Other specific DSP article suggested by Editorial Board
Antimicrobial Photodynamic Therapy in the Treatment of Diabetic Foot Ulcers: A Pilot Randomized Clinical Trial.
DOI: 10.1002/jbio.70278
Authors: Brandão MGSA, et al
Abstract
This pilot randomized clinical trial evaluated photodynamic therapy (PDT) in diabetic foot ulcers (DFUs), comparing an intervention group (IG, n = 5) with a control group (CG, n = 4). Participants were followed for 7 weeks. The IG received PDT, while the CG underwent conventional care. The microbiological profile was assessed by biopsy before and after treatment, and wound progression was evaluated using the Bates-Jensen Wound Assessment Tool. In the IG, only one participant showed an increase in the number of bacterial species, while the others maintained the count with changes in species composition. In the CG, two participants presented an increase in bacterial species. All participants in the IG showed a reduction in ulcer size, with an average decrease of more than 63%, whereas two participants in the CG exhibited an increase in lesion area. These results suggest clinically relevant differences, supporting PDT as a promising adjuvant strategy for antimicrobial stewardship in DFUs.
Other specific DSP article suggested by Editorial Board
Integrating resistance biology, virulence networks, and precision therapeutics against multidrug-resistant Pseudomonas aeruginosa.
Authors: Abdelmoneim HM, et al.
Abstract
Multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) has emerged as a major threat in contemporary clinical microbiology, driven by the convergence of extensive antimicrobial resistance, biofilm-mediated persistence, and tightly coordinated virulence regulation. Global surveillance reveals a sustained increase in MDR and carbapenem-resistant P. aeruginosa (CRPA), characterized by marked regional heterogeneity and the dissemination of high-risk international clones. Conventional antibiotic-centered strategies are increasingly compromised by the interplay between intrinsic resistance determinants, including low outer membrane permeability, multidrug efflux systems, and inducible β-lactamase, and acquired mechanisms such as carbapenemases, target-site mutations, and adaptive biofilm-associated tolerance. This review presents a systems-level framework that integrates global epidemiology, resistance architecture, clinical manifestations of acute and chronic infections, pathogenicity, diagnostic innovation, and emerging therapeutic strategies into a cohesive translational perspective. Emphasizing the mechanistic convergence of resistance, persistence, and virulence reframes MDR P. aeruginosa as a dynamically regulated pathogenic network rather than solely a drug-resistant organism. Next-generation interventions are critically examined within the context of precision diagnostics and antimicrobial stewardship. Taken together, these developments signal a shift from antibiotic escalation toward integrated, precision-informed, and evolution-aware therapeutic frameworks. Sustainable control of MDR P. aeruginosa will require coordinated implementation of targeted pathogen disruption, rapid molecular diagnostics, robust stewardship strategies, hygiene measures, and antimicrobial resistance surveillance to redefine antimicrobial practice as we get closer to the post-antibiotic era.
Other specific DSP article suggested by Editorial Board
Evaluating emerging molecular diagnostics for severe infections in neutropenic patients with hematological malignancies.
Authors: Liborio MP, et al
Abstract
Introduction: Neutropenia significantly increases infection risk in hematologic malignancies patients, when clinical signs are often subtle and fever may be the only indicator. Molecular diagnostic methods promise faster, more sensitive pathogen detection compared to conventional methods, aiming to improve timely and appropriate therapy.
Areas covered: This review summarizes emerging molecular diagnostics for severe infections in neutropenic hematological malignancies patients, focusing on microbiological performance and, where available, clinical impact. We conducted a search in PubMed and Embase using subject headings: ‘molecular diagnosis,’ ‘neutropenic,’ ‘infections,’ ‘hematological malignancies,’ supplemented by information from manufacturers of commercial assays. The technologies reviewed include multiplex polymerase chain reaction, microarray-based assays, metagenomic and targeted next-generation sequencing, host transcriptomics, and methods for diagnosing invasive fungal infections. For each, we describe key characteristics, diagnostic performance, and clinical utility when reported.
Expert opinion: Emerging molecular diagnostics shorten time to pathogen and resistance identification and broaden detection of organisms in febrile neutropenic patients with hematological malignancies. These methods are best integrated as complements to culture-based methods within centers with antimicrobial stewardship programs, where they inform earlier targeted therapy and rational de-escalation of antimicrobials. Priority actions include prospective trials powered for measuring clinical outcomes and economic endpoints, with standardized workflows, reporting, and quality assurance to enable clinical implementation.
Other specific DSP article suggested by Editorial Board
Implementation of the BIOFIRE Meningitis/Encephalitis Panel: A Mixed-Methods Implementation Study in a Nonmetropolitan Tertiary Hospital.
DOI: 10.1093/ofid/ofag240
Authors: Subedi S, et al
Abstract
Background: Meningitis and encephalitis (ME) are associated with significant morbidity and mortality. Rapid pathogen identification is essential to guide early treatment and support antimicrobial stewardship (AMS). The BIOFIRE® FILMARRAY® ME panel allows simultaneous detection of multiple pathogens from cerebrospinal fluid. This study evaluated the implementation strategy and clinician adoption of the panel in a large nonmetropolitan tertiary hospital in Australia.
Method: A mixed-methods study was conducted at the Sunshine Coast University Hospital following implementation of the BIOFIRE ME panel. Strategies included education sessions, testing criteria development, and continuous stakeholder engagement. Clinician knowledge, confidence, and antimicrobial decision-making practices were assessed at baseline and during implementation via surveys and semistructured interviews based on the Cabana et al conceptual framework. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically using Braun and Clarke’s 5 step process.
Results: A total of 213 clinicians participated in the surveys across 4 time points. Median perceived usefulness of rapid CSF PCR testing was 9/10. Confidence in ceasing antibiotics based on the assay results increased from 18% at 9 months to 52% at 12 months (P = .06), while confidence in ceasing antivirals remained high (85%-86%). Qualitative findings identified 5 themes influencing implementation: test-ordering practices, perceived diagnostic value, trust in results, antimicrobial stewardship, and behavioral change. Confidence in interpretation was highest where infectious diseases input was available.
Conclusions: Implementation of the syndromic panel improved diagnostic efficiency and clinician confidence in antimicrobial decision making. Sustained education, multidisciplinary collaboration, and integration of stewardship frameworks were key to achieving successful adoption.”
Other specific DSP article suggested by Editorial Board
Targeting the disease response with NlpD and LytM for effective non-antibiotic treatment of urinary tract infections
Authors: Hien Thi Tran ,
Abstract
Background: Finding new ways of treating bacterial infections is essential. The NlpD protein, which inhibits RNA Polymerase II (Pol II), has shown therapeutic efficacy against urinary tract infection. This study investigated the mechanism of Pol II inhibition and protection by NlpD and its LytM peptide.
Methods: Recombinant NlpD and LytM were screened for interactions with constituents of the RNA Polymerase II complex, using AlphaFold predictions and protein interaction technology. Treatment effects were quantified in infected tissues and regulated host response pathways identified by genome-wide transcriptomics analysis in models of acute pyelonephritis and acute cystitis in Irf3-/- and Asc-/- mice, respectively.
Results: LytM was shown to interact with constituents of the Pol II multiprotein complex, inhibiting the CDK12 kinase from phosphorylating the Pol II subunit RPB1 and disrupting Pol II complex formation by interfering with the interaction between PAF1C and RPB1. The protection by LytM against acute pyelonephritis was accompanied by a reduction in gene expression in infected kidneys from >1,900 significantly regulated genes (FC>6) in the placebo group to about 150 in LytM treated mice. The inhibition of gene expression in infected kidneys particularly targeted the excessive innate immune response. A similar effect was observed in acute cystitis. Bacterial clearance was accelerated in both model by LytM treatment, with effects against antibiotic sensitive and resistant Escherichia coli strains.
Conclusions:
The results suggest that inhibiting the disease response of the host, using NlpD or LytM, may offer an efficient alternative to antibiotics in these models.”
Other specific DSP article suggested by Editorial Board
Host plasma protein biomarkers for tuberculosis disease screening in febrile adults in Tanzania
Authors: Michael Prodanuk
Abstract
Background : Host circulating biomarkers may enhance access to tuberculosis (TB) diagnostics in low-resource settings. We sought to identify host plasma proteins that differentiate TB disease from other infectious causes of fever.
Methods : This secondary analysis of a prospective cohort included outpatients ≥18 years in urban Tanzania presenting with ≤7 days of fever. Fourteen plasma proteins reflecting endothelial and immunoregulatory pathways were evaluated against a composite reference standard including sputum Xpert MTB/RIF, urine lipoarabinomannan, and/or chest x-ray. Multivariable models assessed proteins and symptoms associated with TB diagnosis.
Results: Of 507 participants, 40 (7.9%) had TB disease and 467 (92.1%) had other causes of fever. Eight proteins were significantly elevated (p<0.05) in people with TB. Regression modeling identified a four-protein biosignature (sTREM-1, CHI3L1, sTNFR-1, and CRP) with a cross-validated median AUC of 0.81 (2.5th–97.5th percentiles: 0.65–0.93), sensitivity of 80.0% (2.5th–97.5th percentiles: 41.4–100%), and specificity of 65.5% (2.5th–97.5th percentiles: 54.2–76.6%); however, discrimination was lower in people living with HIV (AUC 0.71; 95% CI 0.61–0.81). Classification and regression tree analysis yielded a simplified algorithm incorporating cough and sTREM-1, with a cross-validated AUC of 0.79 (95% CI: 0.69–0.88), sensitivity of 77.5% (95% CI: 61.6–89.2%), and specificity of 84.2% (95% CI: 80.5–87.4%); this approach may be more pragmatic for low-resource settings.
Conclusions : This exploratory analysis identified a parsimonious biosignature and biomarker-based algorithm for TB evaluation among febrile adults in a high-burden setting. With further development, host protein-based assays may enhance TB case detection in resource-limited settings.”
Other specific DSP article suggested by Editorial Board
AI-enabled digital wound monitoring after cardiac surgery: a randomised controlled feasibility, safety and acceptability trial
Authors: Melissa Rochon
Abstract
Background: Surgical site infection after cardiac surgery is a common cause of morbidity and unplanned healthcare use, with most infections developing after hospital discharge. Remote wound monitoring using smartphone technology and artificial intelligence (AI) may support earlier identification of complications.
Aim
To evaluate the feasibility, acceptability, and safety of an AI-enabled digital wound monitoring platform plus usual care (Isla-AI) compared with usual care (UC) alone.
Design, setting, and participants
This multi-centre, two-arm randomised controlled feasibility trial was conducted at two UK hospitals between August 2024 and January 2025. Adults undergoing cardiac surgery were randomised to receive Isla-AI or UC. The study was not powered to assess effectiveness.
Results
120 patients were randomised and participated (Isla-AI n=62; UC n=58). Feasibility targets were exceeded: 60% of eligible patients approached consented, 95% of Isla-AI participants submitted at least one image, and 92% completed the study. 98% of images were suitable for clinical assessment. Clinician agreement with AI priority flags was 87%. AI prioritisation performance was slightly better for patients with darker skin tones. More than half of participants required assistance to capture or submit wound images. Patient and staff acceptability of AI was largely favourable. Adverse and serious adverse event rates were similar across both groups. The proportion of patients accessing NHS resources for wound-related problems and antibiotics was lower in the Isla-AI group.
Conclusions
These findings support progression to a large, definitive multi-centre effectiveness trial, with further attention to equity, usability, and workflow integration.”
Other specific DSP article suggested by Editorial Board
Assessing pneumonia severity using neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: a cross-sectional comparison with CURB-65 score
Authors: Muhammad Osama
Abstract
Background: Community-acquired pneumonia continues to be a leading cause of morbidity and mortality worldwide. Several validated scoring systems are available for stratifying pneumonia severity, with the CURB-65 being well known. Recently, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported as reliable indicators of disease severity and adverse outcomes in patients with pneumonia, particularly when used alongside established scoring systems.
Objectives: To evaluate the association of NLR and PLR with higher clinical severity classification (CURB-65 ⩾ 3), and to compare their discriminatory performance with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in patients with community-acquired pneumonia.
Design:
Cross-sectional study.
Methods: In this cross-sectional study conducted at a tertiary care hospital in Peshawar, Pakistan, we enrolled 121 adults with community-acquired pneumonia. Baseline demographic characteristics, comorbid conditions, clinical presentation, and laboratory measures were recorded. Pneumonia severity was assessed using the CURB-65 score. The discriminatory performance of NLR, PLR, CRP, and ESR was evaluated by receiver operating characteristic (ROC) curve analysis, with severe pneumonia defined as a CURB-65 score of 3 or higher. Multivariable logistic regression was performed to assess independent associations after adjustment for age and comorbidities.
Results: The mean (±SD) age of the patients was 59.2 ± 20.6 years, and 69.4% were male. Common comorbidities included diabetes (31.4%), chronic obstructive pulmonary disease (28.1%), and chronic heart failure (19.8%). The mean CURB-65 score was 2.23 ± 1.20. NLR and PLR were significantly higher in severe pneumonia than in non-severe pneumonia (both p < 0.001), whereas CRP and ESR did not differ significantly (p = 0.083 and p = 0.197, respectively). In multivariable analysis, NLR remained independently associated with severe pneumonia (adjusted OR 1.91, 95% CI 1.46–2.51; p < 0.001). In ROC analysis, PLR showed the highest discriminative ability (area under the curve (AUC) 0.9935, 95% CI 0.9847–1.0000), followed by NLR (AUC 0.9436, 95% CI 0.8977–0.9895), CRP (AUC 0.6028, 95% CI 0.4878–0.7178), and ESR (AUC 0.5501, 95% CI 0.4258–0.6744).
Conclusion: In this cohort, NLR and PLR demonstrated strong agreement with higher CURB-65 severity classification and superior discriminatory performance compared with CRP and ESR.”