Experience in Ceftazidime-Avibactam for treatment of MDR BGN infection in Oncologic Children

BACKGROUND

Ceftazidime-Avibactam (CAZ-AVI) plays a key role in the treatment of Multidrug Resistant Gram-Negative Bacilli (MDR-GNB) infections. In pediatrics, CAZ-AVI is clinically approved for treatment of urinary tract or intra-abdominal infection. However, there is limited data available about its use in children with cancer who have complicated infections caused by MDR-GNB.

OBJECTIVE

This study aims to describe our experience in using CAZ-AVI for the treatment of MDR GNB infections in children with cancer.

METHODS

This retrospective observational study was conducted at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), including pediatric oncologic patients who received CAZ-AVI for the treatment of infections caused by GNB.

RESULTS

From Jan/2021 to Jun/2022, 11 patients with 13 episodes were included in the analysis. Among them, 45 % were female, with a median age of 7 years. Three patients had Acute lymphoblastic Leukemia (ALL), three had Acute Myeloid Leukemia (AML), two had Non-Hodgkin Lymphoma (NHL). Additionally, there was one case each of medulloblastoma, fibrosarcoma, and craniopharyngioma. All patients presented significant risk factors for MDR-GNB, such as neutropenia and two were submitted to Hematopoietic Stem Cell Transplantation (HSCT). The infection episodes included six Bloodstream Infections (BSI), two Urinary Tract Infections (UTI), two tracheobronchitis cases, along with one case each of necrotizing pneumonia, ventriculitis, and endocarditis. The identified pathogens included Klebsiella pneumoniae, Pseudomonas spp., Enterobacter cloacae, and Stenotrophomonas maltophilia. The primary reason for prescribing CAZ-AVI was either Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection or clinical worsening after initial therapy. Combination therapy was prescribed in eight episodes with a median prescription length of nine days. Microbiological sterilization was achieved in 92 % of episodes, and the 30-day survival rate was 84 %. Notably, no deaths were associated with treatment failure, and no adverse events associated with CAZ-AVI use were observed.

CONCLUSION

CAZ-AVI could be used for treating GNB infections in oncologic pediatric patients.

Incidence and severity of community acquired pneumonias in children before and after the COVID-19 pandemic

BACKGROUND

During the first year of the covid-19 pandemic the adoption of non-pharmacological interventions (NPI), resulted in a significant fall in the incidence of respiratory tract infections. However, after the relaxation of these restrictions some of these infections have returned. This study evaluates the incidence and severity of community acquired pneumonias (CAPs) in children before and after the onset of pandemic.

METHODS

Characteristics of CAPs admitted to Archbishop Makarios Hospital, between March 2016 and February 2023 were reviewed. Comparison was made between the first, second and third pandemic year, and the four pre-pandemic years.

RESULTS

The mean annual number of admissions in the pre-pandemic years was 32 and dropped to 11 during the first pandemic year. However, admissions increased again in the second year of the pandemic to 41 (increase by 28%), and this increase was sustained into the third year. The proportion of complicated pneumonias, approximately doubled, from 20% in the pre-pandemic years to 35% and 33% in the second and third pandemic year, respectively.

CONCLUSIONS

During the first year the use of NPIs appeared to have decreased the incidence of pneumonias. However, during the second and third pandemic years, an increase in the numbers and severity of pneumonias was noted.

Cost-effectiveness Analysis of Nirmatrelvir/Ritonavir Compared with Molnupiravir in Patients at High Risk for Progression to Severe COVID-19 in Japan

Background: Nirmatrelvir/ritonavir (NMV/r) and molnupiravir are oral antiviral drugs approved for the treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression to severe disease in Japan. Objective: This study evaluated, from a Japanese payer perspective, the cost-effectiveness of NMV/r compared with molnupiravir among patients with COVID-19. Methods: This cost-effectiveness model describes the COVID-19 disease history and the impact of antiviral treatment on short-term and long-term outcomes. Nirmatrelvir/ritonavir was compared with molnupiravir, and in the scenario analysis NMV/r was compared with standard of care over a lifetime horizon. Results: When compared with molnupiravir, NMV/r showed higher quality-adjusted life years (QALYs) (15.752 vs 15.739) and higher total cost (¥6 248 014 vs ¥6 245 829 [US 44   136.86 v s 44 121.42]). The incremental cost-effectiveness ratio was ¥164 934 (US 1165.12 ) p e r Q A L Y g a i n e d , w h i c h w a s l o w e r t h a n t h e w i l l i n g n e s s - t o - p a y ( W T P ) t h r e s h o l d i n J a p a n ( ¥ 5   000   000 / Q A L Y [ U S 35 320.71/QALY]). In the scenario analysis, the incremental cost-effectiveness ratio was ¥3 646 821 (US 25   761.66 ) p e r Q A L Y g a i n e d . O n e - w a y s e n s i t i v i t y a n a l y s i s a n d p r o b a b i l i s t i c s e n s i t i v i t y a n a l y s i s s h o w e d t h a t N M V / r w a s c o s t - e f f e c t i v e c o m p a r e d w i t h m o l n u p i r a v i r a n d s t a n d a r d o f c a r e c o n s i s t e n t l y . A l l r e s u l t s o f o n e - w a y s e n s i t i v i t y a n a l y s i s s h o w e d t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o s w e r e b e l o w t h e W T P t h r e s h o l d i n J a p a n . T h e r e s u l t o f t h e c o s t - e f f e c t i v e n e s s a c c e p t a b i l i t y c u r v e s h o w e d t h a t t h e p r o b a b i l i t y t h a t t h e i n c r e m e n t a l c o s t - e f f e c t i v e n e s s r a t i o w a s b e l o w t h e W T P o f ¥ 5   000   000 / Q A L Y ( U S 35 320.71/QALY) was 100.00%. Conclusion: Nirmatrelvir/ritonavir is cost-effective compared with molnupiravir and standard of care from a Japanese payer perspective. This study provides evidence for the cost-effectiveness of NMV/r for patients with COVID-19.

A customized postoperative wound management model tailored to the healing dynamics of the upper lip: a retrospective cohort study

BACKGROUND

Clinical observations suggest that upper lip injuries often exhibit prolonged healing and reduced healing efficacy. The unique anatomical and physiological characteristics of the lips make them particularly susceptible to infection and delayed recovery, posing significant challenges for postoperative management. The aim of this research, grounded in the anatomical and physiological subtleties of the upper lip, was to contrast the wound management outcomes between patients treated with a conventional wound management approach and those treated with a customized wound management model. Additionally, it aimed to explore the efficacy of a dynamic model in the assessment and treatment of upper lip wounds.

METHOD

It is a retrospective cohort study. Patients with maxillofacial injuries who attended the Emergency Department of West China Hospital of Stomatology of Sichuan University were selected for retrospective analysis. Between February and August 2023, 89 out of 783 patients with maxillofacial injuries who had upper lip injuries formed the control group. From February to August 2024, 84 patients with upper lip injuries, selected from 643 patients with maxillofacial injuries, constituted the experimental group. The control group applied the traditional wound management method, while the experimental group implemented the customized wound management model, which involved optimizing the team, devising a wound-healing model, improving dressings, innovating in both the timing and method of dressing changes, and providing customized care for complex wounds. The outcomes of upper lip wound management between the two groups were compared, including the wound infection rate, the Vancouver Scar Scale (VSS) score 30 days after surgery, and patients' satisfaction. Data analysis was conducted using SPSS 23.0 software.

RESULTS

There were no statistically significant differences in the demographic variables between the two groups (P > 0.05). The upper lip infection rates were 18% (16 out of 89) in the control group and 1.2% (1 out of 84) in the experimental group, respectively. Notably, the incidence of wound complications and wound infection rates differed significantly between the control and experimental groups, with the experimental group showing lower figures for both (P < 0.001). Compared to the control group, the experimental group had a lower VSS score and a higher patients' satisfaction score, with these differences being statistically significant (P < 0.001).

CONCLUSION

The customized wound management model demonstrated superior clinical efficacy in treating upper lip injuries. Patients gain advantages from a customized postoperative wound management model designed according to the upper lip healing kinetics. By aligning postoperative care with the unique healing kinetics of the upper lip, this approach significantly reduces infection rates and enhances patient satisfaction. These findings advocate for wider adoption of this personalized wound management model in the clinical treatment of upper lip injuries.

TRIAL REGISTRATION

Clinical Trial Registration No. ChiCTR2300079287, Registration Date 29 December 2023.

Genetically Engineered Bacteria as a Promising Therapeutic Strategy Against Cancer: A Comprehensive Review

As a significant cause of global mortality, the cancer has also economic impacts. In the era of cancer therapy, mitigating side effects and costs and overcoming drug resistance is crucial. Microbial species can grow inside the tumor microenvironment and inhibit cancer growth through direct killing of tumor cells and immunoregulatory effects. Although microbiota or their products have demonstrated anticancer effects, the possibility of acting as pathogens and exerting side effects in certain individuals is a risk. Hence, several genetically modified/engineered bacteria (GEB) have been developed to this aim with ability of diagnosing and selective targeting and destruction of cancers. Additionally, GEB are expected to be considerably more efficient, safer, more permeable, less costly, and less invasive theranostic approaches compared to wild types. Potential GEB strains such as Escherichia coli (Nissle 1917, and MG1655), Salmonella typhimurium YB1 SL7207 (aroA gene deletion), VNP20009 (∆msbB/∆purI) and ΔppGpp (PTet and PBAD), and Listeria monocytogenes Lmat-LLO have been developed to combat cancer cells. When used in tandem with conventional treatments, GEB substantially improve the efficacy of anticancer therapy outcomes. In addition, public acceptance, optimal timing (s), duration (s), dose (s), and strains identification, interactions with other strains and the host cells, efficacy, safety and quality, and potential risks and ethical dilemmas include major challenges.

The role of bacterial metabolism in antimicrobial resistance

The relationship between bacterial metabolism and antibiotic treatment is complex. On the one hand, antibiotics leverage cell metabolism to function. On the other hand, increasing research has highlighted that the metabolic state of the cell also impacts all aspects of antibiotic biology, from drug efficacy to the evolution of antimicrobial resistance (AMR). Given that AMR is a growing threat to the current global antibiotic arsenal and ability to treat infectious diseases, understanding these relationships is key to improving both public and human health. However, quantifying the contribution of metabolism to antibiotic activity and subsequent bacterial evolution has often proven challenging. In this Review, we discuss the complex and often bidirectional relationships between metabolism and the various facets of antibiotic treatment and response. We first summarize how antibiotics leverage metabolism for their function. We then focus on the converse of this relationship by specifically delineating the unique contribution of metabolism to three distinct but related arms of antibiotic biology: antibiotic efficacy, AMR evolution and AMR mechanisms. Finally, we note the relevance of metabolism in clinical contexts and explore the future of metabolic-based strategies for personalized antimicrobial therapies. A deeper understanding of these connections is crucial for the broader scientific community to address the growing crisis of AMR and develop future effective therapeutics.

Some artificial intelligence tools may currently be useful in orthopedic surgery and traumatology

Artificial intelligence (AI) can help in diagnosing fractures and demonstrating effusions, dislocations, and focal bone lesions in both adult and pediatric aged individuals and also aid in early tumor discovery (bone osteosarcoma) and in robot-assisted surgery. A recent AI model [Mask R-CNN (region-based convolutional neural network)] has shown to be dependable for detecting surgical target zones in pediatric hip and periarticular infections, offering a more convenient and quicker alternative to conventional methods. It can help inexperienced physicians in pre-treatment evaluations, diminishing the risk of missed diagnosis and misdiagnosis. AI has some very interesting applications in orthopedic surgery, which orthopedic surgeons should be aware of and if possible use. Although some interesting advances have been made recently on AI in orthopedic surgery, its usefulness in clinical practice is still very limited. Ethical concerns, such as transparency in AI decision-making, data privacy, and the potential loss of human intuition cannot be forgotten. Besides, it is paramount to explore how to gain trust from both healthcare professionals and patients in the utilization of AI.

Oral Microbiota and Inflammatory Bowel Diseases: Detection of Emerging Fungal Pathogens and Herpesvirus

Background/Objectives: Ulcerative colitis (UC) and Crohn's disease (CD) are the usual clinical forms of inflammatory bowel disease (IBD). Changes in the oral microbiota, especially the presence of emerging fungi and herpesviruses, have been shown to worsen the clinical aspects of IBD. The aim of this study was to screen for emerging pathogens in the oral yeast microbiota and the presence of herpesvirus in IBD patients. Methods: Oral swabs of seven UC or CD patients were collected. The samples were plated on Sabouraud Dextrose Agar and subcultured on CHROMagar Candida and CHROMagar Candida Plus. Polyphasic taxonomy was applied and identified using molecular tools, such as MALDI-TOF MS and ITS partial sequencing. Multiplex qPCR was used to identify the herpesvirus. Results: The mean age was 38.67 ± 14.06 years, 57.14% were female, and two had diabetes. The CD patients presented with Rhodotorula mucilaginosa, Candida orthopsilosis and Kodamaea jinghongensis, while the UC patients presented with Cutaneotrichosporon dermatis, Candida glabrata, Candida lusitanea and Candida tropicalis. Two UC individuals had at least one herpesvirus. In the first individual, a co-detection of Herpes Simplex Virus 1 (HSV-1) and C. lusitaniae was observed. The second presented with co-infections of Epstein-Barr virus (EBV), Human Herpesvirus 7 (HHV-7) and C. tropicalis. Conclusions: We identified rarely described yeasts and co-infections in IBD patients, highlighting the need to identify emerging pathogens in the oral microbiota, as they may contribute to opportunistic infections.

Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs

Introduction

The inappropriate prescribing and use of antibiotics have contributed to the emergence and spread of antimicrobial resistance (AMR). In Zambia, there is a paucity of information on the prescribing patterns and use of antibiotics among hospitalized patients in level 1 hospitals. This study investigated antibiotic use in five level 1 hospitals in Lusaka, Zambia.

Methods

This cross-sectional study utilized the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology among in-patients admitted in level 1 hospitals before 08:00 a.m. on the survey day in August 2024. Data were analysed using IBM SPSS version 23.0.

Results

The prevalence of antibiotic use among inpatients was 59.0%, with ceftriaxone being the most prescribed. Antibiotics were prescribed mainly for paediatrics and male inpatients. This study found that 53.0% of prescribed antibiotics were from the Access group while 38.2% were from the Watch group of the World Health Organization Access, Watch, and Reserve (AWaRe) classification. Adherence to national treatment guidelines was 36.0%, with most antibiotics prescribed empirically without evidence of culture and sensitivity tests.

Conclusion

This study found a high use of antibiotics and low adherence to treatment guidelines in level 1 hospitals in Lusaka, Zambia. The findings of this study demonstrate the need to establish and strengthen antimicrobial stewardship programs and strengthen laboratory capacity to aid clinicians in diagnosing, treating, and managing patients across level 1 hospitals in Zambia.

Impact of disease severity, age, sex, comorbidity, and vaccination on secondary attack rates of SARS-CoV-2: a global systematic review and meta-analysis

BACKGROUND

Understanding the key drivers of SARS-CoV-2 transmission is essential for shaping effective public health strategies. However, transmission risk is subject to substantial heterogeneity related to disease severity, age, sex, comorbidities, and vaccination status in different population settings and regions. We aimed to quantify the impact of these factors on secondary attack rates (SARs) of SARS-CoV-2 across diverse population settings and regions, and identify key determinants of transmission to inform targeted interventions for improving global pandemic response.

METHODS

To retrieve relevant literature covering the duration of the COVID-19 pandemic, we searched Ovid MEDLINE, Ovid Embase, Web of Science, and the Cochrane COVID-19 Study Register between January 1, 2020 and January 18, 2024 to identify studies estimating SARs of SARS-CoV-2, defined as the proportion of close contacts infected. We pooled SAR estimates using a random-effects model with the Freeman-Tukey double arcsine transformation and derived Clopper-Pearson 95% confidence intervals (CIs). Risk of bias was assessed using a modified Newcastle-Ottawa scale. This study was registered with PROSPERO, CRD42024503782.

RESULTS

A total of 159 eligible studies, involving over 19 million close contacts and 6.8 million cases from 41 countries across five continents, were included in the analysis. SARs increased with disease severity in index cases, ranging from 0.10 (95% CI: 0.06-0.14; I2 = 99.65%) in asymptomatic infection to 0.15 (95% CI: 0.09-0.21; I2 = 92.49%) in those with severe or critical conditions. SARs by age were lowest at 0.20 (95% CI: 0.16-0.23; I2 = 99.44%) for close contacts under 18 years and highest at 0.29 (95% CI: 0.24-0.34; I2 = 99.65%) for index cases aged 65 years or older. Among both index cases and close contacts, pooled SAR estimates were highest for Omicron and lowest for Delta, and declined with increasing vaccine doses. Regionally, North America had the highest SAR at 0.27 (95% CI: 0.24-0.30; I2 = 99.31%), significantly surpassing SARs in Europe (0.19; 95% CI: 0.15-0.25; I2 = 99.99%), Southeast Asia (0.18; 95% CI: 0.13-0.24; I2 = 99.24%), and the Western Pacific (0.11; 95% CI: 0.08-0.15; I2 = 99.95%). Among close contacts with comorbidities, chronic lung disease and hypertension were associated with the highest SARs. No significant association was found between SARs and the sex of either index cases or close contacts.

CONCLUSIONS

Secondary attack rates varied substantially by demographic and regional characteristics of the studied populations. Our findings demonstrate the role of booster vaccinations in curbing transmission, underscoring the importance of maintaining population immunity as variants of SARS-CoV-2 continue to emerge. Effective pandemic responses should prioritise tailored interventions that consider population demographics and social dynamics across different regions.

ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in solid organ transplant recipients

OBJECTIVES

We aimed to address existing knowledge gaps regarding risk stratification, best use of diagnostic resources, optimal treatment, and general management of SARS-CoV-2 infection in solid organ transplant (SOT) recipients. As high-quality evidence specific to this fragile population is lacking, our final aim was to provide an expert consensus evidence-informed guidance that can aid clinicians in their daily practice.

METHODS

This study was conducted within the Working Package 4 (fragile population cohorts) of the H2020-funded ORCHESTRA study (https://orchestra-cohort.eu). Eight infectious disease and one clinical pharmacology specialists conducted a comprehensive scoping literature review which covered five key areas: the role of SOT as a risk factor for evolution to severe disease; the optimal use of diagnostic resources, considering cost-benefit ratios and appropriateness of active screening; population-specific therapeutic management, including antiviral use and drug-drug interactions and appropriate duration of treatment; the potential need for withdrawal of immunosuppressive agents and management of potential donors and recipients with recent and/or ongoing SARS-CoV-2 infection at the time of transplantation. On the basis of this review, a 28-item questionnaire was developed and administered to a panel of experts through two rounds, following the Delphi methodology.

RESULTS

The panel consisted of 21 experts, 13 females and 8 males, from Italy (n = 11), Spain (n = 5), Switzerland (n = 2), Brazil (n = 1), United States (n = 1), and United Kingdom (n = 1). Consensus was achieved for 18 out of 28 items after the first round and for 9 out of 13 items after the second round, according to agreement/disagreement levels obtained for each question and round, ten statements were finally produced.

DISCUSSION

The consensus statements derived from this study offer a framework for standardizing care and improving outcomes in SOT recipients affected by SARS-CoV-2 infection in a field where high-quality evidence specific to this high-risk population is currently lacking.

Microbiome Integrity Enhances the Efficacy and Safety of Anticancer Drug

The intricate relationship between anticancer drugs and the gut microbiome influences cancer treatment outcomes. This review paper focuses on the role of microbiome integrity in enhancing the efficacy and safety of anticancer drug therapy, emphasizing the pharmacokinetic interactions between anticancer drugs and the gut microbiota. It explores how disruptions to microbiome composition, or dysbiosis, can alter drug metabolism, immune responses, and treatment side effects. By examining the mechanisms of microbiome disruption caused by anticancer drugs, this paper highlights specific case studies of drugs like cyclophosphamide, 5-fluorouracil, and irinotecan, and their impact on microbial diversity and clinical outcomes. The review also discusses microbiome-targeted strategies, including prebiotics, probiotics, postbiotics, and fecal microbiota transplantation (FMT), as promising interventions to enhance cancer treatment. Furthermore, the potential of microbiome profiling in personalizing therapy and integrating these interventions into clinical practice is explored. Finally, this paper proposes future research directions, including developing novel biomarkers and a deeper comprehension of drug-microbiome interactions, to respond to current gaps in knowledge and improve patient outcomes in cancer care.

Exploring New Delhi Metallo Beta Lactamases in Klebsiella pneumoniae and Escherichia coli: genotypic vs. phenotypic insights

BACKGROUND

Carbapenemase-producing Enterobacterales pose a serious clinical threat, particularly in high-burden settings of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae (CREK), where rapid detection tools are essential to aid patient management. In this study, we focused on blaNDM, the most frequently reported carbapenemase in the region, and evaluated a combined phenotypic (lateral flow) and genotypic (PCR and WGS) approach for its detection. This research underscores the utility of lateral flow assays as a practical alternative to resource-intensive genotypic methods, offering a scalable solution for settings with limited laboratory capacity.

METHOD

One hundred seventy-seven extensively drug-resistant strains were characterized using MALDI-TOF. Isolates were analyzed to detect Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae (CREK) using disk diffusion, MIC test, and PCR targeting blaNDM. Antibiotic susceptibility patterns were analyzed and visualized using single-linkage hierarchical clustering, with results displayed on a permuted heat map. Immunochromatographic assay, RESIST-5 O.K.N.V.I (Coris Bioconcept®) was used for CREK isolates [(n = 17), positive and negative)] and Oxford Nanopore Sequencing was conducted on subsets [(n = 5) blaNDM-positive co-producers of blaNDM and blaOXA, and (n = 2) blaNDM-negative blaOXA producers) to evaluate the reliability of phenotypic and genotypic tests.

RESULT

Most of the XDR strains (90%) were CREK, with K. pneumoniae (71.2%) more prevalent than E. coli (28.7%) (p < 0.05). All CREK strains exhibited complete resistance (100%) to multiple antibiotics with 66% showing sensitivity to levofloxacin. Furthermore, K. pneumoniae (57.8%) had higher blaNDM gene prevalence than E. coli (36.9%). Among blaNDM-positive CREK, lateral flow assay revealed approximately half of each bacteria type co-produced blaOXA (E.coli, 52.9%), and (K. pneumoniae, 47%). For blaNDM-negative strains, blaOXA was more prevalent in K. pneumoniae (82.35%) than E. coli (41%) (p < 0.05). Comparing phenotypic to genotypic assays, E. coli showed 100% (CI 80.49 - 100%) sensitivity and specificity with a high Kappa agreement coefficient (0.91) (CI 95% 0.661-1, p < 0.01), whereas K. pneumoniae assays had lower sensitivity and specificity (40%) (CI 5.27 - 85.34%), with a lower Kappa agreement coefficient (0.20) (CI 95% 0.104-0.298, p < 0.01).

CONCLUSION

This study demonstrates the value of the RESIST-5 O.K.N.V.I. lateral flow assay as a rapid and reliable diagnostic tool for detecting blaNDM in Escherichia coli, with strong agreement to PCR and WGS. While performance for Klebsiella pneumoniae was lower, the assay offers a practical alternative in resource-limited settings, aiding antimicrobial stewardship and improving diagnostic capacities in high-burden regions.

Unlocking the secrets of the human gut microbiota: Comprehensive review on its role in different diseases

The human gut microbiota, a complex and diverse community of microorganisms, plays a crucial role in maintaining overall health by influencing various physiological processes, including digestion, immune function, and disease susceptibility. The balance between beneficial and harmful bacteria is essential for health, with dysbiosis - disruption of this balance - linked to numerous conditions such as metabolic disorders, autoimmune diseases, and cancers. This review highlights key genera such as Enterococcus, Ruminococcus, Bacteroides, Bifidobacterium, Escherichia coli, Akkermansia muciniphila, Firmicutes (including Clostridium and Lactobacillus), and Roseburia due to their well-established roles in immune regulation and metabolic processes, but other bacteria, including Clostridioides difficile, Salmonella, Helicobacter pylori, and Fusobacterium nucleatum, are also implicated in dysbiosis and various diseases. Pathogenic bacteria, including Escherichia coli and Bacteroides fragilis, contribute to inflammation and cancer progression by disrupting immune responses and damaging tissues. The potential for microbiota-based therapies, such as probiotics, prebiotics, fecal microbiota transplantation, and dietary interventions, to improve health outcomes is examined. Future research directions in the integration of multi-omics, the impact of diet and lifestyle on microbiota composition, and advancing microbiota engineering techniques are also discussed. Understanding the gut microbiota's role in health and disease is essential for formulating personalized, efficacious treatments and preventive strategies, thereby enhancing health outcomes and progressing microbiome research.

To construct and validate a risk score model of angiogenesis-related genes to predict the prognosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with high morbidity and mortality worldwide. Angiogenesis is essential for HCC progression and metastasis. Some angiogenesis-related genes promote this process, whereas other antiangiogenic genes inhibit HCC growth and metastasis. Therefore, finding new potential biomarkers for HCC prognosis prediction and treatment is essential. Public RNAseq and clinical data from TCGA and GEO database, download angiogenesis-related genes from the GeneCards, MSigDB database, through the single factor analysis of Cox, LASSO build risk score-Cox regression analysis model and external validation verified from the GEO. Cox regression analysis, Kaplan Meier (KM) curve, ROC curve, and decision-curve analysis will be used to evaluate and examine the risk score prediction effect of the model. GSVA analysis was used to assess the variation of gene sets between groups, and ClBERSOFT, ESTIMATE, and TIMER databases were used to analyze the immune infiltration in the single-cell level analysis of gene expression differences between cells. Finally, in the three pairs of HCC tissues and tissue adjacent to carcinoma by real-time fluorescent quantitative PCR (qRT_PCR) and western blotting (WB) to evaluate angiogenesis-related genes (ATP2A3 AEBP1 PNMA1, PLAT) expression level in HCC, and AEBP1 was knocked out in HCCLM3 cells, which is to study AEBP1 biological function in HCC. We established a prognostic risk assessment model based on 13 significant genes associated with HCC prognosis by Cox analysis and LASSO-Cox regression analysis. The median was used to divide these patients into high-risk and low-risk groups, and the prognosis of the high-risk group was worse than that of the low-risk group. Through the multivariate Cox regression analysis, it was found that the risk score was an independent predictor of overall survival (OS). The GSVA analysis suggested that the predicted high-risk population showed higher activity in the purine, pyrimidine, and riboflavin metabolic pathways. Compared with the low-risk group, the tumor microenvironment in the high-risk group showed a reduction in the number of cells promoting anti-tumor immunity and an increase in the number of cells inhibiting anti-tumor immunity, as well as a reduction in overall immune infiltration and matrix components. On the single-cell level, it was confirmed that the key genes (AEBP1, ATP2A3, PLAT, and PNMA1) expressed differently between liver cancer and adjacent tissue cell groups. Finally, qRT_PCR and WB results showed that ATP2A3, AEBP1, PNMA1, and PLAT were highly expressed in liver cancer tissue compared to adjacent tissue, and the proliferation, migration, and invasion of HCCLM3 cells were inhibited after knocking out AEBP1. We constructed novel risk score models as prognostic biomarkers for HCC, which has the potential to guide the development of more personalized treatment strategies for HCC patients. In addition, AEBP1 is a potential therapeutic target for HCC.

Acinetobacter baumannii Complex Infections: New Treatment Options in the Antibiotic Pipeline

Acinetobacter baumannii complex (ABC) can result in a panoply of severe syndromes, including pneumonia and septic shock. Options available for treating infections caused by ABC and, more importantly, by carbapenem-resistant ABC (CRAB) are limited because of the increasing prevalence of antimicrobial resistance. Furthermore, many older agents, such as polymyxin and colistin, have limited lung penetration and are associated with significant toxicities. These factors underscore the urgent need for new paradigms to address ABC and CRAB. Two agents, cefiderocol and sulbactam-durlobactam, are now available to treat CRAB infections. In addition, several anti-infectives that target CRAB are in later-stage clinical trials. In order to place these newer molecules in context and to help clinicians appreciate the emerging potential drug development pipeline, we describe the in vitro activity, mechanisms of action, and clinical trial data not only for the commercially now available alternatives, such as cefiderocol and sulbactam-durlobactam, but also review these topics for molecules undergoing phase II and III clinical trials. Specifically, we discuss and analyze data related to four novel drugs from ABC: BV-100, cefepime-zidebactam, zosurabalpin, and OMN6.

A One Health Perspective on the Resurgence of Flea-Borne Typhus in Texas in the 21st Century: Part 1: The Bacteria, the Cat Flea, Urbanization, and Climate Change

Flea-borne typhus (FBT), due to Rickettsia typhi and R. felis, is an infection typically causing fever, headache, rash, hepatitis, and thrombocytopenia. About one quarter of patients suffer pulmonary, neurologic, hematologic, renal, hepatic, cardiac, ocular or other complications. In the 21st century, the incidence of FBT has increased in both Texas and California compared to the 1990s. In this paper, county-level epidemiological data for the number of cases of FBT occurring in Texas for two decades, 1990-1999 and 2010-2019, were compared with respect to county of residence, urbanization, and climatic region. Human population growth in Texas has promoted FBT by increased urbanization and the abundance of pet dogs and cats, stray/feral dogs and cats, and opossums. Increasing temperatures in Texas in the new millennium have increased the flea-borne transmission of FBT by promoting host infestation and flea feeding and defecation, accelerating the flea life cycle, and increasing rickettsial replication within the flea. Increased numbers of opossums and stray cats and dogs in the urban/suburban landscape have increased the risk of flea transfer to humans and their pets.

Intracapsular and extracapsular fracture types and inpatient mortality in failed hemiarthroplasty

BACKGROUND

Increasing life expectancy has led to a rise in hip fractures and an associated increase in hemiarthroplasty procedures aimed at restoring mobility and preventing muscle loss. Despite the extensive literature on failed hemiarthroplasty, limited data address the influence of pre-operative fracture types-intracapsular versus extracapsular-on outcomes, including inpatient mortality. This study investigates the revisions of uncemented bipolar hemiarthroplasties concerning fracture type and identifies risk factors for inpatient mortality.

METHODS

This retrospective cohort study included 68 patients (16 males and 52 females) who underwent revision of uncemented bipolar hemiarthroplasties at a single institution between 2017 and 2024. Data on demographics, comorbidities, fracture type, surgical details and outcomes were analysed. Statistical analyses included t tests, chi-square tests and logistic regression, with significance set at p < 0.05.

RESULTS

Of 1,690 hemiarthroplasties performed, 68 required revision (revision rate: 4%). Revisions for extracapsular fractures were associated with a higher prevalence of diabetes mellitus (p = 0.01) and elevated Almelo Hip Fracture Score (AHFS; p = 0.01). The overall inpatient mortality rate was 19%, significantly higher in males (43.75%) than females (11.54%; p = 0.00). Deceased patients demonstrated higher AHFS and American Society of Anaesthesiologists scores but lower Parker Mobility Scores (p = 0.01). Prolonged intensive care unit (ICU) stays were also linked to increased mortality (p = 0.02). Logistic regression identified male sex as an independent predictor of mortality (odds ratio: 9.37; p < 0.05).

CONCLUSIONS

Pre-operative fracture type significantly influences revision outcomes in failed hemiarthroplasties. Moreover, extracapsular fractures are linked to diabetes mellitus and higher AHFS, whereas male sex, ICU stay duration and comorbidity scores predict inpatient mortality. These findings highlight the need for tailored perioperative care to mitigate risks.

TRIAL REGISTRATION

Not applicable.

Genomic Characterization of Carbapenemase-Producing Klebsiella pneumoniae ST895 Isolates from Canine Origins Through Whole-Genome Sequencing Analysis

The widespread application of carbapenems and other broad-spectrum antibiotics has significantly escalated the threat posed by highly drug-resistant Klebsiella pneumoniae to human public health. In this research, we isolated a carbapenem-resistant K. pneumoniae strain from the feces of pet dogs at a veterinary hospital in Changchun, Jilin Province, China. To gain insights into its genetic makeup and resistance mechanisms, we conducted comprehensive whole-genome sequencing and antimicrobial susceptibility testing on the isolated strain. Our findings revealed the presence of three distinct plasmids within the strain, classified as IncFIB&IncFII, IncR, and IncX3. Notably, the blaNDM-5 gene, conferring resistance to carbapenems, was uniquely harbored on the IncX3 plasmid, which was devoid of any other resistance genes beyond blaNDM-5. In contrast, the remaining two plasmids, IncFIB&IncFII and IncR, were found to encode an array of additional drug resistance genes, contributing to the strain's broad-spectrum resistance phenotype. The IncX3 plasmid, specifically, measures 45,829 bp in length and harbors the IS5D-blaNDM-5-Ble-MBL-PRAI cassette, which has been closely linked to the dissemination of blaNDM-5 genes in K. pneumoniae strains. We reported the blaNDM-5-carrying IncX3 in K. pneumoniae isolates recovered from the pet dog and revealed the molecular characterization. Emphasis should be placed on, and continuous monitoring carried out for, the dissemination of K. pneumoniae harboring the blaNDM-5 gene among humans, companion animals, and their related environments.

Antibiotic use at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin: a point prevalence survey

Background

Antimicrobial stewardship promotes the appropriate use of antibiotics to prevent the emergence and spread of antimicrobial resistance. This study evaluated the use of antibiotics using a point prevalence survey at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin.

Methods

This cross-sectional study utilized the WHO point prevalence survey methodology for monitoring antibiotic use among inpatients in hospitals. The survey was conducted from 11 January 2022 to 19 January 2022 among hospitalized patients before 8:00 a.m. on the day of the survey.

Results

Of the 111 inpatient medical files reviewed, the prevalence of antibiotic use was 82.9%. The number of antibiotics received per patient ranged from 1 to 5, with a mean of 2.45 ± 1.11 and a median of 2. The most commonly prescribed class of antibiotics was beta-lactams (46.7%), aminoglycosides (20.6%) and nitroimidazoles (19.7%). According to the WHO AWaRe classification, 30.4% of inpatients received the Access group of antibiotics and 44% received a combination of Access and Watch group antibiotics; treatment was empiric in 94.5% of encounters. Only 22.7% of patients were treated based on microbiological examination/culture and sensitivity testing.

Conclusions

This study found a high prevalence of antibiotic use among inpatients at the CHUZ/AS Tertiary Care Hospital in Benin. The most prescribed antibiotics were ampicillin, metronidazole and ceftriaxone. Consequently, the study found a low use of culture and sensitivity testing to guide treatment, particularly in the paediatric and surgical population, and the preference for broad-spectrum antibiotics suggests that antibiotic use at the CHUZ/AS Tertiary Care is not optimal. Therefore, antimicrobial stewardship programmes, policies and guidelines must be instigated and strengthened to address these gaps and promote rational use of antibiotics.

Cardoso F, P. Marques H. Carbapenem-Resistant Enterobacteriaceae Colonization or Infection Was Not Associated with Post-Liver Transplant Graft Failure: An Observational Cohort Study

Introduction

Carbapenem-resistant Enterobacteriaceae (CRE) epidemiology among liver transplant (LT) recipients is variable. We studied the impact of CRE colonization and infection on LT recipients' outcomes.

Methods

This observational cohort study included consecutive adult LT recipients between January 2019 and December 2020 at Curry Cabral Hospital, Lisbon, Portugal. Primary exposures were CRE colonization (rectal swabs under a screening program) and infection within 1 year of index LT. Primary endpoint was graft failure within 1 year of the index LT.

Results

Among 209 patients, the median (interquartile range [IQR]) age was 57 (47-64) years and 155 (74.2%) were male. CRE colonization was identified in 28 (13.4%) patients during the first year posttransplant (median [IQR] number of rectal swabs per patient of 4 [2-7]). CRE resistance genes identified were OXA48 in 8 (3.6%) patients, KPC in 19 (67.9%) patients, and VIM in 1 (3.6%) patient. Any bacterial/fungal and CRE infections were diagnosed in 88 (42.1%) and 6 (2.9%) patients, respectively, during the first year posttransplant. After adjusting for confounders, neither CRE colonization (aOR [95% CI] = 1.83 [0.71-4.70]; p = 0.21) nor infection (aOR [95% CI] = 1.35 [0.17-11.06]; p = 0.78) was associated with graft failure within 1 year of index LT.

Discussion/Conclusion

Under a screening program, CRE colonization and infection prevalence was low and neither was associated with graft failure.

Body composition and cardiometabolic risks of patients with adrenal tumours in relation to hormonal activity: a large cross-sectional single-centre study

OBJECTIVE

We aimed to examine how different types of adrenal hormone excess influence body composition.

DESIGN

A retrospective, cross-sectional, single-centre study.

METHODS

We retrospectively enrolled 2971 consecutive adults with adrenal tumours and age-, sex-, and body mass index-matched controls at a 1:3 ratio. The area and attenuation of skeletal muscle and fat at the L3 vertebrae were measured using computed tomography-based analysis software. Prevalence ratios of cardiometabolic outcomes were calculated using the Poisson regression.

RESULTS

Patients with non-functioning adenoma (n = 1354) and mild autonomous cortisol secretion (MACS; n = 786) showed similar body compositions. Patients with overt Cushing's syndrome (CS) had the highest visceral fat (VF) area to skeletal muscle area ratio (1.14), while pheochromocytoma (PHEO) patients had the lowest (0.52). Muscle attenuation was lowest in CS and highest in PHEO (32.6 vs 41.5 Hounsfield units, P < .001). Mild autonomous cortisol secretion patients had higher risks of hypertension and dyslipidaemia than non-functioning adenoma patients. Non-functioning adenoma and MACS patients had higher VF area and lower muscle/fat attenuation compared with controls, while primary aldosteronism patients had body compositions similar to controls, except for higher fat attenuation.

CONCLUSIONS

Adrenal tumours are associated with altered body composition. Even patients with non-functioning adenoma and MACS had increased VF area and lower muscle and fat attenuation compared with controls, indicating potential cardiometabolic risks.

Assessing the role of environment in Pseudomonas aeruginosa healthcare-associated bloodstream infections: a one-year prospective survey

BACKGROUND

Deciphering precise sources and patterns of healthcare-associated Pseudomonas aeruginosa colonization/infection is crucial in defining strategies of prevention and control.

AIM

To prospectively investigate the role of hospital environment in P. aeruginosa nosocomial bloodstream infections (Pa-BSIs) during one year in a tertiary-care hospital.

METHODS

Clinical records of patients presenting Pa-BSIs after >48 h of hospitalization were investigated to confirm the nosocomial character of BSIs and identify the routes of entry and risk factors. Environmental investigations were performed to track P. aeruginosa source/reservoir along the care pathway. Clinical and environmental strains were compared by whole-genome sequencing to identify the route of contamination from hospital environment to patients.

FINDINGS

Fifty-three BSIs episodes in 49 patients were considered as nosocomial, mostly involving men (73%), with an average age of 62.4 years, immunosuppressed in >40% of cases, and after previous antibiotic therapy in almost 92% of cases. BSIs occurred after 27 days of hospitalization on average. The main routes of entry were urinary (30%, on indwelling catheters for two-thirds of cases) and cutaneous (17%, catheter-related in almost 80% of cases). P. aeruginosa was found in 16 out of 49 investigations, representing 34 positive samples, including 54% of sink traps, 23% of water, and 20% of tap aerators. An epidemiological link was established between environmental and clinical strains only for eight patients, representing 15% of nosocomial BSIs.

CONCLUSION

The hospital environment usually considered as the main source of P. aeruginosa healthcare-associated infections was identified as responsible for nosocomial BSIs in only 15% of patients. Since the implementation of water and hospital environment management, one may hypothesize that P. aeruginosa has become a community-acquired pathogen with a nosocomial expression in infection.

Antibiotic duration for common bacterial infections-a systematic review

Background

Reducing antibiotic duration is a key stewardship intervention to mitigate antimicrobial resistance (AMR). We examined current evidence informing antibiotic duration for common bacterial infections to identify any gaps in terms of settings, patient populations and infectious conditions. Trial methodologies were assessed to identify areas for improvement.

Methods

MEDLINE and Embase were searched up to July 2024 for randomized trials comparing antibiotic durations in hospital and community settings (PROSPERO 2021, CRD42021276209). A narrative synthesis of the results was performed with a review on the major guidelines published by IDSA, NICE, WHO and other international societies to assess the impact of these trials on practice guidance.

Results

Out of 315 studies, 85% concluded equivalence or non-inferiority of shorter courses. Adult bacterial sinusitis, community-acquired pneumonia, female cystitis/pyelonephritis, uncomplicated cellulitis and intra-abdominal infection with adequate source control and perioperative prophylaxis had robust evidence supporting shorter durations. Few trials studied severe infections, such as bloodstream infections and ventilator-associated pneumonia. Twenty-three (7%) of the trials were conducted in intensive care settings and only 43 trials (14%) enrolled patients from low-to-middle- or low-income countries. Only 15% of studies were at low risk for bias.

Conclusions

Reducing antibiotic duration likely remains an important strategy for antibiotic stewardship, and an area of active research. While shorter antibiotic courses may be suitable for many bacterial infections, more evidence is needed for severe infections and in low- and middle-income settings.

The Role of Cortisol and Dehydroepiandrosterone in Obesity, Pain, and Aging

Obesity, chronic pain, and aging are prevalent global challenges with profound implications for health and well-being. Central to these processes are adrenal hormones, particularly cortisol and dehydroepiandrosterone (DHEA), along with its sulfated form (DHEAS). Cortisol, essential for stress adaptation, can have adverse effects on pain perception and aging when dysregulated, while DHEA/S possess properties that may mitigate these effects. This review explores the roles of cortisol and DHEA/S in the contexts of obesity, acute and chronic pain, aging, and age-related diseases. We examine the hormonal balance, specifically the cortisol-to-DHEA ratio (CDR), as a key marker of stress system functionality and its impact on pain sensitivity, neurodegeneration, and physical decline. Elevated CDR and decreased DHEA/S levels are associated with worsened outcomes, including increased frailty, immune dysfunction, and the progression of age-related conditions such as osteoporosis and Alzheimer's disease. This review synthesizes the current literature to highlight the complex interplay between these hormones and their broader implications for health. It aims to provide insights into potential future therapies to improve pain management and promote healthy weight and aging. By investigating these mechanisms, this work contributes to a deeper understanding of the physiological intersections between pain, aging, and the endocrine system.

Cortisol Circadian Rhythm and Sarcopenia in Patients With Type 2 Diabetes: A Cross-Sectional Study

BACKGROUND

Patients with Type 2 diabetes mellitus (T2DM) have elevated late-night cortisol levels and a flattened circadian rhythm. Cortisol oversecretion mediates muscle breakdown and reduces muscle strength and mass, thus possibly leading to sarcopenia. This study first investigated the association between cortisol circadian rhythm and sarcopenia in patients with T2DM.

METHODS

Patients with T2DM and adrenal nodules were screened for eligibility. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were obtained by analysing computed tomography images at Lumbar 3 level. Sarcopenia was defined as the presence of both myopenia and myosteatosis. Cortisol and adrenocorticotropic hormone levels at 8 AM, 4 PM and 0 AM were measured. The cumulative logit models and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between cortisol circadian rhythm and sarcopenia.

RESULTS

In total, 128 patients with T2DM and nonfunctional adrenal adenomas were enrolled in this study, of whom 25 were diagnosed with sarcopenia. The mean age was 54.4 years, and 83 (64.8%) patients were male. Patients with sarcopenia showed higher nighttime cortisol levels at 0 AM (Cor 0 AM) (4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL, p < 0.001) than those without. The Cor 0 AM was negatively correlated with both SMI and SMD (r = -0.318, p < 0.001 and -0.284, p < 0.001, respectively). As the Cor 0 AM tertiles increased, the odds ratios (ORs) for sarcopenia consistently increased (OR = 4.69 [0.93, 23.53], p = 0.061, for the intermediate group and OR = 11.39 [2.41, 53.84], p = 0.002, for the high group). After adjustment for multiple risk factors, the high Cor 0 AM group still showed a significantly higher risk of sarcopenia than the low group (OR = 7.92 [1.45, 43.29], p = 0.017). ROC curve analyses showed that Cor 0 AM had the highest predictive power for sarcopenia, with an area under the ROC curve (AUC) of 0.760, compared to haemoglobin, age, alanine transaminase and sex (AUC = 0.703, 0.695, 0.679, and 0.633, respectively).

CONCLUSIONS

The cortisol circadian rhythm is associated with sarcopenia in patients with T2DM. Patients with higher levels of nighttime cortisol, rather than morning or afternoon cortisol, have a higher risk of sarcopenia. This result offers a new strategy for the further research of sarcopenia.

[Importance of Hygiene for the Prevention of Antimicrobial Resistance]

In addition to antibiotic stewardship, infection prevention and control (IPC) measures at the hospital are crucial for containing antimicrobial resistance (AMR). Nosocomial infections can be prevented through the consistent application of recommended IPC measures. This reduces the use of antibiotics and therefore the development of AMR. In this way, antibiotic stewardship and IPC go hand in hand.

Insights Into Antimicrobial Resistance From Dental Students in the Asia-Pacific Region

BACKGROUND

Dentists, as prominent prescribers, are key stakeholders in addressing the antimicrobial resistance (AMR) crisis. Dental students' perceptions about the topic have been underexplored in the Asia-Pacific region, a key location for the development and spread of AMR. Thus, the aim of this study was to evaluate the awareness and confidence to prescribe antimicrobials amongst dental students studying in the region.

METHODS

Students from 15 dental schools in 4 countries were invited to participate in a cross-sectional online survey during 2022-2023. A previously validated and standardised 14-item instrument was utilised.

RESULTS

In all, 1413 responses were collected from Australia (n = 165), Sri Lanka (n = 112), Japan (n = 173), and Vietnam (n = 963). Of those, 201 were from final-year students (14.2%). On a scale from 1 to 10, awareness on AMR was placed at a mean (SEM) priority of 8.09 (0.05). With regards to target areas to address for mitigation of the AMR crisis, participants placed general public awareness at the top (mean [SEM] 8.53 [0.05]). Final-year students presented a mean (SEM) level of confidence to prescribe antibiotics of 6.01 (0.14) on a scale from 1 to 10, whilst 59.7% and 56.8% indicated feeling pressured to prescribe by patients or when lacking time, respectively. Final-year students participating in research activities assigned a higher priority to AMR compared to their peers not involved in research (mean [SEM] 8.6 [0.19] vs 7.81 [0.16]; P = .01).

CONCLUSIONS

This study highlights a need for increased awareness and confidence to prescribe amongst dental students in the Asia-Pacific region, an understudied population thus far. To mitigate this issue, the implementation (followed by assessment) of local educational and antibiotic stewardship initiatives is warranted.

The Temperature-Associated Effects of Rift Valley Fever Virus Infections in Mosquitoes and Climate-Driven Epidemics: A Review

Rift Valley fever virus (RVFV) is a mosquito-borne zoonotic disease within the genus Phlebovirus. Symptoms of the disease in animals range from moderate to severe febrile illness, which significantly impacts the livestock industry and causes severe health complications in humans. Similar to bunyaviruses in the genus Orthobunyavirus transmitted by mosquitoes, RVFV progression is dependent on the susceptibility of the physical, cellular, microbial, and immune response barriers of the vectors. These barriers, shaped by the genetic makeup of the mosquito species and the surrounding environmental temperature, exert strong selective pressure on the virus, affecting its replication, evolution, and spread. The changing climate coupled with the aforementioned bottlenecks are significant drivers of RVF epidemics and expansion into previously nonendemic areas. Despite the link between microclimatic changes and RVF outbreaks, there is still a dearth of knowledge on how these temperature effects impact RVF transmission and vector competence and virus persistence during interepidemic years. This intricate interdependence between the virus, larval habitat temperatures, and vector competence necessitates increased efforts in addressing RVFV disease burden. This review highlights recent advancements made in response to shifting demographics, weather patterns, and conveyance of RVFV. Additionally, ongoing studies related to temperature-sensitive variations in RVFV-vector interactions and knowledge gaps are discussed.

Deep learning in disease vector image identification

Vector-borne diseases (VBDs) represent a critical global public health concern, with approximately 80% of the world's population at risk of one or more VBD. Manual disease vector identification is time-consuming and expert-dependent, hindering disease control efforts. Deep learning (DL), widely used in image, text, and audio tasks, offers automation potential for disease vector identification. This paper explores the substantial potential of combining DL with disease vector identification. Our aim is to comprehensively summarize the current status of DL in disease vector identification, covering data collection, data preprocessing, model construction, evaluation methods, and applications in identification spanning from species classification to object detection and breeding site identification. We also discuss the challenges and possible prospects for DL in disease vector identification for further research. © 2024 Society of Chemical Industry.

Impact of hospital formulary intervention on carbapenem use: a segmented time-series analysis of consumption and a propensity score-matched non-inferiority study of treatment efficacy

BACKGROUND

Pharmaceutical formularies play a crucial role in guiding medication use by balancing clinical effectiveness and cost efficiency. Although formulary implementation has been increasing in Japan, comprehensive evaluations of its impact on both clinical and economic outcomes are limited. This study aimed to assess the effect of introducing an antimicrobial formulary at Yokohama City University Hospital on antibiotic usage and treatment outcomes in intra-abdominal infections.

METHODS

We conducted a segmented time-series analysis to evaluate changes in carbapenem usage, including doripenem, before and after formulary implementation in October 2018. Monthly antibiotic consumption was measured by antibiotic use density (AUD). The primary outcomes were changes in doripenem use and treatment efficacy for intra-abdominal infections. To assess treatment efficacy, we used non-inferiority analysis with propensity score matching based on age, sex, body mass index, cancer status, and baseline blood test results. The treatment outcomes were evaluated using predefined clinical indicators.

RESULTS

Following the formulary intervention, doripenem use significantly decreased from 10.8 to 4.9%, meropenem use slightly increased, and imipenem/cilastatin usage remained stable. Overall, carbapenem use significantly decreased during the study period. Treatment effectiveness for intra-abdominal infections remained non-inferior, with a higher proportion of patients classified as having an "effective" response post-intervention (86.6% vs. 79.4% pre-intervention). The confidence interval confirmed the non-inferiority margin, indicating no clinically significant reduction in treatment effectiveness following the formulary introduction.

CONCLUSIONS

The introduction of an antibiotic formulary at Yokohama City University Hospital effectively reduced the use of doripenem without compromising the effectiveness of treatment of intra-abdominal infections. These findings suggest that formulary management can be a valuable strategy for optimizing antibiotic use while maintaining clinical outcomes and contributing to improved antimicrobial stewardship in healthcare settings. Further research is warranted to explore the broader implications of formulary implementation in Japanese healthcare practices.

AI driven decision support reduces antibiotic mismatches and inappropriate use in outpatient urinary tract infections

Urinary tract infections (UTIs) often prompt empiric outpatient antibiotic prescriptions, risking mismatches. This study evaluates the impact of "UTI Smart-Set" (UTIS), an AI-driven decision-support tool, on prescribing patterns and mismatches in a large outpatient organization. UTIS integrates machine learning forecasts of antibiotic resistance, patient data, and guidelines into a user-friendly order set for UTI management. From 6/1/2021-8/31/2022, 171,010 UTI diagnoses were recorded, with UTIS used in 75,630 cases involving antibiotic prescriptions. Overall acceptance rate of UTIS recommendations was 66.0%. Among 19,287 cases with urine cultures, antibiotic mismatch rate was significantly lower when UTIS recommendations were followed (8.9% vs. 14.2%, p < 0.0001). Among women over 18, mismatch rate was 47.5% lower, and among women over 50, 55.6% lower (p < 0.001). Additionally, an overall reduction of 80.5% in ciprofloxacin usage (6.4% vs 32.9%, p < 0.0001) was observed. UTIS improved prescribing accuracy, reduced mismatches, and minimized quinolone use, highlighting AI's potential for personalized infection management.

Pattern of antibiotic dispensing at pharmacies according to access, watch, reserve (AWaRe) classification: multicenter study after COVID-19 waves in different districts of Pakistan

OBJECTIVE

The dispensing of non-prescription antibiotics is a worldwide concern, and antibiotics should only be dispensed with a legitimate prescription.

METHODOLOGY

A cross-sectional study was conducted using the simulated client methodology, with data collected, recorded, and analyzed using SPSS.

RESULTS

The simulated client visited 210 pharmacies, of which 70 dispensed antibiotics without a prescription. Outcomes The most often suggested antibiotics for upper respiratory tract infections (URTIs) were Amoxicillin (n = 17, 8.1%), Clarithromycin (n = 20, 9.5%), and Moxifloxacin (n = 13, 6.2%), with 33.3% of medications dispensed without a prescription for URTIs. Cefixime (n = 20, 9.5%) and ceftriaxone (n = 17, 8.1%) were the most often administered medications for urinary tract infections (UTIs). The non-prescribed dispensing of upper respiratory tract infections (URTIs) and urinary tract infections (UTIs) was markedly elevated (p < 0.05). Antibiotics were dispensed without a prescription for diarrheal diseases in over 50% of pharmacies, with Metronidazole (n = 23, 11%), Azithromycin (n = 16, 7.6%), and Rifaximin (n = 15, 7.1%) being the most often prescribed. In all bivariate and multivariate models, male gender was associated with reduced likelihood (COR: 0.30, 95% CI: 0.12-0.72; p = 0.0079 and AOR: 0.03, 95% CI: 0.005-0.15; p = 0.0001). Individuals aged 30 years and older exhibited increased odds of dispensing in both bivariate (COR: 3.67, 95% CI: 1.69-8.87; p = 0.0018) and multivariate analyses (AOR: 9.44, 95% CI: 2.55-61.70; p = 0.001). The presence of a pharmacist on duty markedly diminished the likelihood of administering antibiotics without a prescription (COR: 0.13, 95% CI: 0.06-0.25; p = < 0.001; AOR: 0.06, 95% CI: 0.03-0.16; p = < 0.001).

CONCLUSION

These findings highlight the imperative of enforcing existing laws and implementing rigorous rules, alongside pharmacy-centered antimicrobial stewardship programs that focus on accurate dispensing practices to mitigate antimicrobial resistance.

Systemic Mechanisms of Ionic Regulation in Carcinogenesis

Cancer is a complex disease characterized by uncontrolled cell proliferation at various levels, leading to tumor growth and spread. This review focuses on the role of ion homeostasis in cancer progression. It describes a model of ion-mediated regulation in both normal and cancerous cell proliferation. The main function of this system is to maintain the optimal number of cells in the body by regulating intra- and extracellular ion content. The review discusses the key points of ion regulation and their impact on tumor growth and spread during cancer development. It explains that normal levels of sodium, potassium, calcium, chloride, and hydrogen ions are regulated at different levels. Damage to ion transport mechanisms during carcinogenesis can lead to an increase in sodium cations and water content in cells, disrupting the balance of calcium and hydrogen ions. This, in turn, can lead to chromatin compaction reduction, gene overexpression, and instability at the epigenetic and genomic levels, resulting in increased cell proliferation and mutagenesis. Restoring normal ion balance can reduce the proliferative potential of both normal and tumor cell populations. The proposed model of systemic ionic regulation of proliferation aims to reconcile diverse data related to cell mitotic activity in various physiological conditions and explain tumor growth. Understanding the mechanisms behind pathological cell proliferation is important for developing new approaches to control ion homeostasis in the body, potentially leading to more effective cancer treatment and prevention.

Knowledge, Attitudes, and Practices of Infection Prevention and Control Nurses in Public Hospitals in the Limpopo Province: A Qualitative Study

A crucial aspect of delivering healthcare is infection prevention and control (IPC), especially in public hospitals where the high volume of patients and limited resources can heighten the risk of healthcare-associated infections. This qualitative study explores IPC nurses' knowledge, attitudes, and practices in public hospitals within the Limpopo province of South Africa. The study adopted a qualitative descriptive design. This qualitative study utilized self-developed validated semi-structured interviews with IPC nurses from 12 public hospitals (4 tertiary, 4 regional, and 4 district). The interviews were transcribed verbatim and analysed using thematic analysis to identify key themes related to knowledge, attitudes, and practices in IPC. Each interview lasted approximately 15 to 20 min. Themes and subthemes that emerged provided a structured overview of the key aspects discussed. Each theme captures a different facet of the experiences, perceptions, and challenges faced by IPC nurses in their role. The subthemes further break down these views into specific areas of focus, offering deeper insights into the nurses' experiences of their professional responsibilities. This study shows that, although IPC nurses have a good understanding of infection control and a positive attitude toward it, systemic problems and resource constraints make it difficult to consistently implement optimal practices. Affective mood, opportunity cost, coherence of the intervention, burden, perceived efficacy, self-efficacy, and ethics are among the major themes that were found. To improve IPC efforts, there is a clear need for more focused training, resources, and managerial support.

Population-specific differences in the human microbiome: Factors defining the diversity

Differences in microbial communities at different body habitats define the microbiome composition of the human body. The gut, oral, skin vaginal fluid and tissue microbiome, are pivotal for human development and immune response and cross talk between these microbiomes is evident. Population studies reveal that various factors, such as host genetics, diet, lifestyle, aging, and geographical location are strongly associated with population-specific microbiome differences. The present review discusses the factors that shape microbiome diversity in humans, and microbiome differences in African, Asian and Caucasian populations. Gut microbiome studies show that microbial species Bacteroides is commonly found in individuals living in Western countries (Caucasian populations), while Prevotella is prevalent in non-Western countries (African and Asian populations). This association is mainly due to the high carbohydrate, high fat diet in western countries in contrast to high fibre, low fat diets in African/ Asian regions. Majority of the microbiome studies focus on the bacteriome component; however, interesting findings reveal that increased bacteriophage richness, which makes up the virome component, correlates with decreased bacterial diversity, and causes microbiome dysbiosis. An increase of Caudovirales (bacteriophages) is associated with a decrease in enteric bacteria in inflammatory bowel diseases. Future microbiome studies should evaluate the interrelation between bacteriome and virome to fully understand their significance in the pathogenesis and progression of human diseases. With ethnic health disparities becoming increasingly apparent, studies need to emphasize on the association of population-specific microbiome differences and human diseases, to develop microbiome-based therapeutics. Additionally, targeted phage therapy is emerging as an attractive alternative to antibiotics for bacterial infections. With rapid rise in microbiome research, focus should be on standardizing protocols, advanced bioinformatics tools, and reducing sequencing platform related biases. Ultimately, integration of multi-omics data (genomics, transcriptomics, proteomics and metabolomics) will lead to precision models for personalized microbiome therapeutics advancement.

Knowledge, attitudes, and practices among physicians and pharmacists toward antibiotic use in sepsis

Background

Sepsis management in the Intensive Care Unit (ICU) presents a significant challenge within contemporary healthcare. The primary challenge lies in ensuring the timely and appropriate utilization of antibiotics. Inappropriate antibiotic use in sepsis management can result in a multitude of adverse outcomes. There has been insufficient focus on thoroughly understanding and resolving the issues related to the improper application of antibiotics in sepsis treatment by physicians and pharmacists. This gap in research is concerning, considering its potential implications for patient outcomes and public health. This study aimed to assess the knowledge, attitudes and practices (KAP) among physicians and pharmacists toward antibiotic use in sepsis.

Methods

This web-based cross-sectional study was conducted at Shanxi Bethune Hospital between June 2023 and October 2023. A self-designed questionnaire was developed to collect demographic information of physicians and pharmacists, and to assess their knowledge, attitudes and practices toward antibiotic use in sepsis.

Results

A total of 200 valid questionnaires were collected. Among the participants, 115 (57.5%) were female and 118 (59%) had experience with ICU patient management. The mean knowledge, attitudes and practices scores were 10.2 ± 1.14 (possible range: 0-12), 45.88 ± 4.00 (possible range: 10-50) and 48.38 ± 5.84 (possible range: 11-55), respectively. Multivariate logistic regression showed that attitudes (OR = 1.59, 95%CI: 1.34-1.87, p < 0.001), work experience of 15 years and above (OR = 7.17, 95%CI: 2.33-22.0, p = 0.001) were independently associated with proactive practices. For physicians, the structural equation model (SEM) demonstrated that attitudes directly affects practices, as indicated by a path coefficient of 0.91 (p < 0.001). For pharmacist, SEM showed that knowledge directly affect attitudes, with a path coefficient of 0.75 (p < 0.024), moreover, attitudes directly affect practices, with a path coefficient of 0.87 (p < 0.001).

Conclusion

The findings revealed that physicians and pharmacists have sufficient knowledge, active attitudes, and proactive practices toward the antibiotic use in sepsis. Nonetheless, the findings also reveal the persistence of certain misconceptions, alongside notable shortcomings in both attitudes and practices. Comprehensive training programs are imperative for enhancing the practices of physicians and pharmacists in this field.

Evolving spectrum of Pneumocystis host specificity, genetic diversity, and evolution

Following over a century's worth of research, our understanding of Pneumocystis has significantly expanded in various facets, spanning from its fundamental biology to its impacts on animal and human health. Its significance in public health has been underscored by its inclusion in the 2022 WHO fungal priority pathogens list. We present this review to summarize pivotal advancements in Pneumocystis epidemiology, host specificity, genetic diversity and evolution. Following a concise discussion of Pneumocystis species classification and divergence at the species and strain levels, we devoted the main focus to the following aspects: the epidemiological characteristics of Pneumocystis across nearly 260 mammal species, the increasing recognition of coinfection involving multiple Pneumocystis species in the same host species, the diminishing host specificity of Pneumocystis among closely related host species, and the intriguingly discordant evolution of certain Pneumocystis species with their host species. A comprehensive understanding of host specificity, genetic diversity, and evolution of Pneumocystis can provide important insights into pathogenic mechanisms and transmission modes. This, in turn, holds the potential to facilitate the development of innovative strategies for the prevention and control of Pneumocystis infection.

Using electronic medical records in hospital simulation for infection control intervention assessment

BACKGROUND

Clinical trials for assessing the effects of infection prevention and control (IPC) interventions are expensive and have shown mixed results. Mathematical models can be relatively inexpensive tools for evaluating the potential of interventions. However, capturing nuances between institutions and in patient populations have adversely affected the power of computational models of nosocomial transmission.

METHODS

In this study, we present an agent-based model of ICUs in a tertiary care hospital, which directly uses data from the electronic medical records (EMR) to simulate pathogen transmission between patients, HCWs, and the environment. We demonstrate the application of our model to estimate the effects of IPC interventions at the local hospital level. Furthermore, we identify the most important sources of uncertainty, suggesting areas for prioritization in data collection.

RESULTS

Our model suggests that the stochasticity in ICU infections was mainly due to the uncertainties in admission prevalence, hand hygiene compliance/efficacy, and environmental disinfection efficacy. Analysis of interventions found that improving mean HCW compliance to hand hygiene protocols to 95% from 70%, mean terminal room disinfection efficacy to 95% from 50%, and reducing post-handwashing residual contamination down to 1% from 50%, could reduce infections by an average of 36%, 31%, and 26%, respectively.

CONCLUSIONS

In-silico models of transmission coupled to EMR data can improve the assessment of IPC interventions. However, reducing the uncertainty of the estimated effectiveness requires collecting data on unknown or lesser known epidemiological and operational parameters of transmission, particularly admission prevalence, hand hygiene compliance/efficacy, and environmental disinfection efficacy.

Synthesizing evidence to guide the design and implementation of effective strategies for discontinuing postoperative antibiotic prophylaxis in surgical settings: an umbrella review post-WHO 2018 recommendations

BACKGROUND

Postoperative antibiotic prophylaxis (PAP) involves using antibiotics after surgery to prevent surgical site infections (SSIs). However, studies have shown that PAP offers no additional benefits compared to discontinuation after surgical incision closure, prompting its de-implementation to prevent unnecessary antibiotic use that may contribute to antibiotic resistance. We conducted this review to synthesize evidence for guiding the design and implementation of effective strategies for discontinuing PAP practice and optimizing antibiotic use in surgical settings.

METHODS

This umbrella review searched for articles from PubMed/MEDLINE and Scopus, focusing on reviews conducted on human subjects on PAP to prevent SSIs, published in English language from 2019 to 5th July 2024. This review followed guidelines from PRISMA-P and PRIOR. The risk of bias (methodological quality) was assessed using AMSTAR-2. The pooled risk ratio (RR) was estimated using a fixed-effects model (Mantel-Haenszel method), while I2 was used to assess the heterogeneity between reviews. This review was registered with PROSPERO (CRD42024566124).

RESULTS

In our umbrella review, we screened 1156 articles, with 28 review articles found eligible for final analysis, involving over 457 primary studies. About 80,483 patients were involved in 9 meta-analysis reviews, which were used to estimate the pooled RR. We found no significant benefits to patients from continuing PAP beyond 24-h post-surgery compared to immediate discontinuation, RR: 1.07 (95% CI: 0.97-1.17, I2: 25%, p-value: 0.22). Strategies such as regularly assessing and refining guidelines to fit specific surgical settings and patients' characteristics, multidisciplinary collaboration, availability of resources needed for best practices, education and training healthcare workers on SSI prevention and antibiotic stewardship, and patient education in SSI prevention and proper antibiotic use were recommended to improve best practices in surgical settings.

CONCLUSIONS

Prolonging antibiotic prophylaxis beyond 24-h post-surgery did not show significant protective benefits against SSIs. Our findings support the 2018 WHO recommendation for the immediate discontinuation of PAP following surgical incision closure in clean and clean-contaminated procedures. Further de-implementation research studies are needed to guide the effective discontinuation of PAP practice.

Transcriptomic Insights into Post-Spawning Death and Muscle Atrophy in Ayu (Plecoglossus altivelis)

In semelparous species like the ayu (Plecoglossus altivelis), spawning is followed by rapid physiological decline and death; yet, the underlying molecular mechanisms remain largely unexplored. This study examines transcriptomic changes in ayu skeletal muscle before and after spawning, with a focus on key genes and pathways contributing to muscle atrophy and metabolic dysfunction. Through RNA sequencing and DEG analysis, we identified over 3000 DEGs, and GSEA and KEGG pathway analysis revealed significant downregulation of energy metabolism and protein degradation. In post-spawning ayu, a rapid decrease in body weight was observed, accompanied by a decline in the expression of myosin heavy chain genes, which are major muscle protein genes, and gene expression changes indicative of muscle atrophy. Decreased expression of AP-1 transcription factors associated with muscle development and aging was also evident. PPI network analysis identified carbohydrate catabolism protein gapdh may be the key factor that led to muscle atrophy and accelerated aging in ayu. Our study revealed that after spawning, the ayu muscle tissue undergoes strong metabolic disorders and cellular stress responses, providing special insights into the mechanisms through the post-spawning death of ayu.

Integrative Machine Learning of Glioma and Coronary Artery Disease Reveals Key Tumour Immunological Links

It is critical to appreciate the role of the tumour-associated microenvironment (TME) in developing strategies for the effective therapy of cancer, as it is an important factor that determines the evolution and treatment response of tumours. This work combines machine learning and single-cell RNA sequencing (scRNA-seq) to explore the glioma tumour microenvironment's TME. With the help of genome-wide association studies (GWAS) and Mendelian randomization (MR), we found genetic variants associated with TME elements that affect cancer and cardiovascular disease outcomes. Using machine learning techniques high dimensional data was analysed to obtain new molecular sub-types and biomarkers that are important for prognosis and treatment response. F3 was identified as a top regulator and revealed potential angiogenic and immunogenic characteristics within the TME that could be harnessed in immunotherapy. These results demonstrate the potential of machine-learning approaches in identifying and dissecting TME heterogeneity and informing treatment in precision oncology. This work proposes improving the immunotherapeutic response through targeted modulation of relevant cellular and molecular interactions.

An ecological study on the correlation between sanitary vulnerability and air pollution with COVID-19 pandemic burden: What lessons can we learn?

OBJECTIVES

Air quality, socioeconomic status, access to healthcare, genetic predispositions, among other factors impacted the COVID-19 pandemic burden. We explored the relationship between PM2.5 levels and sanitary vulnerability in COVID-19 pandemic health outcomes in Argentina.

STUDY DESIGN

Ecological study.

METHODS

We used the Sanitary Vulnerability Index (SVI) to account for social determinants of health and distance to health centers. PM2.5 air concentration and human emissions were obtained from the Atmospheric Composition Analysis Group V5.GL.03 dataset and the inventory of anthropogenic gas-phase and particle emissions for Argentina (GEEA-AEIv3.0M), respectively. Finally, we extracted data from March 1, 2020, to January 1, 2021 from the official Argentinean database of COVID-19 (Argentine Ministry of Health).

RESULTS

SVI correlated with the rate of positive COVID-19 tests per 100,000 people (r = -0.56, p < 0.01), Intensive Care Unit (ICU) admissions per 100,000 people (r = -0.52, p < 0.01), and deaths per 100,000 people (r = -0.58, p < 0.01). PM2.5 air concentration correlated with the rate of positive tests (r = -0.09, p = 0.03), ICU admissions (r = -0.16, p < 0.01), and mortality (r = -0.11, p = 0.01). PM2.5 human emissions did not show significant correlations with COVID-19 outcomes. There was a significant interaction between SVI and PM2.5 air concentration for the rate of positive COVID-19 tests and mortality. PM2.5 air quality showed a positive and significant association with the outcomes only in areas with high SVI. A machine-learning model including these variables accounted for 46 % of the variability.

CONCLUSIONS

The interplay between health vulnerability and air quality in human health is complex. Addressing the burden of COVID-19 pandemic requires the consideration of a comprehensive range of determinants.

New Insights into the Antibacterial Activity of Hydroxytyrosol Extracted from Olive Leaves: Molecular Docking Simulations of its Antibacterial Mechanisms

This study investigated the biological activities of a hydroxytyrosol-rich extract from Olea europaea leaves, particularly its ability to eradicate severe pathogenic bacteria producing Extended-Spectrum Beta-Lactamases (ESBLs). The latter bacteria are emerging microorganisms that pose significant challenges due to their resistance to a broad range of potent therapeutic drugs. The extract was prepared through an accessible acid hydrolysis method. In vitro and In silico analyses through MIC, MBC analysis and molecular docking were conducted to evaluate the antibacterial properties. The extract showed remarkable antioxidant activity and significant antibacterial potential against reference species and ESBL bacteria. MIC and MBC calculations confirmed the extract's capacity to kill bacteria rather than just inhibit their growth. Further in silico analyzes demonstrated the high binding affinity of HT to the active sites of the gyrase B subunit and the peptidoglycan DD-transpeptidase domain from proteins located in the cytoplasm and the cell wall of the bacteria, respectively. Results confirmed the structure-activity relationship and the ability of HT to disrupt essential bacterial functions. This study validates the debated antimicrobial potential of HT and highlights its importance as a potential therapeutic agent against resistant bacteria, which is a critical area of research given the global challenge of antibiotic resistance.

A Flea-Borne Mystery: Unraveling Murine Typhus in a Patient with Unexplained Encephalopathy

Murine typhus is a flea-borne rickettsial infection caused by Rickettsia typhi, commonly seen in endemic regions like Southern California and Texas. While it typically presents with fever, rash, and headache, neurological symptoms such as altered mental status are rare. We present a case of a 66-year-old male in southern Texas with alcohol use disorder who developed progressive confusion, decreased appetite, and subjective fevers. He was found to have severe hyponatremia, acute kidney injury, and atrial fibrillation with rapid ventricular response. Despite supportive care and empiric antibiotics for a urinary tract infection, his encephalopathy persisted. Further history revealed exposure to flea-infested cats, prompting rickettsial testing and empiric doxycycline. Typhus immunoglobulin M antibodies later confirmed the diagnosis, and the patient showed marked improvement with doxycycline therapy. Murine typhus with altered mental status is a rare presentation, often leading to diagnostic delays. This case occurred in an endemic region, with exposure to flea-infested cats as a significant risk factor. The patient's persistent encephalopathy prompted a broad workup, including rickettsial testing, which was confirmed on serology testing. Early doxycycline initiation led to symptom resolution. This case highlights a rare neurological presentation of murine typhus and emphasizes the importance of considering it in patients with unexplained encephalopathy in endemic areas.

Antimicrobial resistance with a focus on antibacterial, antifungal, antimalarial, and antiviral drugs resistance, its threat, global priority pathogens, prevention, and control strategies: a review

Antimicrobial resistance (AMR) poses a significant global health threat by diminishing the effectiveness of once-powerful antimicrobial agents, leading to higher rates of illness and death, along with escalating healthcare costs. While bacterial resistance is a primary concern, resistance is also increasing against antifungal, antiparasitic, and antiviral drugs. Many of the last-resort drugs are becoming less effective due to AMR. Projections indicate that by 2050, AMR could cause up to 10 million deaths annually, making it the leading cause of death worldwide, a situation that could result in a post-antibiotic era with substantially increased morbidity and mortality. This review aims to raise awareness about the dangers of AMR and its potential to become a silent global pandemic. It begins by examining antimicrobial drugs, followed by a discussion on AMR, focusing on resistance to antibacterial, antifungal, antimalarial, and antiviral drugs, along with its effects on health, and the economy, and prioritized global pathogens. Finally, it explores preventive measures and innovative strategies to combat AMR.

A Systematic Review on Evaluation of WHO Core Prescribing Indicators Across Healthcare Facilities in Low Resource Asian Setting: A Case of Nepal

Inappropriate drug use is a significant global health issue, particularly in low-resource settings. This systematic review evaluates drug utilization across healthcare facilities in Nepal, a low-resource setting, using WHO core prescribing indicators to identify areas for improvement. A systematic review was conducted by searching literature in PubMed, Embase, CINAHL, INRUD bibliography, NepJOL, NepMed, and Google Scholar. Original studies assessing at least one WHO prescribing indicator in healthcare settings of Nepal were included. Eligible studies were analyzed descriptively and through proportional meta-analysis using a random-effects model. Eighty-eight studies were identified involving 2108 healthcare facilities and 60 191 patient encounters. The average of three drugs per encounter (95% CI: 2.5-3.2) was determined. Generic prescribing occurred only in 21.8% (95% CI: 15.6%-28.8%) prescriptions, showing a decline trend. Antibiotics were prescribed in 64.4% (95% CI: 57.7%-70.8%) encounters, with higher prevalence in secondary and tertiary care settings. Injectables were prescribed in 22.9% encounters (95% CI: 12.2-35.8). Drugs prescribed from WHO and Nepal essential medicine lists accounted for 53.0% (95% CI: 41.1-64.7) and 54.4% (95% CI: 47.7-60.9), respectively. The evaluation of drug utilization in Nepal suggested that the standards for WHO core prescribing indicators were not met, including overuse of antibiotics, underuse of essential medicines, and minimal generic prescribing. Targeted interventions, including prescriber education, policy reforms, enhanced monitoring, and regular prescription audits, are essential to promote rational prescribing and improve drug-related outcomes, including an opportunity to reduce antimicrobial resistance.

Enhancing the Therapeutic Potential of Peptide Antibiotics Using Bacteriophage Mimicry Strategies

The rise of antibiotic resistance, coupled with a dwindling antibiotic pipeline, presents a significant threat to public health. Consequently, there is an urgent need for novel therapeutics targeting antibiotic-resistant pathogens. Nisin, a promising peptide antibiotic, exhibits potent bactericidal activity through a mechanism distinct from that of clinically used antibiotics. However, its cationic nature leads to hemolysis and cytotoxicity, which has limited its clinical application. Here, nanodelivery systems have been developed by mimicking the mechanisms bacteriophages use to deliver their genomes to host bacteria. These systems utilize bacteriophage receptor-binding proteins conjugated to loading modules, enabling efficient targeting of bacterial pathogens. Peptide antibiotics are loaded via dynamic covalent bonds, allowing for infection microenvironment-responsive payload release. These nanodelivery systems demonstrate remarkable specificity against target pathogens and effectively localize to bacteria-infected lungs in vivo. Notably, they significantly reduce the acute toxicity of nisin, rendering it suitable for intravenous administration. Additionally, these bacteriophage-mimicking nanomedicines exhibit excellent therapeutic efficacy in a mouse model of MRSA-induced pneumonia. The facile synthesis, potent antimicrobial performance, and favorable biocompatibility of these nanomedicines highlight their potential as alternative therapeutics for combating antibiotic-resistant pathogens. This study underscores the effectiveness of bacteriophage mimicry as a strategy for transforming peptide antibiotics into viable therapeutics.

Novel Curvularia species causing disseminated phaeohyphomycosis in a dog

Phaeohyphomycosis is an uncommon disease caused by dematiaceous fungi that is almost exclusively found in immunocompromised dogs. Here we describe the case of a dog treated with prednisone (1.1 mg/kg/day) and cyclosporine (11.2 mg/kg/day) for immune thrombocytopenia that developed cutaneous/subcutaneous lesions affecting both forelimbs 29 days after initiation of immunosuppression. The owner elected conservative outpatient treatment that consisted of wound care, antibiotics, mirtazapine, maropitant, and a dose reduction of prednisone (0.3 mg/kg/day) in lieu of biopsies or cultures. The dog was subsequently euthanized 13 days later because of an acute onset of increased respiratory rate and effort, obtunded mentation, and an inability to ambulate. Postmortem examination revealed widespread fungal dissemination in the heart, pericardium, intercostal muscles, lymph nodes, skin, subcutis, kidneys, lungs, pleura, and nasal cavity. Histopathology of the widespread plaques and nodules revealed fungal hyphae that were 4-8 µm in diameter, pigmented, variably septate, non-parallel, and toruloid with acute branching and occasional terminal bulbous dilations up to 20 µm in diameter, resembling chlamydoconidia. Yeast-like cells had a thick, variably pigmented wall and internal, foamy to granular, pale amphophilic contents. Fungal culture of swabs from the right elbow subcutaneous granulomas and from the left lateral pleural nodules yielded pure growth of Curvularia sp. Genomic DNA was extracted from harvested mycelia and molecular sequencing confirmed the presence of a novel Curvularia sp., C. arizonensis.