Infection and Drug Resistance最新文献

{"title":"Genomic Characterization of SARS-CoV-2 NB.1.8.1 and PQ.2 from the Infants and Young Children with Gastrointestinal Symptoms.","authors":"Xianyan Zhang, Xuemin Guo","doi":"10.2147/IDR.S614363","DOIUrl":"10.2147/IDR.S614363","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the viral genomic characteristics of infants and young children who presented to our hospital with gastrointestinal symptoms during a local COVID-19 epidemic and were confirmed to have SARS-CoV-2 infection.</p><p><strong>Patients and methods: </strong>Between May and August 2025, pharyngeal swab samples were collected from four infants and young children who presented to the outpatient department of Meizhou People's Hospital in Meizhou, with gastrointestinal symptoms. Nucleic acid testing and whole-genome sequencing were performed. The viral mutation profile was analyzed, and the potential impact of mutations on protein function was predicted.</p><p><strong>Results: </strong>Pangolin typing identified the NB.1.8.1 variant in three patients and the PQ.2 variant in one patient. Genome sequences from three of the four viral variants displayed varying degrees of mutation. The nonsynonymous mutations for both variants were concentrated in the spike protein. A comparison with the parental XDV.1.5.1 lineage revealed 14 specific mutations, with 7 nonsynonymous sites conserved across all gene sequences. Five of these mutation sites, <i>NSP12</i>: D284Y, <i>ORF3a</i>: L46F, <i>ORF3a</i>: F207C, <i>N</i>: Q9H, and <i>N</i>: Q384H, were predicted to be functionally deleterious and structurally destabilizing.</p><p><strong>Conclusion: </strong>SARS-CoV-2 variants from specimens obtained from four infants and young children exhibited varying degrees of mutation, providing evidence for the ongoing evolution of emerging variants in pediatric patients. However, monitoring genomic changes of circulating variants requires further clinical specimens, which contributes to understanding the dynamic changes at mutation sites, thereby supporting epidemic prevention and control.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"614363"},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497509","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":"Metagenomic Next-Generation Sequencing for Brain Abscess: Improved Pathogen Detection, Targeted Antimicrobial Therapy, and Association with Fewer Surgical Interventions.","authors":"Xiangyun Li, Meixiang Fan, Jiang Yue, Jiahui Xie, Yutu Zhang, Xiaozhe Lu, Liangliang Liu, Xiantao Li, Yanyan Huang","doi":"10.2147/IDR.S617362","DOIUrl":"10.2147/IDR.S617362","url":null,"abstract":"<p><strong>Background: </strong>Brain abscesses demand prompt, accurate pathogen identification; however, identification using conventional culture is limited, especially for anaerobic and polymicrobial infections. We compared the diagnostic and clinical utility of metagenomic next-generation sequencing (mNGS) with that of conventional culture in patients with brain abscess.</p><p><strong>Methods: </strong>We retrospectively included 115 patients with confirmed brain abscess pathogens. Seventy-two patients underwent both mNGS and conventional culture, and 43 underwent culture alone. We evaluated diagnostic performance, pathogen profiles, adjustments to antimicrobial regimens, and clinical outcomes.</p><p><strong>Results: </strong>mNGS detected pathogens in 86.1% of patients versus 44.4% for culture (Cohen's kappa test p=0.004; McNemar's test p=0.0001). It identified mixed infections in 53.2% of cases, whereas culture predominantly revealed single pathogens. mNGS produced substantially higher detection rates than culture for anaerobic bacteria (50.0% vs 16.7%) and oral-derived bacteria (77.6% vs 61.1%). Antimicrobial regimens were adjusted in 54.2% of patients based on mNGS results; 61.5% of these adjustments involved de-escalation, and vancomycin was discontinued in 77.8% of patients. mNGS use was associated with a lower surgical intervention rate (47.2% vs 65.1%, P = 0.002). There were no differences in length of hospital stay, fever duration, Glasgow Outcome Scale score, or hospitalization costs. In eight patients without reported dental history, mNGS revealed occult odontogenic foci, enabling source control and potentially reducing recurrence risk.</p><p><strong>Conclusion: </strong>mNGS outperformed conventional culture for detecting mixed infections, anaerobes, and pathogens of d origin. It may inform targeted antimicrobial therapy and assist in identifying the infection source. In this single‑center retrospective study, which is subject to potential selection bias, mNGS use was associated with a lower rate of surgical intervention; however, this finding should be interpreted as an association rather than causation, and prospective studies are needed to confirm this observation. These findings support the integration of mNGS into diagnostic algorithms for brain abscess.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"617362"},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497598","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 and Microbiological Characteristics Associated with Treatment Outcomes Among Rifampicin-Resistant Tuberculosis Patients in Limpopo Province.","authors":"Ivy Rukasha, Kgothatso Ashley Rakgate, Kabelo Gabriel Kaapu","doi":"10.2147/IDR.S613052","DOIUrl":"10.2147/IDR.S613052","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis (DR-TB) remains a major public health concern in South Africa, particularly in rural provinces such as Limpopo, where access to specialized care is limited. High HIV prevalence, population mobility, and constrained diagnostic capacity further complicate disease control. Province-specific data are essential to guide targeted interventions; however, factors associated with treatment outcomes in rural settings remain poorly characterized.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using routinely collected laboratory and programmatic data. All laboratory-confirmed DR-TB cases recorded in Limpopo Province between 2023 and 2025 were included. Microbiological data were obtained from the National Health Laboratory Service, while demographic, clinical, and treatment outcome data were extracted from the Electronic Drug-Resistant Tuberculosis Register. Descriptive statistics summarized patient characteristics. Associations with treatment outcomes were assessed using chi-square tests and multivariable logistic regression. Kaplan-Meier analysis compared survival by HIV status.</p><p><strong>Results: </strong>A total of 86 RR-TB patients were included. Most were aged 25-44 years (65.1%), with males comprising 70.9%, and 55.8% were HIV co-infected. Favourable treatment outcomes were observed in 62 (71.4%) patients, while 12 (14.3%) experienced unfavourable outcomes and 12 (14.3%) remained on treatment. In multivariable analysis, younger age (15-24 years) (AOR = 9.97, 95% CI: 1.48-67.33) and smear-negative status (AOR = 39.62, 95% CI: 3.33-471.83) were independently associated with unfavourable outcomes, whereas HIV status was not significant after adjustment. Kaplan-Meier analysis showed poorer survival among HIV-positive patients (log-rank p = 0.002), although this was not retained in the adjusted model.</p><p><strong>Conclusion: </strong>DR-TB in Limpopo is characterized by a high burden of TB-HIV co-infection and rifampicin resistance. Clinical factors, rather than resistance patterns, were key determinants of unfavourable outcomes. Strengthening integrated TB-HIV services, improving early diagnosis, and expanding drug susceptibility testing are critical to improving outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"613052"},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519950","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 and Epidemiologic Characteristics of Anaerobic Bacteria Originating from Blood Cultures: A Five-Year Retrospective Study.","authors":"Yaqin Peng, Jiamin Qin, Lu Bai, Lihong Bai, Xiaowen Jiang, Huiting Li, Kang Liao, Shuai Wang, Penghao Guo","doi":"10.2147/IDR.S611452","DOIUrl":"10.2147/IDR.S611452","url":null,"abstract":"<p><strong>Background: </strong>With the rise of anaerobic bacteremia and resistance to anaerobes for commonly used agents, the resistance patterns of many anaerobes have changed significantly among different geographic areas and medical facilities. This study investigated the clinical and epidemiologic characteristics of anaerobic bacteremia for therapeutic optimization at the local level.</p><p><strong>Methods: </strong>This retrospective observational study included all positive blood cultures (BC) from 2020 to 2024. For patients with anaerobic bacteria originating from BCs, clinical and microbiological data were collected.</p><p><strong>Results: </strong>In total, 239 anaerobic strains were isolated from 223 patients. Among BC-positive bacteria, the proportion of anaerobes accounted for 4.4% (239/5450), with a gradual increase from 3.0% in 2020 to 6.1% in 2024. The most common anaerobes were <i>Bacteroides fragilis</i> (34.7%) and <i>Cutibacterium acnes</i> (20.5%). The resistance rates of gram-negative anaerobes to penicillin, imipenem, and meropenem were 94.4%, 21.1%, and 35.2%, respectively, which were much higher than those of gram-positive anaerobes (16.7%, 0%, 0%). Among the 223 cases, abdominal disorders were the most frequent underlying condition (54.7%). In the empirical antibiotic therapy, 94.6% of the patients received β-lactam antibiotics, and the infection symptoms improved in 74.9% of the patients. For <i>Bacteroides</i> spp. bacteremia, the improvement rate in patients treated with carbapenems and β-lactam/β-lactamase inhibitor combinations was 78.1% and 40.0%, respectively.</p><p><strong>Conclusion: </strong>The study presents valuable data for monitoring and improving anaerobic bacteremia treatment in Southern of China.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"611452"},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497541","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, Antimicrobial Resistance, and Seasonal Dynamics of Respiratory Bacterial Pathogens in a Saudi Tertiary Care Hospital (2023-2025).","authors":"Ahmed J Alzahrani, Samar El-Shahidy, Amina Lahyani, Ahmed Al Hussain, Bilal Al Olayan, Nada Alruwais, Soheir A A Hagras, Ahmed Al Faran, Osamah T Khojah","doi":"10.2147/IDR.S610414","DOIUrl":"10.2147/IDR.S610414","url":null,"abstract":"<p><strong>Background: </strong>Respiratory tract infections (RTIs) remain a major cause of morbidity and mortality, particularly among hospitalized and critically ill patients. The increasing prevalence of multidrug-resistant organisms (MDROs) complicates treatment and highlights the need for local surveillance to guide antimicrobial stewardship. This study investigated the epidemiology, antimicrobial resistance patterns, and seasonal trends of respiratory bacterial pathogens in a tertiary care hospital in Riyadh, Saudi Arabia.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on 5582 respiratory specimens collected between January 2023 and December 2025. Samples included tracheal aspirates, sputum, bronchoalveolar lavage, throat swabs, pleural fluids, ear swabs, and nasal swabs. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK® 2 Compact system and interpreted according to CLSI M100-S35 guidelines. Statistical analyses included Chi-square tests and logistic regression.</p><p><strong>Results: </strong>Culture positivity was 38.6% (2154/5582), with tracheal aspirates and sputum accounting for the most positive specimens. The predominant pathogens were <i>Pseudomonas aeruginosa</i> (31.9%), <i>Klebsiella</i> spp. (21.3%), <i>Staphylococcus aureus</i> (10.2%), <i>Serratia marcescens</i> (6.3%), <i>Escherichia coli</i> (5.7%) and <i>Acinetobacter baumannii</i> (5.5%). Culture positivity increased significantly with age (p<0.001), with Gram-negative bacteria predominating in older patients. MDROs were slightly prevalent, including, carbapenem-resistant organisms (22.9%) and ESBL producers (12.3%). The highest MDRO burden occurred in intensive care and other high-acuity wards. Seasonal analysis demonstrated a significant increase in MDRO prevalence during the summer months, with carbapenem-resistant Gram-negative pathogens rising from 18.2% in the winter to 28.7% in the summer (OR 1.82, 95% CI: 1.45-2.28; p<0.001).</p><p><strong>Conclusions: </strong>Respiratory pathogens in this Saudi tertiary care hospital exhibited a high prevalence of multidrug resistance, particularly among Gram-negative bacteria and in critical care settings. Seasonal increases in resistance during the summer months suggest the need for intensified infection control measures, strengthened antimicrobial stewardship, and ongoing surveillance to reduce MDRO transmission and optimize patient outcomes.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"610414"},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497577","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":"Early Tacrolimus C0/D Ratio and Subsequent Proven Invasive Fungal Disease After Liver Transplantation with Routine Early Echinocandin Prophylaxis.","authors":"Wenjing Hou, Zhizhong Liang, Xiao Luo, Heng Guo, Yuhong Zhang, Hongwei Li, Jinlin Guo","doi":"10.2147/IDR.S623612","DOIUrl":"10.2147/IDR.S623612","url":null,"abstract":"<p><strong>Background: </strong>Invasive fungal disease (IFD) may occur despite routine early echinocandin prophylaxis after liver transplantation, but the relationship between early tacrolimus exposure metrics and subsequent proven IFD remains uncertain. We evaluated whether early tacrolimus trough concentration and the concentration-to-dose (C0/D) ratio were associated with subsequent proven IFD in this prophylaxis-treated cohort.</p><p><strong>Methods: </strong>In a two-center retrospective cohort of adult liver transplant recipients receiving routine postoperative caspofungin for 5 days, tacrolimus exposure was summarized as the patient-level median trough concentration and C0/D ratio during postoperative days (PODs) 3-10. Inpatient fungal outcomes were classified as no fungal infection, probable/possible IFD, or proven IFD according to consensus criteria. Multinomial logistic regression adjusted for prespecified demographics, illness severity, immunosuppression, and center; exposure quartiles and restricted cubic splines assessed dose-response and nonlinearity. Exploratory sensitivity analyses examined severity-adjusted associations, apparent discrimination, and incremental area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among 164 recipients, 25 (15.2%) developed proven IFD and 18 (11.0%) probable/possible IFD; proven cases were predominantly mould infections, including <i>Aspergillus</i> spp. and Mucorales. Higher tacrolimus trough concentrations were associated with proven IFD (per 5 ng/mL: adjusted odds ratio [aOR], 4.84; 95% confidence interval [CI], 2.20-10.66) but not with probable/possible IFD. The C0/D ratio showed a stronger and more consistent association with proven IFD than trough concentration alone. In exploratory analyses, the apparent AUC of C0/D was 0.802 (95% CI, 0.682-0.903); adding log(C0/D) to a clinical severity panel increased the apparent AUC from 0.902 to 0.928 (ΔAUC, 0.026; 95% bootstrap CI, -0.034 to 0.087).</p><p><strong>Conclusion: </strong>A higher tacrolimus C0/D ratio was associated with subsequent proven IFD in recipients receiving routine early echinocandin prophylaxis. These hypothesis-generating findings do not establish causality, an actionable C0/D threshold, or a management strategy, and require prospective external validation before clinical implementation.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"623612"},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578413","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 Predictive Value of Sepsis in Patients with Liver Abscess.","authors":"Xiaoyan Ma, Yanni Chen, Xing An, Jie Zhang, Xigang Ma","doi":"10.2147/IDR.S618903","DOIUrl":"10.2147/IDR.S618903","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors associated with sepsis in patients with liver abscess (LA) and assess their predictive value for the early identification of high-risk patients.</p><p><strong>Methods: </strong>Clinical data from 798 patients with LA were retrospectively analyzed. LA was diagnosed according to established diagnostic criteria, and sepsis was defined according to the Sepsis-3 criteria. Patients were divided into a sepsis group (n = 558) and a non-sepsis group (n = 240). Baseline characteristics, laboratory parameters, microbiological features, treatment details, and clinical outcomes were compared between the two groups. Multivariable logistic regression analysis was performed to identify factors associated with sepsis, and receiver operating characteristic (ROC) curve analysis was used to evaluate their predictive value.</p><p><strong>Results: </strong>Patients in the sepsis group were younger and had a higher prevalence of hepatobiliary surgery history and a higher incidence of jaundice than those in the non-sepsis group (<i>P</i> < 0.05). Multivariable logistic regression analysis showed that a history of hepatobiliary surgery, elevated serum creatinine (Cr), elevated total bilirubin (TBIL), and decreased platelet count (PLT) were independently associated with sepsis (<i>P</i> < 0.05). ROC curve analysis indicated that TBIL, Cr, and PLT each had predictive value, and their combination demonstrated the best predictive performance (AUC = 0.848). In addition, patients in the sepsis group had a longer hospital stay and a higher 28-day mortality rate (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Sepsis in patients with LA is closely associated with a history of hepatobiliary surgery, elevated Cr and TBIL levels, and decreased PLT. A combined predictive model based on TBIL, Cr, and PLT demonstrated good discriminative ability and may facilitate the early identification of patients at high risk of sepsis, thereby supporting risk stratification and clinical decision-making.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"618903"},"PeriodicalIF":3.2,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436497","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 Short-Course Regimen Containing Delamanid, Bedaquiline and Linezolid for the Treatment of Drug-Resistant Tuberculosis: A Retrospective Study from China.","authors":"Long Jin, Xiaolei Zhang, Huailong Jiang, Qijian Li, Weinan Liu, Jiayao Wang, Zheyu Cao, Yuqin Liu","doi":"10.2147/IDR.S596822","DOIUrl":"10.2147/IDR.S596822","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the efficacy and safety of delamani (Dlm), bedaquiline (Bdq) and linezolid (Lzd) in multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant tuberculosis (RR-TB).</p><p><strong>Patients and methods: </strong>We retrospectively analyzed the clinical data of 71 patients with MDR/RR-TB. All patients were given a 6-9 month short-course treatment based on Dlm, Bdq and Lzd. Outcomes included treatment success, sputum culture conversion rate and time, clinical and imaging improvement, adverse events (AEs), serious adverse events (SAEs), and QTcF prolongation were recorded. Logistic regression and Cox proportional hazards models were used to identify factors associated with treatment success and time to sputum culture conversion, respectively.</p><p><strong>Results: </strong>57.75% of patients were male, and the median (IQR) age of all patients was 42.00 (30.50, 54.00) years. At the end of the treatment, 73.24% of patients achieved a good therapeutic outcome, 85.19% of patients achieved negative sputum culture, and the median (IQR) time for sputum culture to turn negative was 62.50 (28.00, 126.00) days. The clinical symptoms of the patients were all significantly improved (<i>P</i> < 0.001). 94.37% of patients showed lesion absorption, and the proportion of lesion area/volume to the whole lung was significantly reduced (<i>P</i> < 0.001). 36.62% of patients developed any grade AEs, the incidence of grade ≥3 AEs was 8.45%, and one patient (1.41%) developed SAEs, which was grade 4 anemia caused by Lzd. 12.68% of patients experienced prolonged QTcF. Previous history of tuberculosis (OR = 0.188, <i>P</i> = 0.015) and hepatitis B (OR = 0.150, <i>P</i> = 0.038) was associated with non-favorable outcomes. No baseline characteristics were associated with time to sputum culture conversion (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The Dlm-Bdq-Lzd regimen demonstrated favorable efficacy and safety in patients with MDR/RR-TB, and may represent a mechanistically distinct, shorter-course alternative to conventional regimens, while potential risks such as prolonged QTcF need to be noted.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"596822"},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446084","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":"Culture-Confirmed Severe Methicillin-Susceptible <i>Staphylococcus aureus</i> Pneumonia with Lung Abscess, Bacteremia, and Hydropneumothorax Managed without ECMO: A Case Report.","authors":"Xuqin Li, Yue Zhu, Fangfang Huang, Yunlong Jiang, Li Zhou","doi":"10.2147/IDR.S624501","DOIUrl":"10.2147/IDR.S624501","url":null,"abstract":"<p><strong>Background: </strong>Methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA) can cause rapidly destructive pneumonia complicated by lung abscess, bacteremia, empyema, and hydropneumothorax. Extracorporeal membrane oxygenation (ECMO) may be considered for refractory hypoxemia but is not always feasible. We report a young adult with severe MSSA pneumonia who recovered with optimized conventional support without ECMO.</p><p><strong>Case presentation: </strong>A 36-year-old man presented with fever, melena, hemoptysis, and progressive dyspnea. He developed severe hypoxemic respiratory failure with a PaO₂/FiO₂ ratio of 75 mmHg, septic shock requiring high-dose vasopressors, and extensive purulent airway secretions. ECMO was considered but declined for financial reasons. Immediate modified prone positioning was initiated through a rapid emergency-to-ICU workflow, and bronchoscopy performed in the prone position removed large volumes of purulent secretions. Computed tomography later showed right hydropneumothorax with approximately 60% lung compression and partial right lung destruction, as well as left pneumothorax with approximately 30% compression. Bilateral chest tubes were inserted with continuous negative-pressure drainage. Repeated early blood and sputum cultures grew <i>Staphylococcus aureus</i>, and oxacillin susceptibility with negative cefoxitin screening confirmed MSSA bacteremia and pneumonia. Antimicrobial therapy was dynamically adjusted according to microbiological results, including later isolation of carbapenem-resistant <i>Acinetobacter baumannii</i> and <i>Klebsiella pneumoniae</i>. Lesion-guided multi-segmental postural drainage was individualized according to imaging findings, air leakage, and drainage characteristics. The patient gradually improved, was weaned from mechanical ventilation, decannulated, and discharged on hospital day 80 with good functional recovery at follow-up.</p><p><strong>Conclusion: </strong>Fulminant MSSA pneumonia with lung abscess, bacteremia, and bilateral hydropneumothorax may be managed without ECMO in selected patients when rapid, coordinated conventional support and source-control measures are feasible. Early prone positioning, timely pleural drainage, individualized postural drainage, dynamic antimicrobial adjustment, and stepwise rehabilitation may provide a feasible multimodal approach when advanced support is unavailable.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"624501"},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446037","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":"Adult Empyema Caused by Refractory Methicillin-Resistant <i>Staphylococcus aureus</i> Treated Using Linezolid as Salvage Therapeutic Option: A Report of Two Cases.","authors":"Masafumi Seki, Takuya Nagai, Konosuke Ozawa","doi":"10.2147/IDR.S625227","DOIUrl":"10.2147/IDR.S625227","url":null,"abstract":"<p><strong>Background: </strong>The pathogenesis and treatment of pulmonary lesions caused by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infection have been unclear because MRSA has usually been considered a colonizer.</p><p><strong>Case series: </strong>Two adult cases of MRSA empyema were treated using linezolid (LZD) because they were refractory to the glycopeptides vancomycin (VCM) and teicoplanin (TEIC). Case 1 was a 50-year-old man with a history of lung cancer and pneumothorax who was admitted with pulmonary empyema with a severe dry cough. MRSA empyema was diagnosed because only MRSA was detected by video-assisted thoracoscopy (VATS) from his effusions. He was initially treated using VCM for 10 days, but his inflammatory markers and condition did not so improve; therefore, VCM was switched to LZD. His condition improved with LZD for 14 days. Case 2 was a 77-year-old man with pharyngeal cancer who was admitted with respiratory failure. He was diagnosed with MRSA empyema because only MRSA was detected from his pleural effusions on pleural drainage. He received a TEIC drip infusion for 10 days, but his respiratory status did not so improve; therefore, his treatment was switched to LZD. His condition improved with LZD for 14 days.</p><p><strong>Conclusion: </strong>MRSA empyema was diagnosed in these two cases because only MRSA was detected from pleural effusions. Both patients finally improved following the switch from glycopeptide antibiotics to LZD. These findings suggest MRSA as the true cause of the infections and that LZD, rather than VCM and TEIC, might be effective in cases of MRSA empyema.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"625227"},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446077","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}