Methicillin-Resistant Staphylococcus aureus Inhibitory Activity of some New Thiazole-Based Schiff Bases: One-pot Synthesis and In Vitro Screening

Twelve thiazole-based Schiff bases derived from salicylaldehyde derivatives are efficiently prepared in the current study. A typical Hantzsch thiazole reaction was used to prepare the targeted molecules in 80%-92%. Therefore, a one-pot protocol was developed involving the reaction of salicylaldehydes, thiosemicarbazide, and the appropriate hydrazonyl chlorides in dioxane at reflux for 5-6 h in the presence of one equivalent of triethylamine. The new products were tested against six different American Type Culture Collection bacterial strains with the reference ciprofloxacin. In general, integrating an aryldiazenyl unit into the structure of the tested 4-methylthiazole-based Schiff bases at thiazole-C5 resulted in improved antibacterial activity. Moreover, Schiff bases linked to 5-((4-chlorophenyl)thio)methyl units outperformed their analogs linked to 5-(phenyl)thio)methyl units by 2-fold. Thiazole-based Schiff base linked to 5-((4-chlorophenyl)thio)methyl and 5-((4-methoxyphenyl)diazenyl) units showed the highest activity against all strains tested, particularly Staphylococcus aureus and Enterococcus faecalis. It had minimum inhibitory concentration/minimum bactericidal concentration (MIC/MBC) up to 7.4/14.9 µM. Moreover, it demonstrated comparable Methicillin-resistant S. aureus (MRSA) inhibitory activity to linezolid against two MRSA strains with MIC/MBC up to 7.4/29.8 µM.

The Challenge of Bacterial Infections During Intensive Care Unit Stay After Heart Transplantation

BACKGROUND

Infections occurring in the early post-heart transplant (HT) period heavily contribute to morbidity and mortality. Our goal is to evaluate the incidence of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAPs) and/or bloodstream infections (BSIs) after HT during the intensive care unit (ICU) stay and identify their associated risk factors in our tertiary hospital.

METHODS

Observational prospective study including all adult patients who consecutively underwent HT from January 1, 2015 to August 31, 2023 at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. HAP/VAPs and BSIs diagnosed during ICU were included in the analysis.

RESULTS

A total of 106 patients were included, 38 of whom had at least one infectious episode (35.8%), for a total of 57 independent episodes and their incidence was 2.2 per 100 days (95% CI 1.7-2.8). Length of ICU stay was 8 days (IQR: 6-11) for patients without infectious events and 27 days (IQR 14-52) for those with infectious events (p < 0.001). Gram-negative bacteria were associated with 62.8% of BSIs (mainly Enterobacterales) and with 77.9% of HAP/VAP, in this setting Pseudomonas aeruginosa accounted for 17.6% of infections while Klebsiella spp. accounted for 22.1% of infections. Colonization with resistant bacteria (HR 2.21, 95% CI 1.12-4.35) was associated with increased risk of infections while perioperative antimicrobial prophylaxis (PAP) covering Gram-negative bacteria at transplant (HR 0.45, 95% CI 0.23-0.90, p = 0.023) was a protective factor.

CONCLUSION

This study shows that Gram-negative infections represent the major challenge for HT patients during ICU stay and shows some evidence in support of the PAP covering Gram-negative infections at transplant.

A rapidly progressive case of tuberculous pleurisy and pericarditis in a patient with non-small cell lung cancer that developed one month after receiving pembrolizumab monotherapy

We report a rapidly progressive case of tuberculous pleurisy and pericarditis. A 59-year-old, male patient with non-small-cell lung cancer commenced pembrolizumab monotherapy one month before but soon thereafter had fevers and dyspnea. Radiography revealed increased right pleural effusion, novel left pleural effusion and cardiomegaly, which had been absent 10 days earlier when a reduction in the target lesion was confirmed. Computed tomography revealed the presence of pericardial fluid. Analysis of the pleural effusion didn't detect malignancy; however, the culture was positive for tuberculosis. It suggests that pembrolizumab may have induced severe inflammation leading to the rapid progression of the disease.

Age-dependent mechanisms of exercise in the treatment of depression: a comprehensive review of physiological and psychological pathways

Depression has become one of the most common mental disorders in the world. The rising incidence rate and disability rate pose a serious challenge to public health and socio-economic development. Traditional medication and psychotherapy are positive, but they often come with limitations such as side effects, poor compliance, and resource constraints, which highlights the urgent need for more proactive and sustainable non pharmacological interventions. We mainly explored the physiological and psychological mechanisms of exercise in alleviating depression in different age groups. In particular, we evaluated the characteristics and influencing factors of depression in each age group and compared the pathways through which exercise works, aiming to provide scientific basis for clinical practice and public health policies, and strengthen the application of non pharmacological treatment in depression management. It is worth noting that, in the context of a comprehensive search and analysis of recent literature, we have covered the epidemiology of depression, the impact of exercise on mental health, the characteristics of depression in different age groups, and the specific ways in which exercise alleviates depression through physiological and psychological mechanisms. Exercise alleviates symptoms of depression by regulating neurotransmitters, enhancing neuroplasticity, regulating hormone levels, reducing inflammatory responses through physiological pathways, as well as enhancing cognitive function, strengthening emotional regulation, triggering social interactions, and improving self-efficacy through psychological pathways. The differences in physiological and psychological mechanisms among different age groups determine the age dependent characteristics of exercise in mitigating depression. Teenagers, middle-aged people, and elderly people can improve depressive symptoms by enhancing neural progression, regulating stress responses, and strengthening social support, respectively.

Clinical characteristics and risk factors of late-stage lung adenocarcinoma patients with bacterial pulmonary infection and its relationship with cellular immune function

Background

To research the clinical characteristics, risk factors, the correlation between bacterial pulmonary infection and immune function of advanced lung adenocarcinoma patients complicated with bacterial pulmonary infection.

Methods

334 stage III and IV lung adenocarcinoma patients admitted to the first affiliated hospital of Zhengzhou University from January 2020 to March 2023 were selected and divided into an infection group (n = 240) and a control group (n= 72) according to whether complicated with bacterial pulmonary infection. The clinical characteristics were analyzed. The pulmonary microbiota and human T lymphocyte subsets (CD3+, CD4+, CD8+) were detected. Multivariate logistic regression analysis was performed to explore the risk factors for pulmonary bacterial infection in advanced lung adenocarcinoma patients.

Results

Among 334 patients, 264 cases were complicated with pulmonary bacterial infection, and 70 cases had no pulmonary bacterial infection. In total, 544 pathogenic bacteria were isolated from the patients. Of these, 170 strains (31.25%) were Gram-negative bacilli, 162 strains (29.78%) were Gram-positive cocci, 27 strains (4.96%) Gram-positive bacilli. There were statistically significant differences in age, smoking, combined diseases, TNM staging, CD3+ T cell percentage, and CD4+ T cell percentage between the two groups (P < 0.05). Multivariate logistic regression analysis revealed smoking, bronchiectasis, and diabetes were independent risk factors leading to late-stage lung adenocarcinoma patients with bacterial pulmonary infection (P < 0.05). In those patients on immune checkpoint inhibitors, the lung Gram-positive group has a higher number of CD4+ T cells and CD4+/CD8+ T cell ratio than the Gram-negative group (P < 0.05).

Conclusion

Smoking, bronchiectasis, and diabetes are risk factors for lung bacterial infection in patients with advanced lung adenocarcinoma. The effect of immune checkpoint inhibitor treatment on T cells is more pronounced in Gram positive bacteria.

Non-Severe Hypophosphatemia in Older Patients: A Systematic Review

Background/Objectives: Phosphorus plays a fundamental role in cellular and extracellular metabolism, contributing to nucleic acid synthesis, enzymatic activity, neurologic function, and skeletal mineralization. Despite its significance, non-severe hypophosphatemia (HP) remains largely asymptomatic and underdiagnosed, with limited data on its prevalence in the general population. Most studies focus on specific subgroups, such as critically ill or dialysis patients, while the impact of mild HP in older adults, a potentially vulnerable demographic, is not well understood. The objective of this systematic review is to investigate the prevalence and clinical implications of non-severe HP in older adults. Methods: The study followed PRISMA guidelines to assess HP in patients aged ≥ 65 years without critical illnesses or genetic disorders. A systematic search was conducted in PubMed, Web of Science, and Scopus (March 2024). Eligible studies included RCTs and prospective/retrospective studies, excluding cancer-related studies or insufficient phosphate data. Results: We identified 1350 articles, with 26 meeting eligibility criteria. Ultimately, eight studies involving 26,548 patients were included, with an HP prevalence of 12.5%. Studies reveal a higher prevalence of HP in frail individuals, particularly those with increased frailty scores, and an association between HP and cognitive decline, depressed mood, falls, and chronic comorbidities. HP was also prevalent in infectious diseases, especially bacterial pneumonia, with longer hospital stays and increased mortality rates. Malnutrition was significantly more common in HP patients, characterized by weight loss and poor nutritional status. Furthermore, HP increased fall risk during hospitalization and worsened outcomes after coronary artery bypass graft surgery, including higher mortality and graft failure rates, underscoring its clinical importance. Discussion: This review identified that non-severe hypophosphatemia (HP) is associated with conditions such as frailty, cognitive decline, and an increased risk of falls. The evidence suggests that low phosphate levels may negatively impact health, increasing mortality and the risk of adverse clinical outcomes. Despite limitations in diagnostic criteria and sample variability, the findings indicate that HP can be a useful marker for identifying patients at risk of health deterioration. Further research is needed to clearly define the management and treatment of HP in this vulnerable population.

AWaRe classification analysis for European countries with ARIMA forecasts to assess prescribing patterns and 'One Health' targets

BACKGROUND

Antimicrobial resistance is a major threat to public health, with a well-established link between antibacterial consumption and bacterial resistance. Stewardship needs to focus on reducing overall consumption and optimising the quality of prescribing. The European Union's 'One Health' approach aims for at least 65% of antibacterial consumption to be in the 'Access' category of the AWaRe framework until 2030.

PURPOSE

This study advances the field by shifting the focus from simply quantifying antibacterial consumption to a nuanced assessment of prescribing quality. Prudent and problematic prescribing behaviour is identified in past and projected trends, both for individual countries and European regions. Progress towards the EU's 'One Health' targets for the human sector is assessed and compared with total antibacterial consumption.

METHODS

This study analyses data from 1997-2023 and predicts future proportions of AWaRe drug classes for European countries until 2030, using the ARIMA(1,0,1) model. The distribution and changes of the AWaRe groups were analysed to assess prescribing behaviour. Total antibacterial consumption is compared with findings of the 'One Health' targets, and bivariate correlation analyses are performed.

RESULTS

Robust forecast models were developed for the AWaRe classification for 30 European countries. In 2030, the 'Access' group is projected to exceed 65% in Iceland, Denmark, Ireland, Latvia, Finland, France, the Netherlands, Sweden, Lithuania, the United Kingdom, Belgium and Estonia. On the other hand, low shares are expected for Greece (43.8%), Slovakia and Bulgaria (45.9%), Italy (47.3%), Malta (49.9%), Cyprus (50.9%), Hungary (51.8%) and Romania (53.4%). The other 10 countries fall in between, with shares ranging from 56.4% to 64.7%. Of particular concern are Italy, Cyprus and Malta, with low'Access'shares, high consumptions and worsening trends, in contrast to the exemplary performance of Iceland, Norway and Denmark. Germany stands out for its worryingly excessive use of 'Reserve'. Most forecasts were considered reliable, although some showed moderate or poor fit.

CONCLUSION

The findings predict that many European countries are unlikely to meet the EU's 'One Health' target by 2030. Countries with higher'Access'shares and lower total consumption tend to have lower levels of bacterial resistance, while those with high consumption and problematic prescribing patterns face higher levels of resistance. While most Northern European countries are considered to have a prudent use of medicines, problematic use is observed particularly in Southern and Eastern Europe, a practice being apparent across many medicine classes. Regional differences in prescribing patterns highlight the need for tailored interventions. For certain countries, particularly in Northern Europe, the high proportion of unclassified substances suggests that the AWaRe classification may not fully capture the range of antibacterial substances used.

Mycobacterium tuberculosis Sulfate Ester Dioxygenase Rv3406 Is Able to Inactivate the RCB18350 Compound

Among the critical priority pathogens listed by the World Health Organization, Mycobacterium tuberculosis strains resistant to rifampicin present a significant global threat. Consequently, the study of the mechanisms of resistance to new antitubercular drugs and the discovery of new effective molecules are two crucial points in tuberculosis drug discovery. In this study, we discovered a compound named RCB18350, which is active against M. tuberculosis growth and exhibits a minimum inhibitory concentration (MIC) of 1.25 μg/mL. It was also effective against multidrug-resistant isolates. We deeply studied the mechanism of resistance/action of RCB18350 by using several approaches. We found that Rv3406, an iron- and α-ketoglutarate-dependent sulfate ester dioxygenase, is capable of metabolizing the compound into its inactive metabolite. This finding highlights the role of this enzyme in the mechanism of resistance to RCB18350.

Carbapenem-resistant Enterobacterales acquisition following piperacillin-tazobactam versus carbapenem treatment: a propensity-matched cohort study

OBJECTIVES

We aimed to quantify the ecological consequences of carbapenems versus piperacillin-tazobactam treatment on the risk of carbapenem-resistant Enterobacterales (CRE) acquisition.

METHODS

We conducted a retrospective cohort study with propensity-score matching. The study was conducted in a single large hospital in Israel from 2014 to 2023. We included all adult patients treated with piperacillin-tazobactam (PTZ) or a carbapenem for at least 5 days. We excluded patients with known carriage of CRE at treatment initiation and patients in the PTZ group who received a carbapenem within 30 days before or 90 days after the start of PTZ. The outcome assessed was CRE acquisition through surveillance or clinical samples from day 5 to day 90 after treatment initiation. The propensity score for treatment selection was derived to match patients in the treatment groups using 1:1 nearest-neighbour matching with a calliper of 0.01. A sensitivity analysis of the full cohort was performed through a regression model of CRE acquisition, adjusting the analysis using inverse probability of treatment weighting.

RESULTS

We included 7731 patients, of whom 6.2% (483/7731) acquired CRE: 4.5% (219/4887) of patients treated with PTZ versus 9.3% (264/2844) of patients treated with a carbapenem (unadjusted odds ratio [OR] 0.46, 95% CI, 0.38-0.55). In the matched cohort, CRE acquisition occurred in 6.4% (130/2018) of patients treated with PTZ versus 8.7% (175/2018) of patients treated with carbapenems (propensity score-matched OR 0.72.95% CI, 0.57-0.92). Independent risk factors for CRE acquisition included hospitalization in the haemao-oncology or neurosurgical wards, longer antibiotic exposure and hospitalization, bloodstream infections, low albumin and higher glucose levels. Adjusted to these and weighted by the inverse probability of treatment, PTZ was associated with CRE acquisition with an OR of 0.81, 95% CI, (0.66-0.98).

DISCUSSION

Carbapenem were significantly associated with CRE acquisition compared with PTZ in a CRE endemic settings.

Effectiveness of an Early Intervention in Mild Hyponatremia to Prevent Accidental Falls in Hospitalized Older Adults-A Crossover Ecological Clinical Trial

Background: Falls in hospitalized patients cause injuries of varying severity and even death. There is a link between falls and low blood sodium levels in older patients. Identifying and treating hyponatremia could help prevent falls and reduce hospital stays. The purpose of this study was to evaluate the effectiveness of the correction of hyponatremia on reducing the incidence of falls and the mean stay of hospitalized patients aged more than 65 years. Methods: A crossover ecological clinical trial was conducted in adult hospitalization units of a hospital in Madrid (Spain) over 12 months. Patients meeting inclusion criteria were divided into two randomized groups. The intervention was applied in two six-month phases, alternating between groups with a 15-day washout period. Early diagnosis and treatment of hyponatremia were implemented in the intervention group, while the control group received standard care. Primary outcomes included fall incidence and length of hospital stay. Data were collected using REDCap and analyzed with SPSS v.21. Statistical significance was set at p < 0.05 (ClinicalTrials identifier of the manuscript: NCT03265691). Results: A total of 1925 patients were included (408 intervention, 1517 control). Fall incidence was significantly lower in the intervention group (6.7 vs. 9.8, p = 0.000). Hyponatremia was corrected in 72% of cases. No significant differences were found in functional scores. The intervention effectively reduced falls compared to standard care. Conclusions: Early hyponatremia treatment reduces falls and hospital stay in older patients, supporting its inclusion in fall prevention strategies.

Clinical significance and antifungal susceptibility profile of 103 clinical isolates of Scedosporium species complex and Lomentospora prolificans obtained from NIH patients

Reduced susceptibility to antifungals is common among members of genera Scedosporium and Lomentospora, with optimal treatments still not fully defined. In vitro antifungal susceptibility results and clinical data do not comprehensively account for the advent of new Scedosporium species identified by molecular phylogenetics. Using Clinical and Laboratory Standards Institute (CLSI) methodology, we tested a total of 103 clinical isolates obtained from patients at the NIH Clinical Center. The most frequent species were Scedosporium apiospermum (63%) and Scedosporium boydii (11%), followed by Lomentospora prolificans (7%). The novel antifungal olorofim showed the lowest MICs against all Scedosporium spp. and L. prolificans, followed by micafungin. Among the triazoles, voriconazole showed lower MICs against Scedosporium spp. Amphotericin B and posaconazole demonstrated species-specific and inter-species variable activity. Itraconazole, isavuconazole, and terbinafine had higher MIC values against Scedosporium spp. and L. prolificans. Clinical data were retrospectively reviewed for 90 isolates, of which nine patients (28 isolates) had active disease/infection and received antifungal treatment that included voriconazole or posaconazole. Five of these patients (56%) died, while three patients (33%) with chronic granulomatous disease were cured following hematopoietic cell transplantation. In 24 patients (62 isolates), the presence of the fungus was considered airway colonization. In conclusion, our data support the existence of species-specific and inter-species differences in the antifungal susceptibility patterns among members of genera Scedosporium and L. prolificans. The novel investigational antifungal olorofim may be a promising therapy. Our clinical data suggest that host status and administration of antifungal therapy most effective for each Scedosporium species complex are important determinants of outcomes.IMPORTANCEUnderstanding the epidemiology and clinical spectrum of infections caused by Scedosporium species complex and Lomentospora prolificans is integral to improving outcomes, particularly in severely ill and immunocompromised patients. In vitro antifungal susceptibility testing can provide an estimate of antifungal activity against fungal pathogens. Our study showed that species-specific and inter-species differences exist in the distribution of antifungal susceptibility patterns between Scedosporium and L. prolificans. Our clinical data also highlight that host status, along with effective antifungal therapy, plays a crucial role in determining treatment outcomes.

Rapid bacterial identification and resistance detection using a low complexity molecular diagnostic platform in Zimbabwe

BACKGROUND

Sepsis is a major cause of mortality in low-resource settings. Effective microbiological culture services are a bottleneck in diagnosis and surveillance.

AIM

We aimed to evaluate the performance of the BIOFIRE FILMARRAY Blood Culture Identification 2 (BCID2, bioMérieux) assay in a low-resource setting laboratory in comparison to standard practice.

METHODS

This five month prospective validation study included all positive blood cultures collected at Sally Mugabe Central Hospital, Harare, Zimbabwe. BCID2 testing was done in parallel to standard phenotypic procedures and resistance testing. Reference identification was performed using mass spectrometry or whole genome sequencing. Only samples with available reference standard results were included in the analysis. Data captured on paper-based forms was entered into electronic case report forms (ODK Collect). Specificity and sensitivity for BCID2 were calculated in comparison to the reference standards, with performance measures calculated using the Wilson score. Biomedical scientists using BCID2 completed a system usability survey (SUS).

RESULTS

Positive results were recorded in 780/2,023 (38.5%) blood cultures, within which 377 (48.3%) had reference results and so were included in analysis. Neonatal samples were most frequent (182, 48.3%), then paediatric (150, 39.8%), then adults (18, 4.8%) and unknown (27, 7.2%). Specificity exceeded 95% throughout. Sensitivity ranged from 50% (A. calcoaceticus-baumanii complex, Proteus spp.) to 100% (S. pneumoniae, Salmonella spp). Using BCID2, CTX-M was detected in 111/175 (74.5%) Enterobacterales, from which 5/111 also had NDM and VIM detected. NDM-5 was detected in 2/5 NDM samples using sequencing. In total 3/23 S. aureus isolates were methicillin resistant, from which one was confirmed using phenotypic antimicrobial susceptibility testing. Usability was good (SUS score = 79.5).

CONCLUSION

Rapid molecular tests have potential to improve turn-around time and quality of sepsis diagnostics. However, specific work-flows are critical to supplement molecular tests with minimal phenotypic tests for optimal clinical decision-making.

Genomic census of invasive nontyphoidal Salmonella infections reveals global and local human-to-human transmission

Extraintestinal infections caused by Enterobacteriaceae represent a global concern, further exacerbated by the growing prevalence of antimicrobial resistance (AMR). Among these, invasive nontyphoidal Salmonella (iNTS) infections have become increasingly challenging to manage, and their global spread remains poorly understood. Here we compiled 1,115 patient records and generated a comprehensive genomic dataset on iNTS. Age and sex emerged as significant risk factors, with Salmonella Enteritidis identified as a major cause. We observed serovar-specific AMR patterns, with notable resistance to fluoroquinolones and third-generation cephalosporins. A global phylogenomic analysis of Enteritidis revealed three distinct clades, highlighting the accumulation of AMR determinants during its international spread. Importantly, our genomic and transmission analyses suggest that iNTS infections may involve human-to-human transmission, with diarrheal patients acting as potential intermediaries, deviating from typical zoonotic pathways. Collectively, our newly generated cohort and iNTS genomic dataset provide a framework for precise local iNTS burden and underscore emerging transmission trends.

Clinical Significance and Therapeutic Challenges of Scedosporium spp. and Lomentospora prolificans Isolates in a Single-Center Cohort of Lung Transplant Recipients

(1) Background: Emerging fungal infections associated with Scedosporium spp. and Lomentospora prolificans (S/L) are becoming more frequent and are very difficult to treat. Our objective was to analyze the frequency and management of S/L isolates in lung transplant (LTx) recipients, the patient outcomes and in vitro antifungal sensitivity. (2) Methods: We included all patients with S/L isolation during post-transplant follow-up. Data were collected from electronic medical records. All samples were cultivated on Sabouraud Chloramphenicol agar. Isolations of S/L were submitted to in vitro susceptibility tests. (3) Results: A total of 11 (2%) of the 576 LTx recipients included had at least one isolation of S/L. Classification for the 11 cases were colonization (4; 36%) and infection (7; 65%). Five infections were pulmonary (71%) and two were disseminated (29%). S. apiospermum complex was the most frequently occurring isolation in patients with pulmonary disease while L. prolificans was the most frequent in patients with disseminated disease. Ten patients were treated. The most frequent antifungal drugs used were voriconazole (n = 8) and terbinafine (n = 6). Seven patients (70%) received more than one drug. The mortality rate associated with L. prolificans isolation was 50% for colonization and 100% for disseminated disease. (4) Conclusions: Scedosporium spp. and L. prolificans infections are associated with high morbidity and mortality rates. New diagnostic and therapeutic tools are required to reduce the impact of these infections.

Therapeutic potential of microbiome modulation in reproductive cancers

The human microbiome, a complex ecosystem of microbial communities, plays a crucial role in physiological processes, and emerging research indicates a potential link between it and reproductive cancers. This connection highlights the significance of understanding the microbiome's influence on cancer development and treatment. A comprehensive review of current literature was conducted, focusing on studies that investigate the relationship between microbiome composition, reproductive cancer progression, and potential therapeutic approaches to modulate the microbiome. Evidence suggests that imbalances in the microbiome, known as dysbiosis, may contribute to the development and progression of reproductive cancers. Specific microbial populations have been associated with inflammatory responses, immune modulation, and even resistance to conventional therapies. Interventions such as probiotics, dietary modifications, and fecal microbiota transplantation have shown promise in restoring healthy microbiome function and improving cancer outcomes in pre-clinical models, with pilot studies in humans indicating potential benefits. This review explores the therapeutic potential of microbiome modulation in the management of reproductive cancers, discussing the mechanisms involved and the evidence supporting microbiome-targeted therapies. Future research is warranted to unravel the complex interactions between the microbiome and reproductive cancer pathophysiology, paving the way for innovative approaches.

Telemedicine interventions for improving antibiotic stewardship and prescribing: A systematic review

The global antibiotic resistance crisis necessitates optimized stewardship programs, with telemedicine emerging as a promising delivery strategy. This systematic review evaluated the effectiveness of telemedicine interventions in improving antibiotic stewardship across clinical settings. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched seven databases from January 2010 to July 2024. Two independent reviewers assessed studies using Risk of Bias in Non-randomized Studies (ROBINS-I) and Cochrane Risk of Bias 2.0 tools, with evidence certainty evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Twenty-one studies met inclusion criteria (10 observational, 8 quasi-experimental, 2 Randomized Controlled Trials [RCTs], 1 mixed-methods), predominantly from the United States (57.0%, n = 12). Among studies reporting antibiotic use outcomes (52.4%, n = 11), 90.9% demonstrated significant reductions ranging from 5.3% to 62.7%, with the highest-quality evidence showing a 28% reduction (95% Confidence Interval [CI]: 22-34%). Guideline adherence studies (57.1%, n = 12) showed acceptance rates of 67.7% to 98%, with comparable effectiveness between telemedicine and in-person consultation (79.1% vs 80.4%, p = 0.36). Prescribing rate outcomes (38.1%, n = 8) revealed setting-dependent variations: inpatient implementations demonstrated significant reductions (Relative Risk [RR] 0.68; 95% CI: 0.63-0.75), while outpatient findings showed mixed results. Quality assessment revealed predominantly low risk of bias [ROB] (66.7%, n = 14). These findings suggest that telemedicine effectively improves antibiotic stewardship compared to traditional care models, particularly in hospital settings, while outpatient applications demonstrated variable effectiveness. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023454663).

Perioperative Management During Liver Transplantation: A National Survey From the French Special Interest Group in "Liver Anesthesiology and Intensive Care"

BACKGROUND

Perioperative management practices in liver transplantation (LT) evolve very quickly. There are few specific recommendations, often based on a low level of evidence, resulting in wide heterogeneity of practices.

METHODS

We performed a survey in all 16 French centers in 2021 by focusing on center organization, preoperative cardiovascular assessment, antimicrobial prophylaxis, hemostasis management, intraoperative use of hemodynamic monitoring and renal replacement therapy, immunosuppression, and postoperative prevention of arterial complications and compared it with current recommendations.

RESULTS

The organization of perioperative LT care involved 1 single team throughout the perioperative LT process in 7 centers (43.7%). The coronary evaluation was systematic in one-third of the centers and guided by risk factors in the other centers. Antibiotic prophylaxis was strictly intraoperative in only 7 centers (44%). Antifungal prophylaxis targeting high-risk LT recipients was administered in 15 centers (93%). Intraoperative coagulation assessment was based on standard coagulation tests in 8 centers (50%), on viscoelastic assays in 4 centers (25%), and both methods in 4 centers (25%). Hemodynamic monitoring practices greatly varied between centers.Concerning immunosuppression, molecules and dosages were heterogeneous. Aspirin was systematically administered in one-third of cases (6 centers; 37.5%). Of the 21 recommendations tested, the concordance rate was 100% for 3 recommendations and <50% for 7 recommendations.

CONCLUSIONS

Our study precisely describes French practices regarding LT in perioperative care and highlights the paucity of data in this setting, leading to very weak recommendations that are poorly followed in LT centers.

Diagnosing and Preventing Q Fever in Regional New South Wales, Australia-A Qualitative Exploration of Perspectives of General Practitioners

OBJECTIVE

To qualitatively explore the perceptions of general practitioners in regional New South Wales, Australia, on diagnosing, managing and preventing Q fever.

SETTING

Q fever is a prevalent zoonosis in regional New South Wales, but diagnosis may be missed as patients have symptoms similar to influenza or COVID. Perspectives of general practitioners who are the primary health care providers in rural areas are important to understand the logistical difficulties in providing optimum care to Q fever patients.

PARTICIPANTS

General practitioners practicing outside of metropolitan Sydney in regional postcodes of New South Wales, Australia.

METHODS

Eligible general practitioners were interviewed online using a semi-structured interview guide on their approach to diagnosis, management and prevention of Q fever. The data were transcribed, coded using NVivo software, and analysed to identify emerging overarching themes.

RESULTS

Thematic saturation was achieved after 11 interviews. Diagnostic delays due to prioritising more common differential diagnoses for an influenza-like illness, difficulties in navigating the complex serological test interpretations for diagnosis, logistical difficulties in arranging immunisation, and the need for continuing medical education were the broad themes emerging from the data analysis.

CONCLUSIONS

Investment in continuing medical education and expansion of the reference resources made available to general practitioners regarding the diagnosis and management of Q fever will improve health care for people suffering from and at risk of Q fever in regional New South Wales.

A Retrospective Closed Cohort Study on Distribution of Multidrug-Resistant Bacteria in Ventilator-Associated Pneumonia and its Impact on Patient Outcome

Objectives: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection affecting critically ill patients undergoing mechanical ventilation. This study investigated the prevalence of multidrug-resistant (MDR) organisms in VAP, the VAP rate, and the outcomes associated with MDR-VAP. Methods: This retrospective single-center study, conducted in 2022, included adult ICU cases from April 2021 to March 2022, receiving mechanical ventilation for more than 48 h. Patient data were analyzed for demographics, comorbidities, empirical antibiotic use, and outcomes. MDR organisms were identified in respiratory cultures. Results: Among 447 patients, 133 developed VAP, with 96 cases being MDR-VAP. The mean age of the overall VAP population was 52 years, 70% of which were males. The incidence of VAP was 30.0% (95% CI: 25.7%-34.5%), while that of MDR-VAP was 21.6% (95% CI: 17.9%-25.8%). The most prevalent MDR organisms were Acinetobacter species (50%) and Klebsiella pneumoniae (46.9%). Empirical antibiotics were administered in 96% of VAP cases. The overall VAP rate was 38.03/1000 ventilator days. No single antimicrobial agent seemed to offer an empirical cover, as the susceptibility rate for most tested antimicrobials was less than 85%. Patients with MDR-VAP had a low survival rate (64.6%) and were less likely to be extubated at 13.5% compared to non-MDR-VAP (survival rate of 62.2%). COVID-19 patients had a high incidence of MDR VAP, especially with Acinetobacter. Overall, VAP mortality was 57.1%. The median ventilator days were 16 for VAP and only four for non-VAP. Conclusion: Gram-negative organisms, particularly Klebsiella and Acinetobacter, were the main MDR VAP culprits. MDR-VAP exhibited higher morbidity and mortality. A study focused on developing resistance by microorganisms is warranted for further understanding.

Threshold modeling for antibiotic stewardship in Oman

BACKGROUND

Antimicrobial stewardship supports rational antibiotic use. However, balancing access to antibiotic treatment while controlling resistance is challenging. This research used a threshold logistic modeling approach to identify targets for antibiotic usage associated with carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Klebsiella pneumonia, and extended-spectrum β-lactamases-producing Escherichia coli incidence in hospitals.

METHODS

This study utilizes an ecological population-level design. Monthly pathogen cases and antibiotic use were retrospectively determined for inpatients between January 2015 and December 2023. The hospital pharmacy and microbiology information systems were used to obtain this data. Thresholds were identified by applying nonlinear modeling and logistic regression.

RESULTS

Incidence rates of 0.199, 0.175, and 0.146 cases/100 occupied bed-days (OBD) for carbapenem-resistant A baumannii, carbapenem-resistant K pneumonia, and extended-spectrum β-lactamases-producing E coli, respectively, were determined as the cutoff values for high (critical) incidence rates. Thresholds for aminoglycosides (0.59 defined daily dose [DDD]/100 OBD), carbapenems (6.31 DDD/100 OBD), piperacillin-tazobactam (3.71 DDD/100 OBD), third-generation cephalosporins (3.71 DDD/100 OBD), and fluoroquinolones (1.91 DDD/100 OBD), were identified. Exceeding these thresholds would accelerate the gram-negative pathogens' incidence rate above the critical incidence levels.

CONCLUSIONS

Threshold logistic models can help inform and implement effective antimicrobial stewardship interventions to manage resistance within hospital settings.

Hyperbilirubinemia at hospitalization predicts nosocomial infection in decompensated cirrhosis: Data from ATTIRE trial

BACKGROUND

To identify clinical characteristics and serological biomarkers that predicted subsequent nosocomial infection in ATTIRE trial patients.

METHODS

We identified 360 patients at hospitalization without infection and not prescribed antibiotics and compared clinical characteristics between those who subsequently developed a nosocomial infection and not. In a 68-patient subcohort, we compared plasma biomarkers of bacterial translocation, infection, and inflammation at hospitalization between those who developed a nosocomial infection and not. In a 56-patient subcohort, we investigated plasma lipidomic profiles in those who did and did not develop nosocomial infection using Lipotype Shotgun platform analysis and multivariate statistical techniques. To further investigate lipid pathways, we compared outcomes in patients taking statins or not at hospitalization.

RESULTS

Serum bilirubin >188 µmol/L at hospitalization predicted subsequent nosocomial infection in univariate and multivariate analyses, with 80% specificity. The most common nosocomial infections were respiratory tract (29%) and those developing infection had significantly greater 28 and 90-day mortality than those not (p=9.34E-05 and 0.014). Serological biomarkers of bacterial translocation, infection, and inflammation did not predict subsequent infection. Partial least squares discriminatory analyses identified cholesterol esters (CEs) (CE.18.1.2, CE.18.1.0, and CE.16.0.0) as important predictors of infection but provided only a small improvement in predictive ability over bilirubin alone. RNA-sequencing analyses suggest this is mediated by a downregulation of the cellular cholesterol esterification enzyme sterol O-acyltransferase 1. Statin use was not associated with nosocomial infection prevention.

CONCLUSIONS

In ATTIRE, elevated serum bilirubin at hospitalization was the only clinical characteristic that predicted subsequent development of nosocomial infection. Considering the rising incidence of antimicrobial resistance, these data could be used to limit antibiotic prophylaxis or aid trial design for investigating use in high-risk patients.

Aberrant functional connectivity patterns in the pregenual anterior cingulate cortex and anterior midcingulate cortex of patients with irritable bowel syndrome accompanied by depressive symptoms

Irritable bowel syndrome (IBS) is a common brain-gut disorder often accompanied by depressive symptoms, with atrophy and hyperactivity of the anterior cingulate gyrus (ACC) being key drivers of both IBS and its psychiatric comorbidities. This study aimed to investigate the functional connectivity (FC) patterns of pregenual ACC (pgACC) and anterior midcingulate cortex (aMCC) in IBS patients with depressive symptoms (DEP-IBS). A whole-brain FC analysis was conducted using pgACC and aMCC as regions of interest in three groups: 28 DEP-IBS patients, 21 IBS patients without depressive symptoms (nDEP-IBS), and 36 matched healthy controls (HCs). Partial correlation and mediation analyses were performed between abnormal FC and clinical symptoms. The ability of aberrant FC to identify IBS and its psychiatric comorbidity was evaluated using receiver operating characteristic (ROC) curve. DEP-IBS patients exhibited increased pgACC-related FC in the left medial prefrontal cortex (mPFC) and aMCC-related FC in the right middle frontal gyrus, angular gyrus and cerebellum, while showing decreased aMCC-related FC in the right precentral gyrus, superior parietal gyrus and precuneus. Both patient groups demonstrated increased FC between aMCC and left dorsolateral prefrontal cortex (dlPFC), effectively distinguishing them from HCs (AUC = 0.755). The FC between pgACC and left mPFC partially mediated the relationship between gastrointestinal and depressive symptoms, effectively distinguishing DEP-IBS from nDEP-IBS patients (AUC = 0.808). Aberrant FC within the emotional arousal network may serve as a neurobiological marker for IBS with comorbid depression. Furthermore, abnormal FC between the aMCC and the dlPFC may underlie the neural mechanism of IBS.

Iron-dependent mechanisms in Acinetobacter baumannii: pathogenicity and resistance

Acinetobacter baumannii is a Gram-negative opportunistic pathogen that poses a significant challenge in healthcare settings, particularly in ICUs, due to its MDR and high mortality rates, especially among critically ill coronavirus disease 2019 patients. Iron is crucial for the survival, growth and pathogenicity of A. baumannii, and the bacterium has developed multiple iron acquisition systems, including siderophore production, haem uptake and TonB-dependent transport mechanisms, to adapt to the iron-limited environment within the host. Although specific studies on A. baumannii are limited, mechanisms from other bacterial species suggest that similar iron acquisition strategies may play a key role in its virulence. Therapeutic approaches targeting these iron-dependent systems, such as the siderophore-conjugated cephalosporin cefiderocol, have shown potential in overcoming MDR A. baumannii infections. Additionally, strategies such as synthetic siderophores, TonB receptor inhibitors and iron chelators are under investigation to enhance treatment outcomes. Future research should prioritize validating these mechanisms in A. baumannii, advancing clinical trials for these therapies and exploring combination treatments to mitigate resistance and improve clinical outcomes in severely affected patients.

Prevalence of colistin-resistant Enterobacteriaceae isolated from clinical samples in Africa: a systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance among Enterobacteriaceae poses a significant global threat, particularly in developing countries. Colistin, a critical last-resort treatment for infections caused by carbapenem-resistant and multidrug-resistant strains, is increasingly facing resistance due to inappropriate use of colistin and the spread of plasmid-mediated resistance genes. Despite the significance of this issue, comprehensive and updated data on colistin resistance in Africa is lacking. Thus, the current study was aimed to determine the pooled prevalence of colistin-resistant Enterobacteriaceae in Africa.

METHODS

A systematic search was conducted across PubMed, Scopus, ScienceDirect, and Google Scholar to identify relevant studies. Forty-one studies reporting on the prevalence of colistin resistance in Enterobacteriaceae isolates from clinical specimens in Africa were included in the analysis. Stata 17 software was used to calculate the pooled prevalence of colistin resistance, employing a random-effects model to determine the event rate of resistance. Heterogeneity across studies was assessed using the I2 statistic, and publication bias was evaluated using Egger's test. Subgroup analyses were performed to address any identified heterogeneity.

RESULTS

This systematic review analyzed the colistin resistance profile of 9,636 Enterobacteriaceae isolates. The overall pooled prevalence of colistin resistance was 26.74% (95% CI: 16.68-36.80). Subgroup analysis by country revealed significant variability in resistance rates, ranging from 0.5% in Djibouti to 50.95% in South Africa. Species-specific prevalence of colistin resistance was as follows: K. pneumoniae 28.8% (95% CI: 16.64%-41.05%), E. coli 24.5% (95% CI: 11.68%-37.3%), Proteus spp. 50.0% (95% CI: 6.0%-106.03%), and Enterobacter spp. 1.22% (95% CI: -0.5%-3.03%). Analysis based on AST methods revealed significant differences in colistin resistance rates (p = 0.001). The resistance rates varied between 12.60% for the disk diffusion method and 28.0% for the broth microdilution method. Additionally, a subgroup analysis of clinical specimens showed significant variation (p < 0.001) in colistin resistance. Stool specimen isolates had the highest resistance rate at 42.0%, while blood specimen isolates had a much lower resistance rate of 3.58%.

CONCLUSIONS

Colistin resistance in Enterobacteriaceae is notably high in Africa, with significant variation across countries. This underscores the urgent need for effective antimicrobial stewardship, improved surveillance, and the development of new antibiotics.

A Self-Calibrating Chemiluminescence Sensor for Rapid and Precise Antibiotic Prescribing Guidelines on Urinary Tract Infections

Traditional antimicrobial-susceptibility testing methodologies, including the isolation and culture of bacteria from urine samples and antibiotic-susceptibility test (AST), are expensive and time-consuming. Therefore, a rapid, user-friendly phenotypic AST is urgently needed to guide treatment strategies. Several novel phenotypic AST platforms based on the physiological characteristics of bacteria obtained directly from clinical urine samples have been proposed as promising methods as rapid AST and appropriate antibiotic treatments. However, inaccurate bacterial quantification can lead to false results when high-accuracy quantitative assays are required using these procedures. Coupling the expression of catalase by pathogens with a chemiluminescence-based analytical method enables a convenient and low-cost operation. Herein, we demonstrate a rapid self-calibrating chemiluminescence sensor that can measure bacterial viability through the variation in catalase activity and its response to hydrogen peroxide after treatment with antibiotics. This rapid nanosensor platform can be utilized to determine the antibiotic susceptibility of uropathogenic Escherichia coli and Klebsiella pneumoniae, which account for 80% of all urinary tract infections, directly from clinical urine samples within 40 min without bacterial quantification. The proposed ultrafast and highly accurate AST can enable the precise guidance of antibiotic prescriptions and shorten the time required for clinical decision-making.

Antibacterial sonodynamic nanomedicine: mechanism, category, and applications

Sonodynamic therapy (SDT) has emerged as a cutting-edge strategy for combating multidrug-resistant bacterial infections. Unlike conventional antibiotics, SDT leverages the generation of reactive oxygen species during the treatment process to inflict multifaceted damage on bacterial cells, thereby significantly reducing the likelihood of developing drug resistance. Compared to other physical sterilisation methods, such as ultraviolet irradiation, SDT offers enhanced tissue penetration, making it particularly suitable for addressing deep-seated infections, including osteomyelitis. Despite its significant advantages, the clinical translation of SDT for antibacterial applications faces several challenges. This review discusses the fundamental mechanisms of SDT, with a focus on phenomena such as cavitation-induced reactions and piezocatalytic generation of reactive oxygen species. Furthermore, it provides a comprehensive analysis of various sonosensitisers used in SDT, emphasising their potential to enhance therapeutic outcomes in areas such as infected wound healing, bone regeneration, and the mitigation of deep tissue inflammation. While SDT shows great promise in addressing multidrug-resistant bacterial infections, further research and development are essential to overcome existing limitations and unlock its full clinical potential.

Neonatal Mucormycosis: A Rare but Highly Lethal Fungal Infection in Term and Preterm Newborns-A 20-Year Systematic Review

BACKGROUND/OBJECTIVES

Mucormycosis is a rare but life-threatening fungal infection, particularly in neonates, due to their undeveloped immune system. This systematic review aims to analyze the risk factors, clinical presentations, treatments, and outcomes of neonatal mucormycosis reported between 2004 and 2024.

METHODS

A systematic literature search was conducted in PubMed, Scopus, and Web of Science following PRISMA guidelines. Only studies reporting cases of mucormycosis in neonates (≤28 days old) were included. Data on risk factors, clinical features, diagnostic methods, antifungal therapies, surgical interventions, and outcomes were extracted and analyzed.

RESULTS

A total of 44 studies met the inclusion criteria, comprising 61 neonatal cases. The most common clinical presentations were gastrointestinal (n = 39), cutaneous (n = 19), rhino-orbito-cerebral (n = 2), and disseminated mucormycosis (n = 1). Diagnosis was primarily based on histopathology (93.4%) and fungal culture (26.2%). The main antifungal treatment was liposomal amphotericin B (63.9%), often combined with surgical debridement (60.6%). Mortality rates remained high (47.5%), particularly in cases of prematurely extreme neonates with angioinvasive disease or delayed diagnosis.

CONCLUSIONS

Neonatal mucormycosis remains a severe condition with high morbidity and mortality. Early diagnosis through a combination of clinical suspicion and laboratory confirmation, along with prompt antifungal therapy and surgical management, apparently is crucial for improving outcomes. Further studies are needed to optimize treatment strategies and improve neonatal survival.

Current Risks and Prevention Strategies Against Vector-Borne Diseases in Cyprus

The island of Cyprus has historically been prone to vector-borne diseases due to its location at the crossroads of three continents. The introduction of novel vectors, microorganisms, or strains in Cyprus, coupled with the global climate change and antimicrobial resistance crisis, can lead to an altered infectious disease landscape and entomological status, causing a rise in vector-borne diseases on the island. The current review provides a broad snapshot of the status of vector-borne infectious diseases and associated risks in Cyprus. Our research has uncovered a pressing issue, the risk of the spread and emergence of various infectious diseases, including West Nile virus and malaria, respectively, due to the presence of Aedes and Anopheles spp. mosquitoes on the island, while underscoring the animal reservoirs of several pathogenic microorganisms. Our research emphasizes the importance of the One Health approach and the collaboration between communities for the improvement of vector control strategies to limit the spread of vector borne diseases.

Antimicrobial Investigation of Phthalimide and N-Phthaloylglycine Esters: Activity, Mechanism of Action, Synergism and Ecotoxicity

Motivated by the search for novel antimicrobials against opportunistic resistant pathogens and based on the reported antimicrobial activity of phthalimides, two series of phthalimide and N-phthaloylglycine esters were designed to investigate whether the addition of butyl and aryl groups enhances their antimicrobial properties. Thus, in vitro antimicrobial activity, antifungal mechanism of action, effect combined with Chloramphenicol, in silico/vitro toxicity, and a docking molecular were studied. Phthalimide and N-phthaloylglycine aryl esters were obtained in yields of 75-98%. Phthalimide aryl ester 3b (R = Me) showed the best results against Gram-(+) and Gram-(-) bacteria, S. aureus and P. aeruginosa, respectively, and yeast fungi, C. tropicalis and C. albicans, with MIC values equal to 128 µg·mL-1. Regarding the antifungal mechanism of action on C. albicans, the MIC values of compound 3b changed from 128 to 1024 µg·mL-1 in the presence of ergosterol. Furthermore, compound 3b showed synergy with Chloramphenicol against P. aeruginosa, with a FICI value equal to 0.5. Finally, the four most promising compounds had their in silico/vitro toxicity evaluated, which showed moderate toxicity to non-toxicity on Artemia salina larvae. With the exception of Chloramphenicol, all selected compounds, including Fluconazole, are potentially hepatotoxic, but they were predicted not to cause skin sensitization, suggesting a potential application for topical use. Molecular docking revealed that compound 3b exhibits superior binding affinity and stability with the 50S ribosomal subunit (-92.69 kcal·mol-1) compared to Chloramphenicol, and a unique π-sulfur interaction with CYP51, suggesting its potential as a dual-action antibacterial and antifungal candidate against resistant pathogens.

Exploring the antibacterial efficacy of Opuntia monacantha in combatting methicillin-resistant Staphylococcus aureus

Public health is seriously threatened by the rise of antibiotic-resistant strains of bacteria, especially methicillin resistant Staphylococcus aureus (MRSA). This study investigated the phytochemical compounds, and possible antibacterial effects of a methanolic extract of the cactus species Opuntia monacantha Haw. against MRSA. The powdered substance was extracted with methanol and filtered, and the filtrate was partitioned with n-hexane, chloroform and ethyl acetate. The fractions with higher percentage yields such as the n-hexane and chloroform fractions went through GC-MS analysis. They consist of various compounds that are known to have strong antioxidant and antimicrobial activities. The antimicrobial activity of the plant was measured via a diffusion assay. On the basis of these results, the Opuntia monacantha crude methanolic extract, and the n-hexane and chloroform fractions significantly inhibited all the MRSA strains used in the test at 100, 75 and 50 mg/mL. Furthermore, the minimum inhibitory concentrations of various fractions of the methanolic extract of Opuntia monacantha were also examined. Therefore, Opuntia could be a promising candidate for strengthening the existing formulations in pharmaceutical science for the treatment of MRSA. However, additional research is necessary before its therapeutic use is recommended. The results are intended to provide important new information for the creation of sustainable and alternative antimicrobial agents.

WHO global research agenda for hand hygiene improvement in health care: a Delphi consensus study

OBJECTIVE

To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023-2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety.

DESIGN

Expert consensus study using a modified Delphi process.

PARTICIPANTS

A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels.

METHODS

The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel's aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined "strongly agree" and "agree" frequency of at least 70%.

RESULTS

Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds.

CONCLUSIONS

A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.

Antibiotic-induced gut dysbiosis: unraveling the gut-heart axis and its impact on cardiovascular health

Cardiovascular diseases (CVDs) remain the major cause of morbidity and mortality amongst people of all ages across the world. Research suggests that the initiation and progression of CVDs are associated with antibiotic-induced gut dysbiosis. Antibiotics are primarily intended to be used to treat bacterial infections, which can alter gut microbiota (GM) composition, by lowering the abundance of beneficial bacteria, like Firmicutes, Bacteroidetes, and increasing the profusion of Enterobacteriaceae, leading to harm on gut health. Additionally, it reduces short-chain fatty acids (SCFAs) and bile acid metabolism, increases trimethylamine N-oxide (TMAO) production, intestinal permeability allowing lipopolysaccharide (LPS) and TMAO into systemic circulation. SCFAs play a key role in lipid metabolism, inflammation, and strengthening of the intestinal barrier, and participate in CVDs through FFAR2 and FFAR3 receptors, whereas dysbiosis reduces SCFAs levels and worsens these effects. TMAO enhances oxidative stress, inflammation, endothelial dysfunction, and cholesterol dysregulation, thus worsening CVDs. Furthermore, LPS develops systemic inflammation, insulin resistance, and endothelial dysfunction by activating the NF-κB pathway. Dysbiosis also affects bile acid synthesis, disrupting lipid and glucose metabolism, further participating in the progression of CVDs. This article aims to explore the role of gut dysbiosis in various CVDs, including congenital heart disease, hypertension, valvular heart disease, coronary heart disease, and heart failure. Furthermore, this article aims to bridge the knowledge gap regarding the gut-heart axis by exploring how antibiotics alter the gut microbiota homeostasis, further contributing to the development of CVDs and therapeutic interventions that reduce cardiovascular risks and restore the gut microbiota homeostasis.

Rare or Unusual Non-Fermenting Gram-Negative Bacteria: Therapeutic Approach and Antibiotic Treatment Options

Non-fermenting Gram-negative bacteria (NFGNB) are a heterogeneous group of opportunistic pathogens increasingly associated with healthcare-associated infections. While Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia are well known, rarer species such as Burkholderia cepacia complex, Achromobacter spp., Chryseobacterium spp., Elizabethkingia spp., Ralstonia spp., and others pose emerging therapeutic challenges. Their intrinsic and acquired resistance mechanisms limit effective treatment options, making targeted therapy essential. Objectives: This narrative review summarizes the current understanding of rare and unusual NFGNB, their clinical significance, resistance profiles, and evidence-based therapeutic strategies. Methods: A literature review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies on the epidemiology, antimicrobial resistance, and treatment approaches to rare NFGNB. Results: Rare NFGNB exhibits diverse resistance mechanisms, including β-lactamase production, efflux pumps, and porin modifications. Treatment selection depends on species-specific susceptibility patterns, but some cornerstones can be individuated. Novel β-lactam/β-lactamase inhibitors and combination therapy approaches are being explored for multidrug-resistant isolates. However, clinical data remain limited. Conclusions: The increasing incidence of rare NFGNB requires heightened awareness and a tailored therapeutic approach. Given the paucity of clinical guidelines, antimicrobial stewardship and susceptibility-guided treatment are crucial in optimizing patient outcomes.

Efficacy of Molnupiravir in Reducing the Risk of Severe Outcomes in Patients with SARS-CoV-2 Infection: A Real-Life Full-Matched Case-Control Study (SAVALO Study)

We conducted a real-life case-control study among outpatients with Omicron SARS-CoV-2 infection to assess the effectiveness of molnupiravir (MNP) in reducing hospital admission, admission to the intensive care unit, and death at day 28. Cases were SARS-CoV-2-positive patients seeking medical care within five days of symptom onset from 1 January to 31 December 2022, who received MNP. Controls were selected from a regional database among positive subjects who did not receive antiviral treatment for SARS-CoV-2. A total of 1382 patients were included (146 cases, 1236 controls). Vaccinated patients had a lower risk of mortality and of the composite outcome (hospital admission, ICU admission, or all-cause death) than unvaccinated ones (0.6% vs. 7.8%, p < 0.001 and 2% vs. 7.8%, p = 0.001, respectively). After full-matching propensity score analysis, MNP-treated subjects had a lower incidence of the composite outcome, although no effect was observed on individual outcomes. In subgroup analyses by vaccination status, MNP was effective in preventing all outcomes among unvaccinated patients and reduced the risk of ICU admission in both vaccinated and unvaccinated patients. Molnupiravir treatment effectively reduced the composite outcome risk in outpatients with SARS-CoV-2 infection, with a more pronounced benefit in unvaccinated patients. These findings highlight MNP's potential to help prevent disease progression in high-risk patients, thereby supporting its role as an outpatient therapeutic option for COVID-19.

Recent HIV testing and self-reported HIV prevalence among men who inject drugs in Afghanistan: a nationwide survey in 2019-2020

BACKGROUND

People who inject drugs (PWID) remain at high risk for HIV in many countries, including Afghanistan. Previous reports on HIV testing and prevalence in Afghanistan were published in 2012. This study assessed recent HIV testing and self-reported HIV prevalence among male PWID in Afghanistan from 2019 to 2020.

METHOD

We visited 374 public venues and hotpots where PWID used to gather and meet their peers across 8 cities in Afghanistan to enroll eligible participants in our study. Using interviews and a survey, our trained interviewers collected data on the demographics, types of drugs, HIV testing history, and self-reported HIV status of the participants. We analyzed the data using the venues and hotpots as clusters to report the percentages of recent HIV tests and self-reported HIV prevalence overall and in subgroups defined by demographic characteristics and locations.

RESULTS

Among the 1385 participants, most were from Kabul city (28.9%), spoke Dari (67.4%), were aged 25-34 years (42.1%), and were married (52.4%). Overall, 70.7% (95% CI 67.6-73.6) (ranging from 20.0% in Kandahar to 99.3% in Mazar-i-Sharif) were tested for HIV within the past 12 months. Among those who had ever been tested for HIV, 20.7% (95% CI 17.8-24.0) (ranging from 0% in Zarang to 63.2% in Kabul) reported being positive for HIV.

CONCLUSION

Compared with the results of a similar study in 2012, we found a significant improvement in HIV testing coverage among PWID in Afghanistan. The high self-reported HIV prevalence among this group also highlights the need for targeted screening and treatment programs for PWID in Afghanistan, particularly in the cities of Kabul and Jalalabad.

Clinical aspects and recent advances in fungal diseases impacting human health

Fungal diseases are of growing clinical concern in human medicine as the result of changes in the epidemiology, diversity in clinical presentation, emergence of new pathogens, difficulties in diagnosis and increasing resistance to antifungals of current available classes. There is a need for high disease awareness among the public and healthcare physicians, improvement in diagnostic methods and the development of drugs from new therapeutic classes with an improved resistance profile. In this article, we will explore some key aspects of fungal diseases in humans and provide a general overview of this important topic.

Knowledge, attitudes, and practices of ICU head nurses regarding infection control and antimicrobial resistance in Iran: a cross-sectional study

BACKGROUND

In the intensive care unit (ICU), infections due to multidrug-resistant (MDR) bacteria lead to poor clinical outcomes, prolonged ICU and hospital stays, high mortality and morbidity rates, and higher patient care cost. This study investigated knowledge, attitudes and practices (KAP) of ICU head nurses in Iran towards infection prevention and control (IPC) measures and antimicrobial resistance (AMR).

METHODS

This study was conducted among 61 ICU head nurses of the 36 hospitals in Isfahan, Iran on 19th July 2023. Data was collected by self-administer questionnaires. Data analysis was performed using SPSS version 25.0 level of significance was considered to be less than 0.05 in all tests.

RESULTS

Of the 61 participants, 56 (91.8%) were female and their ages ranged from 27 to 56 years old with a mean age of 39.3 ± 5.6 years. 75.4% of participants had a bachelor's degree and 24.6% had a master's degree. The mean work experience in the ICU and duration of experience in the hospital was 8.1 and 16.2 years, respectively. The mean scores for KAP were 3.84 ± 1.86 (with a range of 0-9), 55.00 ± 12.50, 35.84 ± 4.19 (with a range of 24-48) and 21.27 ± 3.13 (with a range of 17-29), respectively. There was a significant relationship between knowledge and total years of experience (r = 0.256, P < 0.048).

CONCLUSION

The study showed that most participants had weak knowledge, a positive attitude and weak practices. Consequently, more emphasis is needed to improve the ICU head nurses' KAP toward IPC measures and AMR, especially in areas where gaps were identified. Additionally, there is a need to an educational plan on these topics in the training of nursing programs.

Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey

Introduction: Antimicrobial stewardship (AMS) can improve the rational use of antibiotics in hospitals. This study assessed the impact of a multifaceted AMS intervention on antibiotic use and prescribing patterns at three tertiary hospitals in Zambia. Methods: Point Prevalence Surveys (PPS) were conducted in three tertiary hospitals in August 2022 and in October 2023. It was part of a 3-year AMS demonstration project that aimed to optimize the use of antibiotics in treating urinary tract infections (UTIs) and bloodstream infections (BSIs) in various health sector settings in Zambia. Up to 170 medical records in 2022 and 265 in 2023 were included in the assessment. Results: Overall, the prevalence of antibiotic use in this PPS was 75%. Eighty-one percent (81%) and 71% of patients assessed were on at least one antibiotic in 2022 and 2023, respectively, indicating a decrease of 10%. Similarly, prescribing ceftriaxone, the most prescribed antibiotic, declined from an average of 48% in 2022 to 38% in 2023. Adherence to Standard Treatment Guidelines (STGs) slightly increased from 42% in 2022 to 45% in 2023. Additionally, antibiotic prescribing was reduced from 1.38 to 1.21. Conclusions: Antimicrobial stewardship had an early positive impact on antibiotic use and adherence to Standard Treatment Guidelines.

Antimicrobial Resistance and Migration: Interrelation Between Two Hot Topics in Global Health

Background: Antimicrobial resistance (AMR) and migration are two interlinked issues and both pose an escalating threat to global health. With an increasing trend, there are 281 million migrants globally, while AMR is contributing to over 5 million deaths annually, with a projected rise to 10 million by 2050 if left unaddressed. Both AMR and migration are multifaceted problems that extend beyond human health, involving animals, plants, and the environment-a fact highlighted by the One Health approach. Objective: The aim of this work is: (1) to examine the complex relationship between migration and AMR, drawing on epidemiological data, surveillance strategies, and healthcare access challenges and (2) to address an interventional strategy proposal. Methods: We performed a narrative review of the most updated literature about migration and AMR using three primary databases: PubMed, Scopus, and Embase. Findings: Migrants, particularly from low‑ and middle‑income countries, represent a unique group at increased risk of AMR due to factors such as overcrowded living conditions, limited access to healthcare, uncontrolled use of antibiotics, and high prevalence of AMR in origin countries. Studies reveal higher rates of AMR colonization and infection among migrants compared with native populations, with specific pathogens such as MRSA and multidrug‑resistant gram‑negative bacteria posing significant risks. Migratory conditions, socioeconomic vulnerability, and healthcare barriers contribute to this heightened risk. Conclusion: To address the intersection of migration and AMR, interventions must focus on improving living conditions, enhancing healthcare access, promoting appropriate antibiotic use, and strengthening microbiological surveillance. Multisectoral collaboration is essential to mitigate the spread of AMR and safeguard both migrant and global public health.

A Critical Review of the Prospect of Integrating Artificial Intelligence in Infectious Disease Diagnosis and Prognosis

This paper explores the transformative potential of integrating artificial intelligence (AI) in the diagnosis and prognosis of infectious diseases. By analyzing diverse datasets, including clinical symptoms, laboratory results, and imaging data, AI algorithms can significantly enhance early detection and personalized treatment strategies. This paper reviews how AI-driven models improve diagnostic accuracy, predict patient outcomes, and contribute to effective disease management. It also addresses the challenges and ethical considerations associated with AI, including data privacy, algorithmic bias, and equitable access to healthcare. Highlighting case studies and recent advancements, the paper underscores AI's role in revolutionizing infectious disease management and its implications for future healthcare delivery.

Development of a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide empiric antibiotic treatment for ventilator-associated pneumonia in a Mexican tertiary care university hospital

BACKGROUND

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in critically ill patients, leading to high morbidity, mortality, and increased healthcare costs. The diversity of local microbiology and resistance patterns complicates the empirical treatment selection. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) offers an innovative tool to optimize empirical antibiotic therapy by integrating local microbiological data and resistance profiles.

OBJECTIVE

To develop a WISCA tailored for VAP in a Mexican tertiary care university hospital, aiming to enhance empirical antibiotic coverage by addressing the unique pathogen distribution and resistance patterns within the institution.

METHODS

This retrospective study included 197 VAP episodes from 129 patients admitted to a critical care unit between June 2021 and June 2024. Clinical and microbiological data, including pathogen susceptibility profiles, were analyzed using a Bayesian hierarchical model to evaluate the coverage of multiple antibiotic regimens. We also assessed the current impact of inappropriate empiric or directed treatment on in-hospital mortality using Cox regression models to support the development of a WISCA model.

RESULTS

The median age of the patients was 44 years (IQR 35-56), with Acinetobacter baumannii (n = 71), Enterobacterales (n = 53) and Pseudomonas aeruginosa (n = 36) identified as the most frequently isolated pathogens. The developed WISCA models showed variable coverage based on antibiotic regimens and the duration of invasive mechanical ventilation (IMV). Inappropriate directed therapy during the VAP episode was associated with increased mortality, as were the diagnosis of Acute Respiratory Distress Syndrome (ARDS) and a high Sequential Organ Failure Assessment (SOFA) score (p < 0.01).

CONCLUSIONS

The tailored WISCA with Bayesian hierarchical modeling provided more adaptive, subgroup-specific estimates and managed uncertainty better compared to fixed models. The implementation of this WISCA model demonstrated potential to optimize antibiotic strategies and improve clinical outcomes in critically ill patients in our hospital.

TOPIC

Optimizing Empirical Antibiotic Therapy for Ventilator-Associated Pneumonia Using a Weighted-Incidence Syndromic Combination Antibiogram in a Mexican Tertiary Care Hospital.

Causal relationship between immune cell signatures and colorectal cancer: a bi-directional, two-sample mendelian randomization study

BACKGROUND

Prior studies have demonstrated the association between immune cells and colorectal cancer (CRC). However, the causal link to specific immunophenotypes is limited. This study intends to elucidate the causal relationship of immune cell signatures on CRC.

METHODS

We performed a bi-directional and two-sample mendelian randomization (MR) study, utilizing GWAS summary data of 731 immune cell traits (n = 3,757) and CRC statistics (n = 470,002). The primary MR methodology was inverse-variance weighted (IVW) method. Furthermore, heterogeneity was evaluated by Cochran's Q test. MR-PRESSO and MR-Egger were employed to assess horizontal and vertical pleiotropy respectively. Sensitivity analysis and FDR correction were conducted in our results. These results were validated in both the UK Biobank and FinnGen cohorts. We also extracted transcriptomic data of CRC and adjacent non-tumor tissues from TCGA, and used CIBERSORT to compare the infiltration patterns of 22 immune cell panels between normal tissues and the tumor microenvironment (TME).

RESULTS

Our study indicated nine immune cell signatures had significant causality with the risk of CRC after sensitivity analysis and FDR correction. The positive results covered four panels: B cell, CD8 + T cell, Treg, and monocyte. IgD- CD38br and IgD + CD38br B cell, CD8dim and CD28 + CD45RA- CD8dim T cell, and CD14 on CD14 + CD16- monocyte were the protective factors of CRC. However, CD39 + resting Treg, CX3CR1 on CD14- CD16 + monocyte, FSC-A on HLA DR + T cell, and BAFF-R on B cell increased the risk of CRC. The results were validated in the UK Biobank data and FinnGen cohorts. The data from the TCGA database also confirmed the infiltration of B cell, CD8 + T cell, Treg, and monocyte panels in the TME.

CONCLUSION

This study highlights the causal link between specific immune cell phenotypes and CRC, providing valuable insights into the immune microenvironment's role in CRC. The validation of our findings using large-scale datasets (UK Biobank, FinnGen) and TCGA underscores the robustness of our results, offering new potential therapeutic targets for CRC treatment.

Assessment of physicians' proficiency concerning antibiotic use for upper respiratory tract infections in children: a cross-sectional study

Since most upper respiratory tract infections (URTIs) are caused by viruses, treatment with antibiotics is considered nonbeneficial and futile. Nonetheless, antibiotic misuse remains a concern that has a profound impact on global health, owing to the possible development of antibiotic resistance. Therefore, understanding the factors influencing physicians' practices and attitudes and assessing their level of knowledge regarding antibiotic prescriptions for children with URTIs is advisable to determine the factors that lead to the emergence of antibiotic resistance. A cross-sectional study was conducted among pediatricians and pediatric residents in the northern West Bank, Palestine, from December 2021 to the end of January 2022. Data were collected via a validated self-administered questionnaire with four sections: demographic details, knowledge (scored 0-1), attitudes (11-item Likert scale, maximum 55), and prescribing behavior for pediatric URTIs (scored 1-5, maximum 55). Statistical analysis was performed via SPSS v21, with nonparametric tests (Mann‒Whitney U, Kruskal‒Wallis) applied for nonnormal variables (p < 0.05). Demographics, knowledge, attitudes, and behaviors were summarized using frequencies, percentages, medians, and interquartile ranges. A total of 108 questionnaires were collected and returned, yielding a response rate of 90%. The overall level of knowledge among the respondents was commendable but concerning, as 22% of them mistakenly believed that antibiotics functioned as anti-inflammatory drugs. T The participants' attitudes ranged from 29 to 52 points, with a maximum possible score of 55. The average score was 41.1 ± 3.6, reflecting generally favorable attitudes toward antibiotic usage among the participants. However, 6.5% of the respondents expressed a preference for the use of broad-spectrum antibiotics for most cases of acute URTIs. The practice score also followed a normal distribution, with an average score of 35.4 ± 7.7 out of 55. Some respondents identified challenges in properly prescribing antibiotics, such as the time required to explain antibiotics to parents, parental requests for antibiotics, and uncertainty regarding the illness. The age of the respondents was significantly positively correlated with their behavioral state (p = 0.037), with older respondents exhibiting better behavioral patterns. Pediatric residents and female respondents had comparatively lower perceptions of antibiotic behavior and practices (p = 0.004 and p = 0.03, respectively). Additionally, the results revealed positive correlations between participants' attitudes and practices (rs = 0.434, p < 0.001) and between their knowledge and practices (rs = 0.355, p < 0.001). Several factors influencing physicians' practices, as well as factors related to parents, were identified. Thus, enhancing knowledge alone may not be sufficient. Possible recommendations were examined, with a focus on improving the doctor‒patient relationship and implementing essential educational interventions to increase awareness of antibiotic resistance and promote better prescribing and purchasing behaviors for both physicians and the general public.

Clinical application of acute Q fever -induced systemic capillary leak syndrome in a patient by using metagenomic next-generation sequencing: a case report and literature review

INTRODUCTION

Query fever (Q fever), a zoonotic disease, caused by Coxiella burnetii, is an infectious disease that has long been considered a rare and regionally restricted disease. It can be responsible for endocarditis and endovascular infections. Systemic capillary leak syndrome (SCLS), a rare disease of unknown etiology that most commonly develops in adults 50-70 years of age, is diagnosed clinically based on a characteristic symptomatic triad of hypotension, hemoconcentration (elevated hemoglobin or hematocrit), and serum hypoalbuminemia resulting from fluid extravasation. Although Q fever has increasingly been recognized and reported in recent years, the treatment of Q fever complicated by SCLS, with an etiological diagnosis aided by metagenomic next-generation sequencing (mNGS), remains uncommon.

CASE PRESENTATION

This report describes a case of acute Q fever with concurrent SCLS in a 54-year-old male who worked in a slaughterhouse. The patient presented with fever, chest tightness, and shortness of breath, accompanied by severe headache. His condition rapidly deteriorated, leading to acute fever, generalized weakness, and hypotension. Due to respiratory failure and shock, he was admitted to the intensive care unit (ICU) for treatment. Despite empirical antibiotic therapy along with fluid resuscitation, his blood pressure continued to decline, and metabolic acidosis and respiratory distress worsened. As his condition failed to improve, tracheal intubation was performed. mNGS detected both Coxiella burnetii in his BALF and blood samples. Based on the mNGS results, he was started on doxycycline, alongside penicillin antibiotics, vasopressors, and continuous renal replacement therapy (CRRT). The patient's condition gradually improved, and he was discharged home after 12 days of treatment. At his 90-day follow-up, he had nearly fully recovered to his pre-illness status.

CONCLUSIONS

mNGS plays a crucial role in assisting the diagnosis of Q fever, which enables the timely treatment of the underlying disease triggering SCLS. This, combined with restrictive fluid resuscitation strategies, is essential for improving patient outcomes.

The Swiss Transplant Cohort Study: Implications for Transplant Infectious Diseases Research

The longitudinal, nationwide Swiss Transplant Cohort Study (STCS) follows > 92% of all transplant recipients with comprehensive data collection tailored to overall and organ-specific transplant outcomes. Transplant infectious disease events are assembled under the auspices of transplant ID specialists using common definitions. With over 6000 active patients and a median follow-up exceeding 6 years, the cohort offers a unique platform for understanding real-world epidemiology in transplanted patients. Beyond observational analysis, the STCS supports randomized controlled trials to address specific research questions. This overview highlights the achievements of the STCS and explores its future directions.

Introducing new antibiotics for multidrug-resistant bacteria: obstacles and the way forward

BACKGROUND

Following intense efforts to revive the dry antibiotic research and development pipeline, a few highly awaited antibiotics with activity against multidrug-resistant (MDR) bacteria were recently approved.

OBJECTIVES

We aim to highlight gaps in the evidence generated for new antibiotics by the time of their approval and to review the consequent limitations of treatment guidelines for priority MDR bacteria. We also report on the availability of the new antibiotics, reimbursement strategies allowing the use of these antibiotics in hospitals, and antibiotic stewardship efforts.

SOURCES

We searched PubMed for phase 3 randomized controlled trials, guidelines, and publications on access, usage, regulatory aspects and antimicrobial stewardship of antibiotics approved for use against MDR bacteria between 2013 and 2023. Other sources included governmental and professional documents regarding policies for reimbursement and use of the new antibiotics.

CONTENT

Several gaps in the evidence available regarding the new antibiotics are described related to the trials' target populations, comparators, management algorithm within the trial, non-inferiority hypotheses, and assessment of resistance development within the studies. We highlight the risk of current guidelines to increase the usage of new antibiotics and consequently accelerate resistance development. Updated mapping of antibiotic availability reveals critical inequality in access to the new antibiotics. Finally, strategies used nationally in Europe to provide access to the new antibiotics are not sufficiently balanced by antibiotic stewardship efforts to calibrate the judicious use of the new antibiotics.

IMPLICATIONS

Antibiotic resistance is an immediate threat. The present review highlights areas where more systematic and uniform strategies across countries and geographical regions are warranted to improve evidence, availability, and use of new broad-spectrum antibiotics.