Infection and Drug Resistance最新文献

{"title":"Phage Therapy as a Self-Replicating Strategy for Besieged Health Systems.","authors":"Emmanuel Olalere, Sidra Saif, Warda Imran, Faiza Khalid, Dadullah Faiz, Javeria Akhter, Laiba Manzoor, Ashesh Das","doi":"10.2147/IDR.S638488","DOIUrl":"https://doi.org/10.2147/IDR.S638488","url":null,"abstract":"<p><strong>Background: </strong>Active conflict zones and resource-limited health settings face compounding challenges from disrupted antibiotic supply chains concurrent with the proliferation of multidrug-resistant (MDR) and pan-drug-resistant (PDR) pathogens. In such settings, drug availability directly determines clinical outcomes.</p><p><strong>Methods: </strong>A narrative review of the literature was conducted in accordance with adapted SANRA (Scale for the Assessment of Narrative Review Articles) criteria, searching PubMed/MEDLINE, EMBASE, Cochrane Library, and grey literature sources for articles published between 1^st January 2001 and 1^st April 2026. Of 8003 records identified, 42 met inclusion criteria and were incorporated into this review Seminal pre-2001 works and non-English-language sources from Eastern European phage therapy programmes were deliberately included to mitigate geographic publication bias.</p><p><strong>Main findings: </strong>Bacteriophages possess unique pharmacokinetic properties, including self-replication exclusively at infection sites, enabling pathogen clearance from a minimal dose burden. The Phage Support Ukraine (PhageSP UKR) initiative demonstrated rapid local phage isolation against circulating MDR and PDR <i>Klebsiella pneumoniae</i> strains from combat casualties, bypassing conventional pharmaceutical manufacturing chains. In a subset of strains, phage-driven evolutionary tradeoffs can compel ESKAPE pathogensto shed resistance plasmids, including NDM-1metallo-β-lactamase determinants, re-sensitizing the effected strains to existing antibiotics - a strain-specific phenomenon rather than a general clinical outcome These effects act synergistically with host immune defences. Decades of data from the Eliava Institute and growing compassionate use evidence provide a foundational safety profile. The PhagoBurn randomised trial found bacterial burden reduction to be significantly slower with phage therapy than standard of care, a result attributable to subtherapeutic dosing in a substantial proportion of participants; it does not establish efficacy but highlights dose-optimisation as a critical unmet need prior to wider deployment.</p><p><strong>Conclusion: </strong>Bacteriophage therapy represents a biologically rational and logistically feasible intervention for health systems under siege. While large-scale randomised controlled trial evidence remains limited, pragmatic deployment supported by compassionate use data and adaptive regulatory frameworks provides justification for clinical application against otherwise untreatable infections in conflict and resource-limited settings. Targeted investments in phage biobanking, rapid point-of-care production protocols, and harmonized international regulatory pathways are urgently needed.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"638488"},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227763","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}

{"title":"Recurrence of Helicobacter Pylori after Successful Eradication in Northwestern China: Rates, Risk Factors, and Resistance Profiles of Recurrence Isolates.","authors":"Min Niu, Xiaoming Su, Zhen Ma, Lulu Li","doi":"10.2147/IDR.S636223","DOIUrl":"https://doi.org/10.2147/IDR.S636223","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the recurrence rate of <i>H. pylori</i> after successful eradication in Ningxia, to identify independent risk factors associated with recurrence, and to characterize the antibiotic resistance profiles of isolates obtained from recurrent patients.</p><p><strong>Methods: </strong>This study is a retrospective cohort study. A total of 891 <i>H. pylori</i>-infected patients who received initial eradication treatment and completed 1-year follow-up from June 2021 to October 2024 were included. Demographic characteristics, lifestyle, family hygiene habits, and antibiotic exposure history were collected through questionnaires. A total of 27 strains successfully isolated and cultured from patients with recurrence were tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method.</p><p><strong>Results: </strong>The <i>H. pylori</i> recurrence rate was 4.1% (37/891). Multivariate logistic regression identified six independent risk factors: rural residence (OR = 3.52, <i>P</i> = 0.003), smoking (OR = 6.06, <i>P</i> < 0.001), frequent shared tableware (OR = 3.46, <i>P</i> = 0.013), frequent dining out (OR = 7.41, <i>P</i> = 0.008), poor dining-out hygiene (OR = 4.50, <i>P</i> = 0.007), and having an <i>H. pylori</i>-infected household member (OR = 5.68, <i>P</i> < 0.001). Of the 37 patients with recurrence, 27 had successful <i>H. pylori</i> culture and obtained susceptibility results. The resistance rates to metronidazole (MET), clarithromycin (CLA), levofloxacin (LEV), and amoxicillin (AMO) were 96.3%, 77.8%, 62.9%, and 3.7%, respectively; all isolates were susceptible to furazolidone (FUR) and tetracycline (TET). Multidrug-resistance was observed in 51.8%, mainly as MET+CLA+LEV pattern (48.1%).</p><p><strong>Conclusion: </strong>The one-year recurrence rate of <i>H. pylori</i> in Ningxia is 4.1%. Factors significantly associated with an increased risk of recurrence include rural residence, smoking, shared tableware, regular dining out, poor dining-out hygiene, and household infection. Isolates from patients with recurrence exhibited high resistance rates to MET, CLA, and LEV, predominantly in multidrug-resistant patterns, whereas resistance to AMO, FUR, and TET remains low.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"636223"},"PeriodicalIF":3.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224031","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}

{"title":"Protective Effect of Xuebijing Injection on Gastrointestinal Function in Septic Patients of Non-Gastrointestinal Origin.","authors":"Fang Li, Rui Wang, Tingting Ding, Shuyang Pan, Mian Qin","doi":"10.2147/IDR.S642072","DOIUrl":"10.2147/IDR.S642072","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to assess the 28-day prognosis and gastrointestinal protection of early Xuebijing in non-gastrointestinal sepsis.</p><p><strong>Methods: </strong>Septic patients with infection origins outside the gastrointestinal system and no history of acute gastrointestinal injury (AGI) were included in this single-center retrospective analysis. The two groups' baseline characteristics were balanced by propensity score matching (PSM). Secondary objectives were organ function, enteral nutrition tolerance, inflammatory markers, AGI onset time, and clinical outcomes. The primary endpoint was the incidence of 28-day AGI.</p><p><strong>Results: </strong>After matching, each group had 87 patients, and the baseline variables were evenly distributed among them (<i>P</i> > 0.05). The 28-day cumulative AGI rate for the Xuebijing group was 44.8%, which was considerably lower than the control group's rate of 69.0% (<i>P</i> = 0.002). Additionally, there was a significant delay in the beginning of AGI in the treated group (log-rank <i>P</i> < 0.001). Furthermore, Xuebijing treatment resulted in shorter hospital and ICU stays as well as larger drops in CRP, PCT, and SOFA ratings (all between-group <i>P</i> < 0.05). Patients receiving Xuebijing achieved earlier enteral nutrition initiation (<i>P</i> = 0.0016) and a higher rate of day‑7 caloric targets (66.7% vs 49.4%, <i>P</i> = 0.031). Feeding intolerance showed a trend toward being lower in the Xuebijing group (24.14% vs 39.08%), but this difference did not reach statistical significance (<i>P</i> = 0.050); 28‑day mortality and adverse events also did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Xuebijing use initiated within 24 hours of sepsis diagnosis in septic patients without pre-existing AGI was associated with protection of gastrointestinal function and improvement in several secondary outcomes, including lower AGI incidence, shorter hospital stays, reduced inflammation and organ dysfunction, and better enteral nutrition outcomes, without additional safety concerns. However, no significant difference in 28-day mortality was observed.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"642072"},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216222","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}

{"title":"In vitro Combinatorial Effects of 18β-Glycyrrhetinic Acid with Azole Antifungals.","authors":"Yixin Zeng, Jing Hu, Lu Ge, Junhao Yu, Menghua Tang, Jufang Tan, Heng Zhang, Yi Sun","doi":"10.2147/IDR.S631019","DOIUrl":"10.2147/IDR.S631019","url":null,"abstract":"<p><strong>Objective: </strong>To explore the combined effects of multiple drugs and provide more therapeutic options for invasive fungal infections, this study evaluated the in vitro susceptibility of <i>Aspergillus</i> spp. <i>Candida</i> spp. <i>Cryptococcus neoformans</i>, and <i>Exophiala dermatitidis</i> to 18β-glycyrrhetinic acid(GA) in combination with itraconazole(ITC), voriconazole(VRC), posaconazole(POS), and fluconazole(FLU).</p><p><strong>Methods: </strong>The antifungal activity of GA combined with ITC, VRC, POS, and FLU against 107 clinical isolates was evaluated using the CLSI broth microdilution method (M27-A3 and M38-A2), including 56 strains of <i>Aspergillus</i> spp. 16 strains of <i>E. dermatitidis</i>, 26 strains of <i>Candida</i> spp. and 9 strains of <i>C. neoformans</i>. Minimum inhibitory concentrations(MICs) and fractional inhibitory concentration indices(FICIs) were determined to evaluate the synergistic effects.</p><p><strong>Results: </strong>GA alone exhibited no antifungal activity. However, its combination with azoles showed complex biphasic effects. The synergistic rates of GA-POS against <i>Aspergillus</i> spp. <i>E. dermatitidi</i>s, <i>Candida</i> spp. and <i>C. neoformans</i> were 87.50%(49/56), 43.75%(7/16), 30.77%(8/26), and 55.56%(5/9), respectively, with no antagonism observed, indicating broad-spectrum synergistic potential. In contrast, the synergistic rates of GA-ITC against the above pathogens were only 5.36%(3/56), 6.25%(1/16), 26.92%(7/26), and 22.22%(2/9), respectively. GA-FLU exerted synergistic effects only against <i>C. neoformans</i>(11.11%, 1/9). The overall synergistic rate ranked POS(64.49%, 69/107) > ITC(12.15%, 13/107) > FLU(4.00%, 1/25). Additionally, partial antagonistic effects were observed in <i>Candida</i> spp. and <i>C. neoformans</i>. For <i>Candida</i> spp. the antagonistic rates of GA-VRC and GA-FLU were 23.08%(6/26) and 25.00%(4/16), respectively. For <i>C. neoformans</i>, the antagonistic rate of GA-FLU was 22.22%(2/9).</p><p><strong>Conclusion: </strong>In vitro experiments demonstrate that synergistic or antagonistic effects can be observed when GA is combined with azoles. These findings deepen our understanding of the combinatorial efficacy of GA and azoles and provide new perspectives for targeted antifungal combination therapy.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"631019"},"PeriodicalIF":3.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216226","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}

{"title":"Population Pharmacokinetics and Exposure-Response Analysis of Voriconazole in ICU and Non-ICU Hospitalized Adults.","authors":"Liu Yang, Cao Yaling, Letao Li, Hong Lu, Xiuying Zeng, Huamei Chen","doi":"10.2147/IDR.S636395","DOIUrl":"10.2147/IDR.S636395","url":null,"abstract":"<p><strong>Background: </strong>Voriconazole has marked pharmacokinetic variability and a narrow therapeutic window, making individualized dosing difficult. Published population pharmacokinetic (PopPK) models most derive from ICU or general-ward patients, and exposure-response studies are limited. This retrospective study aimed to characterize voriconazole PopPK and exposure-response analysis in real‑world hospitalized patients containing both ICU and non-ICU patients.</p><p><strong>Methods: </strong>Adults receiving voriconazole with therapeutic drug monitoring were included. PopPK analysis used NONMEM. Demographic variables and lab biomarkers were screened. Monte Carlo simulations were used to show covariates' effect on drug exposure under standard dosing regimen. Model-derived voriconazole exposure was linked to treatment outcome and adverse drug reactions (ADR) using logistic regression.</p><p><strong>Results: </strong>292 patients with 473 voriconazole concentrations were included. A one-compartment model with first-order elimination adequately described the data, with estimated population clearance, volume of distribution and derived half-life of 3.3 L/h, 92 L and 19 h, respectively. Voriconazole clearance increased with body weight and albumin and decreased with age, CRP, total bilirubin, and serum creatinine. These covariates decrease clearance inter-individual variability from 44.5% to 32.6 %; all parameters fell within bootstrap 90% interval. With a standard regimen 300 mg every 12 h for first day then 200 mg every 12 h, simulations showed underexposure in younger patients without organ dysfunction and overexposure in elderly patients with elevated CRP, total bilirubin or serum creatinine. In multivariable logistic regression, excessively high average concentration (Cavg) derived by model was associated with treatment failure (adjusted odds ratio 1.45 per mg/L, 95% CI 1.07-2.03, p=0.019). Cavg was not significant, whereas older age was associated with higher ADR risk (adjusted odds ratio 1.05, 95% CI 1.01-1.10).</p><p><strong>Conclusion: </strong>Age, CRP, albumin, total bilirubin and creatinine explain clinically relevant variability in voriconazole exposure and indicate that a fixed regimen may not benefit all patients. The association between higher Cavg and treatment failure is observational and needs further prospective studies and external validations.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"636395"},"PeriodicalIF":3.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193235","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}

{"title":"Genomic Epidemiology and Antimicrobial Resistance Analyses of <i>bla</i> _KPC-2-Producing <i>Pseudomonas aeruginosa</i> in Zhejiang, China.","authors":"Siwen Bao, Li Zhu, Xiaoqin Niu, Junhua Tian, Minjie Mao, Weifeng Shen, Qinlong Yu, Wei Wang","doi":"10.2147/IDR.S639126","DOIUrl":"10.2147/IDR.S639126","url":null,"abstract":"<p><strong>Introduction: </strong><i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing carbapenem-resistant <i>Pseudomonas aeruginosa</i> is a global health burden due to its multidrug resistance. However, the resistance characteristics, molecular epidemiology, and dissemination mechanisms of <i>bla</i> _KPC-2-producing carbapenem-resistant <i>P. aeruginosa</i> in China remain limited.</p><p><strong>Methods: </strong>A total of 23 <i>bla</i> _KPC-2-producing carbapenem-resistant <i>P. aeruginosa</i> isolates were collected in a hospital in Jiaxing, Zhejiang, from February 2021 to January 2025. Antimicrobial susceptibility testing and whole-genome sequencing were performed. Multilocus sequence typing, antimicrobial resistance genes, and virulence factors were identified. Phylogenetic analyses were performed, and genetic context analyses were conducted.</p><p><strong>Results: </strong>Six sequence types (STs) were identified among 23 isolates, with ST463 accounting for 56.5%. All isolates exhibited multidrug-resistant phenotypes and were identified as carbapenem-resistant <i>Pseudomonas aeruginosa</i>. 17.4% of isolates showed resistance to ceftazidime/avibactam (CZA). All ST463 isolates co-harbored <i>exoS</i> and <i>exoU</i>. The core-genome MLST analysis identified two clusters within ST463 isolates, and the core-genome single-nucleotide polymorphism analysis revealed close genomic relatedness among ST4424 and ST4526 isolates. The <i>bla</i> _KPC-2 genetic context was mainly associated with an ISKpn27-<i>bla</i> _KPC-ISKpn6-like structure and IncU-related sequences.</p><p><strong>Conclusion: </strong>ST463 was identified as the predominance lineage among <i>bla</i> _KPC-2-producing carbapenem-resistant <i>P. aeruginosa</i> in this study, and multidrug resistance genes and multiple virulence factor genes in the ST463 were demonstrated. Genomic analyses identified closely related isolates consistent with potential nosocomial transmission in the hospital. These findings highlighted the importance of continuous genomic surveillance, susceptibility monitoring, and strengthened infection control strategies for limiting the persistence and potential nosocomial spread of high-risk <i>bla</i> _KPC-2-producing carbapenem-resistant <i>P. aeruginosa</i>.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"639126"},"PeriodicalIF":3.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193190","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}

{"title":"Response to \"Fragility of Observed Associations in Selection of Empirical Antifungal Therapy for Critically Ill Non-Neutropenic Patients\" [Response to Letter].","authors":"Shahad A Albakri, Ahmad K Aljabri, Emad A Alharbi, Buthainah B Alammash, Salman A Alabdali, Maha F Alahmadi, Nawaf T Almutairi, Hindi S Alharbi, Fahad Alzahrani, Faris S Alnezary","doi":"10.2147/IDR.S639697","DOIUrl":"https://doi.org/10.2147/IDR.S639697","url":null,"abstract":"","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"639697"},"PeriodicalIF":3.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181653","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}

{"title":"Carbapenem-Resistant Gram-Negative Bacteria: Mechanisms, Pathogen-Specific Strategies.","authors":"Xiangquan Li, Xing Tang, Huafeng Ding, Jiaqiong Li","doi":"10.2147/IDR.S630483","DOIUrl":"https://doi.org/10.2147/IDR.S630483","url":null,"abstract":"<p><p>Carbapenem-resistant Gram-negative bacteria (CRGNB)-including carbapenem-resistant <i>Enterobacteriaceae</i> (CRE), carbapenem-resistant <i>Pseudomonas aeruginosa</i> (CRPA), and carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB)-pose a critical threat to public health due to their high associated morbidity and mortality. Key resistance mechanisms involve carbapenemase production, porin mutations, efflux pump overexpression, penicillin-binding proteins (PBPs) alterations, and biofilm formation, with prevalence varying geographically and by species. Effective management requires identifying the infection site, assessing disease severity, and determining the pathogen and its resistance profile to guide antimicrobial selection. Recommended agents include ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, aztreonam-avibactam, ceftolozane-tazobactam, sulbactam-durlobactam, colistin, and tigecycline. For CRE, treatment depends on the carbapenemase type: KPC-producing strains are managed with novel β-lactam/β-lactamase inhibitor combinations (ceftazidime-avibactam, imipenem-relebactam, meropenem-vaborbactam); MBL-producing strains with ceftazidime-avibactam plus aztreonam or aztreonam-avibactam; and OXA-48-type-producing strains with ceftazidime-avibactam alone. For CRPA, ceftolozane-tazobactam is the primary option, while CRAB is treated with sulbactam-durlobactam-based combination therapy. However, disparities in treatment access persist; while these novel agents are recommended, alternative salvage strategies are often required in resource-limited settings. This review details the epidemiology of CRGNB, outlines pathogen-specific resistance mechanisms and corresponding therapies, highlights knowledge gaps, and suggests future directions to inform prevention and treatment efforts.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"630483"},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170298","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}

{"title":"Development and Validation of an Interpretable Machine Learning Model for Predicting Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Using Routine Peripheral Blood Indicators: A Retrospective Study.","authors":"Mingda Wu, Naijin Wei, Zheng Zhang, Yunfeng Qiao, Zhihui Zhang, Yuejiao Lan, Xiaodan Lu","doi":"10.2147/IDR.S634892","DOIUrl":"https://doi.org/10.2147/IDR.S634892","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate an interpretable machine learning model for early prediction of carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) infection using routine peripheral blood indicators, providing a rapid risk assessment tool before antimicrobial susceptibility results.</p><p><strong>Methods: </strong>A retrospective study was conducted on 285 patients with culture-confirmed <i>Klebsiella pneumoniae</i> infection (242 carbapenem-susceptible <i>Klebsiella pneumoniae</i> (CSKP), 43 CRKP), with all isolates obtained from sputum specimens, from June 2024 to June 2025. Given the significant class imbalance between the CSKP (n = 242) and CRKP (n = 43) groups, key features were screened by LASSO regression and Boruta algorithm. Six machine learning models were constructed, with synthetic minority oversampling technique (SMOTE) for class imbalance processing and stratified 5-fold cross-validation for optimization. Model performance was evaluated by area under the curve (AUC), accuracy, calibration curve, decision curve analysis (DCA), and interpreted by SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>Seven core predictors (HGB, LYMPH_p, NEUT_p, MONO, BASO, PCT, AISI) were identified. The random forest model achieved the best performance, with an AUC of 0.863 (95% CI: 0.672-0.980), accuracy of 0.821, sensitivity of 0.750 (95% CI: 0.571-1.000), specificity of 0.834 (95% CI: 0.643-0.841), and Brier score of 0.077. DCA showed clear net benefit in the threshold probability range of 0.1-0.8. SHAP analysis confirmed aggregate index of systemic inflammation (AISI) as the most important predictive factor.</p><p><strong>Conclusion: </strong>The interpretable prediction model based on routine peripheral blood indicators demonstrated good discrimination, calibration, and clinical utility in this single-center retrospective study. It has the potential to assist early risk stratification of CRKP infection and support clinical decision-making. External multicenter prospective validation is warranted before clinical implementation.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"634892"},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181684","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}

{"title":"Postoperative <i>Candida auris</i> Bloodstream Infection Following Cardiac Surgery: Diagnostic Delay and Serial Changes in Azole MIC Values: A Case Report.","authors":"Muhammad Khalid, Xin Li, Liming Lei, Yingkai Xiao, Huanlei Huang, Biaochuan He","doi":"10.2147/IDR.S625639","DOIUrl":"https://doi.org/10.2147/IDR.S625639","url":null,"abstract":"<p><strong>Background: </strong><i>Candida auris</i> is an emerging multidrug-resistant fungal pathogen associated with healthcare-associated outbreaks and invasive infections, particularly in critically ill patients. Early recognition remains challenging due to nonspecific clinical presentations and overlap with bacterial infections. Postoperative bloodstream infection due to <i>C. auris</i>, especially following cardiac surgery, is still relatively uncommon and may be underrecognized in clinical practice.</p><p><strong>Case presentation: </strong>A 69-year-old man developed persistent fever, dyspnea, and bilateral postoperative pulmonary infiltrates after modified Morrow surgery and bioprosthetic mitral valve replacement. The pulmonary findings were clinically diagnosed as severe pneumonia, although imaging was nonspecific and also raised the possibility of pulmonary edema or heart failure. Despite broad-spectrum anti-infective therapy, his condition did not improve. Three separate catheter-drawn blood cultures collected on 21, 24, and 28 July 2025 subsequently yielded <i>Candida auris</i>, confirming candidemia. No respiratory specimen yielded <i>C. auris</i>; therefore, the pulmonary abnormalities were considered concurrent with, rather than microbiologically attributable to, the bloodstream infection. Antifungal susceptibility testing showed persistently high fluconazole MICs, while itraconazole and voriconazole MICs increased in the third isolate. Because validated <i>C. auris</i>-specific clinical breakpoints were unavailable for these agents, the MIC findings were interpreted descriptively. Following adjustment of antifungal therapy and continued supportive care, the patient became afebrile, achieved clinical stabilization, and had a negative follow-up blood culture before discharge.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenge of <i>Candida auris</i> bloodstream infection in postoperative patients, where clinical features may mimic bacterial pneumonia. Persistent fever unresponsive to empirical antimicrobial therapy should prompt early consideration of invasive fungal infection. Timely microbiological diagnosis and appropriate antifungal treatment are essential for improving outcomes. Increased awareness of <i>C. auris</i> infection in surgical and hospitalized patients is critical for early recognition and effective management.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"625639"},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165952","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}