Current Opinion in Infectious Diseases最新文献_第9页

Blood mucorales quantitative PCR ready for prime time. 血液粘膜定量PCR已准备就绪。

IF 4.5 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1097/QCO.0000000000001161

Laurence Millon, Julie Rousselot, Emeline Scherer, Anne-Pauline Bellanger

{"title":"Blood mucorales quantitative PCR ready for prime time.","authors":"Laurence Millon, Julie Rousselot, Emeline Scherer, Anne-Pauline Bellanger","doi":"10.1097/QCO.0000000000001161","DOIUrl":"10.1097/QCO.0000000000001161","url":null,"abstract":"Purpose of review: Mucorales quantitative PCR (qPCR) was first developed and evaluated in 2013, and since then, substantial evidence has accumulated supporting its clinical utility. This review highlights the major advances this technique has brought to the management of mucormycosis.Recent findings: Different in-house and commercial assays are now available, targeting a broad range of clinically relevant Mucorales species. Performance depends strongly on preanalytical parameters such as volume of plasma or serum used for DNA extraction, and ratio of DNA input in the PCR reaction mix. Multiplex assays have expanded diagnostic scope to include Aspergillus and other molds, supporting differential diagnosis of invasive mold infections. Serial qPCR monitoring provides prognostic information, with DNA clearance after treatment associated with improved survival. Routine screening in high-risk populations, including hematology and severely burned patients, shortens diagnostic delays and improves outcomes.Summary: Compared with conventional methods, Mucorales qPCR provides a rapid, noninvasive, and sensitive diagnostic tool. Large studies have shown that it enables earlier detection, facilitates timely antifungal treatment, and is associated with improved survival.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":"38 6","pages":"530-534"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Doing more with less: a narrative review of recent evidence in diagnostic stewardship. 事半功倍：对诊断管理新近证据的叙述性回顾。

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-09-03 DOI: 10.1097/QCO.0000000000001147

Paul M Kinsella, Katie Cronin, Eddie Chan, Katherine A Bond

{"title":"Doing more with less: a narrative review of recent evidence in diagnostic stewardship.","authors":"Paul M Kinsella, Katie Cronin, Eddie Chan, Katherine A Bond","doi":"10.1097/QCO.0000000000001147","DOIUrl":"10.1097/QCO.0000000000001147","url":null,"abstract":"Purpose of review: Diagnostic stewardship (DS) aims to optimise the use of laboratory testing to improve patient care while reducing unnecessary tests. This review examines recent evidence on DS interventions to optimise the use of resources, focusing on three key areas: reducing unnecessary testing, maximising the impact of existing tests, and avoiding the overdiagnosis of hospital-acquired infections.Recent findings: Multiple interventions have demonstrated effectiveness in reducing unnecessary blood and urine culture testing, including clinical decision support tools, education programs, and multidisciplinary approaches. Studies on optimising existing tests have focused on blood culture workflows, reporting of nonsterile samples, and implementation of multiplex PCR panels. Interventions to reduce overdiagnosis of catheter-associated urinary tract infections and Clostridioides difficile infection have shown promise. However, the monitoring of unintended consequences varies across studies. Most publications were retrospective cohort studies, with few randomized trials.Summary: DS can safely reduce inappropriate testing and maximise test effectiveness. Successful implementation requires multidisciplinary engagement and careful monitoring of the unintended consequences. Further high-quality studies, especially randomised trials, are needed to assess the clinical impact of DS interventions robustly.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"501-511"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The secret weapon to reduce multidrug-resistant Gram-negative infections: can vaccines help decrease MDR risk? 减少耐多药革兰氏阴性感染的秘密武器：疫苗能帮助降低耐多药风险吗？

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-09-12 DOI: 10.1097/QCO.0000000000001149

Maddalena Peghin, Paolo Antonio Grossi

{"title":"The secret weapon to reduce multidrug-resistant Gram-negative infections: can vaccines help decrease MDR risk?","authors":"Maddalena Peghin, Paolo Antonio Grossi","doi":"10.1097/QCO.0000000000001149","DOIUrl":"10.1097/QCO.0000000000001149","url":null,"abstract":"Purpose of review: To describe the current and potential role of vaccination to fight against antimicrobial resistance (AMR), with a special focus on multidrug resistance (MDR) Gram-negative bacteria (GNB).Recent findings: The increasing threat of AMR and the complexities of developing new antibiotics has stimulated the search for alternative preventive strategies, including vaccines.Summary: Vaccination is an important and underestimated tool for counteracting AMR both in high- and low-income countries. Vaccine use produces various direct and indirect effects that reduce infections caused by MDR bacteria and antibiotic consumption associated with diseases at population level. Vaccines are associated with risk for resistance, yet the probability is extremely low compared to antibiotics. The main strategic goals to prevent and control AMR include not only expanding the use of licensed vaccines, but also developing new vaccines and improving knowledge of related impact on AMR. Current vaccine pipeline for GNB has several options, but needs to overcome diverse challenges. Future research ought to optimize the use of vaccines to fight AMR crisis.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"624-628"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Microbial cell-free DNA for diagnosis of bacterial and fungal infection in the immunocompromised host - what do we know? 无微生物细胞DNA用于诊断免疫功能低下宿主的细菌和真菌感染——我们知道些什么？

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-08-22 DOI: 10.1097/QCO.0000000000001146

Hazim Allos, Teny M John, Adam G Stewart

{"title":"Microbial cell-free DNA for diagnosis of bacterial and fungal infection in the immunocompromised host - what do we know?","authors":"Hazim Allos, Teny M John, Adam G Stewart","doi":"10.1097/QCO.0000000000001146","DOIUrl":"10.1097/QCO.0000000000001146","url":null,"abstract":"Purpose of review: Plasma metagenomic next-generation sequencing (mNGS) enables detection of microbial cell-free deoxyribonucleic acid (mcfDNA) in blood without the need for culture or organism-specific primers. Here, we review clinical performance, methodological variability, and real-world application of plasma mNGS for infectious disease diagnosis in immunocompromised hosts (ICHs).Recent findings: Plasma mNGS has rapidly gained attention as a novel diagnostic tool for infections in ICHs, offering broad-range pathogen detection from a noninvasive blood sample. A growing number of observational studies have assessed its diagnostic yield, clinical impact, and potential to reduce invasive procedures or time to diagnosis. However, results remain variable, with significant differences in study design, patient populations, and adjudication methods. While some studies report meaningful added value, others highlight challenges related to clinical interpretation, limited standardization, and uncertain cost-effectiveness. Moreover, although mNGS offers a wide organismal scope, its sensitivity is influenced by pathogen type, immune status, and technical limitations - particularly in fungal infections and low-burden diseases. Overall, mNGS has yet to find a clearly defined role in routine diagnostic workflows.Summary: Understanding the current evidence, limitations, and variability surrounding plasma mNGS is essential to guide its appropriate clinical use and to inform future integration into diagnostic pathways for ICHs.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"535-543"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pneumocystis jiroveci : still troublesome to diagnose and treat. 耶氏肺囊虫：诊断和治疗仍然困难。

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-10-17 DOI: 10.1097/QCO.0000000000001155

Maddalena Peghin, Jay A Fishman, Paolo Antonio Grossi

{"title":"Pneumocystis jiroveci : still troublesome to diagnose and treat.","authors":"Maddalena Peghin, Jay A Fishman, Paolo Antonio Grossi","doi":"10.1097/QCO.0000000000001155","DOIUrl":"10.1097/QCO.0000000000001155","url":null,"abstract":"Purpose of review: Pneumocystis jiroveci pneumonia (PJP) poses an important risk in immunodeficient patients. Several aspects of the pathogenesis and management of PJP remain poorly understood. The aim of this review is to describe new trends and challenges in the diagnosis and treatment of PJP focused on non-HIV patients compared with patients living with HIV.Recent findings: The immune response to Pneumocystis jiroveci infection varies among different host types and modifies clinical and radiological presentation. The performance of microbiological diagnostic tests depends on pretest probability according to baseline disease, clinical presentation, and radiological pattern. Real-time qualitative and quantitative PCR tests have been proposed as the optimal method for PJP diagnosis, but it is essential to interpret PCR results within the clinical context. Therapy of PJP has not changed substantially, but new options with low-dose trimethoprim/sulfamethoxazole and combination treatment with old and new antifungals are being explored. The use of complementary steroid treatment is well established in patients living with HIV but is controversial in non-HIV patients. Protocols for primary and secondary PJP prophylaxis are evolving. Evidence for nosocomial acquisition and possible person-to-person transmission of infection suggests the need for formal infection control policies.Summary: Early diagnosis and treatment are crucial for improving the prognosis of PJP, but several challenges remain to be addressed. Future efforts should focus on developing new diagnostic methods, treatment options and risk stratification tools to improve prevention strategies.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"522-529"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From clinical trials to daily practice: how to adequately administer sulbactam-durlobactam? alone or combined with imipenem? 从临床试验到日常实践：舒巴坦-杜氯巴坦如何充分给药？单独使用还是与亚胺培南联合使用？

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-10-27 DOI: 10.1097/QCO.0000000000001148

Cecilia Bonazzetti, Maddalena Giannella, Renato Pascale

{"title":"From clinical trials to daily practice: how to adequately administer sulbactam-durlobactam? alone or combined with imipenem?","authors":"Cecilia Bonazzetti, Maddalena Giannella, Renato Pascale","doi":"10.1097/QCO.0000000000001148","DOIUrl":"10.1097/QCO.0000000000001148","url":null,"abstract":"Purpose of review: Sulbactam-durlobactam (SUL-DUR) is a novel β-lactam/β-lactamase inhibitor combination recently approved for carbapenem-resistant Acinetobacter baumannii (CRAB) infections. This review summarizes current knowledge on the optimal use of SUL-DUR, whether administered alone or in combination with carbapenems, particularly imipenem.Recent findings: Data from registrational trial demonstrate that SUL-DUR is an effective and well tolerated treatment option for CRAB severe infections. However, this trial assessed the efficacy of SUL-DUR exclusively in combination with imipenem. Real-world reports have described successful use of SUL-DUR in combination with carbapenems and other agents, particularly in complex or drug-resistant cases. Microbiological data suggest synergistic effects between SUL-DUR and carbapenems due to complementary inhibition of different penicillin-binding proteins.Summary: Combination therapy of SUL-DUR with carbapenems remains the preferred strategy in critically ill or high-risk patients. Future trials should specifically evaluate the comparative efficacy of monotherapy vs. combination regimens and establish which could be the best companion in the treatment of CRAB infections.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"579-587"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How I manage patients with New Delhi metallo-beta-lactamase and OXA-48-producing Enterobacterales infections: a practical approach. 我如何管理新德里金属- β -内酰胺酶和产生oxa -48的肠杆菌感染患者：一种实用的方法。

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-09-26 DOI: 10.1097/QCO.0000000000001151

Giusy Tiseo, Valentina Galfo, Marco Falcone

{"title":"How I manage patients with New Delhi metallo-beta-lactamase and OXA-48-producing Enterobacterales infections: a practical approach.","authors":"Giusy Tiseo, Valentina Galfo, Marco Falcone","doi":"10.1097/QCO.0000000000001151","DOIUrl":"10.1097/QCO.0000000000001151","url":null,"abstract":"Purpose of review: Infections caused by New Delhi metallo-β-lactamase (NDM) and OXA-48-producing Enterobacterales pose a critical threat due to increasing global prevalence and limited therapeutic options. This review provides an updated overview of evolving epidemiological trends, clinical implications, and both current and emerging treatment options.Recent findings: In the past decade, the epidemiology of carbapenem-resistant Enterobacterales (CRE) has changed, with NDM and OXA-48 replacing KPC in several regions. Outcomes of infections caused by NDM-producing CRE remain poor, due to limited treatment options. Ceftazidime/avibactam and aztreonam is the first-line therapeutic option, whereas cefiderocol represents an alternative if susceptibility is confirmed. Resistance to both aztreonam/avibactam and cefiderocol has been reported among NDM-5-producing Escherichia coli , raising concerns in the scientific community. New agents, including cefepime-zidebactam and cefepime-taniborbactam, are currently in development and may expand the future treatment landscape. For OXA-48-producing CRE, ceftazidime/avibactam and cefiderocol are currently available therapeutic options, whereas cefepime/enmetazobactam may become available in the next future.Summary: Optimal management of NDM- and OXA-48-producing Enterobacterales requires individualized approach guided by pathogen type, resistance profile, and patient characteristics. Improved diagnostics and surveillance are essential to guide early treatment, while novel agents may enhance therapeutic options in the near future.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"588-597"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding antiviral intolerance in the management of cytomegalovirus; a scoping review. 巨细胞病毒治疗中抗病毒药物不耐受的认识范围审查。

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-10-13 DOI: 10.1097/QCO.0000000000001154

Violet Z Zhu, Priya Garg, Nikhil Singh, Philip R Selby, Courtney Ierano, Michelle K Yong

{"title":"Understanding antiviral intolerance in the management of cytomegalovirus; a scoping review.","authors":"Violet Z Zhu, Priya Garg, Nikhil Singh, Philip R Selby, Courtney Ierano, Michelle K Yong","doi":"10.1097/QCO.0000000000001154","DOIUrl":"10.1097/QCO.0000000000001154","url":null,"abstract":"Purpose of review: Older antiviral agents for managing cytomegalovirus (CMV) infections post transplantation are associated with treatment limiting toxicities. Presently, there is no consensus on the definition of 'antiviral intolerance' however for the purposes of this systematic scoping review, it was defined as a Type A adverse drug reaction leading to cessation or dose modification. The literature was evaluated to improve clinician understanding to the extent and impact of antiviral intolerance when managing CMV infection post transplantation.Recent findings: In the 71 studies evaluated, intolerance to CMV antivirals (161 instances) were identified as hematological toxicities (44%), predominantly neutropenia (grade 3 to 4), leukopenia, and thrombocytopenia, acute kidney injury (AKI) (20%), and gastrointestinal intolerances (12%). Granulocyte colony stimulating factor was used for neutropenia or leukopenia in 43% of instances. Maribavir and letermovir were identified in fewer studies ( n = 16). Dose reductions were reported as a management strategy in 15% of intolerances. Severity and supportive management of intolerances were poorly characterized.Summary: The most commonly identified intolerances were acute kidney injury, hematological and gastrointestinal effects in older anti-CMV agents. Fewer studies described intolerance of the newer agents. Detailed descriptions of intolerances are absent within the literature and there is an opportunity to standardize terminology used to help guide clinical practice.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"568-578"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New drugs for the management of tuberculosis. 治疗肺结核的新药。

IF 4.5 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-09-24 DOI: 10.1097/QCO.0000000000001156

Gail B Cross

{"title":"New drugs for the management of tuberculosis.","authors":"Gail B Cross","doi":"10.1097/QCO.0000000000001156","DOIUrl":"10.1097/QCO.0000000000001156","url":null,"abstract":"Purpose of review: This review summarizes recent and emerging advances in tuberculosis (TB) treatment, focusing on new therapeutics, repurposed agents, and shortened treatment regimens. It aims to contextualize key developments within the evolving TB treatment landscape and assess their potential to transform clinical management of both drug-susceptible and drug-resistant disease.Recent findings: Evidence from landmark trials, including Nix-TB, ZeNix, TB-PRACTECAL, STREAM, Study 31/A5349, SHINE, TRUNCATE-TB, endTB and BEAT-TB has supported the use of licensed, repurposed, and novel agents as new treatment strategies. These studies have demonstrated the feasibility of treatment-shortening regimens for drug-susceptible TB and improved outcomes for multidrug-resistant TB. Progress has expanded the therapeutic armamentarium, with promising regimens incorporating new agents, higher-dose rifamycins, and safer, all-oral combinations.Summary: These advances have direct implications for clinical practice, offering shorter, safer, and more effective treatment options. Adoption of these new regimens into treatment guidelines will allow us to reduce treatment burden, improve adherence, and lower the risk of adverse effects. Continued optimization of drug combinations, dosing strategies, and safety profiles will be essential to achieving durable, scalable treatment options. Future research should prioritize regimen simplification, host-directed therapies, and tools for predicting and monitoring treatment response to support personalized, globally accessible TB care.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"512-521"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12582603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical trials that could change the management of severe multidrug-resistant Gram-negative infections. 可能改变严重耐多药革兰氏阴性感染管理的临床试验。

IF 4 3区医学

Current Opinion in Infectious Diseases Pub Date : 2025-12-01 Epub Date: 2025-09-24 DOI: 10.1097/QCO.0000000000001150

Matteo Bassetti, Antonio Vena, Daniele Roberto Giacobbe

{"title":"Clinical trials that could change the management of severe multidrug-resistant Gram-negative infections.","authors":"Matteo Bassetti, Antonio Vena, Daniele Roberto Giacobbe","doi":"10.1097/QCO.0000000000001150","DOIUrl":"10.1097/QCO.0000000000001150","url":null,"abstract":"Purpose of review: This article reviews recent and ongoing randomized controlled trials (RCTs) investigating novel antibiotics and treatment strategies for severe Gram-negative infections, particularly those caused by multidrug-resistant (MDR) organisms. It discusses how these trials are reshaping clinical practice and outlines current limitations in their applicability to real-world scenarios.Recent findings: Several novel β-lactams and β-lactam/β-lactamase inhibitor combinations have shown efficacy in RCTs targeting infections like complicated urinary tract infections, intra-abdominal infections, and hospital-acquired pneumonia. Additional considerations on the results of recent RCTs challenge the necessity of combination regimens, and a growing body of evidence from other RCTs support shorter treatment durations for selected Gram-negative infections, overall potentially reinforcing antimicrobial stewardship. However, limitations include small sample sizes in pathogen-specific subgroups, frequent exclusion of critically ill or immunocompromised patients, and a focus on sites and types of infections within narrow regulatory definitions.Summary: Current RCTs have enriched clinical management of severe Gram-negative infections by validating new agents and supporting more personalized, safer, and shorter treatments. Nevertheless, gaps persist regarding their generalizability to high-risk populations and real-world infections. Complementary pathogen-focused trials, adaptive designs, and observational studies are needed to expand the evidence base, also for treatment duration in MDR infections, combination regimens, and resistance development. Integrating trial data with clinical judgment remains essential in bridging the gap between trial conditions and bedside care in line with the principles of precision medicine.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":" ","pages":"616-623"},"PeriodicalIF":4.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0