Exploring phenotypic and genotypic diversity among methicillin-resistant, vancomycin-resistant, and sensitive Staphylococcus aureus

BACKGROUND

Methicillin-Resistant Staphylococcus aureus (MRSA) is a global concern owing to the increasing prevalence of multidrug-resistant (MDR) strains. Vancomycin has been the primary treatment for MRSA; however, Vancomycin-resistant strains are being increasingly reported worldwide. Therefore, comparative studies are essential to support antimicrobial stewardship and improving clinical management. Ultimately, the findings from this study are expected to inform treatment strategies and guide public health interventions effectively.

MATERIAL AND METHODS

This study investigated the prevalence, antimicrobial resistance, and virulence characteristics of Vancomycin-sensitive S. aureus (VSSA) and Vancomycin-resistant S. aureus (VRSA) within MRSA strains. By employing a combination of phenotypic methods, such as antimicrobial susceptibility testing, and genotypic techniques, including molecular typing and identification of virulence genes, we obtained comprehensive insights into VRSA and VSSA profiles.

RESULTS

Of 250 clinical samples, 62 (24.8%) were S. aureus and 27 (43.5%) were identified as MRSA. All MRSA isolates exhibited MDR patterns. Most MRSA strains were VSSA (20/27, 74.1%), while 7 (25.9%) were VRSA. The VRSA isolates showed more antimicrobial resistance than VSSA isolates; however, the VRSA isolates had less virulence than VSSA isolates. Linezolid was the most effective treatment, with a 3.7% resistance rate. A higher percentage of biofilm-producing MRSA (96.3%) was confirmed by both phenotypic and genotypic methods. All isolates, except one VRSA, showed multi-virulence patterns (harbored more than 3 virulence genes). High diversity and low clonality (D-value = 0.99) were found in both VSSA and VRSA. Based on our correlation findings, the emergence of vancomycin resistance could modify the association between antimicrobial resistance and virulence, potentially affecting the pathogenic profile of these strains. The study also revealed complex interactions among host factors (including age and gender), sample origin, antimicrobial resistance, biofilm production, and virulence genes.

CONCLUSION

This study highlights the alarming spread of MRSA and VRSA, which show significant resistance and virulence.

Mitigating Health Risks Through Environmental Tracking of Pseudomonas aeruginosa

Pseudomonas aeruginosa is a prevalent nosocomial pathogen and a significant reservoir of antimicrobial resistance genes in residential and built environments. It is also widespread in various indoor and outdoor settings, including sewage, surface waters, soil, recreational waters (both treated and untreated), and industrial effluents. Surveillance efforts for P. aeruginosa are primarily focused on hospitals rather than built environments. However, evidence links multidrug-resistant P. aeruginosa of human origin with activity in built environments and hospital settings. Consequently, tracking this pathogen across all environments is crucial for understanding the mechanisms of reverse transmission from built environments to humans. This review explores public health hygiene by examining the prevalence of P. aeruginosa in various environments, its sequence types, the factors contributing to multidrug resistance, and the identification methods through global surveillance. Whole-genome sequencing with sequence typing and real-time quantitative PCR are widely used to identify and study antimicrobial-resistant strains worldwide. Additionally, advanced techniques such as functional metagenomics, next-generation sequencing, MALDI-TOF, and biosensors are being extensively employed to detect antimicrobial-resistant strains and mitigate the ongoing evolution of bacterial resistance to antibiotics. Our review strongly underscores the importance of environmental monitoring of P. aeruginosa in preventing human infections. Furthermore, strategic planning in built environments is essential for effective epidemiological surveillance of P. aeruginosa and the development of comprehensive risk assessment models.

Functional Capacity Among Brazilian Older Adults 12 Months After COVID-19 Infection: A Cross-Sectional Study

Background/Objectives: Evidence suggests that older adults who survived COVID-19 were exposed to greater functional dependence in their daily living activities. This study aims to examine the prevalence of functional dependence and associated factors among Brazilian older people with functional dependence 12 months after COVID-19 infection. Methods: A cross-sectional study was carried out involving people aged 60 years or older in the state of Paraná, Brazil. One year after notification or hospital discharge due to COVID-19, between June 2021 and March 2022, participants responded to a questionnaire via telephone call about sociodemographic data and data on functionality using the Measure of Functional Independence (FIM). The outcome variable "assessment of functional capacity" was divided into functional dependence (FIM Total < 104) and functional independence (FIM Total ≥ 104). Results: A total of 768 older adults participated, with an average age of 68.03 ± 6.8 years (range between 60 and 100). A majority of them were female (50.3%), white (46%), with low education (37.4%), had a partner (56.3%), did not live alone (72.4%), and had their own home (52.2%). The prevalence of functional dependence was 7.2%. On average, participants scored 5.4 points lower on FIM one year after COVID-19 infection compared with those in the acute phase of COVID-19 (125.5 vs. 120.1; p < 0.001). Functional dependence was higher (p < 0.05) among women when compared to men (aOR = 2.28); in people who changed their work situation due to COVID-19 when compared to those with no change (aOR = 5.27); in people with fair/poor/bad self-reported health compared to those with excellent/good health (aOR = 2.97); in people with cardiovascular symptoms compared to those without cardiovascular symptoms (aOR = 3.37); and among the most severe cases of the disease (treatment in ICU) compared to mild cases (outpatient treatment) (aOR = 10.5). Conclusions: Most participants presented functional independence 12 months after COVID-19 infection. Cases of functional dependence were influenced by multidimensional factors, including physical health, economic, and psychosocial aspects.

Green-synthesized α-Fe2O3-nanoparticles as potent antibacterial, anti-biofilm and anti-virulence agent against pathogenic bacteria

BACKGROUND

Antimicrobial resistance (AMR) presents a serious threat to health, highlighting the urgent need for more effective antimicrobial agents with innovative mechanisms of action. Nanotechnology offers promising solutions by enabling the creation of nanoparticles (NPs) with antibacterial properties. This study aimed to explore the antibacterial, anti-biofilm, and anti-virulence effects of eco-friendly synthesized α-Fe₂O₃ nanoparticles (α-Fe₂O₃-NPs) against pathogenic bacteria.

METHODS

The α-Fe2O3-NPs were synthesized using a green synthesis method that involved Bacillus sp. GMS10, with iron sulfate as a precursor. The NPs were characterized through ultraviolet-visible (UV-Vis) spectroscopy, Field Emission Scanning Electron Microscopy (FESEM), Energy Dispersive X-ray Spectroscopy (EDX), Dynamic Light Scattering (DLS), Zeta Potential Analysis, X-ray Diffraction (XRD), and Fourier Transform Infrared Spectroscopy (FT-IR). Their antimicrobial activity was assessed against Gram-positive and Gram-negative bacteria. The study also evaluated the effect of the α-Fe2O3-NPs on bacterial cell membrane disruption, biofilm formation, efflux pump inhibition, and swarming motility.

RESULTS

The UV-Visible spectrum showed a peak at 228 nm, indicating plasmon absorbance of the α-Fe2O3-NPs. FESEM revealed spherical NPs (~ 30 nm), and DLS confirmed a hydrodynamic size of 36.3 nm with a zeta potential of -25.1 mV, indicating good stability. XRD identified the rhombohedral α-Fe2O3 phase, and FTIR detected O-H, C-H, C = O, and Fe-O functional groups, suggesting organic capping for stability. Antibacterial assays demonstrated that the α-Fe2O3-NPs had MIC values ranging from 0.625 to 5 µg/mL and MBC values between 5 and 20 µg/mL, with a strong effect against Gram-positive bacteria. The NPs significantly increased membrane permeability, inhibited biofilm formation in S. aureus and E. coli, and disrupted efflux pumps in S. aureus SA-1199B (a fluoroquinolone-resistant strain overexpressing norA). Additionally, the α-Fe2O3-NPs inhibited P. aeruginosa swarming motility.

CONCLUSION

The bacteria-synthesized α-Fe2O3-NPs demonstrated significant antimicrobial activity, particularly against Gram-positive bacteria, and exhibited strong potential for inhibiting biofilm formation and efflux pump activity, offering a promising strategy to address AMR. Focus on further evaluating their therapeutic potential in clinical settings and conducting comprehensive assessments of their safety profiles to ensure their applicability in medical treatments.

CLINICAL TRIAL NUMBER

Not applicable.

Causal Mediation Analysis of Foodborne Salmonella Outbreaks in the United States: Serotypes and Food Vehicles

Various Salmonella serotypes have caused numerous foodborne outbreaks associated with food vehicles in different categories. This study provides evidence on the occurrence and inter-relations between Salmonella serotypes and the number of deaths mediated by the number of illnesses and hospitalizations. Confirmed foodborne outbreaks of Salmonella serotypes (n = 2868) that occurred between 1998 and 2021 were obtained from the Centers for Disease Control and Prevention National Outbreak Reporting System. Causal mediation analysis was performed based on 500 bootstrap samples. The serotypes and the Interagency Food Safety Analytics Collaboration (IFSAC) food categories as confounding effects were considered as categorical variables. A total of 106 single Salmonella serotypes were associated with foodborne outbreaks. Foodborne outbreaks caused by Salmonella serotypes resulted in 81,996 illnesses, 11,018 hospitalizations, and 115 deaths between 1998 and 2021 in the United States. The serotypes Enteritidis (815 outbreaks, 28.42%), Typhimurium (359 outbreaks, 12.52%), and Newport (220 outbreaks, 7.67%) accounted for almost half of Salmonella-linked outbreaks. Poultry products, "chickens", "eggs", and "turkey", were the leading IFSAC food categories, accounting for 14.02% of total outbreaks and 10.44% of total deaths. Certain serotypes had a significant effect on illness, hospitalization, and death counts. Two serotypes, Heidelberg and Saintpaul, and "fruits" as the food vehicle in IFSAC categories had a significant direct effect on the number of illnesses, hospitalizations, and deaths as outcomes of Salmonella outbreaks (p ≤ 0.05). There was strong evidence that illness and hospitalization counts played a key role in the pathway from serotype to death counts on foodborne outbreaks caused by Salmonella based on causal mediation analysis. The findings of this study can help outbreak investigations and lead to prevention and control measures by providing insightful information about the frequencies of Salmonella serotypes and the associated food vehicles causing foodborne diseases.

Helicobacter pylori infection is associated with the risk and phenotypes of cholelithiasis: A multi-center study and meta-analysis

BACKGROUND

Helicobacter pylori (H. pylori) is a prevalent pathogen associated with various diseases. Cholelithiasis is also a common condition. H. pylori infection has been identified in the biliary system, suggesting its potential involvement in biliary diseases. However, the specific role of H. pylori in the development of cholelithiasis remains inconclusive.

AIM

To investigate the potential association between H. pylori infection and the development of cholelithiasis.

METHODS

We performed a retrospective study in more than 70000 subjects in health examination center from 3 institutions in the middle, northern and eastern China, from October 2018 to December 2021, to explore the potential association between H. pylori and cholelithiasis through univariate and multivariate analysis. Meanwhile, the influence of H. pylori on biliary-related parameters was investigated. A comprehensive analysis of previous studies concerned about H. pylori and cholelithiasis was also executed.

RESULTS

In our multi-center study, H. pylori was positively associated with cholelithiasis [odds ratio (OR) = 1.103, 95% confidence interval (CI): 1.001-1.216, P = 0.049]. Furthermore, H. pylori patients had less total and direct bilirubin than uninfected patients, while the total cholesterol and low-density lipoprotein cholesterol were more in H. pylori-positive participants (P < 0.05). In the published articles, the cohort studies indicated H. pylori was a risk factor of cholelithiasis (hazard ratio =1.3280, 95%CI: 1.1810-1.4933, P < 0.0001). The pooled results of case-control and cross-sectional studies showed positive association between H. pylori and cholelithiasis in Asia (OR = 1.5993, 95%CI: 1.0353-2.4706, P = 0.034) but not in Europe (OR = 1.2770, 95%CI: 0.8446-1.9308, P = 0.246). Besides, H. pylori was related to a higher choledocholithiasis/cholecystolithiasis ratio (OR = 3.3215, 95%CI: 1.1034-9.9986, P = 0.033).

CONCLUSION

H. pylori is positively correlated with cholelithiasis, choledocholithiasis phenotype particularly, especially in Asia, which may be relevant to bilirubin/cholesterol metabolism. Cohort studies confirm an increased risk of cholelithiasis in H. pylori patients.

The role of CEUS in diagnosing tuberculous abscess of the right diaphragm

PURPOSE

To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in detecting tuberculous diaphragmatic abscess (TDA) of the right diaphragm and provide a reference for its clinical diagnosis.

METHODS

A retrospective analysis was conducted on 33 patients with right TDA confirmed via surgery and biopsy. The diagnostic accuracy of CEUS and routine ultrasound for detecting right TDA was compared.

RESULTS

Among the 33 right TDA cases, the lesions primarily exhibited mixed and low echogenicity, with an orientation parallel to the diaphragmatic surface. Eighteen patients (54.5%) demonstrated the characteristic "crocodile mouth sign." Heterogeneous enhancement was observed in most cases (24 patients) compared to homogeneous or no enhancement. The diagnostic accuracy of routine ultrasound for right TDA was 54.50% (18/33), whereas CEUS demonstrated a significantly higher accuracy of 78.78% (26/33) (χ2 = 4.364, P = 0.037).

CONCLUSION

CEUS provides valuable insights into the vascular characteristics of right TDA, with most cases showing mixed echogenicity and heterogeneous enhancement. The "crocodile mouth sign" was a distinctive feature, highlighting the utility of CEUS in improving diagnostic accuracy for right TDA.

Identifying multidrug-resistant organisms in diabetic foot ulcers: a study of risk factors and antimicrobial resistance genes

This study aims to evaluate the antibiotic susceptibility profiles of bacterial isolates from DFU patients, identify the prevalence of MDROs, and identify specific risk factors contributing to these infections to inform effective antibiotic treatment strategies. This prospective cohort study included 187 DFU patients from March 2023 to February 2024 at King Khalid Hospital, Saudi Arabia. The exclusion criteria were nondiabetic ulcers, specific infections, tumours, or recent antibiotic use. Data on demographics, diabetes duration, DFU characteristics, and antibiotic history were collected. Ethical approval and informed consent were obtained. During the 1-year study, 187 DFU patients were included, with 72.7% males and 27.3% females. The mean age of the study participants was 54.9 ± 11.8 years. The average duration of diabetes was 6.3 ± 3.7 years, and the mean HbA1c was 8.0 ± 1.0%. Over half (54.5%) of the patients had Wagner ulcer grade III, and neuropathy (67%) and retinopathy (73%) were the most common complications. Polymicrobial infections were identified in 54% of the cases, with 61.5% of the isolates producing biofilms. The key risk factors for MDR infections included amputation (OR: 5.92), polymicrobial infections (OR: 7.49), biofilm production (OR: 5.00), recent antibiotic use (OR: 3.97), and an ulcer duration > 30 days (OR: 2.23). Sex, age, and weight were not significantly associated with MDR infections. Among the 27 MRSA isolates, 81.5% carried the mecA gene, and 98.8% of the ESBL-producing organisms harboured at least one ESBL gene, with blaCTX-M being the most common (27.2%). Carbapenem resistance was confirmed in 25.6% of the isolates, with blaNDM being the predominant carbapenemase gene (69.3%). Coresistance with ESBL genes was detected in 66.7% of the blaNDM-producing isolates. This study demonstrates a high prevalence of MDROs in DFUs, primarily driven by biofilm-producing polymicrobial infections and resistance genes like blaNDM and blaCTX-M. The findings accentuate the clinical importance of integrating molecular diagnostics for early detection of resistance determinants, enabling precise, targeted therapy. Tailored antibiotic stewardship and enhanced infection control measures are critical to optimizing treatment outcomes, reducing complications, and mitigating the burden of chronic DFUs in healthcare settings.

Geographical mapping and temporal trends of Acinetobacter baumannii carbapenem resistance: A comprehensive meta-analysis

BACKGROUND

Carbapenem-resistant Acinetobacter baumannii (CRAB) is of critical concern in healthcare settings, leading to limited treatment options. In this study, we conducted a comprehensive meta-analysis to assess the prevalence of CRAB by examining temporal, geographic, and bias-related variations.

METHODS

We systematically searched prominent databases, including Scopus, PubMed, Web of Science, and EMBASE. Quality assessment was performed using the JBI checklist. Subgroup analyses were performed based on the COVID-19 timeframes, years, countries, continents, and bias levels, antimicrobial susceptivity test method and guidelines.

RESULTS

Our comprehensive meta-analysis, which included 795 studies across 80 countries from 1995 to 2023, revealed a surge in carbapenem resistance among A. baumannii, imipenem (76.1%), meropenem (73.5%), doripenem (73.0%), ertapenem (83.7%), and carbapenems (74.3%). Temporally, 2020-2023 witnessed significant peaks, particularly in carbapenems (81.0%) and meropenem (80.7%), as confirmed by meta-regression, indicating a steady upward trend.

CONCLUSION

This meta-analysis revealed an alarmingly high resistance rate to CRAB as a global challenge, emphasizing the urgent need for tailored interventions. Transparency, standardized methodologies, and collaboration are crucial for the accurate assessment and maintenance of carbapenem efficacy.

The impact of multiplex nested gastrointestinal PCR panel in children with gastroenteridis requiring pediatric infectious disease consultation

Infectious gastroenteritis is an important cause of morbidity and mortality, especially in nations with middle and low incomes. In a pediatric gastroenteritis patient, the aim was to determine the therapeutic impact of using the Gastrointestinal Panel in our clinical practice. A single-center retrospective study was designed to evaluate children who were admitted to the hospital for gastroenteritis and had a gastrointestinal panel between August 2021 and January 2024. 103 patients who had gastrointestinal (GI) panel results were included in the study. The GI Panel positivity rate among 103 patients was 55.3% (n = 57). Bacterial agents were positive in 25 patients (43.8%), viral agents were found in 11 patients (19.2%), and polymicrobial agents were found positive in 21 patients (36.8%). Escherichia coli (9.1%) was the most common bacterial pathogen, and viral pathogens most frequently included Rotavirus (11.6%) and Norovirus (11.6%). When the effect of the GI Panel test on treatment was determined, the treatment of 51 (49.5%) patients was changed according to GI Panel.

CONCLUSIONS

In our study, the treatment regimen of many patients was adjusted based on the GI panel results in patients presenting with gastroenteritis. GI panel had an important impact on the patients care and optimization according to the principles of antimicrobial treatment. GI panel tests had several advantages such as speed and diagnostic accuracy as good as stool culture.

WHAT IS KNOWN

• Infectious gastroenteritis is a major cause of morbidity and mortality, especially in middle- and low-income countries. • BioFire® FilmArray, Gastrointestinal Panel (BioFire- Biomerieux, France) is a rapid and simple technique that uses nested multiplex PCR to detect gastrointestinal pathogens rapidly.

WHAT IS NEW

  • In this study, the GI Panel test was found to have a cumulative impact on 49.5% (n=51) of the clinician's treatment modalities. • With its speed and diagnostic sensitivity, the GI Panel may provide clinicians with an important tool in the fight against antibiotic resistance by decreasing antimicrobial drug treatment at the children with gastroenteritis.

AutoML-Driven Insights into Patient Outcomes and Emergency Care During Romania's First Wave of COVID-19

BACKGROUND

The COVID-19 pandemic severely impacted healthcare systems, affecting patient outcomes and resource allocation. This study applied automated machine learning (AutoML) to analyze key health outputs, such as discharge conditions, mortality, and COVID-19 cases, with the goal of improving responses to future crises.

METHODS

AutoML was used to train and validate models on an ICD-10 dataset covering the first wave of COVID-19 in Romania (January-September 2020).

RESULTS

For discharge outcomes, Light Gradient Boosted models achieved an F1 score of 0.9644, while for mortality 0.7545 was reached. A Generalized Linear Model blender achieved an F1 score of 0.9884 for "acute or emergency" cases, and an average blender reached 0.923 for COVID-19 cases. Older age, specific hospitals, and oncology wards were less associated with improved recovery rates, while mortality was linked to abnormal lab results and cardiovascular/respiratory diseases. Patients admitted without referral, or patients in hospitals in the central region and the capital region of Romania were more likely to be acute cases. Finally, counties such as Argeş (South-Muntenia) and Brașov (Center) showed higher COVID-19 infection rates regardless of age.

CONCLUSIONS

AutoML provided valuable insights into patient outcomes, highlighting variations in care and the need for targeted health strategies for both COVID-19 and other health challenges.

Bacterial Infections, Trends, and Resistance Patterns in the Time of the COVID-19 Pandemic in Romania-A Systematic Review

Background: The COVID-19 pandemic has intensified concerns over bacterial infections and antimicrobial resistance, particularly in Romania. This systematic review explores bacterial infection patterns and resistance during the pandemic to address critical gaps in knowledge. Methods: A systematic review, following PRISMA guidelines, was conducted using databases such as PubMed and Scopus, focusing on studies of bacterial infections from 2020 to 2022. Articles on bacterial infections in Romanian patients during the pandemic were analyzed for demographic data, bacterial trends, and resistance profiles. Results: A total of 87 studies were included, detailing over 20,000 cases of bacterial infections. The review found that Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, were the most frequently identified pathogens, alongside Gram-positive Staphylococcus aureus and Enterococcus spp. Multidrug resistance (MDR) was noted in 24% of the reported strains, with common resistance to carbapenems and cephalosporins. Conclusions: The pandemic has amplified the complexity of managing bacterial infections, particularly in critically ill patients. The rise in MDR bacteria underscores the need for stringent antimicrobial stewardship and infection control measures. Continuous monitoring of bacterial trends and resistance profiles will be essential to improve treatment strategies in post-pandemic healthcare settings.

Mayan Medicinal Plants Bignonia potosina and Thouinia paucidentata Demonstrate Anti-Infective Properties Against the Priority Antibiotic-Resistant Bacteria Acinetobacter baumannii and Pseudomonas aeruginosa

(1) Background: Carbapenem-resistant Acinetobacter baumannii (CBRAB) and Pseudomonas aeruginosa (CBRPA) are critical and high-priority pathogens that require new therapeutic developments. Medicinal plants are valuable pharmaceutical resources. This study explored the anti-infective properties of Mayan plants, Bignonia potosina, and Thouinia paucidentata. (2) Methods: Plant parts were extracted using n-hexane, and their ability to inhibit bacterial growth and counteract resistance mechanisms and virulence factors in CBRAB and CBRPA was assessed. GC-MS analysis of the composition of the non-polar extracts and chemometric techniques correlated the phytoconstituents with anti-infective properties. (3) Results: Bignonia potosina liana and flower extracts exhibited potent antibacterial activity against A. baumannii strains (MIC 15.7 to 250 µg/mL) and moderate activity against P. aeruginosa strains (MIC 250 to 1000 µg/mL). Thouinia paucidentata leaf extract at 1000 µg/mL reduced imipenem MIC by 2048-fold for CBRAB, and B. potosina flower extract significantly inhibited A. baumannii catalase activity (at 62.5 µg/mL) and reduced P. aeruginosa pyocyanin production (at 1000 µg/mL). Chemometric analysis identified fatty acids, fatty acid amides, terpenes, and higher alkanes as contributors to their anti-infective properties. (4) Conclusions: This study highlights the potential of medicinal plants in the development of novel anti-infective therapies against CBRAB and CBRPA with various targets.

Intravesical BCG therapy: implications for radiologists in abdominal imaging follow-up

This study reviews the intravesical Bacillus Calmette-Guérin therapy for treatment of non-muscle invasive bladder cancer including mechanism of action, dosing considerations, treatment success and surveillance. A variety of common and uncommon adverse effects are reviewed with a focus on abdominal -pelvic complications stratified into genitourinary and systemic categories. The complications included more common entities such as chemical cystitis, which has been reported to be present in approximately 35% of the patients to more serious but rare complications such as vascular involvement with only a few reported cases in the literature. For each complication, the pertinent imaging findings and available examples are provided. Additionally, it is important to consider the potential for recurrence or progression of bladder cancer in this patient population, with reported rates of 38.2% and 9.8%, respectively. This underscores the necessity of a thorough differential diagnosis when interpreting imaging findings related to these complications.

Adjunctive Diagnosis of Mycobacterium gordonae Pneumonia by Metagenomic Next-Generation Sequencing in an Immunocompetent Patient: A Case Report and Literature Review

Introduction

Mycobacterium gordonae is a nonpathogenic pathogen commonly found in nature and is generally considered a contaminant in clinical practice. Although there have been few reported cases of infection, most of them are secondary to immunosuppression. This paper described a rare case of globular shadow in the chest of an immunocompetent male who was diagnosed with M. gordonae pulmonary disease. He went to the hospital with chest pains that had lasted for more than two weeks. The routine clinical pathogen detection failed to discover the cause of the infection. Although metagenomic next-generation sequencing (mNGS) of the lung tissue was negative, M. gordonae was detected in the background microorganism with only one read. Based on the pathological results, it was considered to be the causative pathogen. Two months of treatment with rifampicin, ethambutol, clarithromycin, and levofloxacin resulted in significant reduction and absorption of lung lesions. No abnormalities were detected in either lung one year later. The lack of positive culture and other conventional microbiological test results make this case is not a strictly confirmed case. This study also explored the clinical features and treatment options of 32 cases of M. gordonae pulmonary disease through a systematic review of the literature. Although there is no standard recommended treatment regimen for M. gordonae infection, but combination therapy with macrolides, rifampicin, and ethambutol has been proven effective.

Conclusion

This case highlights that when the clinical highly suspected of infection, mNGS can contribute to the early identification of non-tuberculous Mycobacterium (NTM) even with low reads, when clinical suspicion is high. Analyzing background microorganisms in sterile samples may help diagnose rare pathogens.

Helicobacter pylori Inhibition, Gastritis Attenuation, and Gut Microbiota Protection in C57BL/6 Mice by Ligilactobacillus salivarius NCUH062003

Helicobacter pylori (H. pylori), one of the most prevalent pathogenic bacteria worldwide, is the leading cause of gastritis, gastric intestinal metaplasia, and gastric cancer. Antibiotics, the conventional treatment for eliminating H. pylori, often lead to severe bacterial resistance, gut dysbiosis, and hepatic insufficiency and fail to address the inflammatory response or gastric mucosal damage caused by H. pylori infection. In this study, based on 10-week animal experiments, two models of L. salivarius NCUH062003 for the prophylaxis and therapy of H. pylori infection in C57BL/6 mice were established; a comprehensive comparative analysis was performed to investigate the anti-H. pylori effect of probiotics, the reduction in inflammation, and repair of gastric mucosal damage. ELISA, immunohistochemistry, and pathology analyses showed that NCUH062003 decreased the expression of pro-inflammatory cytokine interleukins (IL-1β, IL-6) and myeloperoxidase (MPO) and reduced neutrophil infiltration in the gastric mucosa lamina propria. Immunofluorescence and biochemical analysis showed that NCUH062003 resisted gastric epithelial cell apoptosis, increased the level of superoxide dismutase (SOD) in gastric mucosa, and promoted the expression of tight junction protein ZO1 and Occludin. In addition, through high-throughput sequencing, in the probiotic therapy and prophylactic mode, the diversity and composition of the gut microbiota of HP-infected mice were clarified, the potential functions of the gut microbiota were analyzed, the levels of short-chain fatty acids (SCFAs) were measured, and the effects of L. salivarius NCUH062003 on the gut microbiota and its metabolites in HP-infected mice treated with amoxicillin/metronidazole were revealed. This study provides functional strain resources for the development and application of microbial agents seeking to antagonize H. pylori beyond antibiotics.

Comparative Analysis of Gut Microbiota in Humans Living with and Without Companion Animals

Cohabitation with companion animals (CAs) has been suggested as a significant modifier of gut microbial diversity. This study investigated the influence of cohabitation with CAs on human gut microbiota composition. Using 16S rRNA gene sequencing, we analyzed the gut microbiota of 20 families with CAs (40 adults, 20 children) and 20 families without CAs (40 adults, 20 children). Alpha and beta diversity analyses were performed, and the differentially abundant genera were identified. There were significant differences in beta diversity across the groups (p-value = 0.001). The Bacillota/Bacteroidota ratio was considerably lower in the CAs group (0.67) than in the without-CAs group (1.02). Prevotellaceae_UCG-003 (log2 fold change: 7.3; adjusted p-value ≤ 0.001), Ruminococcaceae (log2 fold change: 6.3; adjusted p-value ≤ 0.001), and Oscillospira (log2 fold change: 5.1; adjusted p-value = 0.012) were elevated in the group cohabiting with CAs, whereas Megamonas (with CAs: 3.81%; without CAs: 13.52%) and Veillonella (with CAs: 3.77%; without CAs: 6.50%) were more prevalent in the group without CAs. Cohabitation with CAs may positively influence the gut microbiota by promoting the presence of beneficial bacteria and reducing the Bacillota/Bacteroidota ratio. This study highlights the potential for cohabitation with CAs to promote gut microbial health.

A peptide targeting outer membrane protein A of Acinetobacter baumannii exhibits antibacterial activity by reducing bacterial pathogenicity

The World Health Organization has classified multidrug-resistant (MDR) Acinetobacter baumannii as a significant threat to human health, necessitating the urgent discovery of new antibacterial drugs to combat bacterial resistance. Outer membrane protein A of A. baumannii (AbOmpA) is an outer membrane-anchored β-barrel-shaped pore protein that plays a critical role in bacterial adhesion, invasion, and biofilm formation. Therefore, AbOmpA is considered a key virulence factor of A. baumannii. Herein, we screened three phage display peptide libraries targeting AbOmpA and identified several peptides. Among them, P92 (amino acid sequence: QMGFMTSPKHSV) exhibited the highest binding affinity with AbOmpA, with a KD value of 7.84 nM. In vitro studies demonstrated that although P92 did not directly inhibit bacterial growth, it significantly reduced the invasion and adhesion capabilities of multiple clinical isolates of MDR A. baumannii and concentration-dependently inhibited biofilm formation by acting on OmpA. Furthermore, the polymerase chain reaction results confirmed a significant positive correlation between the antibacterial effect of P92 and OmpA expression levels. Encouragingly, P92 also displayed remarkable therapeutic efficacy against A. baumannii infection in various models, including an in vitro cell infection model, a mouse skin infection model, and a mouse sepsis model. These results highlight P92 as a novel and highly effective antimicrobial molecule specifically targeting the virulence factor AbOmpA.

Tracking Multidrug Resistance in Gram-Negative Bacteria in Alexandria, Egypt (2020-2023): An Integrated Analysis of Patient Data and Diagnostic Tools

BACKGROUND

The rise in carbapenem-resistant Enterobacteriaceae (CRE) in Egypt, particularly in hospital settings, poses a significant public health challenge. This study aims to develop a combined epidemiological surveillance tool utilizing the Microreact online platform (version 269) and molecular microarray technology to track and analyze carbapenem-resistant Escherichia coli strains in Egypt. The objective is to integrate molecular diagnostics and real-time data visualization to better understand the spread and evolution of multidrug-resistant (MDR) bacteria.

METHODS

The study analyzed 43 E. coli isolates collected from Egyptian hospitals between 2020 and 2023. Nanopore sequencing and microarray analysis were used to identify carbapenemase genes and other resistance markers, whereas the VITEK2 system was employed for phenotypic antibiotic susceptibility testing. Microreact was used to visualize epidemiological data, mapping the geographic and temporal distribution of resistant strains.

RESULTS

We found that 72.09% of the isolates, predominantly from pediatric patients, carried the blaNDM-5 gene, while other carbapenemase genes, including blaOXA-48 and blaVIM, were also detected. The microarray method demonstrated 92.9% diagnostic sensitivity and 87.7% diagnostic specificity compared to whole-genome sequencing. Phenotypic resistance correlated strongly with next-generation sequencing (NGS) genotypic data, achieving 95.6% sensitivity and 95.2% specificity.

CONCLUSIONS

This method establishes the utility of combining microarray technology, NGS and real-time data visualization for the surveillance of carbapenem-resistant Enterobacteriaceae, especially E. coli. The high concordance between genotypic and phenotypic data underscores the potential of DNA microarrays as a cost-effective alternative to whole-genome sequencing, especially in resource-limited settings. This integrated approach can enhance public health responses to MDR bacteria in Egypt.

Monitoring of Antibiotic Resistance Patterns Within Al-Karak Governmental Hospital, Jordan, in 2022

Background/Objectives: Antimicrobial resistance is considered one of the foremost global public health challenges, and its prevalence is increasing. In Jordan, particularly in Al-Karak Governorate, there is a lack of sufficient data on antimicrobial resistance to make accurate assessments. The main aim of the current study was to evaluate antibiotic resistance trends in clinical specimens from 2022 and assess antibiotic resistance patterns. The emphasis on the WHO antibiotic classification as Access, Watch, and Reserved (AWaRe) was adopted in the current study. Results: Among Gram-positive bacteria, Enterococcus faecalis exhibited 100% susceptibility to nitrofurantoin and 96% to vancomycin, Streptococcus viridans exhibited 100% susceptibility to teicoplanin, while CoNS (coagulase-negative Staphylococci) showed moderate resistance to Trimethoprim + Sulfamethoxazole (63%) and clindamycin (47%). Among Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae displayed high susceptibility to fosfomycin (E. coli: 95%, K. pneumoniae: 80%) and amikacin (E. coli: 93%, K. pneumoniae: 81%). Resistance was notable for trimethoprim + sulfamethoxazole (E. coli: 47%, K. pneumoniae: 53%) and nitrofurantoin (K. pneumoniae: 30%). Pseudomonas aeruginosa exhibited the highest proportion of XDR strains (15%), followed by K. pneumoniae (11%) and E. coli (4%), while PDR strains were found in P. aeruginosa (6%), K. pneumoniae (3%), and E. coli (0.6%). XDR was observed in 4% of CoNS and 3% of S. viridans (α), with Staphylococcus aureus exhibiting both XDR and PDR at 1%. Methods: A cross-sectional retrospective study of bacterial species and their antimicrobial susceptibility was carried out at a hospital in Al Karak, Jordan, from January to December of 2022, the study included 1187 isolates from all locations in Al-Karak Governmental Hospital. Conclusions: The significant prevalence of XDR and PDR strains in key pathogens, particularly P. aeruginosa and K. pneumoniae, underscores the need for a robust Antimicrobial Stewardship Program (ASP) and infection control measures at Al-Karak Governmental Hospital. High susceptibility in several Access group antibiotics (e.g., amikacin and nitrofurantoin) supports their prioritization in empirical therapy, while the emergence of resistance in Watch and Reserved antibiotics highlights the necessity for rational use. These findings are very important for adjusting the local strategies to lower the spread of resistant strains and improve clinical outcomes.

Biomaterials-based phototherapy for bacterial infections

Bacterial infections and antibiotic resistance are global health problems, and current treatments for bacterial infections still rely on the use of antibiotics. Phototherapy based on the use of a photosensitizer has high efficiency, a broad spectrum, strong selectivity, does not easily induce drug resistance, and is expected to become an effective strategy for the treatment of bacterial infections, particularly drug-resistant infections. This article reviews antimicrobial strategies of phototherapy based on photosensitizers, including photodynamic therapy (PDT), photothermal therapy (PTT), and their combination. These methods have significant application potential in combating multi-drug-resistant bacterial and biofilm infections, providing an alternative to traditional antibiotics and chemical antibacterial agents.

Bacterial Communities and Their Role in Bacterial Infections

Since infections associated with microbial communities threaten human health, research is increasingly focusing on the development of biofilms and strategies to combat them. Bacterial communities may include bacteria of one or several species. Therefore, examining all the microbes and identifying individual community bacteria responsible for the infectious process is important. Rapid and accurate detection of bacterial pathogens is paramount in healthcare, food safety, and environmental monitoring. Here, we analyze biofilm composition and describe the main groups of pathogens whose presence in a microbial community leads to infection (Staphylococcus aureus, Enterococcus spp., Cutibacterium spp., bacteria of the HACEK, etc.). Particular attention is paid to bacterial communities that can lead to the development of device-associated infections, damage, and disruption of the normal functioning of medical devices, such as cardiovascular implants, biliary stents, neurological, orthopedic, urological and penile implants, etc. Special consideration is given to tissue-located bacterial biofilms in the oral cavity, lungs and lower respiratory tract, upper respiratory tract, middle ear, cardiovascular system, skeletal system, wound surface, and urogenital system. We also describe methods used to analyze the bacterial composition in biofilms, such as microbiologically testing, staining, microcolony formation, cellular and extracellular biofilm components, and other methods. Finally, we present ways to reduce the incidence of biofilm-caused infections.

Isolation and Characterization of Lytic Phages Infecting Clinical Klebsiella pneumoniae from Tunisia

Background: Klebsiella pneumoniae is an opportunistic pathogen that causes a wide range of infections worldwide. The emergence and spread of multidrug-resistant clones requires the implementation of novel therapeutics, and phages are a promising approach. Results: In this study, two Klebsiella phages, KpTDp1 and KpTDp2, were isolated from wastewater samples in Tunisia. These phages had a narrow host range and specifically targeted the hypervirulent K2 and K28 capsular types of K. pneumoniae. Both phages have double-stranded linear DNA genomes of 49,311 and 49,084 bp, respectively. Comparative genomic and phylogenetic analyses placed phage KpTDp2 in the genus Webervirus, while phage KpTDp1 showed some homology with members of the genus Jedunavirus, although its placement in a new undescribed genus may be reconsidered. The replication efficiency and lytic ability of these phages, combined with their high stability at temperatures up to 70 °C and pH values ranging from 3.5 to 8.2, highlight the potential of these phages as good candidates for the control of hypervirulent multidrug-resistant K. pneumoniae. Methods: Phage isolation, titration and multiplicity of infection were performed. The stability of KpTDp1 and KpTDp2 was tested at different pH and temperatures. Genomic characterization was done by genome sequencing, annotation and phylogenetic analysis. Conclusions: The ability of KpTDp1 and KpTDp2 to lyse one of the most virulent serotypes of K. pneumoniae, as well as the stability of their lytic activities to pH and temperature variations, make these phages promising candidates for antibacterial control.

Exploring links between oral health and infective endocarditis

Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. A low incidence rate combined with a high mortality rate mean that IE can be difficult to treat effectively. There is currently substantial evidence supporting a link between oral health and IE with the oral microbiome impacting various aspects of IE, including pathogenesis, diagnosis, treatment, and mortality rates. The oral microbiome is highly diverse and plays a crucial role in maintaining oral health by providing protective functions. However, when dysbiosis occurs, conditions such as periodontal or peri-implant disease can arise, offering a pathway for bacteraemia to develop. The role of the oral microbiome as a coloniser, facilitator and driver of IE remains to be uncovered by next-generation sequencing techniques. Understanding the dysbiosis and ecology of the oral microbiome of IE patients will allow improvements into the diagnosis, treatment, and prognosis of the disease. Furthermore, an increased awareness amongst those at high-risk of developing IE may encourage improved oral hygiene methods and lower incidence rates. This narrative review examines current findings on the relationship between oral health and IE. It draws from key studies on both topics, with manuscripts selected for their pertinence to the subject. It highlights the link between the oral microbiome and IE by exploring diagnostic techniques and treatments for IE caused by oral commensals.

A systematic analysis of neurologic manifestations of Long COVID in Nigeria

Long COVID, also called post-acute sequelae of SARS-CoV-2 infection (PASC) affects millions of people in the world. The neurologic manifestations of PASC (Neuro-PASC) are among the most debilitating but they are largely unreported in Africa. We sought to compare the demographics, symptoms and cognitive profile of post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients in Nigeria. In this cross-sectional study performed at the Lagos University Teaching Hospital, 106/2319 (4.6%) SARS-CoV-2 positive individuals contacted via telephone reported Neuro-PASC symptoms with a higher frequency in PNP than in NNP individuals ((23/200 (11.5%) vs. 83/2119 (3.9%), p = < 0.0001). The predominant neurologic symptoms at any time during the disease course were difficulty remembering / brain fog (63/106; 59.4%), fatigue (59/106; 55.7%), sleep problems (34/106; 32%), headache (33/106; 31%), paresthesia (12/106; 11.3%), and myalgia (10/106; 9.4%). Of 66 participants with Neuro-PASC who underwent in-person neurological evaluation and cognitive screening, all had normal scores on the Intervention for Dementia in Elderly Africans cognition screen, while 11/65 (16.9%) that completed the Montreal Cognitive Assessment had results consistent with mild cognitive impairment (3/16 PNP (18.8%) and 8/49 NNP (16.3%); p = 1.0). Finally, 47/66 (71.2%) had digit span test scores consistent with mild cognitive dysfunction (12/16 PNP (75%) and 35/50 (70%) NNP; p = 1.0). Our findings reveal the previously unrecognized occurrence of Neuro-PASC among COVID-19 survivors in Nigeria and highlight the need for improved screening and diagnosis of Neuro-PASC in our population. Development of cognitive support services for persons suffering from Neuro-PASC in Nigeria is warranted.

Methicillin and vancomycin-resistant Staphylococcus aureus and associated risk factors among patients with wound infection in East Wallaga Zone, Western Ethiopia

Background

Methicillin and vancomycin-resistant S. aureus have become increasingly problematic in recent years. This may be explained by the indiscriminate use of this antibiotic. The aim of this study was to determine the prevalence of methicillin-resistant and vancomycin-resistant Staphylococcus aureus (VRSA) and associated risk factors in patients with wound infections in the East Wallaga Zone, Western Ethiopia.

Methods

A hospital-based cross-sectional prospective study was conducted on 384 patients with wound infections including surgical wound who sought healthcare at Nekemte Specialized Hospital. Wound samples were collected using aseptic techniques and cultured on blood agar and mannitol salt agar. Vancomycin E-test and cefoxitin (30 μg) antibiotic disc diffusion were used to detect MRSA and VRSA, respectively. Data were analyzed using SPSS version 23, and a P-value of less than 0.05 was considered statistically significant.

Results

Of the 384 wound samples collected, 109 (28.4%) were identified as Staphylococcus aureus. Of these, 40.4% (44/109) were identified as MRSA, and 7.3% (8/109) were VRSA. Thirty-two (72.7%) MRSA isolates were showed multidrug resistance. The depth of the wound, patient setting, history of wound infection, and history of antibiotic use became significantly associated with the prevalence of MRSA wound infection.

Conclusions

This study found significant levels of S. aureus, MRSA, and VRSA in patients with wound infection. Therefore, it is crucial to implement effective infection prevention and control measures to prevent the spread of antimicrobial resistance.

Does the heat source affect the risk of wound infection in children with scalds?

INTRODUCTION

Scalds are the leading cause of burns in children younger than 5 years of age with most being related to food preparation and consumption. Hot substances causing scalds have different degrees of viscosity varying from low (liquid substances, such as water), to high (semi-solids or solids, such as oils or grease). It is still underknown whether heat substances with different viscosities are associated with varying risks of developing burn wound infections (BWI). The aim of this study was to investigate the association between heat sources of different viscosities and development of BWI within the first week after injury in children with scalds.

METHOD

Children 5 years and younger of age admitted at the Linköping Burn Center for new scalds between 2015 and 2020 were included. Data source for the study population was the Burn Unit Database. BWI was defined as fulfilment of at least two ABA criteria at the time of systemic antibiotic therapy (AB) initiation between day 2-7 following scald. Medical record review was undertaken to identify the heat source causing the scald, BWI criteria, and the use of AB. Legal guardians were contacted in cases in which information was missing. Logistic regression was used to analyse the association between heat source and development of BWI.

RESULT

The study population consisted of 271 children, median age was 1.5 years, 61 % were boys, median burn size was 3.5 % of the total body surface area (TBSA), 10 (4 %) had a full thickness burn. BWI were identified in 69 (26 %) of the children. Most scalds were caused by contact with hot liquids (n=184), followed by semisolids (n=52) and solids (n=35). The logistic regression model showed that the size of the burn (TBSA) was associated with BWI, while type of heating agent was not.

CONCLUSION

Our results indicate that the viscosity of the heat source does not affect the risk of wound infection in children with scalds; only the size of the area burned was an independent factor for BWI.

Prevalence of major INSTI and HIV-1 drug resistance mutations in pre- and antiretroviral-treated patients in Indonesia

Indonesia has one of the highest HIV infection rates in Southeast Asia. The use of dolutegravir, an integrase strand transfer inhibitor (INSTI), as a first-line treatment underscores the need for detailed data on INSTI drug resistance mutations (DRMs). Currently, there is a lack of comprehensive data on DRMs INSTI and other HIV drug resistance in Indonesian patients, both pre- and post-treatment. The aim of this study was to identify the subtypes and drug resistance mutations of the protease, reverse transcriptase, and integrase genes in both treatment-naive and ARV-treated patients in Bandung, West Java, Indonesia. A cross-sectional study was conducted involving HIV- positive patients at Hasan Sadikin Hospital, Bandung, Indonesia, from September 2022 to January 2023. The patients were categorized into two groups: ARV-treated and pre- treatment patients. Peripheral blood mononuclear cells (PBMCs) were processed for DNA extraction, followed by amplification and sequencing of the pol gene to detect mutations and subtypes. The study found that the predominant subtype was CRF01_AE, accounting for 85.4% and 69% of pre-treatment and treated patients, respectively, followed by recombinant forms such as A1/CRF01_AE, CRF01_AE/CRF02_AG, subtype B, and other subtypes. Among ARV-treated/INSTI-naive patients, major INSTI DRMs R263 K and Y143H were identified, while pre-treatment patients exhibited accessory integrase DRMs. The most common DRMs detected were non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs, with prevalences of 14.6% and 7% in pre-treatment and ARV-treated patients, respectively. In conclusion, CRF01_AE emerged as the predominant subtype in both pre-treatment and ARV-treated patients in Bandung, underscoring the necessity for ongoing surveillance of integrase DRMs, particularly given the presence of major INSTI DRMs in patients undergoing INSTI treatment.

A prospective cohort study to investigate the transmission and burden of Staphylococcus aureus in Sri Lanka

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of infection in both community and healthcare settings, and the household may be a central component linking these two environments. Strategies to prevent S. aureus transmission and thereby reduce the risk of infection must be informed by a detailed understanding of local epidemiology. These data are typically lacking in many low- and middle-income countries. Therefore, we aimed to investigate the circulation of infecting S. aureus strains in Sri Lanka, with a focus on the community and healthcare interface. A prospective longitudinal cohort study was performed between July and December 2021. Index patients with S. aureus infection and up to four of their household contacts were enrolled in the study. Colonization was assessed by sampling participants' nose and axilla at two time points over 3 months of follow-up. Whole-genome sequencing (WGS) was used to characterize isolates and assess strain similarity to identify transmission episodes and environmental clusters. A total of 153 participants were recruited, including 42 S. aureus-positive index patients and 111 household contacts. The baseline prevalence of S. aureus colonization amongst household contacts was 11.7% (13/111), of which 30.8% (4/13) were methicillin-resistant. A total of 88 S. aureus isolates underwent WGS and three multilocus sequence types predominated: ST672, ST5 and ST6. Each type had unique virulence characteristics but was identified in both community and healthcare environments. Colonization of household members with the index's infecting strain was not detected. S. aureus is a major cause of morbidity and mortality in low-resource settings such as Sri Lanka, yet little is known about risk factors and transmission networks. In this descriptive study, we have identified a small number of strains that appear to be well established and capable of causing both severe infection and asymptomatic colonization. Transmission of S. aureus did not appear to be occurring frequently in the household, and, therefore, preventative strategies that target high-risk groups may be more successful than universal community-based measures.

Policy brief: addressing the shortage of human resources in the Iranian health system

This policy brief highlights the critical shortage of healthcare workers in Iran, which hinders access, quality, and patient outcomes. The growing demand from population increases and chronic diseases, coupled with issues like geographic maldistribution, workforce migration, inadequate training, and limited support systems, exacerbates the crisis. Urban areas benefit disproportionately, leaving rural communities underserved and healthcare quality compromised. Evidence-based recommendations include incentivizing rural placements, improving workforce management systems, enhancing salaries and working conditions, expanding education and training, and leveraging digital health tools and task-shifting models. A phased implementation strategy is proposed, combining short-term pilot projects with long-term reforms to build a resilient healthcare workforce.

Emergence of extensively-drug-resistant hypervirulent Acinetobacter baumannii isolated from patients with bacteraemia: bacterial phenotype and virulence analysis

OBJECTIVES

Individuals infected with extensively-drug-resistant (XDR) Acinetobacter baumannii are difficult to cure and have a high mortality rate. This study compared the genomic and phenotypic differences between XDR and non-multi-drug-resistant (MDR) A. baumannii, and further characterized hypervirulent XDR A. baumannii.

METHODS

In total, 1403 acinetobacter isolates were collected from patients with bacteraemia between 1997 and 2015. Antimicrobial susceptibility tests were performed to categorize isolates into non-MDR, MDR and XDR groups. The presence of selected virulence-associated genes was determined by polymerase chain reaction. Bacterial phenotypes, including iron acquisition, biofilm formation, capsule production, and virulence to larvae and mice, were determined.

RESULTS

Multi-locus sequence typing revealed a high prevalence of sequence type (ST) 2 (81.6%) and ST129 (18.4%) among 49 XDR isolates, and the STs of 18 non-MDR isolates were more diverse. Virulence-associated phenotypic assays showed that XDR isolates had higher iron acquisition ability, greater capsule production, and virulence to Galleria mellonella larvae. However, their ability to form biofilm was lower compared with that of non-MDR isolates. XDR isolates were more likely to have virulence genes (tonB, hemO, abaI and ptk), while non-MDR isolates were more likely to have pld and ompA genes. Twenty-one XDR isolates that had a <20% larvae survival rate after 7 days post-infection were defined as hypervirulent XDR isolates. Among them, isolates 1677 (ST129) and 929-1 (ST2) caused the death of all infected mice within 2 days.

CONCLUSION

Some subpopulations of highly-drug-resistant ST2 isolates exhibit high virulence. As such, it is of utmost importance to continue monitoring the spread of hypervirulent XDR A. baumannii isolates.

Serological evidence of Erysipelothrix rhusiopathiae antibodies in wild boars (Sus scrofa) in Poland

Introduction

This study aimed to evaluate the seroprevalence of Erysipelothrix rhusiopathiae among wild boars inhabiting Poland.

Material and Methods

Serum samples were collected from 281 wild boars of varying ages (juveniles, adolescents and adults) and subjected to testing using a commercial indirect ELISA assay.

Results

The prevalence of E. rhusiopathiae antibodies was notably high, reaching 75.1% overall and varying slightly across different age categories (90.0% in juveniles, 70.7% in adolescents and 79.6% in adults). Despite these variations, no statistically significant differences were observed among age groups (P-value > 0.05).

Conclusion

The elevated prevalence of E. rhusiopathiae identified in this study underscores the significance of wild boars as natural reservoirs of this bacterium. Further investigations are warranted to identify the risk factors associated with disease transmission to other species, including humans.

Phenotypic and Genotypic Detection of Hypervirulent Klebsiella pneumoniae Isolated from Hospital-Acquired Infections

Hypervirulent Klebsiella pneumoniae is a highly pathogenic variant of Klebsiella pneumonae, which represents a global public health issue because it is very virulent and spreads easily. The objectives of this study were to assess the predominance of hvKp among health care-associated infections in intensive care units of Tanta University Hospital and to compare hvKp with classical K. pneumoniae (cKp) in terms of antibiotic resistance, virulence, and molecular features. The study included 300 patients suffering from HAIs from different ICUs of Tanta University Hospitals. K. pneumoniae isolates were identified and subjected to string testing and antibiotic susceptibility testing, and the tissue culture assay for biofilm formation and polymerase chain reaction (PCR) tests were performed for the identification of capsular genes (K1, K2, K57) and virulence genes (rmpA, rmpA2, iuc A). Fifty-seven K. pneumonaie isolates were isolated. A total of 21 (36.8%) of them were hvKp and 36 (63.15%) were cKp. Significantly higher antibiotic resistance was detected in the cKp group. There was a significant difference between biofilm formation between cKp and hvKp isolates (p < 0.004*). iucA, rmpA2, and K1 genes were significantly associated with hvKp. The string test shows 100% sensitivity and negative predictive value for the detection of hvKp. Consequently, using the string test alone for the screening of hvKp is required. However, combining aerobactin-positive with hypermucoviscous isolates while screening for hvKp is crucial.

The dynamics and assembly patterns of airborne pathogen communities in the municipal food waste treatment system and its risk implications

While municipal solid waste (MSW) provides an ideal habitat for pathogen propagation, the dynamics and assembly of airborne pathogen communities in these environments remain largely unknown. Here, we combined amplicon and metagenomics with spatiotemporal sampling to study inhalable particulate matter-carried potential pathogenic bacteria at full-scale food waste treatment plants (FWTPs), alongside comparisons to urban air in the area. The results showed that pathogenic bacteria constituted a notable portion (64.5 % ± 20.6 %, n = 75) of the total bacterial communities in FWTPs-impacted air, with species and relative abundance 2-4 times higher than that of urban air, and contributed over 50 % of pathogens to the outdoor air. Airborne pathogen community structures were highly shaped by sampling sites (i.e. treatment units), but conserved across seasons (summer vs. winter) and particle sizes (PM2.5vs. PM10). Notably, Acinetobacter johnsonii-dominated pathogens (i.e. biofilm-related species) presented high levels of aerosolization and consistently occupied the upper-representative niches in all neutral models, highlighting their persistent exposure risk. Furthermore, pathogen community assembly was strongly driven by stochastic processes (58.8 %-96.8 %), while environmental variables explained only limited variations (3.4 %-28.7 %). In particular, the relative importance of stochastic processes clearly increased along an outdoor-to-indoor gradient (84.9 %-96.5 % vs. 71.3 %-76 %), which might be related to indoor anthropogenic activities that weaken microbial network stability and environmental filtering effects. This work enhances our knowledge of the dynamic behaviors and risk of airborne pathogen communities in MSW disposal and underscores the role of FWTPs in disseminating airborne pathogens.

Assessing the Impact of Oral Care Micro-courses on ICU Nurses' Compliance Through a Mixed-Effects Model: A Quasi-experimental Study

Background Ventilator-associated pneumonia (VAP) is a common and severe hospital-acquired infection, and oral care is an effective preventive measure. However, the compliance and quality of oral care among intensive care unit (ICU) nurses need improvement. Methods This quasi-experimental study was conducted in two ICUs at the first affiliated hospital of Gannan Medical University, Ganzhou, China, involving 74 ICU nurses. The participants were allocated to either a micro-course education group or a conventional education group. Of these, 32 nurses were from the General ICU, and 42 were from the Cardiac ICU. Both groups received oral care education, with the micro-course group receiving video-based instruction, and the conventional group receiving PowerPoint-based training (Microsoft® Corp., Redmond, WA, USA). Data on oral care compliance and levels of Knowledge, Attitudes, and Practices (KAP) were collected at baseline and during follow-ups over one month. Statistical analysis was conducted using a mixed-effects model to compare outcomes between the groups, highlighting variations in ICU nurses' oral care practices across different ICU settings. Results Both education methods had statistically significant effects. The micro-course education group showed earlier and more pronounced improvements in oral care compliance. Quantitatively, the micro-course group experienced a mean increase in compliance of 0.281 (p = 0.032) at the third follow-up, whereas the conventional group saw a mean increase of 0.261 (p = 0.042) at the fifth follow-up. Additionally, KAP levels in both groups improved significantly (p < 0.001). Conclusion This study demonstrates that micro-course education has a statistically significant impact on ICU nurses' oral care compliance and levels of KAP in the short term. Although there was no significant difference in oral care compliance between the micro-course and conventional education methods, the micro-course showed certain advantages in teaching quality. Long-term studies are needed to evaluate the sustainability of these improvements. Promoting micro-course education in ICU nursing practice may enhance oral care practices and potentially reduce the incidence of VAP.

Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.

Campylobacter species, Salmonella serotypes and ribosomal RNA-based fecal source tracking in the Kokemäki River watershed

Fecal contamination of surface water compromises the usability of surface water for drinking water production due to an increase in human health risks. In this study, we collected surface water samples for two years from the Kokemäki River (Finland). The downstream river stretch is used for feeding production of artificial ground water for a major drinking water treatment plant. The prevalence of Campylobacter species and Salmonella serotypes together with fecal source identifiers targeting general, human, gull, swine, and ruminant were evaluated at 16 sampling sites throughout the studied watershed. We detected Campylobacter spp. from all 16 sampling sites with Campylobacter jejuni and Campylobacter lari as the most detected species. Salmonella spp. was detected in 10 out of 16 sampling sites, with Salmonella Typhimurium being the most common serovar. Regarding spatial variation in the hygienic quality of surface water, the upstream area (urban proximity) and downstream area (agricultural proximity) had higher microbial loads than the middle section of the study area. Samples taken in fall and spring had higher microbial loads than summer and winter samples. The lower ratio of rRNA to rRNA-gene (rDNA) of studied microbes in the winter than in other seasons may indicate low metabolic activity of bacterial targets during winter. The number of gulls, swine, and cattle in the catchment area concorded with the number of fecal source identifiers in the surface water. Further, the prevalence of gull-specific source identifier agreed with the detection of C. coli, C. lari, and S. Typhimurim, whereas the prevalence of swine- and ruminant-specific source identifiers agreed with the detection of C. jejuni and C. coli. Thus, fecal source identifiers are shown to be important tools for monitoring zoonotic pathogens affecting microbial quality of surface water. Further, variation in fecal loads indicates such variation in health risks related to surface water use.

Prevalence and molecular epidemiology of methicillin-resistant Staphylococcus aureus in livestock farmers, livestock, and livestock products in southern Sri Lanka: A one health approach

Methicillin-resistant Staphylococcus aureus (MRSA) colonization can lead to subsequent severe infections. Unlike community and hospital-associated types, Livestock-associated MRSA (LA-MRSA) transmits to humans through direct contact with livestock and contaminated livestock products. This study aimed to investigate MRSA prevalence and molecular epidemiology in livestock farmers, livestock, and livestock products, including LA-MRSA presence and MRSA abundance in human and animal nasal microbiome, in southern Sri Lanka using a One Health approach. Nasal swabs from farmers and livestock on 50 farms (Nov 2020 - Dec 2021) and livestock products were collected. MRSA was isolated and confirmed using standard microbiological techniques. Staphylococcal chromosomal cassette mec typing, spa typing, and multilocus sequence typing were performed. Identified clones were compared with hospital isolates. Metagenomics analysis was performed on selected samples. MRSA prevalence was 24.0 % (12/50) in farms, 7.9 % (12/152) in farmers, 2.1 % (5/240) in livestock, and 1.9 % (3/157) in products. Of 372 S. aureus collected from clinical cultures, 59.4 % were MRSA. MRSA clones were identified in farm personnel (CC5/ST5/t002, CC1/ST1/t127, and ST45/CC45/t026), livestock (CC5/ST5/t002), and clinical cultures (CC5/ST5/t002 and CC5/ST6/t304), with ST45/CC45/t026 and CC5/ST6/t304 reported for the first time in Sri Lanka. LA-MRSA clones (ST389/ST9) were not detected. Animals had more diverse nasal microbiomes and lower MRSA abundance (<1.4 %) compared to humans (>82.3 %). MRSA colonization prevalence in southern Sri Lanka was relatively low. Two new clones and no LA-MRSA clones were identified. This study highlights the importance of continuing MRSA surveillance under the One Health framework to identify MRSA transmission between humans, animals, and the environment.

Identification of carbapenemase-producing Enterobacteriaceae reservoirs in wet hospital environments as a potential factor in patient acquisition: A cross-sectional study in a French university hospital in 2023

OBJECTIVES

Wet hospital environments have been documented as potential reservoirs for Carbapenemase-producing Enterobacteriaceae (CPE), possibly contributing to outbreaks among inpatients. Our objectives were to assess the prevalence of CPE reservoirs in a hospital's wet environments and to investigate the contamination of adjacent dry surfaces.

METHODS

From March to August 2023, we conducted a cross-sectional study in two hospital wards experiencing ongoing large outbreaks. Sampling of the environment was undertaken in two distinct phases. During phase 1, 38 shower drains and 38 toilet bowls, defined as the wet environment, were sampled using swabs. Phase 2 consisted in sampling adjacent dry surfaces, using wipes in rooms that had tested positive during phase 1. Samples were plated on a selective medium (chromID®CARBASMART, bioMérieux). Species were identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technique. Carbapenemases were detected by OKNVI RESIST-5® (CORIS BioConcept).

RESULTS

From the 38 patient rooms, 76 samples were taken during phase 1. All in all, 33 (86.8%) rooms presented at least one CPE reservoir in the wet environment; there were 32 (84.2%) contaminated shower drains and six (15.8%) contaminated toilet bowls. Among 57 identified CPEs, the most frequent strain was Enterobacter cloacae VIM (13, 22.8%). During phase 2, 11 (8.3%) out of 132 samples tested positive for CPE. Enterobacter cloacae complex VIM accounted for six (54.5%) of the CPE strains.

CONCLUSION

These findings suggest that the wet hospital environments were broadly contaminated with CPE, mostly Enterobacter cloacae VIM. The spread of CPE from wet environments to dry surfaces seemed limited.

Efficacy of Cetylpyridinium Chloride Mouthwash on Denture Plaque Reduction and Microbiome Alteration in a Randomized Crossover Trial

Purpose This study aimed to evaluate the effectiveness of cetylpyridinium chloride (CPC) mouthwash in reducing denture plaque and its impact on the microbial composition of denture plaque. Materials and methods A randomized, placebo-controlled crossover trial included 29 participants with maxillary complete dentures. Participants used either CPC or a placebo mouthwash for one week each in a crossover design. The denture plaque area was quantified using image analysis, and microbiome composition was analyzed via 16S rRNA gene sequencing. Results The use of CPC mouthwash significantly reduced the denture plaque area compared to placebo (p<0.025). Microbiome analysis revealed a significant decrease in the relative abundance of the genus Actinomyces (p=0.025) and a significant increase in the genus Haemophilus (p<0.001) after CPC use. While alpha diversity showed no significant changes, beta diversity analysis indicated a significant shift in microbial composition (p=0.002). Conclusion CPC mouthwash effectively reduces denture plaque accumulation and modifies its microbial composition. These findings highlight the potential of CPC mouthwash as an effective tool in denture hygiene management, which may help lower the risk of denture-related oral and systemic infections.

Associations between neighbourhood-level median household income and outpatients' risk of antibiotic non-susceptible uropathogens in a major urban centre, USA

Introduction

Resistance to first-line antibiotics among urinary tract infections continues to rise, but how neighbourhood-level socioeconomic status impacts this risk remains unclear. We examined the effect of neighbourhood-level income on a patient's risk of having a uropathogen non-susceptible to trimethoprim/sulfamethoxazole (TMP/SMX) or nitrofurantoin.

Methods

We used electronic health record data and antibiotic susceptibility test results for urinary Escherichia coli and Klebsiella pneumoniae collected at Emory Healthcare outpatient facilities in greater Atlanta between October 2022 and September 2023. We determined patients' block group median household income (MHI) using their residential addresses and 2017-21 US census data. We performed a logistic regression with a priori risk factors using a generalized estimating equation, with subgroup analysis by organism and for patients with diabetes mellitus.

Results

We included 9325 urine E. coli and K. pneumoniae isolates from 3867 outpatients. Compared to uropathogenic E. coli, K. pneumoniae were more likely to be non-susceptible to nitrofurantoin (P < 0.001) and less likely to be non-susceptible to TMP/SMX (P < 0.001). Compared to the lowest MHI quintile, patients in the highest MHI quintile neighbourhoods had 0.78 odds of harbouring a non-susceptible uropathogen (95% CI: 0.64, 0.95) after controlling for patient age, sex and race/ethnicity, along with neighbourhood-level characteristics. This association was stronger for K. pneumoniae infections and non-significant among people with diabetes.

Conclusions

Higher neighbourhood-level MHI was associated with lower individual risk of harbouring a first-line antibiotic-non-susceptible uropathogen.

Exploring AMR and virulence in Klebsiella pneumoniae isolated from humans and pet animals: A complement of phenotype by WGS-derived profiles in a One Health study in Egypt

Klebsiella pneumoniae is a ubiquitous nosocomial pathogen associated with various types of infections in hospitalized patients and different animal species. In the current study, 49 Klebsiella strains isolated from humans, dogs, and cats were investigated using NGS technology. MALDI-TOF failed to identify newly discovered K. variicola and K. quasipneumoniae isolates correctly. MLST analysis revealed different sequence types among K. pneumoniae isolates, and the most frequent STs were ST29, ST219, and ST37. Three ST23 that are generally known as hypervirulent type were identified but they lacked major discriminatory determinants for hypervirulent K. pneumoniae (hvKp). K. pneumoniae isolates showed high diversity, and several isolates from humans and animals were assigned to the same ST and were almost identical. Isolates from humans exhibited more pronounced resistance patterns compared to the animal isolates. High levels of resistance were observed for piperacillin, trimethoprim/sulfamethoxazole, and cephalosporins, and resistance to carbapenem compounds was only found in isolates of human origin. Three strains of human origin were extensively drug-resistant (XDR). A diverse range of resistance genes primarily confer resistance to beta-lactams., phenicol/quinolone, aminoglycoside, macrolide, sulfonamides, and fosfomycin were identified in silico. However, there were inconsistencies between the phenotypic characterization of isolates and the set of resistance genes detected in silico in this set of Klebsiella isolates. Further research using a larger number of isolates from various sources is necessary to fully comprehend the relationship between the presence of antimicrobial resistance determinants and phenotypic data. It is also necessary to monitor the spread of K. pneumoniae from a One Health perspective in Egypt.

Orbital hydatid cyst and its successful treatment: A case report from Afghanistan

Purpose

This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management.

Observations

Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy.

Conclusion and Importance

The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.

Prevalence of hepatitis B virus infection and treatment eligibility in Lesotho, Southern Africa: a population-based cross-sectional study with case-based follow-up

Background and aims

There is no data on hepatitis B virus (HBV) prevalence and treatment eligibility among the general population in Lesotho. We aimed to determine the prevalence of HBV infection in a large-scale cross-sectional survey among the general population in Lesotho, assess determinants of seropositivity, and evaluate treatment eligibility according to the 2024 WHO guidelines.

Approach and results

We conducted a household-based, cross-sectional survey among participants≥10 years old in 120 randomly sampled village clusters in two districts. From participants screened positive for HBV surface antigen (HBsAg), we collected dried blood spots for HBV DNA measurement and referred the participants to health facilities for clinical assessment and treatment eligibility evaluation.Out of 6709 participants screened, 6705 had a valid HBsAg test result (3509 (52.3%) female, median age 33 years (IQR: 20-53)), which was positive in 78 participants, yielding a prevalence of 1.2% (95% CI: 0.9 to 1.4). Being≥18 years old, male, living in urban areas, living with HIV, consuming tobacco and belonging to higher wealth index quintiles, were associated with increasing odds of HBV infection. Of the 78 participants with HBV infection, 62 (79.5%) linked to care. Among these, 25/62 (40.3%) were also living with HIV and 23/25 (92%) already taking antiretroviral treatment active against HBV. Among the remaining, 10/37 (27.0%) were eligible for antiviral treatment based on HBV DNA, Aspartate aminotransferase to Platelet Ratio Index or alanine aminotransferase levels.

Conclusions

We observed a low prevalence of HBV infection among Basotho. Treatment eligibility was high mostly due to the presence of HIV co-infection. However, nearly one-third of HBV mono-infected participants were eligible for treatment, suggesting a testing and treatment gap in this population.

A systematic overview of strategies for photosensitizer and light delivery in antibacterial photodynamic therapy for lung infections

Antimicrobial photodynamic therapy (aPDT) emerges as a viable treatment strategy for infections resistant to conventional antibiotics. A complex interplay of factors, including intracellular photosensitizer (PS) accumulation, photochemical reaction type, and oxygen levels, determines the efficacy of aPDT. Recent progress includes the development of modified PSs with enhanced lipophilicity and target-specific strategies to improve bacterial cell wall penetration and targeting. Nanotechnology-based approaches, such as using nanomaterials for targeted PS delivery, have shown promise in enhancing aPDT efficacy. Advancements in light delivery methods for aPDT, such as transillumination of large lesions and local light delivery using fiber optic techniques, are also being explored to optimize treatment efficacy in clinical settings. The limited number of animal models and clinical trials specifically designed to assess the efficacy of aPDT for lung infections highlights the need for further research in this critical area. The potential prospects of aPDT for lung tissue infections originating from antibiotic-resistant bacterial infections are also discussed in this review.

Enterobacteriaceae in Sewage Sludge and Digestate Intended for Soil Fertilization

Substances of organic origin are seeing increasing use in agriculture as rich sources of nutrients for plants. The aim of this study was to determine the microbiological contamination of sewage sludge and digestate to assess their safe use as fertilizers in Poland. The assessment of microbial soil, sewage sludge and digestate contamination was based on the total number of mesophilic bacteria and Gram-negative bacteria from the Enterobacteriaceae family. The presence of Escherichia coli and Salmonella spp. was identified via culture and the presence of Enterobacteriaceae species was determined via biochemical and molecular methods. In laboratory conditions, the survival of E. coli in soil fertilized with sewage sludge or digestate inoculated with a reference strain was determined. The average concentration of Enterobacteriaceae in soil, sewage sludge and digestate samples was 1.1 × 104 CFU/g, 9.4 × 105 CFU/g and 5.6 × 106 CFU/g, respectively. Escherichia coli was detected in all sample types. From the soil samples, Serratia, Enterobacter, Pantoea, Citrobacter and Pseudomonas genera were identified the most frequently, while in sewage sludge and digestate, E. coli was predominant. Based on the results of our laboratory experiment, it can be concluded that after three weeks, fertilization with organic waste in acceptable doses does not significantly increase soil contamination with Enterobacteriaceae.

Diagnostic Accuracy of Mycobacterium tuberculosis Antigen-Based Skin Tests (TBSTs) for Tuberculosis Infection Compared with TST and IGRA: A Network Meta-Analysis

The aim of this study was to evaluate the diagnostic accuracy of the IGRA, TST, and TBST by combining diagnostic test accuracy (DTA) analysis and network meta-analysis (NMA) to increase the reliability and accuracy of diagnostic methods and promote the eradication of TB. An electronic search of the PubMed, Embase, and Cochrane databases was conducted, from the date of establishment to September 30, 2024. Data were synthesized with frequentist random-effects network meta-analyses, a single-group rate meta-analysis algorithm, and a bivariate mixed-effects logistic regression model. Summarized receiver operating characteristic curves and Fagan nomograms were used to assess diagnostic accuracy and clinical utility. Deeks' funnel plots and the Quality Assessment of Diagnostic Accuracy Studies 2 tools were used to assess publication bias and risk of bias. Sources of heterogeneity were investigated using subgroup analyses. Forty-nine studies were identified. The diagnostic performance of the three diagnostic methods for TB infection is summarized as follows: the pooled sensitivity was 77.9% (95% confidence interval [CI], 0.69-0.856), and the pooled specificity was 80.3% (95% CI, 0.75-0.86). The sensitivity and specificity of the IGRA were 82.1% (95% CI, 0.78-0.86) and 81.1% (95% CI, 0.75-0.86), respectively, both higher than the TST. However, the TBST exhibited the highest specificity, at 98.5% (95% CI, 0.96-1.00), with a sensitivity of 78.7% (95% CI, 0.68-0.88), which was between that of the IGRA and TST. Subgroup analysis found that population categories and reference standards, among other factors, may be attributed to heterogeneity. In addition, the TST and IGRA add-on TBST can significantly improve diagnostic accuracy. In our study, the IGRA showed higher sensitivity, whereas the TBST showed higher specificity. Interestingly, under certain conditions, TST add-on TBST and IGRA add-on TBST showed better accuracy than TST and IGRA alone and could provide more effective guidance for clinical practice (PROSPERO CRD42023420136).

Advancing Phage Therapy: A Comprehensive Review of the Safety, Efficacy, and Future Prospects for the Targeted Treatment of Bacterial Infections

BACKGROUND

Phage therapy, a treatment utilizing bacteriophages to combat bacterial infections, is gaining attention as a promising alternative to antibiotics, particularly for managing antibiotic-resistant bacteria. This study aims to provide a comprehensive review of phage therapy by examining its safety, efficacy, influencing factors, future prospects, and regulatory considerations. The study also seeks to identify strategies for optimizing its application and to propose a systematic framework for its clinical implementation.

METHODS

A comprehensive analysis of preclinical studies, clinical trials, and regulatory frameworks was undertaken to evaluate the therapeutic potential of phage therapy. This included an in-depth assessment of key factors influencing clinical outcomes, such as infection site, phage-host specificity, bacterial burden, and immune response. Additionally, innovative strategies-such as combination therapies, bioengineered phages, and phage cocktails-were explored to enhance efficacy. Critical considerations related to dosing, including inoculum size, multiplicity of infection, therapeutic windows, and personalized medicine approaches, were also examined to optimize treatment outcomes.

RESULTS

Phage therapy has demonstrated a favorable safety profile in both preclinical and clinical settings, with minimal adverse effects. Its ability to specifically target harmful bacteria while preserving beneficial microbiota underpins its efficacy in treating a range of infections. However, variable outcomes in some studies highlight the importance of addressing critical factors that influence therapeutic success. Innovative approaches, including combination therapies, bioengineered phages, expanded access to diverse phage banks, phage cocktails, and personalized medicine, hold significant promise for improving efficacy. Optimizing dosing strategies remains a key area for enhancement, with critical considerations including inoculum size, multiplicity of infection, phage kinetics, resistance potential, therapeutic windows, dosing frequency, and patient-specific factors. To support the clinical application of phage therapy, a streamlined four-step guideline has been developed, providing a systematic framework for effective treatment planning and implementation.

CONCLUSION

Phage therapy offers a highly adaptable, targeted, and cost-effective approach to addressing antibiotic-resistant infections. While several critical factors must be thoroughly evaluated to optimize treatment efficacy, there remains significant potential for improvement through innovative strategies and refined methodologies. Although phage therapy has yet to achieve widespread approval in the U.S. and Europe, its accessibility through Expanded Access programs and FDA authorizations for food pathogen control underscores its promise. Established practices in countries such as Poland and Georgia further demonstrate its clinical feasibility. To enable broader adoption, regulatory harmonization and advancements in production, delivery, and quality control will be essential. Notably, the affordability and scalability of phage therapy position it as an especially valuable solution for developing regions grappling with escalating rates of antibiotic resistance.

The impact of the COVID-19 pandemic on hospital-acquired infections and multi-drug resistant organisms, in comparison to seasonal influenza

BACKGROUND

While effective preventive measures reduce hospital-acquired infections (HAIs) and the spread of multi-drug resistant organisms (MDROs), studies on the impact of the COVID-19 pandemic and its associated preventive measures remain inconclusive.

OBJECTIVE

To assess the impact of COVID-19 on HAIs and MDROs and to compare it with the effect of seasonal influenza.

METHODS

A retrospective cohort study analyzed prospectively collected data from a tertiary hospital in Haifa, northern Israel, from 2016 to 2021. It compared pre/during COVID-19 and influenza (Dec-Feb)/non-influenza (Mar-Nov) seasons. Studied parameters: hospital-acquired bloodstream infections (HA-BSI), MDROs, nosocomial Clostridioides difficile infections (CDI) per 10,000 hospital days (HD), central line-associated BSI (CLABSI) per 1000 catheter days (CD) and hand hygiene compliance (HHC).

RESULTS

During the COVID-19 period, rates of HAIs and MDROs decreased compared to the pre-COVID era for methicillin-resistant Staphylococcus aureus (MRSA) (4.2 vs. 6.9/10,000 HD; p < 0.001), carbapenem-resistant Acinetobacter baumani (CRAB) (2.2 vs. 3.1/10,000 HD; p = 0.02), and nosocomial CDI (3 vs. 4.6/10,000 HD; p < 0.001). However, there was a higher rate of carbapenem-resistant Enterobacteriaceae (CRE) (4.6 vs. 2.7/10,000 HD; p < 0.001) and HA-BSI (29.7 vs. 27.3/10,000 HD; p = 0.006) during the COVID-19 era. CLABSI rates showed no significant difference (2.3 vs. 2.7/1000 CD; p = 0.910). HHC rate remained at 70% in both eras (p = 0.151). No significant differences were observed in MDROs, CDI, HA-BSI, or CLABSI rates (p = 0.233, 0.675, 0.267, and 0.563, respectively) between influenza and non-influenza seasons.

CONCLUSIONS

In the COVID-19 era, HAIs and MDROs rates significantly declined, while CRE rates increased, possibly due to a national trend in Israel since 2016. Steady HHC rates suggest additional factors like enhanced environmental cleaning, personal protective equipment usage, and increased infection prevention awareness contributed to this decline. Influenza had no noticeable impact, likely due to healthcare workers' varying perceptions and the brevity of the influenza season, making it challenging to assess impact.

Shigella sonnei: epidemiology, evolution, pathogenesis, resistance and host interactions

Shigella sonnei is a major cause of diarrhoea globally and is increasing in prevalence relative to other Shigella because of multiple demographic and environmental influences. This single-serotype species has traditionally received less attention in comparison to Shigella flexneri and Shigella dysenteriae, which were more common in low-income countries and more tractable in the laboratory. In recent years, we have learned that Shigella are highly complex and highly susceptible to environmental change, as exemplified by epidemiological trends and increasing relevance of S. sonnei. Ultimately, methods, tools and data generated from decades of detailed research into S. flexneri have been used to gain new insights into the epidemiology, microbiology and pathogenesis of S. sonnei. In parallel, widespread adoption of genomic surveillance has yielded insights into antimicrobial resistance, evolution and organism transmission. In this Review, we provide an overview of current knowledge of S. sonnei, highlighting recent insights into this globally disseminated antimicrobial-resistant pathogen and assessing how novel data may impact future vaccine development and implementation.