Other specific DSP article suggested by Editorial Board
Role of Point-of-Care C-reactive Protein Testing on Antibiotic Prescription in Febrile Children: A Randomized Controlled Trial.
DOI: 10.7759/cureus.92646
Authors: Khanna S et al
Abstract
Background: Overprescription of antibiotics in febrile children contributes significantly to antimicrobial resistance. Point-of-care testing (POCT) for C-reactive protein (CRP) may help differentiate bacterial from viral infections and support more rational antibiotic use.
Objective: To assess the effectiveness of POCT CRP testing in reducing antibiotic prescription rates among febrile children in an outpatient pediatric setting.
Methods: A randomized controlled trial was conducted at a tertiary care hospital in Maharashtra, India, involving 208 children aged one month to 18 years with febrile illness (≤5 days). Participants were randomized into two groups: Group 1 (n=106) received POCT CRP testing, and Group 2 (n=102) received standard clinical care. CRP was measured using the LumiraDx fluorescence immunoassay (LumiraDx UK Ltd, Alloa, UK). The primary outcome was the rate of antibiotic prescription.
Results: Antibiotic prescription was significantly higher in Group 1 (59.4%) than in Group 2 (46.1%) (p=0.023). Within the POCT group, 84.2% of children with CRP >20 mg/L were prescribed antibiotics compared to 45.6% with CRP ≤20 mg/L (p=0.0001). Elevated CRP levels were significantly associated with antibiotic prescription, especially in cases of fever and abdominal pain.
Conclusion: POCT CRP influenced physicians’ prescribing decisions, particularly when CRP levels exceeded 20 mg/L. However, without structured integration into clinical algorithms, its use alone did not reduce overall antibiotic use. Physician training and adherence to CRP-based guidance are essential to optimize the benefits of POCT CRP in antimicrobial stewardship.
Other specific DSP article suggested by Editorial Board
Emerging Technologies for the Diagnosis of Urinary Tract Infections: Advances in Molecular Detection and Resistance Profiling.
Authors: Baimakhanova B et al
Abstract
Background/Objectives: Urinary tract infections (UTIs) represent a considerable challenge within the field of clinical medicine, as they are responsible for significant morbidity and intensify the operational pressures encountered by healthcare systems. Conventional diagnostic approaches, which include symptom evaluation, dipstick urinalysis, and standard urine culture, often demonstrate inadequacies in identifying atypical clinical manifestations, infections with low bacterial counts, or pathogens that show growth difficulties under typical laboratory conditions. These limitations undermine diagnostic accuracy and hinder timely therapeutic measures.
Methods: The present manuscript is a systematic review conducted in accordance with PRISMA guidelines. A structured search was performed in PubMed, Scopus, and Google Scholar, yielding 573 records, of which 107 studies were included for qualitative synthesis. The primary aim of this systematic review is to evaluate both conventional and emerging diagnostic methods for UTIs, with specific objectives of assessing their clinical applicability, limitations, and potential to improve patient outcomes.
Results: Recent progress in diagnostic technologies offers promising alternatives. Molecular-based assays, such as multiplex polymerase chain reaction, matrix-assisted laser desorption ionization mass spectrometry, and next-generation sequencing, have substantially improved both the precision and efficiency of pathogen identification. Furthermore, contemporary techniques for evaluating antimicrobial susceptibility, including microfluidic systems and real-time phenotypic resistance assays, enable clinicians to execute targeted therapeutic strategies with enhanced efficacy. Results of this synthesis indicate that while conventional diagnostics remain the cornerstone for uncomplicated cases, innovative molecular and phenotypic approaches demonstrate superior performance in detecting low-count bacteriuria, atypical pathogens, and resistance determinants, particularly in complicated and recurrent infections. These innovations support antimicrobial stewardship by reducing dependence on empirical antibiotic treatment and lessening the risk of resistance emergence.
Conclusions: Nonetheless, the incorporation of these technologies into clinical practice requires careful consideration of implementation costs, standardization protocols, and the necessary training of healthcare professionals. In conclusion, this systematic review highlights that emerging molecular diagnostics and resistance-profiling tools offer substantial promise in complementing or enhancing traditional methods, but their widespread adoption will depend on robust validation, cost-effectiveness, and integration into clinical workflows.
Other specific DSP article suggested by Editorial Board
Hospital-acquired pneumonia: Past, present, and perspectives.
Authors: Martin Loeches I et al
Abstract
Hospital-acquired pneumonia (HAP) remains the most frequent and lethal hospital acquired infection, driving ICU mortality, prolonged length of stay, and resource use. Ventilator-associated pneumonia (VAP), the archetypal form of HAP, has long defined both the risks and unintended costs of intensive care. Historically, management was shaped by timelines, culture-based diagnostics, and the central role of the endotracheal tube as both lifesaving and pathogenic. This paradigm promoted rigid definitions and empiric antibiotic strategies but also generated enduring lessons on airway care, aspiration, and biofilm biology. Contemporary perspectives have shifted toward ecology and host response. The binary early-late VAP model has been replaced by a continuum of ventilatorassociated lower respiratory tract infections (VA-LRTI), from ventilator-associated tracheobronchitis to VAP. Colonisation, biofilm formation, and microbial-host interactions are now recognised as dynamic drivers of infection. Novel diagnostics-including multiplex PCR and next-generation sequencing-offer rapid pathogen and resistance detection, while biomarkers such as procalcitonin support stewardship and shorter antibiotic courses. Recognition of ventilated HAP (VHAP) has blurred traditional boundaries. Looking forward, precision diagnostics, immune monitoring, and artificial intelligence promise to integrate ecology and immunity into personalised management. The future of HAP care lies not in faster antibiotics, but in tailored, ecology-informed, host-guided strategies that improve outcomes and preserve resilience in the critically ill.
Other specific DSP article suggested by Editorial Board
Temporal trend and individual and hospital characteristics associated to vancomycin-resistant Enterococcus faecium bloodstream infections: a retrospective analysis from the national surveillance system, Italy 2015-2023.
Authors: Sacco C et al
Abstract
Background: Several countries have reported an increase in vancomycin-resistant Enterococcus faecium (VREF), a pathogen classified by the WHO as a high-priority threat due to its role in healthcare-associated infections and in-hospital mortality. This study aimed to describe temporal trends in VREF bloodstream infections in Italy from 2015 to 2023 and to explore patient and hospital characteristics associated with VREF.
Methods: A retrospective observational study was conducted using data from the Italian national antimicrobial resistance surveillance system (AR-ISS). All E. faecium bloodstream isolates tested for vancomycin resistance between 2015 and 2023 were included in the trend analysis. To examine associations with individual (sampling year, season, sex, age group, hospital unit, and geographical area) and hospital-level (number of beds, average length of stay, turnover index, bed occupancy rate, and turnover interval) characteristics, the focus was on hospitalized adults (≥ 18 years) from 2022 to 2023. Mixed-effects logistic regression models were used to estimate trends and assess associations, with hospitals included as a random effect.
Results: Among 29,050 E. faecium isolates, the proportion of VREF rose from 11.5% in 2015 to 32.4% in 2023. Central Italy recorded the highest resistance in 2023 (44.8%), while the South and Islands showed the steepest relative increase (from 1.8% to 29.4%). In the 2022-2023 dataset, multivariable analysis showed higher odds of VREF among patients aged 40-79 years (versus ≥ 80 years; OR = 1.18, 95% CI: 1.02-1.38), those admitted to medical units (versus surgical units; OR = 1.18, 95% CI: 1.03-1.36), and in hospitals with more than 400 beds (versus < 400 beds; OR = 1.31, 95% CI: 1.09-1.58) or an average length of stay exceeding 10 days (versus ≤ 10 days; OR = 1.34, 95% CI: 1.07-1.69).
Conclusions: This study reveals a persistent increase in VREF bloodstream infections in Italy from 2015 to 2023. The findings highlight significant regional disparities and hospital characteristics linked to higher resistance rates, emphasizing the need for coordinated national and regional strategies. Strengthening integrated surveillance, antimicrobial stewardship, and infection prevention is essential to mitigate this growing public health concern.”
Other specific DSP article suggested by Editorial Board
Antibiotic-sparing strategies for multidrug-resistant organism (MDRO) infections.
Authors: Geng S et al
Abstract
The global rise of multidrug-resistant organisms (MDROs), such as carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA), has rendered conventional antibiotics increasingly ineffective, particularly in intensive care units (ICUs) where mortality rates exceed 50% in severe infections. Overuse of broad-spectrum antibiotics accelerates resistance while disrupting host microbiota, necessitating innovative “antibiotic-sparing” strategies. This review synthesizes three pillars of intervention: (1) non-antibiotic therapies, including bacteriophages for targeted pathogen lysis, monoclonal antibodies (e.g., BiS4αPa against Pseudomonas aeruginosa), and nanotechnology-enhanced antimicrobial peptides (AMPs) for biofilm disruption; (2) antimicrobial stewardship integrating rapid diagnostics (MALDI-TOF, mNGS), PK/PD-guided dosing, and short-course regimens (7-day therapy validated by RCTs); and (3) transmission prevention through UV-C disinfection, AI-driven hygiene compliance, and gut microbiota modulation. Key innovations include phage-antibiotic synergies, bispecific antibody engineering, and dynamic PK/PD-TDM frameworks. Despite challenges in clinical translation and cost-effectiveness, these strategies collectively reduce antibiotic reliance, mitigate resistance evolution, and offer a paradigm shift toward precision infection control. Future directions emphasize combinatorial therapies, regulatory harmonization, and scalable environmental-behavioral interventions to address the post-antibiotic era crisis.
Other specific DSP article suggested by Editorial Board
Antifungal treatment strategies and their impact on resistance development in clinical settings.
DOI: 10.1093/jac/dkaf382
Authors:Van Rhijn N et al
Abstract
Invasive fungal diseases, particularly among immunocompromised patients, represent a growing clinical challenge due to limited therapeutic options, diagnostic delays and escalating antifungal resistance. Fungal pathogens employ diverse resistance mechanisms, including genetic mutations of antifungal target enzymes, biofilm formation, efflux pump overexpression and reduced drug penetration, which compromise the efficacy of clinically available antifungal classes. This review explores antifungal treatment modalities and evaluates approaches to mitigate resistance development. Advanced diagnostics and therapeutic drug monitoring are pivotal for enabling timely, targeted therapies and personalizing treatment plans, thus minimizing reliance on broad-spectrum agents. New antifungal agents, such as rezafungin, olorofim and fosmanogepix, along with long-acting and advanced formulations plus combination regimens, show substantial promise for managing resistance and improving treatment outcomes. Additionally, the development of immunotherapies and antifungal vaccines offers new avenues for bolstering host defences against fungal pathogens. Addressing antifungal resistance demands a multifaceted ‘One Health’ approach that integrates robust diagnostics, antifungal stewardship (AFS), precision medicine and collaborative global efforts. By advancing drug formulations, enhancing diagnostic tools and implementing forward-thinking AFS practices, the healthcare community can better tackle the escalating burden of fungal infections and deliver improved patient outcomes.