Infection and Drug Resistance最新文献

{"title":"Vaccines as Potential Frontliners Against Antimicrobial Resistance (AMR): A Focused Review.","authors":"Sandip Patil, Indu Singh, Indira Kumari Verma, Anil Kumar, Juhi Sharma, Arun Ratn, Megh Singh Dhakad, Divakar Sharma","doi":"10.2147/IDR.S544665","DOIUrl":"10.2147/IDR.S544665","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) poses a formidable global threat, undermining the efficacy of potent antibiotics and complicating the treatment of infectious diseases, which has attracted the attention of scientific communities to revisit vaccines as a potential candidate against these superbugs. Although vaccines dedicated to bacterial infections are substantially reducing antibiotic use and decreasing annual healthcare expenditures for drug-resistant infections. Therefore, the vaccine can potentially prevent bacterial infections, which ultimately reduces the use of antibiotics and limits the opportunity for the development of resistance. Specific vaccines are being developed specifically to target drug-resistant bacteria like multidrug-resistant bacteria of <i>M. tuberculosis, E. coli</i>, and <i>S. aureus</i>, which not only prevent their spread but also reduce the burden on healthcare systems. However, despite their immense potential, disparate challenges hamper the broader application of vaccines in combating AMR. The most prominent challenge is the restricted accessibility of vaccines for high-priority drug-resistant ESKAPE pathogens. The development of vaccines against these organisms has proven a complicated process due to antigenic variability, immune evasion mechanisms, and a lack of reliable animal models. Furthermore, economic hindrances and logistical barriers, particularly in low- and middle-income countries (LMICs), pose serious hurdles to vaccine access and uptake. In the present review, crucial aspects of the vaccines have been emphasized that are directly correlated with the globalized AMR issues. Therefore, deployment of vaccine development and research against AMR is considered the cornerstone in AMR prevention, promoting balanced use of antibiotics, and ultimately mitigating the dissemination of resistant pathogens.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"5023-5041"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186017","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 Importance of Medical Knowledge About Q Fever in the Context of Timely Diagnosis and Treatment and the Use of the One Health Approach in Combating This and Other Neglected Zoonotic Diseases [Letter].","authors":"Igor Rosa Meurer","doi":"10.2147/IDR.S567142","DOIUrl":"10.2147/IDR.S567142","url":null,"abstract":"","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"5007-5008"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149009","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 Hospital Infection Management Department-Led Intervention to Improve the Pathogen Submission Rate Before Antimicrobial Therapy Using a FOCUS-PDCA Model.","authors":"Lizhen Xu, Qiufang Tang, Yuxiang Guo, Dan Liu","doi":"10.2147/IDR.S547418","DOIUrl":"10.2147/IDR.S547418","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a growing global public health threat, which is primarily driven by the irrational use of antibiotics. Enhancing the pathogen submission rate before antimicrobial therapy is crucial for effective antimicrobial management in healthcare institutions. This study aimed to improve this rate using the FOCUS-PDCA (Find, Orgnize, Clarify, Understand, Select, Plan, Do, Check, Act) model in a tertiary hospital.</p><p><strong>Methods: </strong>The present study was conducted from 2021 to 2024, applying the FOCUS-PDCA model. Led by the Hospital Infection Management Department, a multi-disciplinary collaboration team was set up, with indicators and problems as the guide. The interventions included improving information monitoring technology, optimizing specimen collection and delivery processes, strengthening regulatory efforts, and establishing a diversified training system. Data were collected from 56 clinical departments and compared before and after intervention.</p><p><strong>Results: </strong>The pathogen submission rate before antimicrobial therapy was notably increased from 64.99% in 2021 to 76.40% in 2024 (<i>p</i> < 0.001), with a similar increase in the targeted pathogen submission rate from 55.51% to 69.48% (<i>p</i> < 0.001). The pathogen submission rate related to hospital-acquired infections (HAIs) and the pathogen submission rate before the combined use of key antibiotics were also improved. Specimen quality was enhanced, with the proportion of sterile specimens increasing from 38.07% to 43.24% (<i>p</i> < 0.001). Detection rates of multidrug- resistant organisms (MDRO) were decreased overall, with notable declines in MRSA, CRPA, and CRKP.</p><p><strong>Conclusion: </strong>The FOCUS-PDCA model effectively improved pathogen submission rates and specimen quality, reduced the detection rate of MDRO, and promoted rational antimicrobial use. This approach provides valuable experience for other clinical institutions aiming to enhance antimicrobial stewardship.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"5043-5055"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148837","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":"Antimicrobial Resistance Characteristics of <i>Staphylococcus aureus</i> Isolated From Both Tertiary Hospitals, One Western Medicine Hospital and One Traditional Chinese Medicine Hospital, in Shanghai, China From 2014-2023.","authors":"Kunchen Wei, Wenjing Chen, Yu Li, Guoyan Xie, Fengjiao Li, Jingwen Zhou, Lingyan Pei, Qingzhong Liu","doi":"10.2147/IDR.S546699","DOIUrl":"10.2147/IDR.S546699","url":null,"abstract":"<p><strong>Purpose: </strong>Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) represents a growing threat to global public health. The aim of this study was to characterize the epidemiology and resistance of <i>Staphylococcus aureus (S. aureus)</i> collected between 2014 and 2023 from two Grade A tertiary hospitals in Shanghai: Shanghai Municipal Hospital of Traditional Chinese Medicine (STCMH), and Shanghai General Hospital (SGH).</p><p><strong>Methods: </strong>A total of 9816 non-duplicate <i>S. aureus</i> isolates (STCMH: n=2714; SGH: n=7102) were retrospectively analyzed. Antimicrobial susceptibility testing was conducted following CLSI guidelines. Predictors of bacterial clearance in <i>S. aureus</i>-infected patients were identified using univariate and LASSO regression and incorporated into a nomogram model.</p><p><strong>Results: </strong><i>S. aureus</i> was primarily isolated from sputum and wound secretions, largely from the Intensive Care Medicine (ICU) and surgical departments, and most frequently affected patients aged ≥65 in both institutions. Compared to STCMH, SGH isolates exhibited higher resistance rates to penicillin G (91.00% vs 70.12%), levofloxacin (57.27% vs 49.48%), moxifloxacin (55.34% vs 46.54%), gentamicin (40.07% vs 36.77%), and rifampin (3.17% vs.1.58%). The MRSA prevalence declined markedly at STCMH, dropping from 67.70% in 2017 to 33.30% in 2023, but remained elevated at SGH (54.79% to 69.00%). Furthermore, MRSA isolates from SGH showed higher resistance to levofloxacin (80.75% vs 76.71%), but lower resistance to erythromycin (84.37%vs 87.68%) and moxifloxacin (65.03% vs 74.26%) compared to those from STCMH. After 2016, STCMH revealed accelerated declines in MRSA resistance to erythromycin, clindamycin, and rifampicin. Both hospitals maintained 100% susceptibility to vancomycin, linezolid, and quinupristin/dalfopristin. The nomogram (AUC=0.654) identified combined antibiotic-TCM therapy, leukocyte and lymphocyte counts, and C-reactive protein levels as independent predictors of bacterial clearance.</p><p><strong>Conclusion: </strong>STCMH had lower MRSA prevalence and <i>S. aureus</i> resistance rates than SGH, and TCM-antibiotic combination therapy might promote bacterial clearance, suggesting TCM's potential in combating antimicrobial resistance, which needs further multicenter validation to support the implementation of antimicrobial stewardship strategies.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"5009-5021"},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185889","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":"Lymphocyte Profile Analysis in Lymph Node Puncture Fluid of Mediastinal Reactive Lymphadenopathy and Its Value in Differential Diagnosis with Tuberculous Lymphadenitis.","authors":"Song Mi, Na Cui, Jing Wang, Liming Zhang, Kewu Huang","doi":"10.2147/IDR.S542415","DOIUrl":"10.2147/IDR.S542415","url":null,"abstract":"<p><strong>Background: </strong>Lymphocyte profile (LP) analysis in mediastinal lymph nodes for differentiating reactive lymphadenopathy (RL) from tuberculous lymphadenitis (TBLA) remains understudied.</p><p><strong>Methods: </strong>Patients with intrathoracic lymphadenopathy undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were enrolled. Lymph node puncture fluid (LNPF) was analyzed via flow cytometry to compare LP characteristics between TBLA and RL. Receiver operating characteristic (ROC) analysis identified optimal diagnostic cut-offs, and sensitivity, specificity, and accuracy were calculated.</p><p><strong>Results: </strong>A total of 41 TBLA cases and 45 RL cases were included. Compared with the TBLA group, the RL group exhibited increased proportions of CD4⁺ T cells and B cells, and decreased proportions of CD8⁺ T cells, natural killer (NK) cells, and natural killer T (NKT) cells in LNPF. Among single parameters, the CD4/CD8 ratio demonstrated the highest diagnostic performance for TBLA, with sensitivity of 88.89%, specificity of 70.73%, and accuracy of 80.23%. Among three-parameter combinations, the CD4⁺ T cell, CD8⁺ T cell, and NK cell ratio combination achieved optimal diagnostic performance, with sensitivity of 80.5%, specificity of 86.7%, and accuracy of 82.6%.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4971-4980"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130692","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":"Extended-Spectrum β-Lactamase-Producing <i>Klebsiella pneumoniae</i> in Southwest China: Molecular Characteristics and Risk Factors of Bloodstream Infections.","authors":"Yueshuai Wei, Yuan Jiang, Chenghong Gu, Caihong Ye, Tongtong Guo, Zhangrui Zeng, Jinbo Liu","doi":"10.2147/IDR.S447539","DOIUrl":"10.2147/IDR.S447539","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to investigate the molecular characteristics and risk factors of bloodstream infection (BSI) caused by extended-spectrum beta-lactamase producing <i>Klebsiella pneumoniae</i> (ESBL-Kpn).</p><p><strong>Methods: </strong>Bacterial species were identified using the matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) (Bruker Daltonik GmbH, Bremen, Germany), while antimicrobial susceptibilities were assessed using the MicroScan WalkAway 96 Plus system (Siemens, Germany) and the microbroth dilution method. Polymerase chain reaction (PCR) was employed to detect common extended-spectrum beta-lactamase resistance genes (<i>bla</i> _SHV, <i>bla</i> _TEM, <i>bla</i> _CTX-M). Multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), capsular serotyping, and serum resistance tests were utilized to analyze the molecular characteristics among the isolated strains. Additionally, a logistic regression analysis was conducted to identify the risk factors associated with BSI caused by ESBL-Kpn.</p><p><strong>Results: </strong>A total of 371 <i>Klebsiella pneumoniae</i> (<i>K. pneumoniae</i>) strains were isolated from blood samples collected at the Affiliated Hospital of Southwest Medical University between January 2020 and June 2023, among which 45 were confirmed to produce ESBL. Twenty-eight STs were identified, with ST15 being predominant. Most strains exhibited resistance to multiple antibiotics, with <i>bla</i> _CTX-M-15 as the predominant ESBL resistance genes. Nine strains (n=9, 20%) of bacteria exhibited high serum resistance, and 27 strains matched capsular serotypes predominantly K17. Multivariate analysis indicated that transferred patients, prior use of cephalosporin antibiotics, and prolonged hospital stay were independent risk factors for ESBL-Kpn BSI.</p><p><strong>Conclusion: </strong>BSI caused by ESBL-Kpn exhibit high resistance rates. The newly identified ST6835 and ST6837 indicate the emergence and spread of novel clones in Southwest China, highlighting the imperative for enhanced surveillance of ESBL-producing strains.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4993-5005"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130689","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":"<i>Achaetomium luteum</i> and <i>Exserohilum rostratum</i>, Two Rare Causes of Keratomycosis in China: Case Report.","authors":"Li-Hua Jiang, Li Sheng, Jie Luo, Jin-Cheng Rong","doi":"10.2147/IDR.S550103","DOIUrl":"10.2147/IDR.S550103","url":null,"abstract":"<p><p>Keratomycosis is a severe sight-threatening infection of the human cornea, accounting for around 50% of infectious keratitis cases both in China and globally. Its dominant fungal pathogens vary according to region and climate. It is caused by various pathogenic species with divergent clinical manifestations. Our knowledge on the phylogenetic data of fungal species for keratomycosis is still limited. Here, we describe two clinical cases of immunocompetent patients involving two rare fungal pathogens that cause fungal keratitis. Of these two pathogens, <i>Achaetomium luteum</i> is a novel pathogen for corneal infections, and another species, <i>Exserohilum rostratum</i>, is a rare cause of fungal keratitis. These two cases may provide more insights into the diagnosis, etiology, and treatment of keratomycosis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4965-4970"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130708","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":"Impact of the COVID-19 Pandemic on Multidrug-Resistant Organism Infections in Infected Pancreatic Necrosis: A Post-Hoc Cohort Analysis.","authors":"Baiqi Liu, Caihong Ning, Jiarong Li, Zefang Sun, Chiayen Lin, Xiaoyue Hong, Rong Guo, Lu Chen, Dingcheng Shen, Gengwen Huang","doi":"10.2147/IDR.S535563","DOIUrl":"10.2147/IDR.S535563","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to elucidate the impact of COVID-19 pandemic on multidrug-resistant organism (MDRO) infection in patients with infected pancreatic necrosis (IPN).</p><p><strong>Methods: </strong>This post-hoc analysis of a prospective cohort included patients with IPN stratified into three phases: pre-pandemic (2016-2019), pandemic period (2020-2022), and post-pandemic period (2023-2024). Logistic regression and interrupted time-series analysis (ITSA) were employed to identify risk factors and longitudinal trends.</p><p><strong>Results: </strong>MDRO infection decreased significantly during the pandemic period compared to pre-pandemic levels (44.8% vs 81.1%, <i>P</i><0.001). There was no significant difference in the incidence of MDRO infection between the pandemic and post-pandemic period (44.1% vs 44.8%, <i>P</i>=0.924). During the pandemic, both prophylactic antimicrobial usage (64.8% vs 85.1%, <i>P</i><0.001) and ICU stays (median: 6.0 vs 15.0 days, <i>P</i><0.001) were significantly reduced compared to the pre-pandemic period. Logistic regression identified prophylactic antimicrobial usage (OR 17.28, <i>P</i><0.001), ICU stays (OR 1.07, <i>P</i><0.001), and the COVID-19 pandemic (OR 0.21, <i>P</i><0.001) as independent factors associated with MDRO infection. ITSA revealed a significant decrease in the trend of MDRO infection during the pandemic compared to the pre-pandemic period (<i>P</i>=0.006). An immediate level of MDRO infection increased during the post-pandemic period compared to the pandemic (<i>P</i>=0.040). The similar trend variations were observed in the proportion of prophylactic antimicrobial usage.</p><p><strong>Conclusion: </strong>The COVID-19 pandemic has led to a notable reduction in MDRO infection among IPN patients, likely attributable to stringent infection prevention and control measures which led to reduced prophylactic antimicrobial usage and ICU stays during this period.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4981-4991"},"PeriodicalIF":2.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130716","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":"Identification of Specific LncRNA Markers in Severe Tuberculosis for Early Diagnosis.","authors":"Siyu Yao, Xiuxiu Ji, Ruize Wang, Liping Pan, Qiuyue Liu","doi":"10.2147/IDR.S540446","DOIUrl":"10.2147/IDR.S540446","url":null,"abstract":"<p><strong>Background: </strong>The progression of tuberculosis to severe disease is the main cause of death of tuberculosis patients. Early identification of severe tuberculosis is very important. LncRNA can be used as a potential marker in the diagnosis of tuberculosis, but there is a lack of research on lncRNA in the field of severe tuberculosis.</p><p><strong>Methods: </strong>Peripheral blood samples of severe pulmonary tuberculosis patients, mild pulmonary tuberculosis patients and healthy controls were collected to extract peripheral blood monocytes. The RNA was then extracted and sent to the SBC human ceRNA V1.0 analysis. The results were verified by qPCR and analyzed by KEGG and GO analyses. Differentially expressed lncRNAs were measured by ROC curves.</p><p><strong>Results: </strong>Four lncRNAs exhibited statistically distinct expression patterns in STB versus MTB groups (NR_033909: p=0.0097; lnc-MYCBPAP-2:4: p=0.0053; lnc-PRDM7-1:2: p<0.0001; NR_033841: p=0.0279). The areas under the curve (AUC) value are respectively 0.7280(lnc-PRDM7-1:2), 0.7288(lnc-MYCBPAP-2:4), 0.6647(NR_033909) and 0.6615(NR_033841).</p><p><strong>Conclusion: </strong>LncRNAs NR_033909, lnc-MYCBPAP-2:4, lnc-PRDM7-1:2 and NR_033841 may demonstrate diagnostic potential for differentiating severe from mild pulmonary tuberculosis cases. These results create a platform for monitoring TB progression and open new avenues for studying disease pathogenesis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4953-4964"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113111","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 of a Machine-Learning Immuno-Serologic Diagnostic Model for Non-Neutropenic Invasive Pulmonary Fungal Disease.","authors":"Hui Huang, Fang Fang, Weiguo Lu, Zhihui Liu, Junyuan Huang","doi":"10.2147/IDR.S544469","DOIUrl":"10.2147/IDR.S544469","url":null,"abstract":"<p><strong>Background: </strong>Non-neutropenic invasive pulmonary fungal disease (IPFD) is increasingly recognized but remains challenging to diagnose due to nonspecific clinical and radiological features. This retrospective, single-center study was conducted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine and aimed to develop and evaluate a diagnostic model based on immuno-Serologic biomarkers for distinguishing non-neutropenic IPFD from bacterial pneumonia.</p><p><strong>Methods: </strong>A total of 157 pneumonia patients (65 non-neutropenic IPFD cases and 92 bacterial pneumonia cases) admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine between April 2018 and December 2022 were enrolled. Least Absolute Shrinkage and Selection Operator (LASSO) regression and collinearity analysis were applied to screen key variables, followed by the development of diagnostic models using nine machine learning algorithms. Model performance was comprehensively evaluated, and temporal validation in an independent later cohort from the same center was conducted using data from 102 pneumonia patients (33 non-neutropenic IPFD and 69 bacterial pneumonia cases) admitted between January 2023 and March 2025.</p><p><strong>Results: </strong>Five biomarkers were identified as predictors: galactomannan (GM), monocyte human leukocyte antigen-DR expression (mHLA-DR), monocyte count, interleukin-6 (IL-6), and 1,3-β-D-glucan (BDG). The Light Gradient Boosting Machine (LightGBM) model demonstrated optimal performance in the validation set, with an area under the receiver operating characteristic curve (AUC) of 0.865 (95% CI: 0.728-0.999) and accuracy of 0.781. In the test set, the model achieved an AUC of 0.810 and accuracy of 0.750. Decision curve analysis (DCA) indicated favorable net benefits across probability thresholds of 0-1. Temporal validation yielded an AUC of 0.821 and accuracy of 0.794.</p><p><strong>Conclusion: </strong>The immuno-serologic diagnostic model exhibits strong discriminatory performance in differentiating bacterial pneumonia from non-neutropenic IPFD, highlighting its potential for clinical application.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4941-4952"},"PeriodicalIF":2.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113077","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}