Other specific DSP article suggested by Editorial Board
Impact of multiplex PCR point-of-care platform implementation for respiratory pathogen detection in an emergency department with high daily patient volume.
DOI: 10.1128/jcm.01313-25
Authors:Bigaud B, et al
Abstract
Lower respiratory tract infections (LRTIs) place a substantial burden on emergency departments (EDs) during winter outbreaks. Their microbiological diagnosis is currently based on either broad-spectrum molecular techniques performed in laboratory, with turnaround times incompatible with ED workflows, or point-of-care systems, restricted to SARS-CoV-2, influenza A/B, and RSV (quadriplex panel). The Spotfire combines rapid result and syndromic approach (10 respiratory viruses and 4 atypical bacteria), but its added value in EDs remains unassessed. During the 2023 winter, trained nurses collected nasopharyngeal swabs from adult patients with LRTI symptoms and operated the Spotfire in the ED of the Poitiers University Hospital. Here, the authors described the viral epidemiology and evaluated the impact and efficacy of this rapid broad-spectrum diagnosis by comparing the management of patients with or without respiratory pathogen detected. From 15 December 2023 to 15 March 2024, 1,320 samples were analyzed with Spotfire, with a median turnaround time of 37 min and 10 uninterpretable results. A total of 540 (41%) were positive. Influenza A (30.9%), rhinovirus/enterovirus (21.1%), and SARS-CoV-2 (18.7%) were the main viruses detected, while atypical bacteria represented 8% of all pathogens. Overall, a pathogen not represented on the quadriplex panel was detected in 43% samples. Positive test results were associated with faster medical decision (380 ± 234 vs 431 ± 238 min; P < 0.001), fewer hospital admissions (65% vs 78%; P < 0.001), and shorter hospital stay (10 ± 9 vs 12 ± 14 days; P = 0.006) than negative test results. Antibiotic therapy was administered to 42 of 43 of Mycoplasma pneumoniae-positive patients (98%) compared with 110 of 1,265 (9%) negative patients. This study validated the feasibility of this new diagnostic tool in high-volume EDs improving patient flow, antimicrobial decisions, and isolation strategies.IMPORTANCEThis study provides the first real-world evidence supporting the use of a broad multiplex PCR platform for respiratory pathogens directly at the point of care in a high-volume emergency department. By enabling the simultaneous detection of 14 viruses and atypical bacteria within 20 min, this system bridges a critical gap between laboratory diagnostics and bedside clinical decision-making. Its implementation proved feasible and reliable, improving patient flow, antimicrobial stewardship, and infection control measures. Nearly half of the pathogens identified would have been missed by conventional quadriplex assays, highlighting the added diagnostic value of broader syndromic coverage. These findings are of interest to both clinicians and microbiologists, as they provide pragmatic evidence to guide the integration of advanced molecular diagnostics into acute-care workflows and to optimize patient management during respiratory infection surges.
Other specific DSP article suggested by Editorial Board
Strategies and Recent Advances in Tackling Antibacterial Resistance in India: A Comprehensive Narrative Review.
DOI: 10.7759/cureus.95613
Authors: Goudar T, et al
Abstract
Antibacterial resistance (ABR) in India has emerged as a critical public health challenge. Increasing resistance to key antibiotics, including fluoroquinolones and carbapenems, in prevalent pathogens is driven by several factors. This review aims to summarize (1) the mechanisms of action of antibiotics and the emergence of resistance in India, (2) the multifactorial drivers of ABR across human, animal, and environmental sectors, and (3) public health strategic insights based on historical and contemporary literature to provide a roadmap for future interventions. A literature search was conducted using various keywords and databases such as PubMed, Scopus, and Google. Articles published between 1977 and 2025 were retrieved and reviewed. Additional data were integrated from national healthcare strategies and the Indian Priority Pathogens List. Over 200 articles were analyzed to understand the mechanisms of action of antibiotics, the evolution of resistance patterns, the underlying drivers, and the effectiveness of current policies and interventions. The analysis revealed alarmingly high resistance rates, particularly among gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, as well as significant resistance among gram-positive pathogens such as methicillin-resistant Staphylococcus aureus. Key contributing factors include unregulated antibiotic sales, overprescription, inadequate infection control, and misuse in animal husbandry. The findings further underscore the benefits of integrated approaches, such as the One Health framework and targeted stewardship programs, although regulatory heterogeneity and limited surveillance infrastructure remain substantial obstacles. Addressing the ABR crisis in India requires an integrated, multi-pronged strategy. Over the next 5-10 years, India must prioritize developing and expanding robust surveillance systems for the timely detection of resistance trends, scaling up comprehensive antibiotic stewardship programs in clinical and community settings, and committing significant investment to research and development for new antibiotics and diagnostics. Embracing these forward-looking priorities is essential to mitigate ABR and secure sustainable healthcare outcomes.
Other specific DSP article suggested by Editorial Board
Risk Factor Assessment and Predictive Modeling for Ventilator-Associated Pneumonia: Design and Clinical Implementation of an Artificial Intelligence-Enhanced Early Detection Framework Using Multisource Data Analytics.
DOI: 10.1111/crj.70144
Authors: Zhang J, et al
Abstract
Introduction: Ventilator-associated pneumonia (VAP) is associated with poor patient outcomes. Early identification of high-risk patients remains a major clinical challenge.The aim is to develop and validate a multimodal hybrid neural network (MM-HNN) for improved VAP prediction by integrating multisource data from a retrospective cohort.
Methods: This single-center, retrospective study analyzed data from 213 adult patients who received invasive mechanical ventilation for >48 h. The MM-HNN incorporated three data types: 1) computed tomography (CT) features quantifying consolidation volume through three-dimensional residual neural network-50; 2) dynamic ventilator parameters including fraction of inspired oxygen and positive end-expiratory pressure analyzed via long short-term memory networks; and 3) clinical predictors refined via least absolute shrinkage and selection operator regression to identify six key variables.
Results: The model achieved an area under the curve of 0.86 (95% confidence interval: 0.80-0.91), outperforming the clinical pulmonary infection score (p = 0.021). SHapley Additive exPlanation analysis revealed Acute Physiology and Chronic Health Evaluation II score and CT consolidation volume as primary contributors. The system provided early warnings with 87.5% accuracy (median lead time: 1.5 days), which was associated with a significant increase in appropriate antibiotic use from 68.3% to 92.1% (p = 0.016).
Conclusion: The MM-HNN demonstrates the feasibility of accurate, interpretable VAP risk prediction through multimodal data integration. This artificial intelligence framework provides a clinically actionable tool for dynamic risk assessment, enabling preemptive interventions and improved antibiotic stewardship.
Other specific DSP article suggested by Editorial Board
Unravelling azole resistance in fungal pathogens: molecular mechanisms, diagnostic challenges, and therapeutic strategies.
Authors: Eknure CS, et al
Abstract
The global recognition of azole resistance in fungal infection is steadily increasing and is perceived as a serious health threat, particularly among immunocompromised individuals. The rise in resistance is governed by multifactorial mechanisms including mutations in ERG11/CYP5A, overexpression of efflux transporters, and biofilm formation which enables pathogenic fungi to evade azole’s antifungal activity. Most of the conducted work currently examines distinct processes without relating them to the broader issue, such as therapy inadequacies and diagnostic challenges, even though azole resistance continues to rise in clinical relevance. This review is focused on addressing this gap by providing comprehensive information into one framework for azole resistance. It presents the molecular basis of resistance, highlighting mechanisms such as target enzyme modification, efflux pump overexpression, biofilm-mediated protection, and transcriptional regulation of various fungal pathogens with an emphasis on Candida species. Also, the strengths and limitations of currently used diagnostic platforms and explored therapeutic strategies are critically evaluated , including novel antifungal agents, drug repurposing, immunotherapy, antifungal peptides, and stewardship models. Along with the long-established methods for combating the fungal infections, it also maneuvers through the contemporary approaches of omics and sophisticated bioinformatics tools employed in fungal research. By bridging the mechanistic insights with clinical and ecological relevance, this review aims to shed light on the development of precision diagnostics, novel antifungal targets, and integrative policy approaches to mitigate resistance and improve patient outcomes. Along with it, the article also traverses through the development of fourth generation azoles in combating fungal invasion.
Other specific DSP article suggested by Editorial Board
Applications of Genome Sequencing in Infectious Diseases: From Pathogen Identification to Precision Medicine.
DOI: 10.3390/ph18111687
Authors: Hasan GM, et al
Abstract
Background: Genome sequencing is transforming infectious-disease diagnostics, surveillance, and precision therapy by enabling rapid, high-resolution pathogen identification, transmission tracking, and genomic-informed antimicrobial stewardship.
Methods: The contemporary sequencing platforms (short- and long-read), targeted and metagenomic approaches, and operational workflows that connect laboratory outputs to clinical and public health decision-making are reviewed. Here, strengths and limitations of genomic AMR predictionare highlighted, the role of plasmids and mobile elements in resistance and virulence, and practical steps for clinical translation, including validation, reporting standards, and integration with electronic health records.
Results: Comparative and population genomics reveal virulence determinants and host-pathogen interactions that correlate with clinical outcomes, improving risk stratification for high-risk infections. Integrating sequencing with epidemiological and clinical metadata enhances surveillance, uncovers cryptic transmission pathways, and supports infection control policies. Despite these advances, clinical implementation faces technical and interpretative barriers, as well as challenges related to turnaround time, data quality, bioinformatic complexity, cost, and ethical considerations. These issues must be addressed to realize routine, point-of-care sequencing.
Conclusions: Emerging solutions, including portable sequencing devices, standardized pipelines, and machine-learning models, promise faster, more actionable results and tighter integration with electronic health records. The widespread adoption of sequencing in clinical workflows has the potential to shift infectious disease management toward precision medicine, thereby improving diagnostics, treatment selection, and public health responses.
Other specific DSP article suggested by Editorial Board
Virulence Factors, Capsular Serotypes and Antimicrobial Resistance of Hypervirulent Klebsiella pneumoniae and Classical Klebsiella pneumoniae in Southeast Iran
DOI: 10.3947/ic.2019.0027
Authors: Sanaz Rastegar
Abstract
Materials and Methods: A total of 146 K. pneumoniae isolates were obtained from different clinical specimens. HvKP isolates were identified using the string test. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57 and virulence-associated genes, rmpA, kfu, fimH, mrkD, allS, iutA, magA, entB and ybtS were evaluated by PCR. Antimicrobial susceptibility was also determined using the disc diffusion method.
Results: Out of 146 K. pneumoniae isolates, 22 (15.1%) were hvKP. More than half of the hvKP isolates, 13 (59.1%), belonged to non-K1, K2, K5, K20, K54, K57 serotypes. Out of 22 hvKP isolates, 3 and 3 had K1 and K2 serotypes respectively. Among all isolates, entB 140 (95.9%) and mrkD 138 (94.5%) were the most common virulence genes. RmpA, iutA and kfu were associated with hvKP isolates (P-value <0.05). However, no significant difference was found in fimH, allS, mrkD, entB and ybtS genes between hvKP and cKP strains. HvKP exhibited significantly lower resistance rates to all antimicrobial agents than cKP, except to trimethoprim-sulphamethoxazole and ampicillin (P-value <0.05).The frequency of hvKP was low, but overall, the prevalence of virulence-related genes was higher in hvKP than cKP. HvKP was not related to specific serotypes. Furthermore, hvKP isolates were more susceptible to antimicrobial agents compared to cKP isolates.”
Other specific DSP article suggested by Editorial Board
Vitamin D Receptor Gene FokI Polymorphism in Patient with Human Immunodeficiency Virus – Tuberculosis Coinfection and Associated Risk Factors
DOI: 10.3947/ic.2025.0029
Authors: Anak Agung Ayu Yuli Gayatri
Abstract
Background: There is still unclear method for identifying people with human immunodeficiency virus (HIV) who will develop tuberculosis (TB). This study aimed to investigate the role of vitamin D receptor (VDR) gene FokI allele f and associated risk factors in HIV-TB coinfection.
Material and Methods: This case control study was conducted with 60 total subjects consisting 30 subjects of HIV-TB patients as the case group and 30 subjects HIV without TB as the control. VDR gene FokI polymorphism was detected by polymerase chain reaction and sequencing, whereas light chain 3 (LC3) and caspase-3 levels were measured by enzyme-linked immunosorbent assay, and CD4 T cell by flowcytometry. Data analysis for different proportions used bivariate analysis and relationship analysis tests using logistic regression.
Results: The VDR gene FokI (rs2228570) polymorphism proportion of f alleles in the case group were 26 (86.7%) and control 13 (43.3%). Low LC3 (LC3 ≤30 ng/mL) found in 27 (90.0%) of the cases and 9 of the controls (30.0%). Low caspase-3 (Caspase3 ≤3 ng/mL) found 28 (93.3%) in cases and 15 (50.0%) in the controls. The logistic regression analysis revealed that f allele of FokI VDR gene polymorphism, low LC3, low caspase-3 and low CD4 T cells are risk factors for HIV-TB co-infection as follows respectively; (odds ratio [OR], 6.921; 95% confidence interval [CI], 1.199–39.936; P=0.031); (OR, 16.257; 95% CI, 2.568-102.928; P=0.003) and (OR, 7.448; 95% CI, 0.851–65.211; P=0.070); (OR, 6.227; 95% CI, 0.36-37.419; P=0.046)
Conclusion: VDR gene FokI polymorphism alleles f, low LC3, caspase-3, and low CD4 T cell count were identified as risk factors for HIV-TB Coinfection.”
Other specific DSP article suggested by Editorial Board
Post-marketing Surveillance of a Live Attenuated Herpes Zoster Vaccine (SKYZoster®) in Adults Aged ≥50 Years in Korea
DOI: 10.3947/ic.2025.0036
Authors:Sun Heom Baik
Abstract
Background:
Herpes zoster (HZ; shingles) results from the reactivation of the varicella-zoster virus following a primary infection with varicella (chickenpox) in earlier life. Vaccination against HZ has been effective in preventing the disease. SKYZoster, a live attenuated zoster vaccine developed in Korea, was first licensed in Korea on September 29, 2017, and subsequently approved in Thailand (May 20, 2020) and Malaysia (December 13, 2022). This post-marketing surveillance (PMS) study aimed to assess and evaluate the safety profile of SKYZoster in adults who received the vaccine during a 4-year period in Korea.
Materials and Methods:
This PMS study was an open, non-comparative, multi-center study conducted from September 29, 2017, to September 28, 2021. Adults aged ≥50 years who were vaccinated with SKYZoster in Korea were enrolled in this study. Adverse events (AEs) that occurred during the first 42 days after vaccination were recorded and classified using the System Organ Class and Preferred Term using MedDRA 24.1.
Results: A total of 651 participants were included in the safety evaluation. Participants had a mean age of 62.15±8.59 years, with 55.30% of the participants being female and 1.69% (11 participants) had an allergy history. Overall, 121 AEs were reported in 76 participants (11.67%), including 51 adverse drug reactions (ADRs) in 37 participants (5.68%). Most AEs (120/121; 99.17%) were mild in severity and no serious AEs were reported. The most frequently reported ADRs were injection site reactions including vaccination site pain (2.92%), erythema (1.08%), and pruritus (0.46%). Multiple logistic regression analysis identified that allergy history (P=0.0001), concomitant medication use (P=0.0179) and current medical history (P=0.0351) were significantly associated with an increased AE incidence.
Conclusion:
Over a 4-year post-marketing safety evaluation period, SKYZoster exhibited an acceptable safety profile in routine clinical practice in Korea. The vaccine was well-tolerated, with no serious adverse event reported, reaffirming its role in preventing HZ in adults.
Other specific DSP article suggested by Editorial Board
Rapid diagnosis of tuberculosis using a three-dimensional nanofiber paper-based electrochemical sensor
Authors: Manman Du
Abstract
Tuberculosis (TB) is the leading cause of death caused by a single infectious pathogen. Currently, a variety of conventional methods are widely used for detecting Mycobacterium tuberculosis (Mtb) or diagnosing TB, which have made significant contributions to controlling the TB epidemic. However, these existing TB diagnostic methods still face some difficulties and cannot provide rapid, low-cost, high-sensitivity, and high-accuracy diagnostic results simultaneously. Therefore, it is imperative to develop new TB diagnostic methods that are rapid, cost-effective, and sensitive through rigorous evaluation of potential biomarkers and new detection methods. In this study, a three-dimensional nanofiber (3D NFs) paper-based electrochemical sensor was prepared using electrospinning technology, and Mtb secretory protein Ag85B was utilized as a biomarker to achieve point-of-care detection of TB clinical samples. The 3D NFs paper-based electrochemical sensor can achieve a wide range of Bacillus Calmette–Guérin detection of 101-108 CFU/mL with good specificity. When the clinical bronchoalveolar lavage fluid samples were diluted 103 or 104 times, the 3D NFs paper-based electrochemical sensor could detect TB clinical samples with a sensitivity of up to 92.9% and a specificity of 60% within 5 min. 3D NFs paper-based electrochemical sensor has the advantages of low cost, high sensitivity, and fast response speed, and can realize rapid preliminary screening of TB patients.