Infection and Drug Resistance最新文献

{"title":"Immune Remodeling in People Living with HIV/HBV Co-Infection on Long-Term Therapy: Revisiting the Paradigm of Additive Dysfunction [Letter].","authors":"Dimitra Peppa, Aljawharah Alrubayyi, Sanjay Bhagani","doi":"10.2147/IDR.S609305","DOIUrl":"https://doi.org/10.2147/IDR.S609305","url":null,"abstract":"","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"609305"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837287","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":"Risk Stratification for ESBL-Producing Enterobacterales in Elderly Diabetic Patients with Urinary Tract Infections: A Multicenter Model to Support Empirical Antibiotic Decision-Making.","authors":"Tingting Huang, Jibao Qin, Xi Jiang, Ming Hu, Jiaping Wang, Kaiyong Chen, Fumeng Yang, Jin Gu, Huiyi Wu, Xinkuan Chen","doi":"10.2147/IDR.S604463","DOIUrl":"https://doi.org/10.2147/IDR.S604463","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobial resistance among elderly diabetic patients with urinary tract infections (UTIs) poses a significant challenge for empirical antibiotic therapy. Delayed availability of microbiological susceptibility results often leads to treatment mismatch and inappropriate broad-spectrum antibiotic use. This study aimed to develop and validate a clinically interpretable risk stratification model to estimate the probability of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales isolation prior to microbiological confirmation, thereby supporting early empirical antibiotic decision-making.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study including elderly (≥60 years) patients with type 2 diabetes and positive urine cultures. Multivariable logistic regression was used to construct a prediction model for ESBL-positive isolation. Model discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUC), Brier score, calibration plots, and bootstrap internal validation. Internal-external cross-validation and independent external validation were performed to assess model transportability. Decision curve analysis (DCA) was applied to evaluate clinical net benefit across threshold probabilities.</p><p><strong>Results: </strong>A total of 612 patients were included, of whom 364 (58.6%) had ESBL-positive isolates. Independent predictors included diabetes duration ≥10 years, HbA1c ≥8.5%, recent antibiotic exposure, urinary tract device use, and low-level pyuria (<5 WBC/HPF). The model demonstrated stable discrimination (AUC 0.81 in the training set; 0.79 in internal validation; 0.81 in external validation) and good calibration (Brier score 0.18-0.19). Decision curve analysis showed meaningful clinical net benefit across a wide range of threshold probabilities (10%-65%). Exploratory analysis indicated that empirical therapy mismatch was associated with prolonged hospitalization and increased sepsis incidence, underscoring the potential clinical relevance of early resistance risk identification.</p><p><strong>Conclusion: </strong>This multicenter risk stratification model provides a practical tool for early estimation of ESBL-producing Enterobacterales risk in elderly diabetic patients with UTIs. By integrating routinely available clinical and laboratory variables, the model may support antimicrobial stewardship efforts and improve empirical antibiotic decision-making before susceptibility results become available. Prospective validation in diverse healthcare settings is warranted to confirm its clinical impact.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"604463"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837322","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":"On the Use of Immunoglobulins for Pre-exposure Prophylaxis Against COVID-19 in Immunocompromised Patients.","authors":"Daniele Focosi, Massimo Franchini, Arturo Casadevall","doi":"10.2147/IDR.S540925","DOIUrl":"https://doi.org/10.2147/IDR.S540925","url":null,"abstract":"<p><p>COVID-19 remains a cause of significant mortality and morbidity for immunocompromised patients. In the current absence of effective monoclonal antibodies to SARS-CoV-2, standard commercial intravenous/subcutaneous immunoglobulin (IVIG/SCIG) lots provide an option for passive immunotherapy since these now consistently contain SARS-CoV-2-reactive antibodies. Strong mechanistic considerations and emerging observational data support the use of IVIG/SCIG as a biologically plausible option for COVID-19 pre-exposure prophylaxis (PreEP) in immunocompromised patients. In this review, we summarize the supporting evidence available and consider optimal use cases. Neutralization capacity against Omicron lineages is consistently reduced and highly variable between lots, and there is an intrinsic several-month lag between donor immunity and product infusion. The available information in literature sources consistently reflects the use of standard replacement dosing of IVIG/SCIG and does not systematically analyze COVID-19-specific safety or outcomes with dose intensification. While the available evidence suggests that IVIG/SCIG may be effective in PreEP, without dedicated randomized or well-controlled human trials, the magnitude of clinical benefit from this intervention remains uncertain, especially against contemporary Omicron sublineages.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"540925"},"PeriodicalIF":2.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837293","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":"Analysis of Genetic Characteristics, Biofilm Formation Ability, and Mortality Risk Factors in Patients Infected with Carbapenem-Resistant <i>Acinetobacter baumannii</i>.","authors":"Ziye Liu, Meiyu Deng, Bu Wang, Jianhua Liu, Wei Zhang, Jianqing Zhao","doi":"10.2147/IDR.S583554","DOIUrl":"https://doi.org/10.2147/IDR.S583554","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to investigate the prevalence of resistance genes, efflux pump genes, and biofilm-forming genes in carbapenem-resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt;, as well as the clinical characteristics of patients infected with carbapenem-resistant &lt;i&gt;Acinetobacter baumannii&lt;/i&gt;, in order to provide guidance for rational clinical prevention and control.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study included 244 patients with CRAB infections admitted to a tertiary hospital in Zhangjiakou, China, between June 2021 and December 2024. Statistical analysis was performed using SPSS 27.0 software to investigate potential risk factors for mortality associated with CRAB. Conventional PCR amplification was used to qualitatively detect resistance genes, efflux pump genes, and biofilm-related genes in isolated CRAB strains. Biofilm formation capacity was assessed using the crystal violet staining method. The study analyzed the association between the aforementioned genetic and phenotypic characteristics, biofilm formation capacity, and antibiotic resistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 244 CRAB isolates were collected in this study, primarily from sputum (55.33%), followed by bronchoalveolar lavage fluid (26.23%). The majority of isolates originated from the ICU (48.77%), followed by the Department of Respiratory Medicine (31.15%). PCR results showed that the predominant resistance genes in CRAB isolates from this hospital were &lt;i&gt;bla&lt;/i&gt;OXA-51 and &lt;i&gt;bla&lt;/i&gt;OXA-23, at 89.3% and 87.3%, respectively. The detection rates for &lt;i&gt;bla&lt;/i&gt;NDM, &lt;i&gt;bla&lt;/i&gt;OXA-58, and &lt;i&gt;bla&lt;/i&gt;OXA-24 were 1.6%, 1.2%, and 0.4%, respectively. The efflux pump genes &lt;i&gt;adeB, adeR, adeS&lt;/i&gt;, and &lt;i&gt;adeJ&lt;/i&gt; all showed high detection rates, while the &lt;i&gt;adeG&lt;/i&gt; gene was not detected. The biofilm-related genes with generally high detection rates were &lt;i&gt;bap&lt;/i&gt; (240/244, 98.4%), &lt;i&gt;abaI&lt;/i&gt; (227/244, 93.0%), and &lt;i&gt;ompA&lt;/i&gt; (223/244, 91.4%); the detection rates of the remaining genes ranged between 84.8% and 90.6%. Of the 244 CRAB strains tested in this study, the vast majority (97.95%) possessed biofilm-forming ability. The OD values of the strains were determined using the crystal violet method, with weak biofilm-forming strains (47.54%) and moderate biofilm-forming strains (44.26%) predominating; strong biofilm-forming strains accounted for 6.15%, while strains incapable of biofilm formation accounted for only 2.05%. Antimicrobial susceptibility testing revealed that 99.58% of the 244 CRAB strains were resistant to piperacillin/tazobactam, and 99.15% were resistant to imipenem and meropenem. Resistance rates for amoxicillin/clavulanate, cefepime, ceftazidime, ceftiofur, ciprofloxacin, and levofloxacin, all exceeded 95%, while 3.08% were resistant to tigecycline. No resistance to polymyxin was observed. Results of multivariate logistic regression analysis showed that age (OR = 1.044, 95% CI: 1.009-1.079, P &lt; 0.05) and white blood cell count","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"583554"},"PeriodicalIF":2.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836973","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":"Analysis of <i>Helicobacter pylori</i> Eradication Therapy Based on Drug Susceptibility Testing in Huairou District, Beijing: A Single-Arm Prospective Observational Study.","authors":"Erxuan Qi, Wenyan Liang, Jia Li","doi":"10.2147/IDR.S592505","DOIUrl":"https://doi.org/10.2147/IDR.S592505","url":null,"abstract":"<p><strong>Objective: </strong>To assess the feasibility, effectiveness, and safety of susceptibility-guided individualised <i>H. pylori</i> therapy in a region without prior resistance data, using a single-arm prospective observational design.</p><p><strong>Methods: </strong>This prospective study included patients with confirmed <i>H. pylori</i> infection undergoing gastroscopy at Beijing Huairou Hospital (April 2023-May 2024). Molecular testing targeted <i>23S rRNA</i> mutations (A2142G, A2142C, A2143G) for clarithromycin (CLA) and <i>gyrA</i> mutations (Asn87→Lys/Thr) for levofloxacin (LVX). Patients were assigned to three susceptibility-guided groups: CLA-sensitive, CLA-resistant+LVX-sensitive, and CLA-resistant+LVX-resistant, each receiving 14-day bismuth-containing quadruple therapy. Eradication was confirmed by ¹³C urea breath test 4-8 weeks post-treatment.</p><p><strong>Results: </strong>Intention-to-treat (ITT) eradication rate was 82.3% (per-protocol [PP]: 87.2%). ITT rates by group: CLA-S 81.8%, CLA-R-LVX-S 83.3%, CLA-R-LVX-R 85.0% (P=0.921). PP rates: 86.3%, 92.1%, 85.0% (P=0.602). No significant differences in compliance or safety (P=0.849; P=0.467).</p><p><strong>Conclusion: </strong>Susceptibility-guided therapy achieved 85-90% eradication regardless of resistance profile. Although the ITT rate (82.3%) fell short of the 90% guideline threshold, it remains clinically acceptable in a moderate-to-high resistance setting (Huairou: CLA resistance 26.7%, LVX 28.8%, dual 8.6%), supporting the value of susceptibility testing.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"592505"},"PeriodicalIF":2.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814597","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":"Pathological Proliferation of CD4⁺ T Cells in Late Presentation of HIV Infection After Antiretroviral Therapy.","authors":"Hao Liu, Caiping Guo, Zhen Li, Rui Wang, Letian Liu, Xue Chen, Yanmin Liu, Yulin Zhang, Tong Zhang, Yang Zhang","doi":"10.2147/IDR.S601557","DOIUrl":"https://doi.org/10.2147/IDR.S601557","url":null,"abstract":"<p><strong>Background: </strong>Despite the global success of antiretroviral therapy (ART) in reducing human immunodeficiency virus (HIV) related morbidity and mortality, late presentation of HIV infection remains a major challenge. This study aims to explore whether the immune dysregulation of pathological proliferation exists in late presenters (LP).</p><p><strong>Methods: </strong>People living with HIV (PLWH) were recruited and divided into LP group (n=55, defined as the presence of an AIDS-defining event and/or CD4 count <350 cells/μL) and non-late-presenters (n-LP) group (n=54). We evaluated the phenotype and function of CD4⁺ T cells in PLWH, and their correlation with clinical parameters. Mass cytometry was used to detect and analyze the phenotypic and functional characteristics of CD4⁺ T cells following ART.</p><p><strong>Results: </strong>The LP exhibited significantly lower CD4⁺ T cell counts compared to n-LP. A higher proportion of CD4⁺ T cell subpopulations with characteristics of proliferation (Ki67), activation (HLA-DR), exhaustion (PD-1) and senescence (CD57) was observed in LP. Besides, the proportion of CD4⁺ T cells with \"pathological proliferation\" properties (such as Ki67⁺CD57⁺, Ki67⁺HLA-DR⁺, Ki67⁺CD38⁺) in LP was much higher than that in n-LP. We found that the immune dysregulation characterized by pathological proliferation is related to multiple clinical parameters in LP.</p><p><strong>Conclusion: </strong>LP have persistent immune dysfunction post-ART, characterized by excessive and pathological T cell proliferation accompanied by activation or senescence. Future studies focusing on this pathological proliferation phenomenon will be essential to improve immune recovery, long-term prognosis, and health outcomes in advanced patients.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"601557"},"PeriodicalIF":2.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837261","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":"Predictive Factors for Progression to Severe Pulmonary Tuberculosis in Patients with Concurrent HIV/AIDS and Type 2 Diabetes Mellitus: A Single-Center Retrospective Study.","authors":"Bennan Zhao, Jun Kang, Qing Du, Dafeng Liu","doi":"10.2147/IDR.S603535","DOIUrl":"https://doi.org/10.2147/IDR.S603535","url":null,"abstract":"<p><strong>Purpose: </strong>The concurrent of HIV/AIDS, type 2 diabetes mellitus (T2D), and pulmonary tuberculosis (PTB) is a considerable public health challenge. This study aims to develop and validate a predictive model for the progression to severe PTB in patients with these three specific comorbidities.</p><p><strong>Patients and methods: </strong>A total of 114 patients with all three conditions-HIV/AIDS, T2D, and newly diagnosed PTB-who were admitted to the Public Health Clinical Center of Chengdu between 2018 and 2025, were enrolled as study subjects. We collected general demographic information of the research subjects, as well as laboratory indicators, TB etiological test results, and lung CT scans. First, subjects were divided into severe and non-severe PTB groups according to diagnostic criteria met during hospitalization, the Least Absolute Shrinkage and Selection Operator (LASSO) analysis was used to screen for predictors. Second, a multivariate logistic regression was used to build the predictive model. The model was evaluated using the receiver operating characteristic (ROC) curve, and calibration curve.</p><p><strong>Results: </strong>Binary logistic regression revealed that admission ALB, NLR, and D-Dimer were independently associated with progression to severe PTB. ALB (<i>OR</i>=0.906, 95% <i>CI</i>: 0.822-0.998) served as a protective factor, while NLR (<i>OR</i>=1.234, 95% <i>CI</i>: 1.075-1.417) and D-Dimer (<i>OR</i>=1.500, 95% <i>CI</i>: 1.113-2.021) were risk factors. The area under the curve (AUC) of the model incorporating three variables was 0.892 (95% <i>CI</i>: 0.830-0.955). Internal validation using Bootstrap resampling (1000 iterations) yielded a concordance index of 0.892 (95% <i>CI</i>: 0.825-0.946), confirming the robustness of its discriminative power.</p><p><strong>Conclusion: </strong>This study established a predictive model for progression to severe PTB in patients with these three specific comorbidities. Due to the lack of external validation, the clinical utility of this model remains to be further validated by multicenter studies.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"603535"},"PeriodicalIF":2.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814679","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":"Epidemiology, Risk Factors, and Routine Blood Biomarkers of Aspergillosis in Cancer Patients in Jiangxi, China.","authors":"Hazrat Bilal, Xunsong Wang, Jiamei Yu, Yan Li, Xiaohui Li, Hanman Qiu, Muhammad Nadeem Khan, Rahat Ullah Khan, Muhammad Shafiq, Qiao-Li Lv, Bin Xu","doi":"10.2147/IDR.S599801","DOIUrl":"https://doi.org/10.2147/IDR.S599801","url":null,"abstract":"<p><strong>Objective: </strong>Aspergillosis is a serious public health concern worldwide; however, its epidemiology and clinical predictors remain poorly characterized among cancer patients in China, particularly in regions such as Jiangxi, where regional data are limited. This study aimed to evaluate the epidemiology, risk factors, and potential utility of routine inflammatory biomarkers in distinguishing <i>Aspergillus</i> colonization from infection in this population.</p><p><strong>Methods: </strong>In the current retrospective study, the epidemiology, risk factors, and blood biomarkers of <i>Aspergillus</i> cases among cancer patients at Jiangxi Cancer Hospital in Nanchang, China, were investigated from 2021 to 2025.</p><p><strong>Results: </strong>There were 354 cases in all, with 14.1% colonization, 43.5% possible infections, and 42.4% probable infections. Almost half of the patients had underlying lung cancer (n = 161, 45.48%), and <i>Aspergillus fumigatus</i> (n = 313, 88.42%) was the most frequently detected species. The use of steroids (OR 18.16, p < 0.001), chemotherapy (OR 5.41, p = 0.003), and high glucose levels (OR 1.68, p = 0.02) were shown to be independent risk factors for infection in all cancer populations. In lung cancer patients, smoking (OR 4.11, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR 3.83, p = 0.02), and steroid usage (OR 3.06, p = 0.03) were independently related to higher infection risk. Biomarker analysis revealed that probable infection was associated with higher neutrophil and white blood cell (WBC) counts, a higher neutrophil-to-lymphocyte ratio (NLR), and metabolic markers, including glucose and creatinine. Principal component analysis (PCA) demonstrated distinct clustering driven by inflammatory signatures.</p><p><strong>Conclusion: </strong>This study provides comprehensive epidemiological data on aspergillosis in a large cohort of cancer patients in Jiangxi, China, and highlights the potential value of routinely available inflammatory markers in differentiating colonization from infection. These findings may support early risk stratification and improve clinical decision-making, particularly in resource-limited settings where advanced fungal diagnostics are not readily available.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"599801"},"PeriodicalIF":2.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814698","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":"Necrotizing Myositis Caused by <i>Enterococcus faecium</i> with Concurrent <i>Klebsiella pneumoniae Bacteremia</i>: A Rare Case Report.","authors":"Xilei Niu, Hairu Ji, Shuai Wang, Guoyu Wang, Yu Wang, Yanchao Liu, Lingwei Kong","doi":"10.2147/IDR.S591080","DOIUrl":"https://doi.org/10.2147/IDR.S591080","url":null,"abstract":"<p><p>We present a rare case of necrotizing myositis predominantly caused by <i>Enterococcus faecium</i> in a 68-year-old healthy man, with concurrent <i>Klebsiella pneumoniae bacteremia</i>. The patient rapidly progressed from diarrhea and fever to septic shock, multiple organ dysfunction, and compartment syndrome of the left leg. Blood cultures grew <i>K. pneumoniae</i>, while deep tissue cultures identified <i>E. faecium</i> as the main pathogen in necrotic muscle. Emergent fasciotomy, serial debridements, and targeted antibiotics (meropenem and linezolid/vancomycin) led to full recovery. This first reported case highlights the underappreciated virulence of <i>E. faecium</i> in soft tissue infections and underscores the need for prompt imaging, surgical intervention, and comprehensive microbiological workup in severe infections. The case also emphasizes the importance of considering polymicrobial etiology and monitoring for antibiotic adverse effects.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"591080"},"PeriodicalIF":2.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814689","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":"Clinical Outcomes of Omadacycline in Critically Ill Patients Treated for Carbapenem-Resistant Organism Infections: A Retrospective Study.","authors":"Na Chen, Qiang Xu, Renting Song, Yesi Luo, Lingbo Xie, Jianying Zhou, Xiaojuan Wang","doi":"10.2147/IDR.S582186","DOIUrl":"https://doi.org/10.2147/IDR.S582186","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy and safety of omadacycline (OMA) for the treatment of carbapenem-resistant organisms (CROs) infections, which are associated with substantial morbidity and mortality and limited therapeutic options.</p><p><strong>Methods: </strong>The patients included were ≥18 years old, had CRO-positive cultures, and had been treated with OMA-based combination therapy for ≥72 hours. Common clinical comorbidities and markers of disease progression were collected. The primary outcome was 30-day all-cause mortality. The secondary outcomes included 30-day recurrence, resolution of signs and symptoms of infection, 90-day readmission, and OMA-possible adverse events.</p><p><strong>Results: </strong>This study included 132 patients treated with OMA for CRO infections, with a median age of 67 years and a majority of male patients. Of the 132 patients analyzed, 78.8% were admitted to the intensive care unit, with hypertension, diabetes, and chronic pulmonary disease being the most frequent comorbidities. The median Charlson Comorbidity Index (CCI) score for the entire cohort was 5 (interquartile range [IQR], 4-7), indicating a moderate to high comorbidity burden. Pneumonia represented the predominant infection (84.8%). The overall 30-day mortality rate was 27.3%. In the Carbapenem-Resistant <i>Acinetobacter baumannii</i> (CRAB) cohort (n=89), OMA therapy was initiated promptly following culture confirmation, with a median treatment duration of 8 days. The 30-day mortality rate in this subgroup was 29.2% (26/89). Adverse events included elevated aspartate transaminase (21.3%, 19/89), alanine aminotransferase (18.0%, 16/89), alkaline phosphatase (23.6%, 21/89), blood urea nitrogen (25.8%, 23/89) and decreased fibrinogen levels (18.0%, 16/89). In the Carbapenem-Resistant <i>Klebsiella pneumoniae</i> (CRKP) cohort (n=57), the 30-day mortality rate was 29.8% (17/57), with a safety profile comparable to the CRAB group.</p><p><strong>Conclusion: </strong>The results demonstrated that OMA has promising clinical efficacy against CRAB or CRKP infections in critically ill patients.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"582186"},"PeriodicalIF":2.9,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814578","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}