Other specific DSP article suggested by Editorial Board
Development of a Comprehensive Program for the Early Diagnosis and Treatment of Severe Infections in a Tertiary Hospital in Spain.
DOI: 10.1093/ofid/ofaf532
Authors: Martin-Gutierrez G et al
Abstract
Background: To assess the impact of the rapid diagnosis and treatment of severe infections (rDTSI) program on diagnostic and clinical outcomes in patients with severe infections.
Method: A pre-post quasi-experimental study was conducted evaluating patients with severe pneumonia or sepsis before (October 2019-February 2020) and after (March 2022-March 2023) rDTSI implementation. The program integrated rapid molecular diagnostics, a 24/7 laboratory workflow, and multidisciplinary training. Primary outcomes included time from clinical diagnosis to pathogen-directed therapy and targeted therapy within 48 h. Secondary outcomes assessed antimicrobial appropriateness (DOOR-MAT), length of stay, and mortality.
Results: The rDTSI program significantly reduced the median time to pathogen-directed therapy in pneumonia (48.8 vs 23.6 h, P < .001) and increased targeted therapy within 48 h (36.17% to 58.14%, P = .049). Hospital stays decreased (38.9 to 22.2 days, P < .001). In sepsis, diagnostic times (19.4 vs 18.1 h, P = .028) and DOOR-MAT scores (80.4 vs 88.0, P = .024) improved, while other clinical outcomes remained unchanged.
Conclusions: The rDTSI program accelerated microbiological diagnosis, optimized antimicrobial therapy, and improved hospital efficiency in severe infections. These findings support integrating rapid diagnostics into antimicrobial stewardship programs to enhance severe infection management.
Other specific DSP article suggested by Editorial Board
Artificial intelligence and infectious diseases: tackling antimicrobial resistance, from personalised care to antibiotic discovery.
Authors: Howard A et al
Abstract
Antimicrobial resistance (AMR) is an intractable problem that has the potential to significantly limit advances in human health. Recently, the UN General Assembly (UNGA) High-Level Statement on AMR defined targets for addressing the impact of resistance on human, animal, and environmental health. For human health, the discovery and development of new antibiotics, antimicrobial stewardship programmes, antimicrobial surveillance, and infection control and prevention are all key areas. Artificial intelligence (AI) is ideally placed to help achieve the UNGA targets via its role in revealing patterns in data that are clinically indiscernible, and using that information to build clinical decision support systems. However, significant barriers remain in terms of necessary infrastructure, know-how, and the implementation of AI approaches. In this Series paper, we consider the potential applications of AI in combatting the AMR problem through drug discovery and development, antimicrobial stewardship, diagnostics, and surveillance, and their use in public health. We then discuss the technical, infrastructure, regulatory, ethical, and policy challenges that affect these domains.
Other specific DSP article suggested by Editorial Board
Silent crisis in the intensive care unit: Current antimicrobial resistance landscape in an Indian hospital.
Authors: Jorwal A et al
Abstract
Introduction: Antimicrobial resistance (AMR) is a growing concern, particularly in critical care, where patients are more susceptible to infections by multidrug-resistant organisms. Understanding local resistance trends is essential for guiding effective empirical therapy. This study aimed to assess the prevalence and resistance profile of bacterial pathogens isolated from patients admitted in intensive care units (ICUs) in a tertiary care hospital located in northwestern India.
Materials and methods: This was a retrospective observational study conducted for 1 year from January 2024 to December 2024 in the Department of Microbiology at a tertiary care teaching hospital in northwestern India. All clinical specimens (blood, urine, pus, respiratory secretions, etc.) from patients admitted in ICU were processed using standard microbiological protocols. Organism identification and antimicrobial susceptibility testing were performed using a VITEK-2 Compact system and interpreted using Clinical Laboratory Standard Institute guidelines.
Results: Out of 8858 samples received, 2507 (28.3%) were culture-positive. Gram-negative bacteria constituted 60.4% of isolates, predominated by Klebsiella pneumoniae (34.4%), 88.4% being carbapenem resistant. Among nonfermenters, Acinetobacter baumannii (23.6%) was most common with carbapenem resistance around 98.4%. For Gram-positive, Enterococcus spp 245 (44.6%) predominated, followed by Coagulase-negative Staphylococcus (39.9%). The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) was 58% and 39.7%, respectively.
Conclusions: The ICU ecosystem harbors a substantial burden of multidrug-resistant organisms, including alarming levels of carbapenem-resistance, MRSA, and VRE. These data underscore the urgent need for robust antimicrobial stewardship and stringent infection control practices. Continuous surveillance is vital to optimize empirical treatment strategies in critical care settings.
Other specific DSP article suggested by Editorial Board
Hidden transmissions of Pseudomonas aeruginosa ST111 –the importance of continuous molecular surveillance
Authors: Jasmin Kaur Jasuja
Abstract
Background: A series of transmission of Pseudomonas aeruginosa ST111 blaVIM−2, previously undetected by standard surveillance, was discovered in a tertiary care hospital in Northern Germany through molecular genetic monitoring. Hence, environmental sampling was initiated to find the source of infection.
Methods: First, routine epidemiological data ruled out patient-to-patient transmission and two initial diagnoses were assessed as externally acquired. After the discovery of the highly related cluster by whole genome sequencing, a more detailed epidemiological analysis was carried out, including previous hospitalizations. An environmental investigation was initiated due to a possible connection of transmissions with an intensive care unit.
Results: Between 2018 and 2023 16 clinical isolates of Pseudomonas aeruginosa ST111 blaVIM−2 were identified of which 12 isolates belonged to ST111 carrying an In59-like integron. Routine whole-genome sequencing of carbapenem resistant P. aeruginosa identified a highly related cluster (maximum of three allelic differences) of high-risk ST111 isolates in ICU patients over five years, confirming sink-to-patient transmission associated to sink drains in two ICU rooms. In initial routine epidemiological categorization of these highly related isolates four isolates were categorized as possible nosocomial acquisition without direct epidemiological link to other patients, whereas two isolates were categorized as ‘externally acquired’.
Conclusions: This finding highlights the ability of high-risk clone ST111 to persist in hospital environments and emphasizes the importance of integrating molecular surveillance with routine epidemiology to uncover hidden transmissions. In this case, the frequent detection of the ST111 high-risk clone led to targeted environmental sampling, uncovering a prolonged outbreak that had gone unnoticed by conventional surveillance. The clone was eliminated from the ward during a reconstruction project.”
Other specific DSP article suggested by Editorial Board
Rapid and actionable nasal-swab screening supports antimicrobial stewardship in patients with pneumonia: a prospective study
Authors:Siyao Chen
Abstract
Background : Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening by polymerase chain reaction (PCR) is a rapid diagnostic tool with a high negative predictive value for pneumonia caused by MRSA. MRSA remains an important emerging pathogen in China and at present, there is little published data on the effect of rapid MRSA test results on antibiotic utilization for pneumonia.
Methods :A total of 300 inpatients who met the criteria of pneumonia in a tertiary general hospital were randomly assigned to a notification group (NG, n = 150) or a control group (CG, n = 150). Nasal swabs were collected and tested with the Xpert SA Nasal Complete Test (Cepheid, Sunnyvale, CA) to determine MRSA colonization status. Attending clinicians were immediately informed of test results for patients in NG while results were not released to an attending physician in CG. Subsequently, relevant medical records were collected and analyzed.
Results: Patients in the NG received a shorter duration of antimicrobial therapy compared to the CG (5.66 vs. 7.87 days, P < 0.001). Fewer renal injuries (1.33% vs. 8%; P = 0.015), and lower costs of antimicrobial agents ($621.78 vs. $881.70; P = 0.013) were observed in NG patients compared to those in the CG. Further, this intervention did not increase the in-hospital mortality (12.67% vs. 16.67%, P = 0.327).
Conclusions: Rapid and actionable MRSA PCR screening using nasal swabs helped reduce unnecessary anti-MRSA treatment. Early management of antimicrobials not only reduced the duration of anti-MRSA drug exposure but also antimicrobial-related adverse events.”
Other specific DSP article suggested by Editorial Board
Timely excision of prophage Φ13 is essential for the Staphylococcus aureus infectious process
DOI: 10.1128/iai.00314-25
Authors: Olivier Poupel
Abstract
Mobile genetic elements play an essential part in the infectious process of major pathogens, yet the role of prophage dynamics in Staphylococcus aureus pathogenesis is still not well understood. Here, we studied the impact of the Φ13 hlb-converting prophage, whose integration inactivates the hlb β-toxin gene, on staphylococcal pathogenesis. We showed that prophage Φ13 is lost in approximately half the bacterial population during the course of infection. Inactivation of the Φ13 int recombinase gene, essential for insertion/excision, locked the prophage in the bacterial chromosome, leading to a significant loss of virulence in a murine systemic infection model. In contrast, the non-lysogen strain (ΔΦ13), where the hlb beta-hemolysin gene is reconstituted, displayed strongly increased virulence. Accordingly, histopathological analyses revealed more severe nephritis in mice infected with bacteria lacking prophage Φ13 (ΔΦ13), compared to infection with the parental strain. Infection with the ∆int mutant, where beta-hemolysin production is abolished, led to the least severe renal lesions. Cytokine induction in a human neutrophil model showed significantly increased IL-6 expression following infection with the beta-hemolysin producing strain (ΔΦ13). Our results indicate that timely in vivo excision of the Φ13 prophage is essential for progression of the S. aureus infectious process: early excision leads to rapid host death, whereas the inability to excise the prophage significantly reduces staphylococcal virulence.
IMPORTANCE:This study highlights prophage Φ13 excision as a critical factor in Staphylococcus aureus pathogenesis, influencing infection outcomes by balancing rapid host killing with reduced bacterial virulence. This mechanism may represent a bet-hedging strategy in genetic regulation, resulting in a mixed bacterial population capable of rapidly switching between two processes: bacterial colonization and host damage. Unraveling this dynamic opens new possibilities for developing targeted therapies to disrupt or modulate prophage activity, offering a novel approach to mitigating S. aureus infections.”