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Antibiotic Stewardship: Addressing the “Great Public Health Irony”.
Authors: Epling JW, et al
Abstract
Antibiotic stewardship hopes to address the “”great public health irony””-the golden age of antibiotics in clinical medicine has turned into a global antibiotic resistance threat. This overview summarizes the problem of antibiotic resistance and antibiotic prescribing trends in outpatient primary care in the United States, then reviews the major antibiotic stewardship campaigns and interventions with a focus on primary care practice. The lessons of these campaigns and interventions can provide guidance for clinicians in practice to better integrate patient-focused primary care with population-oriented population health to address the threat of inappropriate antibiotic prescribing and antibiotic resistance.
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The double threat: bacterial and fungal co-/superinfection in viral pneumonia.
Authors: Asis A, et al
Abstract
Introduction: Respiratory viral pneumonias are a leading cause of severe respiratory failure and intensive care unit (ICU) admission worldwide. Although viral infection itself drives significant morbidity and mortality, secondary bacterial and fungal superinfections represent a critical ‘double threat’ in critically ill adults, exacerbating lung injury, prolonging organ dysfunction, and complicating antimicrobial management. Experience from the Influenza A (H1N1) pdm09 and SARS-CoV-2 pandemics highlights a persistent mismatch between low documented bacterial co-infection rates and widespread empiric antibiotic exposure, underscoring diagnostic uncertainty and antimicrobial stewardship challenges in the ICU.
Areas covered: This review examines the epidemiology, immunopathogenesis, and diagnostic approaches to bacterial and fungal superinfection in adult ICU patients with severe viral pneumonia. Evidence is synthesized from large ICU cohorts, pandemic data, and established consensus definitions for influenza- and COVID-19-associated pulmonary aspergillosis (IAPA, CAPA). The review discusses advances in molecular diagnostics, lower respiratory tract sampling, bronchoalveolar lavage – based mycology, and biomarker-guided strategies, with a focused literature search of ICU-specific studies.
Expert opinion: Bacterial and fungal superinfections, while infrequent, carry substantial clinical impact in severe viral pneumonia. A multimodal, ICU-adapted diagnostic strategy integrating pathogen detection with host-response assessment is essential to support timely therapy, enable antimicrobial de-escalation, and align superinfection management with stewardship principles.
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Benchmark evaluation of deepseek AI models in antibacterial clinical decision-making for infectious diseases.
Authors: Zhang L, et al
Abstract
Background: Antimicrobial resistance (AMR) poses a global threat to public health, though AI models have shown transformative potential in combating AMR. China’s DeepSeek, a novel open-source, low-cost, and locally deployable AI model, is increasingly integrated into clinical workflows for infectious diseases, yet the pharmacological validity and real-world impact of its recommended drugs remain poorly understood.
Objective: This study aimed to compare the antibacterial regimens among DeepSeek(V3,R1,R1 + WS), ChatGPT o1, and infectious disease (ID) specialists, while evaluating the performance, timeliness of the two AI models.
Methods: A retrospective analysis was conducted on 101 cases with effective antibacterial therapy. DeepSeek and ChatGPT o1 were identically prompted using comprehensive case data to generate antibacterial regimens. Then, Five independent clinical pharmacists evaluated all outputs. The benchmark evaluation metrics included the concordance rate between two AI models and the patient’s effective antibacterial regimens, as well as the proportion of regimens escalating therapy to higher-tier groups per WHO’s AWaRe classification. Furthermore, performance metrics encompassed overlap rate, precision, recall, F1-score, ID specialists endorsement rate, search latency, and search success rate of DeepSeek and ChatGPT o1. Statistical analyses employed Chi-square and Kruskal-Wallis tests.
Results: DeepSeek-V3 demonstrated the highest overall concordance rate with ID specialists, exceeding those of DeepSeek-R1 and ChatGPT o1. The proportion of antibacterial regimens escalated to higher-tier groups was significantly greater in DeepSeek-R1, DeepSeek-R1 + WS and ChatGPT o1 compared to that of ID specialists(P < 0.005). Regarding the performance metrics, ChatGPT o1 achieved the highest level of overlap rate, while DeepSeek-R1 led in recall. Furthermore, DeepSeek-V3 achieved the optimal F1-score and the highest overall ID specialists’ endorsed rate, reflecting optimal balance. Likewise, Search latency varied substantially (H = 305.53, P < 0.005), with DeepSeek-V3 and ChatGPT o1 exhibiting the fastest response times.
Conclusions: While moderate agreement exists between DeepSeek and ID specialists in antibiotic selection, DeepSeek models exhibit a marked tendency toward recommending higher-tier, broader-spectrum antibacterials. Moreover, DeepSeek’s antibacterial clinical decision-making is comparable to that of ChatGPT o1, with DeepSeek-V3 surpassing it in certain performance metrics. These findings highlight the need for AI refinement to align with stewardship principles and contextual clinical judgment.
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CD48 as a Novel Early Biomarker Complementing Procalcitonin and Lactate for Predicting Bacteremia in Pediatric Febrile Neutropenia: A Prospective Cohort Study.
Authors: Tahta N, et al
Abstract
Background: Febrile neutropenia (FN) remains a frequent and potentially life-threatening complication in pediatric oncology, where prompt recognition of bacteremia is critical for risk-adapted therapy and antimicrobial stewardship. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) are widely used, yet their early predictive value is inconsistent across studies. Cellular activation markers measured by flow cytometry, particularly CD48, have been scarcely investigated in this setting. This study aimed to evaluate conventional, metabolic, and immune biomarkers for predicting bacteremia in children with FN and to assess the incremental diagnostic value of CD48. Methods: This prospective single-center cohort enrolled 38 pediatric oncology patients presenting with 46 FN episodes over 9 months. Clinical data, blood cultures, and serial measurements of CRP, PCT, lactate, interleukin-6, interleukin-8, MCP-1, sTREM-1, CD48, and CD64 were obtained at 0, 24, 48, and 72 hours. Bacteremia was defined by positive culture for a recognized pathogen. Receiver operating characteristic (ROC) analyses were performed to determine the area under the curve (AUC), sensitivity, and specificity. A multivariable logistic regression model evaluated the combined performance of biomarkers. Results: Bacteremia occurred in 12 (26.1%) FN episodes. Sepsis, tachycardia, and elevated lactate were more common among bacteremic patients. CRP showed limited early discrimination (AUC 0.62 on day 2) but improved by day 4 (AUC 0.74). PCT was consistently higher in bacteremia (AUC 0.89 at day 4), and lactate demonstrated strong early predictive value (AUC 0.81). CD48 was significantly elevated from 0-24 h (AUC 0.78), outperforming CD64 (AUC 0.60) and preceding the rise in CRP. In combined modeling, PCT + CD48 + lactate achieved the highest discrimination (AUC 0.92; sensitivity 92%, specificity 85%). Post-hoc power analysis showed 82% power to detect AUC differences ≥0.15. Conclusion: Integration of CD4 with PCT and Lactate markedly improved diagnostic accuracy in this cohort; however, given the limited number of bacteremic episodes, these findings should be considered exploratory and require external validation in larger, multicenter studies before clinical implementation.
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Comparison of Pediatric Risk of Mortality-III, Phoenix Sepsis, and pediatric Sequential Organ Failure Assessment scores for predicting septic shock in Vietnamese children with sepsis
Authors: Khai Quang Tran
Abstract
Background: Early recognition of septic shock is crucial for improving outcomes in children with sepsis. This study aimed to compare the predictive performance of the Pediatric Risk of Mortality-III (PRISM-III), Phoenix Sepsis Score (PSS), and pediatric Sequential Organ Failure Assessment (pSOFA) scores for septic shock in Vietnamese children.
Methods: A cross-sectional study was conducted on 86 children aged 2-months to 15-years with sepsis (including 23 with septic shock) admitted to a pediatric intensive care unit. Septic shock classification was performed independently and single ‒ blinded to score calculations to minimize assessment bias. The PSS and pSOFA were calculated using the worst parameters within the first 6-hours, and PRISM-III within the first 24 hours of admission. Discriminatory ability was assessed by the Area Under the Receiver Operating Characteristic Curve (AUROC). Multivariable logistic regression and calibration analyses were performed. Calibration results should be interpreted cautiously due to the small sample size.
Results: The PSS showed the highest AUROC (0.867, 95 % CI: 0.777–0.931), followed by PRISM-III (0.826, 95 % CI: 0.729–0.899) and pSOFA (0.791, 95 % CI: 0.690–0.871); pairwise comparisons were not statistically significant. The PSS demonstrated the highest sensitivity (95.7 %) and negative predictive value (97.6 %), while PRISM-III had the highest specificity (90.5 %) and positive predictive value (70.0 %). In multivariable analysis, both PSS (Odds Ratio, OR = 2.78) and PRISM-III (OR = 1.23) were independent predictors of septic shock.
Conclusions: The PSS and PRISM-III provide complementary value. A two-step approach using the sensitive PSS for initial screening and the specific PRISM III for confirmation may enhance early septic shock recognition in resource-limited settings.”
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Differences in clinical outcomes according to duration of antibiotic therapy following successful ERCP in patients with acute cholangitis: A retrospective cohort study in Colombia
Authors: Juan Pablo García-Marmolejo
Abstract
Background: Acute cholangitis is a significant cause of mortality and morbidity, particularly in elderly patients and those with comorbidities. However, the optimal duration of antibiotic therapy following biliary drainage remains unclear. This study aimed to evaluate clinical outcomes based on the duration of antibiotic therapy after successful biliary drainage in adults with acute cholangitis.
Methods: We conducted a retrospective cohort study of patients treated for acute cholangitis at a university hospital in Colombia between 2014 and 2022. Short-course antibiotic therapy was defined as ≤4 days after successful post-ERCP drainage. The primary outcome was a composite of in-hospital mortality, ICU admission, or hospital readmission within 30 days of discharge. Univariate and multivariate logistic regression analyses were performed to examine the association between antibiotic duration and the primary outcome.
Results: All in all, 317 patients were included. Escherichia coli was the most frequently isolated microorganism, with 54 % manifesting full antimicrobial susceptibility. Fifty-nine patients received short-course therapy, while 258 received long-course therapy. There were no significant differences in the primary outcome between the groups (p = 1). However, longer hospital stays were observed in the long-course group (p < 0.001). Tokyo III severity (OR 32.07; 95 % CI 11.84–113.16; p < 0.001) and carbapenem resistance (OR 4.07; 95 % CI 1.02–16.96; p = 0.04) were identified as independent risk factors for the composite outcome.
Conclusions: Shorter antibiotic courses following ERCP drainage may be a viable option for patients with acute cholangitis. Further randomized controlled trials and pragmatic studies are necessary to confirm these findings.”
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Risk factors for deep vein thrombosis during peripherally inserted central catheter-related infections: A retrospective study
Authors: Paul Petitgas
Abstract
Background: Peripherally inserted central catheters (PICCs) are associated with complications including deep vein thrombosis (DVT) and infections. However, the risk factors for developing DVT specifically during PICC-related infections remain poorly understood.
Methods
We conducted a retrospective observational study in a tertiary-care hospital in Reunion Island, examining adult patients with PICC-related infections between January 2021 and March 2022. Venous Doppler ultrasound results, microbiological data, and clinical variables were analyzed. Univariate analysis was performed to identify factors associated with PICC-related DVT.
Results
Among 63 patients with PICC-related infections, 40 underwent Doppler ultrasound examinations, with 12 (19 %) diagnosed with PICC-DVT. Infections with Staphylococcus aureus (P = 0.05) and local signs (P = 0.04) were significantly associated with PICC-DVT. Enterobacterales were the predominant pathogens (42.5 %). The incidence rate of PICC-DVT was 5.0/1000 catheter-days in patients with PICC-related infections.
Conclusions
Staphylococcus aureus infection and local signs are associated with PICC-DVT. Our findings suggest that these factors should be considered when managing patients with PICC-related infections. Prospective studies are needed to develop clinical prediction tools to identify which patients would benefit most from Doppler ultrasound.”
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Bioaerosol assessment of indoor air in hospital wards for isolation of Nocardia species from a tertiary care hospital in Iranshahr, Iran
Authors: Zahed Ahmadi
Abstract
Background: Bioaerosols can be a critical role in the transmission of hospital-acquired infections. Nocardia species are opportunistic pathogens that primarily affect immunocompromised patients, accounting for approximately 1–2% of all hospital-acquired bacterial infections in this population. To date, there are no comprehensive studies examining the presence of Nocardia in hospital indoor air. This study aimed to assess the species diversity of the Nocardia genus in different hospital indoor environments at Khatam Hospital, Iranshahr, Iran.
Methods: Particle concentration in various hospital wards was measured using the direct reading method. Bioaerosol sampling followed NIOSH methods 0800 and 0801, using Sauton’s medium plates. Each Petri dish was incubated in an inverted position for three weeks at both 25 °C and 37 °C in parallel. Nocardia isolates were identified through phenotypic tests, including growth in lysozyme broth and substrate degradation assays (tyrosine, xanthine, and hypoxanthine), followed by molecular confirmation.
Results: The orthopedic ward exhibited the highest particle concentration among all wards. Fourteen Nocardia isolates were recovered: four from the emergency department, four from infectious diseases, and three from surgery, two from hemodialysis, and one from orthopedics. The identified species included N. cyriacigeorgica, N. asteroides, N. otitidiscaviarum, N. wallacei, N. kroppenstedtii, N. farcinica, and N. nova.
Conclusion: This study represents one of the earliest documented investigations, detecting clinically relevant Nocardia species in hospital indoor air. Although the direct link between airborne Nocardia and hospital-acquired infections remains to be proven, the detection of pathogenic species in patient-care environments underscores a potential risk to vulnerable individuals.