinical manifestations of severe hyponatremia in emergency cancer patients are varied. Hypoalbuminemia and a higher ECOG score are independent risk factors for 30-day mortality and overall survival. Severe hyponatremia patients with a high ECOG score and/or a low albumin level should be monitored and followed more closely.

Gut Mycobiome: Latest Findings and Current Knowledge Regarding Its Significance in Human Health and Disease

The gut mycobiome, the fungal component of the gut microbiota, plays a crucial role in health and disease. Although fungi represent a small fraction of the gut ecosystem, they influence immune responses, gut homeostasis, and disease progression. The mycobiome's composition varies with age, diet, and host factors, and its imbalance has been linked to conditions such as inflammatory bowel disease (IBD) and metabolic disorders. Advances in sequencing have expanded our understanding of gut fungi, but challenges remain due to methodological limitations and high variability between individuals. Emerging therapeutic strategies, including antifungals, probiotics, fecal microbiota transplantation, and dietary interventions, show promise but require further study. This review highlights recent discoveries on the gut mycobiome, its interactions with bacteria, its role in disease, and potential clinical applications. A deeper understanding of fungal contributions to gut health will help develop targeted microbiome-based therapies.