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Severe Staphylococcus aureus infection: associated factors and outcomes
Authors:Narendra Babu Valobdás
Abstract
Introduction: Staphylococcus aureus causes potentially life-threatening infections, with a somber prognosis when the infection is caused by methicillin-resistant S. aureus due to limited treatment options. The present study describes serious infections by S. aureus in patients hospitalized in an infectious disease’s unit in Rio de Janeiro, Brazil, between 2016 and 2021.
Material and methods: This was a retrospective study based on data from positive samples diagnosed by the microbiology laboratory and by review of medical records. Clinical-demographic variables and outcomes were compared between Patients Living with HIV (PLHIV) and non-HIV patients. Data were analyzed using Jamovi 1.6 and R 4.0.1 statistical software.
Results: A total of 67 patients with a serious S. aureus infection were identified, of whom 29 presented bacteremia and 38 other infections. Thirty-one of 67 (46.3%) were PLHIV. The median age of all patients was 46years, although PLHIV were significantly younger than non-HIV individuals (36 vs. 60 years-old, p < 0.001). The median CD4 lymphocyte count was 95 cells/mm3. Community infection occurred in 36/67 (53.7%) patients, of whom 19/36 (52.7%) had bacteremia. A total of 20 MRSA infections (29.9% of the patients) were identified, which accounted for 14/36 (38.8%) of the community infections. More than a third of PLHIV (38.7%) had MRSA, and all these were sensitive to cotrimoxazole. No difference in mortality was found between PLHIV and non-HIV patients, nor between the MRSA and MSSA groups. Bacteremia was present in 29 patients; MRSA accounted for 9 (31.0%) of these. The 30-day mortality was 4/9 (44.4%) and 2/20 (10%) in MRSA and MSSA bacteremia, respectively.
Conclusions: The most frequent comorbidity in patients with severe S. aureus infections was HIV, with a high rate of MRSA infections recorded in PLHIV. PLHIV were younger, but did not suffer higher mortality, although they did have more relapses and new staphylococcal infections.”
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Bacterial profile and antimicrobial resistance in diabetic foot ulcer infections: a 10-year retrospective cohort study
Authors: Roberto Zambelli
Abstract
Introduction: Diabetic Foot Infections (DFI) are severe complications of diabetes, often resulting in poor clinical outcomes, including amputations. The objective of this study is to identify the main pathogens causing infections in the diabetic foot ulcers, as well as the antibiotic resistance profile.
Methods: This study included all patients treated for diabetic foot infections at a private tertiary hospital between 2013 and 2022. Demographic data, including age, sex, Body Mass Index (BMI), and the level of amputation were extracted from electronic medical records and collected for all patients. Microbiological and resistance patterns were evaluated following standardized protocols. Cases with incomplete demographic or microbiological data were excluded.
Results: This retrospective cohort study analyzed data from 459 diabetic patients, among them, 337 patients with positive cultures were included, resulting in 507 culture results from surgical samples. Gram-negative bacteria accounted for 55.2 % of isolates, with Enterobacterales (41 %) and non-fermenters (14.2 %) being most prevalent. Proteus sp. (10.3 %) and Escherichia coli (8.3 %) were the most common Gram-negative organisms, with significant resistance to ESBL (15.4 %) and quinolones (29.3 %). Among Gram-positive cocci (43.6 %), Staphylococcus aureus (16.8 %) showed 21.1 % methicillin resistance, while Enterococcus sp. exhibited vancomycin resistance (7 %). Multidrug resistance was identified in 16 % of Pseudomonas sp. and 63.6 % of Acinetobacter sp., raising concerns about limited therapeutic options.
Conclusion: The predominance of Gram-negative bacteria and high levels of antimicrobial resistance highlight the need for regular monitoring of local microbiological profiles. Targeted antimicrobial strategies can significantly reduce the morbidity associated with DFI and improve clinical outcomes in diabetic patients.”
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Schistosome Infection is Associated with High-Risk Human Papillomavirus Persistence, Together with Altered Cervicovaginal Microbiota
Authors: Crispin Mukerebe
Abstract
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Cervicovaginal Secretions in Young Women with Bacterial Vaginosis Enhance HIV Infection
Authors: Marla J Keller
Abstract
Background: Bacterial vaginosis (BV) is a major health problem associated with increased HIV risk. To explore underlying mechanisms, we assessed the cervicovaginal mucosal immune environment before and after metronidazole treatment in women with BV and healthy controls.
Methods: Women with BV diagnosed clinically by Amsel criteria were treated with oral or intravaginal metronidazole. Vaginal swabs and cervicovaginal lavage (CVL) were obtained at enrollment and approximately two and four weeks later for assessment of immune mediators, antiviral activity, and 16s rRNA gene sequencing. Healthy controls had sampling at enrollment and four weeks.
Results: Vaginal pH, Nugent score, Shannon alpha diversity index, and vaginal community state types (CST) differed significantly at enrollment comparing women with clinical BV (n=19) and controls (n=13) (p<0.001). BV cases had significantly higher CVL IL-1α and TNF-α, but lower IgG at enrollment compared to controls, which improved following treatment. Similar results were observed if participants with discordant molecular results (n=3) were excluded. Most notably, CVL from BV cases enhanced whereas control CVL inhibited HIV infection of cells relative to buffer (138.4 ± 109.8% vs 30.9 ±37.9%, p=0.001). There was a transient reduction in HIV enhancement following treatment, which was not sustained. Enhancement correlated with CST and markers of dysbiosis. Specifically, decreases in lactobacilli and increases in Prevotella, Dialister micraerophilus, and Peptoniphilus lacrimalis were associated with enhancement.
Conclusions:
These findings provide a potential mechanistic link that may contribute to the increased risk of HIV in association with BV and highlight the importance of early diagnosis and improved treatments.”
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Unveiling the Future of Infective Endocarditis Diagnosis: The Transformative Role of Metagenomic Next-Generation Sequencing in Culture-Negative Cases.
Authors: Shinge SAU et al
Abstract
Culture-negative infective endocarditis (CNE) remains a significant diagnostic challenge in cardiology and infectious disease, often leading to delayed or empirical treatment. Metagenomic next-generation sequencing (mNGS) has emerged as a complementary diagnostic tool capable of identifying fastidious, unexpected, or novel pathogens without prior assumptions. This narrative review synthesizes evidence from 152 studies (2015-2024), evaluating mNGS within existing diagnostic frameworks for culture-negative IE. Compared to conventional diagnostics (blood cultures, PCR, 16 S rRNA sequencing), mNGS demonstrates enhanced detection capabilities for polymicrobial infections and rare pathogens, though methodological heterogeneity across studies precludes definitive performance comparisons. Performance varies substantially based on sample type, sequencing platform, and bioinformatic pipelines. Real-world applications reveal persistent challenges, including cost barriers, interpretive complexities in low-biomass samples, and contamination risks. Integration with host-response biomarkers and AI-driven interpretation platforms shows promise for advancing clinical utility. For mNGS to be effectively integrated into routine CNE care, standardization, regulatory clarity, and equitable implementation will be essential.
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Exploring the Association of Antimicrobial Use with Serratia marcescens Resistance Rates via Multiple Linear Regression.
DOI: 10.2147/IDR.S527225
Authors: Xia F et al
Abstract
Purpose: To investigate the macro-level quantitative relationship between Serratia marcescens resistance and antimicrobial consumption one quarter in advance, aiming to curb resistance and optimize antimicrobial use.
Patients and methods: A retrospective analysis was conducted on S. marcescens resistance rates and antimicrobial consumption data from our hospital. Multiple linear regression models were employed to identify independent linear correlations between resistance rates and defined daily doses (DDDs) of specific antimicrobials.
Results: Over the past four years, 522 S. marcescens strains (3.22% of all bacterial isolates), were identified in the hospital with 86.59% isolated from respiratory samples. The strains showed sensitivity to cefoperazone-sulbactam, cefepime, ertapenem, imipenem, meropenem, amikacin, trimethoprim-sulfamethoxazole, and tigecycline, with resistance rates <10%. The study showed significant correlations between S. marcescens resistance and antibiotic usage. Resistance to cefoperazone-sulbactam and imipenem had independent negative linear relationships with gentamicin DDDs; resistance to cefoxitin correlated negatively with piperacillin-tazobactam DDDs; resistance to cefepime showed a negative association with cefuroxime DDDs. These four relationships were strongly supported by consistent results from Bayesian, Bootstrap, and Winsorized regression. Additionally, amoxicillin-clavulanic resistance positively correlated with meropenem DDDs, and levofloxacin resistance positively correlated with gentamicin DDDs. These positive trends were supported by triple robustness testing. These findings have substantial implications for clinical practice. The negative correlations indicate that the strategic use of specific antimicrobials can effectively suppress the resistance rates to target drugs, while the positive correlations reflect increased co-resistance risks. These findings underscore the necessity for antibiotic rotation and optimized management strategies.
Conclusion: The significant associations between S. marcescens resistance rates and prior antimicrobial consumption patterns underscore the critical impact of antibiotic use on resistance development. This highlights the need for better antimicrobial stewardship to delay resistance and guide prescribing.
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Impact of enhanced infection control and antimicrobial stewardship on infections by Clostridioides difficile, vancomycin-resistant enterococci, and third-generation cephalosporin-resistant Enterobacterales: A stepped-wedge cluster intervention study.
Authors: Classen AY et al
Abstract
Objectives: Infection prevention and control (IPC) and antimicrobial stewardship (AMS) measures are critical to reduce transmission and infection by Clostridioides difficile (CDI) and other enteric pathogens. This study evaluated the impact of enhanced IPC and AMS on CDI and bloodstream infections (BSI) by vancomycin-resistant enterococci (VRE), and third-generation cephalosporin-resistant Enterobacterales (3GCREB). Methods: The study was conducted in five German university hospitals from January 2016 to July 2019. IPC and AMS interventions were sequentially enhanced in three departments with high-incidence CDI at baseline using a stepped-wedge cluster intervention approach. Main outcome measures were incidence densities of CDI and BSI caused by VRE and 3GCREB. An interrupted time series analysis (ITSA) was performed to assess the intervention effects during a normalized study period. Results: Across 15 departments, over 384,000 patient-days were included. Incidence density of target infections was low (CDI 0.77, VRE BSI 0.07, 3GCREB BSI 0.09 per 1,000 patient days). Pooled ITSA results showed a significant reduction in CDI incidence density following enhancement of AMS measures (AMS period reg. slopes diff. -.089, F(p) = 5.400 (0.037)). Regarding the incidence density of VRE/3GCREB BSI no relevant changes could be observed (regression slopes diff. -0.19, F(p) = 0.667 (0.429). A subgroup analysis focusing on haematological and oncological departments showed that AMS influenced prescription behaviour according to implemented AMS strategies, but not clinical outcomes. Conclusions: Combined with IPC enhanced short-term AMS measures led to a significant reduction in the incidence of CDI, while incidence of BSI by VRE and 3GCREB remained unchanged in sites with well-established baseline IPC and AMS programs and low incidence of hospital-associated infections.
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Global variation in antibiotic prescribing guidelines and the implications for decreasing AMR in the future.
Authors: Waldron CA et al
Abstract
Introduction: Antimicrobial resistance (AMR) has become a global burden, with inappropriate antibiotic prescribing being an important contributing factor. Antibiotic prescribing guidelines play an important role in improving the quality of antibiotic use, provided they are evidence-based and regularly updated. As a result, they help reduce AMR, which is a critical challenge in low- and middle-income countries (LMICs). Consequently, the objective of this study was to evaluate local, national, and international antibiotic prescribing guidelines currently available-especially among LMICs-and previous challenges, in light of the recent publication of the WHO AWaRe book, which provides future direction. Methodology: Google Scholar and PubMed searches were complemented by searching official country websites to identify antibiotic prescribing guidelines, especially those concerning empiric treatment of bacterial infections, for this narrative review. Data were collected on the country of origin, income level, guideline title, year of publication, development methodology, issuing organization, target population, scope, and coverage. In addition, documentation on implementation strategies, compliance, monitoring of outcome measures, and any associated patient education or counseling efforts were reviewed to assess guideline utilization. Results/findings: A total of 181 guidelines were included, with the majority originating from high-income countries (109, 60.2%), followed by lower-middle-income (40, 22.1%), low-income (18, 9.9%), and upper-middle-income (14, 7.7%) countries. The GRADE methodology was used in only 20.4% of the sourced guidelines, predominantly in high-income countries. Patient education was often underemphasized, particularly in LMICs. The findings highlighted significant disparities in the development, adaptation, and implementation of guidelines across different WHO regions, confirming the previously noted lack of standardization and comprehensiveness in LMICs. Conclusion: Significant disparities exist in the availability, structure, and methodological rigor of antibiotic prescribing guidelines across countries with different income levels. Advancing the development and implementation of standardized, context-specific guidelines aligned with the WHO AWaRe framework-and supported by equity-focused reforms-can significantly strengthen antimicrobial stewardship and help address the public health challenge of AMR.
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Trends in Prevalence and Antibiotic Nonsusceptibility of Acinetobacter baumannii-calcoaceticus Complex in Thailand (2000-2022): A Secondary Data Analysis.
Authors: Kasemteerasomboon P et al
Abstract
Objectives: Antimicrobial resistance (AMR) is a significant global health concern. Due to its high prevalence in nosocomial infections and its increasing resistance to multiple antibiotics, Acinetobacter baumannii-calcoaceticus complex (ABC) is listed as a critical pathogen. This study aimed to determine the prevalence and antibiotic nonsusceptibility trends of ABC in Thailand over two decades using national surveillance data. Methods: Secondary data from the National Antimicrobial Resistance Surveillance Thailand (NARST) from 2000 to 2022, covering 529,538 ABC isolates was analysed. Linear regression was used to evaluate trends in overall ABC prevalence and antibiotic nonsusceptibility rates across ward types (ICU, inpatient, outpatient) and specimen types (sputum, blood, urine). Results: The prevalence of ABC increased from 8% in 2000 to 14% in 2022, with inpatient wards and sputum specimens showing the highest occurrence. By 2022, the majority of tested antibiotics showed antibiotic nonsusceptibility rates exceeding 70%, with increasing trends. ICU isolates had the highest nonsusceptibility, followed by inpatient and outpatient settings. Although nonsusceptibility rates were lower in the outpatient setting, it exhibited the steepest increasing trends. Among specimen types, urine isolates had the highest nonsusceptibility, followed by sputum and blood. Carbapenem nonsusceptibility increased significantly across all ward types. Conclusions: The increasing prevalence and high nonsusceptibility of ABC in Thailand highlight a growing threat to public health. These findings underscore the urgent need for enhanced infection control, robust antibiotic stewardship, and further research into molecular epidemiology and alternative therapies.
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Minimal Impact of Prophylactic Antibiotics in Pediatric Inguinal Hernia Surgery: Evidence from Real-World Data.
Authors: Fujii T et al
Abstract
Background: The effectiveness of prophylactic antibiotics in pediatric inguinal hernia repair remains unclear. As the procedure is considered clean, the necessity of prophylactic antibiotics is debated. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Pediatric patients aged ≤16 years who underwent open or laparoscopic inguinal hernia repair between 2005 and 2025 were included. Patients were divided based on their receipt of prophylactic antibiotics, and separate analyses were performed based on surgical approach or risk classification. Propensity score matching was applied to balance covariates. The primary outcome was surgical site infection (SSI), and risk factors associated with SSI were evaluated. Results: A total of 42,779 patients were analyzed. In matched cohorts undergoing open repair (n = 2,533 per group), the SSI rate was 0.43% without antibiotics and 0.63% with antibiotics (risk difference [RD], -0.002; 95% CI, -0.006 to 0.002). For laparoscopic repair (n = 2,516 per group), SSI rates were ≤0.40% without and 0.56% with antibiotics (RD, -0.002; 95% CI, -0.005 to 0.002). Among patients who did not receive antibiotics, SSI incidence remained low for both open (0.28%) and laparoscopic (0.27%) repairs (n = 18,865 per group) and was comparable between high-risk (0.65%) and average-risk (0.45%) patients (n = 5,572 per group). Cox regression identified male sex, age under 6 months, and immunosuppressant use as significant predictors. Conclusion: Prophylactic antibiotics did not reduce SSI in pediatric inguinal hernia repair. Their use should be limited to selected high-risk patients, such as those receiving immunosuppressants.