Infection and Drug Resistance最新文献

{"title":"Best Evidence Summary for the Prevention of Ventilator-Associated Pneumonia.","authors":"Wenjuan Wu, Yuanxin Pan, Xiang An, Jiamin Lyu","doi":"10.2147/IDR.S637541","DOIUrl":"10.2147/IDR.S637541","url":null,"abstract":"<p><strong>Objective: </strong>To retrieve, appraise, and synthesize the best available evidence on the prevention of ventilator-associated pneumonia (VAP) from Chinese and international sources, and to provide evidence-based guidance for clinical nursing practice.</p><p><strong>Methods: </strong>Guided by the 6S evidence pyramid model, a comprehensive electronic search was conducted in BMJ Best Practice, UpToDate, the Guidelines International Network, the National Institute for Health and Care Excellence, the Scottish Intercollegiate Guidelines Network, the Registered Nurses' Association of Ontario, the American Association for Respiratory Care, the American Thoracic Society, CHEST, the Cochrane Library, the IBI Evidence-Based Health Care Center database, Embase, PubMed, Medlive, the Chinese Thoracic Society, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang Database. The search period ranged from January 1, 2016, to January 1, 2026. Evidence summaries, clinical practice guidelines, systematic reviews, and other evidence-based resources related to VAP prevention were retrieved. After quality appraisal and evidence synthesis, the best evidence was summarized.</p><p><strong>Results: </strong>A total of 24 publications were included, comprising 2 clinical decision support resources, 10 systematic reviews, 5 guidelines, and 7 evidence summaries. Thirty-three recommendations were synthesized into eight practical domains covering organizational strategies, prevention bundles, airway management, positioning, nutrition, device management, pharmacologic approaches, and non-recommended interventions.</p><p><strong>Conclusion: </strong>This evidence summary systematically synthesizes the best available evidence regarding VAP prevention and provides evidence-based guidance for standardized clinical management. These findings may support clinical decision-making and the development of nursing practice strategies for VAP prevention; however, further studies are needed to evaluate the effectiveness of implementing these recommendations in specific clinical settings.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"637541"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905944","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":"The Re-Emergence of Bundibugyo Ebolavirus in Uganda and the Democratic Republic of Congo: Epidemiological Drivers, Response Strategies, and Implications for Global Health Security.","authors":"Gerald Olwit, Ivy Bochaberi Ombongi, Henon Ataryeba, Andrea Nantongo, Babirye Shamim","doi":"10.2147/IDR.S632723","DOIUrl":"10.2147/IDR.S632723","url":null,"abstract":"<p><p>Bundibugyo ebolavirus (BDBV) is one of the least studied species within the genus Orthoebolavirus (family Filoviridae), despite its capacity to cause severe Ebola virus disease (EVD) with substantial mortality. First identified during a 2007-2008 outbreak in Bundibugyo District, western Uganda (149 reported cases, 37 deaths; case-fatality rate [CFR] approximately 25-36%), BDBV re-emerged in 2012 in Orientale Province, Democratic Republic of the Congo (DRC) (57-59 cases, 29-34 deaths; CFR 34-58%), before resurfacing in Ituri Province, DRC, in April-May 2026. By 11 August 2026, this third outbreak had grown to 4566 laboratory-confirmed cases and 2128 deaths (CFR ≈ 47%) across five DRC provinces and Uganda, becoming the largest, fastest-growing BDBV epidemic on record and the second-largest Ebola-family outbreak overall. This narrative review, not a systematic review or meta-analysis, summarizes peer-reviewed literature, preprints, and official situation reports from WHO, Africa CDC, US CDC, ECDC, and national health ministries, identified through PubMed, Scopus, Web of Science, Google Scholar, and Embase from inception to 12 August 2026, to examine BDBV historical evolution, virology and pathogenesis, drivers of re-emergence, surveillance and response, therapeutic and vaccine gaps, and global health security implications. The 2026 outbreak, unfolding amid conflict and mass displacement in eastern DRC, has been marked by an estimated basic reproduction number of 1.4-2.1 (central estimate 1.71), disproportionate infection among healthcare workers (7.2% of confirmed cases in DRC, 20% in Uganda), and the continued absence of licensed BDBV-specific vaccines or therapeutics. Findings underscore the need for sustained genomic and ecological surveillance, decentralized rapid diagnostics, broadly protective pan-filovirus vaccines, conflict-sensitive response strategies, and strengthened Uganda-DRC collaboration. Because the evidence base for the ongoing outbreak remains preliminary, findings should be interpreted cautiously and revisited as further peer-reviewed data emerge.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"632723"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906028","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":"Late-Onset Sepsis and Meningitis Caused by <i>Elizabethkingia meningoseptica</i>: A Case Report.","authors":"Shasha Liao, Shaoling Qiu, Na Li, Yunyuan Liu, Xiuneng Tang","doi":"10.2147/IDR.S633763","DOIUrl":"10.2147/IDR.S633763","url":null,"abstract":"<p><p><i>Elizabethkingia meningoseptica</i> is a gram-negative bacillus. Increasing body of literature shows that opportunistic infections may be caused by this Gram negative bacillus in immunocompromised adults and neonates. We describe a case of a preterm neonate born at 33 weeks of gestation who presented with fever and reluctance to feed for two days at one month after birth. Initial laboratory tests of blood and cerebrospinal fluid cultures showed evidence of late-onset sepsis and meningitis caused by <i>E. meningoseptica</i>, which was sensitive to piperacillin/tazobactam, cefoperazone/sulbactam, trimethoprim/sulfamethoxazole, levofloxacin, and minocycline. The neonate underwent sequential anti-infective therapy regimens consisting of: 1) cefoperazone/sulbactam (2:1) in combination with levofloxacin; 2) cefoperazone/sulbactam (2:1) paired with rifampicin; and 3) linezolid administered concomitantly with rifampicin. The neonate exhibited clinical manifestations of ventricular dilatation accompanied by hydrocephalus. The neonate received an 85-day course of anti-infective treatment during hospitalization. Follow-up cranial computed tomography (CT) imaging performed four months post-discharge demonstrated complete resolution of the previously observed complications.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"633763"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900217","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 Factors and Microbiological Characterization of Healthcare Associated Infection Post Cardiac Surgery Among Children in Beijing, China.","authors":"Yan Xu, Lei Shen, Nan Ding, Yaobin Zhu, Yige Chen, Gejingwa Zhao, Zhiqiang Li","doi":"10.2147/IDR.S623693","DOIUrl":"10.2147/IDR.S623693","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare associated infection (HAI) in children after open-heart surgery contributes substantially to morbidity and mortality. We aimed to analyze the clinical and microbiological characteristics of HAI after pediatric cardiac surgery.</p><p><strong>Methods: </strong>This single-center retrospective study was conducted in Beijing Children's Hospital from July 1, 2022 to June 30, 2025 including children with congenital heart disease (CHD) who underwent open-heart surgeries.</p><p><strong>Results: </strong>A total of 1206 patients were included in this study. The overall HAI rate was 13.6%. Multivariate logistic regression analysis found underlying diseases (odds ratio [OR] = 12.342; 95% confidence interval [CI]: 5.744-26.518; <i>P</i> < 0.001), moderate and severe preoperative pulmonary artery hypertension (pre-PAH) (OR = 3.141; 95% CI: 1.311-7.527; <i>P</i> = 0.010 and OR = 3.312; 95% CI: 1.407-7.797, <i>P</i> = 0.006), and aortic cross-clamping (ACC) time (OR = 1.026; 95% CI: 1.008-1.045; <i>P</i> = 0.004) were significantly associated with postoperative HAI. Additionally, no significant association was observed between glucocorticoid use and postoperative HAI in our study. Of the 238 organisms detected, bacteria predominated (55.9%, 133/238). Gram-negative bacilli accounted for 89.5% (119/133) of the bacterial isolates, and <i>Klebsiella pneumoniae</i> was the only multi-drug resistant organism (MDRO) identified.</p><p><strong>Conclusion: </strong>Our study suggested underlying diseases, moderate and severe pre-PAH, and ACC time were independently associated with postoperative HAI. <i>Klebsiella pneumoniae</i> was the only MDRO among the most common gram-negative bacilli.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"623693"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900266","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":"Fatal Pharyngeal Cellulitis Caused by <i>Rhizopus microsporus</i> in a Patient with Acute Myeloid Leukemia.","authors":"Junqing Wu, Xueping Luo, Shan Fu, Shuihong Zhou, Jianqin He, Dan Zhang, Weiyan Zheng","doi":"10.2147/IDR.S608970","DOIUrl":"10.2147/IDR.S608970","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with immunodeficiency are highly susceptible to life-threatening fungal infections. Pharyngeal cellulitis caused by <i>Rhizopus microsporus</i> are exceptionally rare.</p><p><strong>Case presentation: </strong>We reported a case of relapsed acute myeloid leukemia (AML) complicated by post-chemotherapy <i>Rhizopus microsporus</i> pharyngeal cellulitis. This cellulitis resulted in severe tissue necrosis, pharyngeal obstruction, and sub-sequent suffocation. Emergency bedside tracheotomy was administered after acute respiratory distress. The metagenomic next-generation sequencing (mNGS) identified <i>Rhizopus microsporus, Klebsiella pneumoniae, Candida albicans</i>, and SARS-CoV-2. Despite surgical intervention and combination antimicrobial therapy (amphotericin B, posaconazole, daptomycin, ceftriaxone, and molnupiravir), the patient stabilized for 2 months before culminating in fatal carotid artery rupture.</p><p><strong>Conclusion: </strong><i>Rhizopus microsporus</i>-related pharyngeal cellulitis is rare yet highly aggressive, demanding timely diagnosis and close monitoring. This case highlights the critical role of rapid mNGS in diagnosing polymicrobial infections, underscores the necessity of combining aggressive surgical debridement with antifungal/antimicrobial regimens, and stresses rigorous surveillance to prevent life-threatening vascular complications.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"608970"},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900290","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":"From Symbiont to Potential Carcinogenic Contributor: Examining the Pathogenic Evolution of <i>Morganella morganii</i> in Colorectal Cancer.","authors":"Kosar Soleymanpour, Behrooz Shokouhi, Hossein Samadi Kafil","doi":"10.2147/IDR.S632383","DOIUrl":"10.2147/IDR.S632383","url":null,"abstract":"<p><p><i>Morganella morganii</i> (<i>M. morganii</i>), a member of the Enterobacteriaceae family, and a constituent of the human gut microbiota, has recently emerged as a candidate microbial contributor to the development of adenomatous polyps (AP) and promoting colorectal carcinogenesis. The present study is a narrative review compiled to evaluate the role of <i>M. morganii</i> in the development and progression of AP and colorectal cancer (CRC). A comprehensive literature search was conducted using Google Scholar and PubMed/Medline (2020-2026) using keywords related to the gut microbiota, <i>M. morganii</i>, and its impact on CRC and intestinal polyps. The ability of <i>M. morganii</i> to produce a specific type of genotoxin, indolimine, is a distinguishing feature of this bacterium compared to other intestinal bacteria. Because its production is independent of the <i>pks</i> gene cluster and the <i>clbI</i> and <i>clbP</i> genes, it exhibits a different damage pattern, namely, DNA smearing. According to reports from previous studies, strains lacking the <i>aat</i> gene exhibited no detectable genotoxic activity, supporting the role of <i>aat</i> in genotoxicity. Available data from in vitro experiments, animal models, a limited number of human observational studies, and findings from research groups suggest that <i>M. morganii</i> may, through the production of a highly potent genotoxin, be associated with distinct genetic damage, metabolic changes, and facilitation of polyp growth, and contribute to the development and acceleration of CRC. These findings establish a new theoretical framework in which CRC is not simply caused by gut microbiota dysbiosis, but rather reflects the activation of genotoxic bacteria and their functional interaction within the intestinal epithelial microenvironment. Nevertheless, owing to the scarcity of longitudinal human studies, it cannot yet be conclusively established whether <i>M. morganii</i> plays a predisposing, an initiating, or merely a consequential role in the development of CRC. Larger human studies investigating the association between <i>M. morganii</i> colonization and CRC development are essential for understanding the causal relationship.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"632383"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897288","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":"A Prediction Model for Persistent Inflammation-Immunosuppression-Catabolism Syndrome in Patients with Sepsis: An Ambispective Cohort Study.","authors":"Xiangning Zhong, Jindai Yang, Le Chang, Xiaoyu Wang, Lan Peng, Wenjuan Yan, Hongbin Hu, Zhongqing Chen, Yaoyuan Zhang","doi":"10.2147/IDR.S623214","DOIUrl":"10.2147/IDR.S623214","url":null,"abstract":"<p><strong>Objective: </strong>To develop and temporally validate an admission-variable model for estimating the risk of persistent inflammation-immunosuppression-catabolism syndrome (PICS) among patients with sepsis who remained in the intensive care unit (ICU) for ≥14 days.</p><p><strong>Methods: </strong>We conducted an ambispective, single-center cohort study. The retrospective development cohort included patients admitted from January 2023 to May 2025, and the prospective temporal validation cohort included patients admitted from June 2025 to February 2026. Candidate predictors measured at ICU admission were selected using least absolute shrinkage and selection operator (LASSO) regression and entered into a multivariable logistic regression model. Discrimination, calibration, and potential clinical utility were evaluated using the area under the receiver operating characteristic curve (AUC), calibration analyses, and decision curve analysis.</p><p><strong>Results: </strong>The development cohort included 242 patients, of whom 93 (38.4%) met the PICS criteria. Compared with respiratory infection, urinary infection (adjusted odds ratio (aOR 0.07, 95% CI 0.01-0.67), gastrointestinal infection (aOR 0.15, 95% CI 0.05-0.45), and skin or soft-tissue infection (aOR 0.29, 95% CI 0.11-0.77) were associated with lower odds of PICS. Higher lactate was associated with higher odds of PICS (aOR 1.20, 95% CI 1.07-1.34), whereas higher lymphocyte count (aOR 0.46, 95% CI 0.28-0.77), albumin (aOR 0.92, 95% CI 0.86-0.99), and vitamin D (aOR 0.88, 95% CI 0.83-0.94) were associated with lower odds. The AUC was 0.803 (95% CI 0.747-0.859) in the development cohort and 0.791 (95% CI 0.718-0.864) in the temporal validation cohort.</p><p><strong>Conclusion: </strong>Among patients with sepsis who remained in the ICU for ≥14 days, an admission-variable model showed acceptable discrimination in the development and temporal validation cohorts. External multicenter validation and prospective impact evaluation are required before clinical use.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"623214"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897266","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":"Immune Biomarker Profiling Across Clinical States and Development of a SOFA-Integrated Model for 28-Day Mortality Prediction in Sepsis: A Prospective Cohort Study.","authors":"Ming Hu, Tingting Huang, Runfeng Sun, Huiyi Wu, Jiaping Wang, Xuan Huang","doi":"10.2147/IDR.S627303","DOIUrl":"10.2147/IDR.S627303","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is characterized by complex immune dysregulation involving innate immune activation, myeloid stress, and adaptive immune exhaustion. Conventional severity scores mainly reflect organ dysfunction and may not fully capture immune heterogeneity. This study aimed to develop and internally validate an immune-based model for predicting 28-day mortality in sepsis.</p><p><strong>Methods: </strong>This prospective cohort study included 695 participants, including 263 patients with sepsis, 160 infection non-sepsis patients, 152 non-infection critically ill patients, and 120 healthy controls. Immune biomarkers, including neutrophil CD64, heparin-binding protein (HBP), membrane-bound neutrophil alkaline phosphatase (mNAP), and PD-1⁺CD4⁺ T cells, were measured within 6 hours of ICU admission. A mortality prediction model was developed exclusively in the sepsis cohort using LASSO logistic regression and multivariable logistic regression. The model was internally validated using bootstrap resampling, Model performance was assessed using discrimination, calibration, decision curve analysis, and bootstrap internal validation.</p><p><strong>Results: </strong>Sepsis patients exhibited significantly higher levels of CD64, HBP, mNAP, and PD-1⁺CD4⁺ T cells than infection non-sepsis patients, non-infection critically ill patients, and healthy controls. Among 263 sepsis patients, 56 died within 28 days. LASSO identified five predictors: CD64, HBP, mNAP, PD-1⁺CD4⁺ T cells, and SOFA score. The combined SOFA-integrated immune model achieved an apparent AUC of 0.930 and a bootstrap-corrected AUC of 0.918, with good calibration.</p><p><strong>Conclusion: </strong>The proposed model provides an exploratory, internally validated framework for 28-day mortality risk stratification in sepsis and requires external validation before clinical application.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"627303"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897337","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":"Diagnostic and Therapeutic Impact of Metagenomic Next-Generation Sequencing in Tuberculous Osteoarticular Infections with Negative or Confounding Conventional Cultures.","authors":"Zhirui Xue, Hongyan Li, Xianming Wang, Yuanqing Cai, Zida Huang, Wenbo Li, Yang Su, Zhaoyang Wu, Xinyu Fang, Wenming Zhang","doi":"10.2147/IDR.S620236","DOIUrl":"10.2147/IDR.S620236","url":null,"abstract":"<p><strong>Purpose: </strong>Diagnosing tuberculous osteoarticular infections (TB-OAI) remains challenging due to frequent false-negative or confounding conventional culture results. This study evaluated the diagnostic and therapeutic utility of metagenomic next-generation sequencing (mNGS) for occult TB-OAI in patients presenting with negative or misleading culture outcomes.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 13 patients with confirmed TB-OAI, encompassing periprosthetic, fracture-related, and native joint infections. Patients were stratified by conventional culture results into strictly culture-negative (n=8) and culture-confounded (n=5; yielding non-mycobacterial organisms) groups. A composite reference standard of mNGS positivity combined with histopathological or clinical validation established the definitive diagnosis. We assessed diagnostic yield, therapeutic modifications, and clinical outcomes.</p><p><strong>Results: </strong>Conventional culture failed to identify <i>Mycobacterium tuberculosis</i> in all 13 cases (0% sensitivity) and yielded misleading non-mycobacterial flora in 5 cases (38.5%). Conversely, mNGS successfully identified the pathogen in 100% (13/13) of patients, corroborated by histopathology in all cases. Consequently, mNGS results changed clinical management from empirical antibiotics to targeted anti-tuberculosis therapy in all cases (100%). Postoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels decreased significantly (<i>P</i> < 0.05). Over a mean follow-up of 17.5 ± 3.0 months, 12 patients achieved durable infection eradication. One patient experienced early recurrence requiring a two-stage revision, ultimately achieving successful infection control.</p><p><strong>Conclusion: </strong>mNGS serves as a promising diagnostic rescue tool for occult TB-OAI when conventional cultures are negative or misleading. While limited by sample size, these preliminary findings suggest mNGS effectively guides the transition from empirical to targeted anti-tuberculosis therapy and limits diagnostic delays.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"620236"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897264","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":"Predictors and Clinical Outcomes of Ciprofloxacin Resistance in Acute Gram-Negative Osteomyelitis: Insights from a Six-Year Retrospective Study.","authors":"Rania A El-Kady, Ahd A Mansour, Mohamed Y Yousef","doi":"10.2147/IDR.S638765","DOIUrl":"10.2147/IDR.S638765","url":null,"abstract":"<p><strong>Background: </strong>Ciprofloxacin resistance among Gram-negative bacteria causing osteomyelitis is an emerging clinical concern that may negatively influence disease severity and patient outcomes. This study sought to assess the burden, independent predictors, and clinical impact of ciprofloxacin resistance in acute Gram-negative osteomyelitis.</p><p><strong>Methods: </strong>A retrospective analysis was performed on patients with acute Gram-negative osteomyelitis between 2019-2024. Clinical, microbiological, laboratory, and outcome variables were compared between ciprofloxacin-resistant and susceptible cohorts. Univariable binary logistic regression analyses were performed to identify factors associated with ciprofloxacin resistance, followed by multivariable binary logistic regression analysis to identify independent predictors. Statistical significance was considered at <i>p</i>-value <0.05 (two-tailed).</p><p><strong>Results: </strong>Antimicrobial resistance patterns were assessed among 279 Gram-negative isolates, while clinical and outcome analyses were conducted among 256 patients. The overall prevalence of ciprofloxacin resistance was 54.5% among Gram-negative isolates. In the univariable binary logistic regression analysis, ciprofloxacin resistance was significantly associated with chronic heart disease (<i>p</i> = 0.03), lower hemoglobin concentration (<i>p</i> = 0.04), hypoalbuminemia (<i>p</i> = 0.0001), and increased inflammatory biomarkers, including c-reactive protein (CRP; <i>p</i> = 0.001), and neutrophil-to-lymphocyte ratio (NLR; <i>p</i> = 0.04). Osteomyelitis caused by ESBL-producing pathogens was also significantly associated with ciprofloxacin resistance (OR = 3.93, 95% CI: 1.87-8.31; <i>p</i> = 0.0001). In the multivariable analysis, hypoalbuminemia (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI]: 0.35-0.79; <i>p</i> = 0.002) and infection with ESBL-producing pathogens (AOR = 0.25, 95% CI: 0.11-0.54; <i>p</i> = 0.0001) remained independently associated with ciprofloxacin resistance. Compared with ciprofloxacin-susceptible cohort, ciprofloxacin-resistant patients required significantly more surgical debridement (<i>p</i> = 0.006) and developed higher rates of chronic osteomyelitis (<i>p</i> = 0.005), septic shock (<i>p</i> = 0.03), and in-hospital mortality (<i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Ciprofloxacin resistance was prevalent among Gram-negative osteomyelitis cases and was associated with greater surgical complexity and poorer clinical outcomes. Early identification of ciprofloxacin-resistant infections and integration of clinical and inflammatory markers may support risk stratification and therapeutic decision-making. Given the retrospective, observational, single-center design, these findings should be interpreted cautiously and validated in larger multicenter studies.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"638765"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897286","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}