Infection and Drug Resistance最新文献

{"title":"Fusing Radiomics and Ultrasonic Features: A Superior Nomogram for Diagnosing Cervical Tuberculous Lymphadenitis.","authors":"Xinyue Liu, Yansong Liu, Fangfang Sun, Lifang Liu, Hongyu Li, Chao Zhang, Jie Du, Lili Zhang, Lirong Zhao","doi":"10.2147/IDR.S623033","DOIUrl":"https://doi.org/10.2147/IDR.S623033","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop and validate a radiomics-based nomogram derived from ultrasound (US) images for differentiating cervical tuberculous lymphadenitis (CTL) from non-CTL in the pre-biopsy setting.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 287 patients with biopsy-confirmed cervical lymphadenopathy (116 CTL and 171 non-CTL), all of whom underwent conventional US examinations. The US images were randomly split into training and validation cohorts at a 7:3 ratio. Radiomics features were extracted from manually delineated regions of interest (ROIs) using PyRadiomics. Features with intra- and inter-observer ICC > 0.75 were retained. Significant features were selected via <i>t</i>-test and LASSO regression. A radiomics score (radscore) was calculated, and a nomogram was constructed by integrating the radscore with US features (necrosis, heterogeneous, and posterior enhancement). Diagnostic performance was evaluated using ROC curves, calibration curves, decision curve analysis (DCA), and the Hosmer-Lemeshow goodness-of-fit test.</p><p><strong>Results: </strong>The nomogram demonstrated discriminative performance, with AUCs of 0.798 (95% CI: 0.738-0.858) in the training cohort and 0.756 (95% CI: 0.654-0.858) in the validation cohort. Its AUC was higher than that of the clinical US model (AUC: 0.764 (95% CI: 0.700-0.829) and 0.744 (95% CI: 0.640-0.847), respectively) and the radiomics-only model (AUC: 0.693 (95% CI: 0.621-0.765) and 0.611 (95% CI: 0.492-0.730), respectively). The AUC difference between the nomogram and the clinical US model was not statistically significant, but calibration and DCA confirmed its favorable clinical applicability and goodness of fit.</p><p><strong>Conclusion: </strong>The US-based radiomics nomogram may help differentiate CTL from non-CTL and serve as an adjunct to pre-biopsy assessment. This approach shows promise for improving the pre-biopsy diagnostic workup of tuberculous lymphadenitis, although formal subgroup validation in pathologically early-stage cases is warranted in future studies. Unlike \"black-box\" machine learning models, this nomogram provides a clear display of each predictor's contribution, which makes the model easier to interpret.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"623033"},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109174","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":"Comparison of Different Corticosteroid Regimens for Refractory <i>Mycoplasma pneumoniae</i> Pneumonia in Children: A Retrospective Cohort Study.","authors":"Yahong Wang, Man Zhang, Xia Qin","doi":"10.2147/IDR.S630304","DOIUrl":"https://doi.org/10.2147/IDR.S630304","url":null,"abstract":"<p><strong>Background: </strong>Refractory <i>Mycoplasma pneumoniae</i> pneumonia (RMPP) poses a significant therapeutic challenge in pediatric practice, and the optimal corticosteroid regimen remains controversial. This study aimed to compare the clinical efficacy and safety of three corticosteroid regimens in children with RMPP.</p><p><strong>Methods: </strong>In this retrospective cohort study, 216 children with RMPP hospitalized between January 2023 and June 2025 were categorized by corticosteroid regimen: Group A (low-dose methylprednisolone, 1-2 mg/kg/day intravenously for 3-5 days, n=73), Group B (high-dose methylprednisolone pulse therapy, 10-30 mg/kg/day for 3 days, n=70), and Group C (step-down regimen: pulse therapy for 3 days followed by an oral prednisolone taper, n=73). The primary outcome was time to fever resolution after corticosteroid initiation. Multivariable logistic and Cox regression, inverse probability of treatment weighting (IPTW), and E-value analyses were performed.</p><p><strong>Results: </strong>Baseline characteristics were largely comparable, although white blood cell counts differed (P=0.013). Defervescence was faster in Groups B (2.40 ± 1.00 days) and C (2.00 ± 0.78 days) than in Group A (4.25 ± 1.71 days; both P<0.001); the Group C-versus-Group B difference (adjusted P=0.047) occurred largely before the oral taper began. Group C had the shortest hospital stay (8.26 ± 1.74 days) and the highest treatment effectiveness (89.04% vs 82.86% vs 64.38%; P=0.001), but the adjusted Group C-versus-Group B comparison was not significant (OR 2.17; 95% CI 0.77-6.12). Both high-dose regimens were independently associated with treatment effectiveness versus Group A (Group C: OR 5.26, 95% CI 2.08-13.32; E-value 2.16) and with faster defervescence; IPTW analyses yielded consistent results. Thirty-day readmission did not differ significantly (exact P=0.130).</p><p><strong>Conclusion: </strong>High-dose corticosteroid regimens were associated with faster defervescence and higher treatment effectiveness than low-dose therapy in children with RMPP. Whether an oral taper after pulse therapy provides additional benefit remains uncertain and warrants prospective validation.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"630304"},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109142","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":"Antibiotic Resistance Trends and Prescribing Patterns in Pediatric Non-Typhoidal <i>Salmonella</i> Enteritis: A 10-Year Single-Centre Retrospective Study.","authors":"Xing Liao, Jiajia Lu, Rongrong Yang, Ling Wu, Chengyi Wang","doi":"10.2147/IDR.S632613","DOIUrl":"https://doi.org/10.2147/IDR.S632613","url":null,"abstract":"<p><strong>Background: </strong>Non-typhoidal <i>Salmonella</i> (NTS) enteritis is a major cause of infectious diarrhoea in children and increasing antibiotic resistance is limiting treatment effectiveness. There is limited longitudinal data on resistance development and on how well prescribing practices align with resistance patterns in hospitalised children. This study aimed to assess trends in antibiotic resistance, the prevalence of multidrug resistance (MDR), and treatment concordance over a decade from a single Chinese Centre.</p><p><strong>Methods: </strong>The study included children with microbiologically confirmed NTS enteritis with available antibiotic susceptibility data. Resistance rates for 11 antibiotics were calculated, and temporal trends were analysed using the Cochran-Armitage trend test. MDR was defined as resistance to three or more antibiotic classes. Treatment concordance was assessed by comparing the empiric antibiotic class with in vitro susceptibility results.</p><p><strong>Results: </strong>Of 486 records reviewed, 422 children were included. Infants under one year included 69.4% of cases. <i>S</i>. <i>Typhimurium</i> was the predominant serotype (58.8%). Ampicillin resistance was highest at 76.3%, followed by ampicillin/sulbactam (61.8%) and co-trimoxazole (34.8%). Ceftriaxone resistance was 28.4%. Ampicillin/sulbactam resistance increased significantly over the decade (44.4% to 65.3%; p = 0.010), while ciprofloxacin resistance declined (44.4% to 4.0%; p = 0.005). MDR was identified in 23.0% of patients, without a significant temporal trend (p = 0.311). Most cases were classified as severe (75.4%), and piperacillin/tazobactam was the most commonly prescribed regimen (49.0%). Overall treatment concordance was 93.7%, with ceftriaxone exhibiting the highest discordance rate (14.9%).</p><p><strong>Conclusion: </strong>Ampicillin/sulbactam resistance rose markedly, while ciprofloxacin resistance decreased in our cohort. The change may be related to reduced fluoroquinolone prescribing and broader antimicrobial-use policy shifts in our institute, although this cannot be confirmed without institutional prescribing data. One in four children showed MDR isolates. Discordance was highest for ceftriaxone-based regimens, indicating that empiric antibiotic selection should be guided by local institutional susceptibility surveillance rather than a fixed choice of agent. Ongoing monitoring of institutional resistance is vital to support antibiotic stewardship in pediatric NTS enteritis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"632613"},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109149","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":"Trimethoprim-Sulfamethoxazole and Azithromycin Resistance in <i>Salmonella</i> and <i>Shigella</i>: Genotype-Phenotype Concordance and Integron-MDR Association.","authors":"Nikta Pourmahdi-Torghabeh, Nafiseh Izadi, Morvarid Boroumand Alipour, Maryam Afzali, Hadi Farsiani","doi":"10.2147/IDR.S633627","DOIUrl":"https://doi.org/10.2147/IDR.S633627","url":null,"abstract":"<p><strong>Background: </strong>Rising antimicrobial resistance in <i>Salmonella</i> and <i>Shigella</i> narrows therapeutic options, especially resistance to first-line agents like trimethoprim‑sulfamethoxazole and azithromycin.</p><p><strong>Methods: </strong>We retrospectively analyzed 156 archived clinical isolates (<i>Shigella</i> n=108; <i>Salmonella</i> n=48) originally recovered from stool specimens collected between January 2017 and December 2020. Isolates were re-evaluated in a blinded manner using phenotypic susceptibility testing and PCR detection of <i>dfrA1, sul1, ermB, mphA</i>, and class 1 integron (<i>IntI1</i>).</p><p><strong>Results: </strong><i>S. sonnei</i> was the predominant species (50.6%). Among <i>Shigella</i> and <i>Salmonella</i> isolates, resistance to trimethoprim-sulfamethoxazole and azithromycin was observed in 97.2% and 67.6% versus 16.7% and 20.8%, respectively. <i>dfrA1</i> was detected in 97.2% of <i>Shigella</i> and 10.4% of <i>Salmonella</i>, while <i>sul1</i> was detected in 58.3% and 14.8%, respectively. <i>mphA</i> was detected in 58.3% of <i>Shigella</i> but was absent in <i>Salmonella</i>, whereas <i>ermB</i> was detected in 0.04% and 58.3%, respectively. The PPV and NPV of <i>ermB</i> for phenotypic azithromycin resistance were 33.3% and 100%, respectively (κ=0.25, P<0.008). 20 <i>Salmonella</i> and two <i>Shigella</i> isolates harboring resistance-associated determinants were susceptible to azithromycin, while five <i>Salmonella</i> isolates with related genotypes remained susceptible to trimethoprim-sulfamethoxazole. MDR was observed in 55.6% of <i>Shigella</i> and 4.2% of <i>Salmonella</i> and was associated with <i>IntI1</i> (χ²=31.99, P<0.001; Cramer's V=0.45).</p><p><strong>Conclusion: </strong><i>Shigella</i> and <i>Salmonella</i> showed distinct resistance and resistance-gene profiles. The low PPV and 100% NPV of <i>ermB</i>, together with genotype-phenotype discordance, indicate that molecular testing cannot replace phenotypic susceptibility testing for azithromycin resistance, although <i>ermB</i> may have potential rule-out value pending external validation. The association between <i>IntI1</i> and MDR supports further investigation of class 1 integrons in multidrug resistance.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"633627"},"PeriodicalIF":3.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109127","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":"Rapid Succession of Multidrug-Resistant Bacteremia and Candidemia in a Patient with Refractory Pemphigus Vulgaris: A Lethal Therapeutic Challenge.","authors":"Ling Li, Cunhuo Jiang","doi":"10.2147/IDR.S634408","DOIUrl":"https://doi.org/10.2147/IDR.S634408","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressed patients with extensive skin barrier disruption face extraordinary risks for polymicrobial infections. The rapid, sequential emergence of multidrug-resistant (MDR) bacteremia and candidemia in such hosts constitutes a particularly lethal complication with limited therapeutic options.</p><p><strong>Case presentation: </strong>We report a 74-year-old woman with refractory pemphigus vulgaris (PV), type 2 diabetes mellitus, and chronic obstructive pulmonary disease who developed a cascade of MDR infections over a 14-day hospitalization. Following initial methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) skin colonization, she developed <i>Serratia marcescens</i> bacteremia, subsequently complicated by wound superinfection with carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) and multiple <i>Candida</i> species, including the rare yeast <i>Kodamaea ohmeri</i>. Despite sequential antimicrobial escalation-from piperacillin-tazobactam/linezolid to meropenem/amikacin, and finally caspofungin-her condition deteriorated with diabetic ketoacidosis, culminating in the family's decision to pursue discharge with comfort care based on the patient's previously expressed wishes; she died three days later. <i>K. ohmeri</i> demonstrated reduced fluconazole susceptibility (MIC = 8 µg/mL), highlighting the diagnostic and therapeutic challenges posed by emerging fungal pathogens.</p><p><strong>Conclusion: </strong>This case starkly illustrates the catastrophic potential of rapid, sequential MDR infections in profoundly immunocompromised hosts with skin barrier defects. It underscores the critical importance of early microbiological surveillance, the clinical urgency of dynamic antimicrobial stewardship, and the imperative for multidisciplinary management to navigate the irreconcilable conflict between necessary immunosuppression and life-threatening infection.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"634408"},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109188","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 Profile of <i>Serratia spp</i>. Isolates and an Exploratory Comparison of Antimicrobial Resistance by Acquisition Setting: A Two-Year Retrospective Study.","authors":"Türkan Tüzün, Sedef Zeliha Öner","doi":"10.2147/IDR.S644832","DOIUrl":"https://doi.org/10.2147/IDR.S644832","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the clinical and microbiological profile of <i>Serratia spp</i>. isolates recovered at a tertiary-care hospital and to explore whether resistance differed by the acquisition category recorded in the source data.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed 157 consecutive clinical isolates from 146 patients recovered from September 27, 2019, through September 27, 2021. The primary between-group analysis retained one first-listed isolate per patient (n=146); Fisher's exact tests, odds ratios with 95% confidence intervals, and Holm adjustment across 12 antimicrobials were used. A generalized estimating equation analysis of all 157 isolates, clustered by patient, was performed as a sensitivity analysis.</p><p><strong>Results: </strong><i>Serratia marcescens</i> accounted for 128/157 isolates (81.5%), and sputum or tracheal aspirate accounted for 86/157 (54.8%). Resistance was lowest for trimethoprim/sulfamethoxazole (2/157, 1.3%), gentamicin (6/157, 3.8%), amikacin (7/157, 4.5%), and meropenem (7/157, 4.5%), and highest for imipenem (27/157, 17.2%). In the patient-level analysis, 90 isolates were community-classified and 56 were hospital-classified. Ertapenem resistance was 6/90 (6.7%) versus 11/56 (19.6%; odds ratio 3.42, 95% CI 1.19-9.86), but the comparison did not remain significant after Holm adjustment (nominal p=0.031; adjusted p=0.342). No antimicrobial showed a multiplicity-adjusted between-group difference. The clustered all-isolate analysis yielded the same overall interpretation.</p><p><strong>Conclusion: </strong>This study provides a historical local description of <i>Serratia</i> isolates collected in 2019-2021. The acquisition-category comparisons were exploratory and did not identify a robust resistance difference after accounting for repeated isolates and multiple comparisons. These data should not be used alone to guide current empirical therapy.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"644832"},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109136","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":"Severe <i>Vibrio vulnificus</i> Sepsis without Typical Wound Exposure in a Patient with Chronic Liver Disease and Diabetes: A Case Report.","authors":"Zanfeng Cao, Jiaying Luo, Haoming Zhuang, Xintong Li, Yuejing Ban, Yu Ouyang, Jiajian Hu, Pengguang You, Xi Liu, Qing Liang, Zuopeng Zhang","doi":"10.2147/IDR.S644649","DOIUrl":"https://doi.org/10.2147/IDR.S644649","url":null,"abstract":"<p><strong>Background: </strong><i>Vibrio vulnificus</i>, a Gram-negative bacillus, is frequently present in warm estuarine and coastal waters and is a notable pathogen responsible for seafood-related fatalities globally. Infection typically arises from ingesting contaminated seafood or exposure of skin wounds to tainted seawater, resulting in primary or secondary sepsis, as well as severe skin and soft tissue infections.</p><p><strong>Case presentation: </strong>Upon hospital admission, a 51-year-old man with chronic gastritis, long-term alcohol use, type 2 diabetes, thrombocytopenia, and active hepatitis B and C presented with acute right upper quadrant abdominal pain, high fever, and a history of consuming raw fish (sashimi) before symptom onset, suggesting a foodborne infection. Despite denial of recent seawater exposure or seafood handling, his condition rapidly deteriorated, resulting in septic shock, moderate acute respiratory distress syndrome, and necrotizing fasciitis of the left lower extremity within 72 hours. Laboratory findings revealed severe thrombocytopenia, hyperlactatemia, multiple organ dysfunction, and metabolic acidosis. <i>Vibrio vulnificus</i> was identified via peripheral blood metagenomic next-generation sequencing. Whole-exome sequencing incidentally detected a heterozygous missense variant in the DOCK2 gene (c.4511C>T, p. Thr1504Met), classified as a variant of uncertain significance. In silico analyses suggested a benign effect, leaving any potential link to disease severity undetermined without functional confirmation.</p><p><strong>Conclusion: </strong>Severe <i>V. vulnificus</i> sepsis may develop through foodborne transmission, even in the absence of typical exposure to seawater or seafood handling. Disease severity in this patient was primarily influenced by chronic liver disease, alcohol abuse, and diabetes. Clinicians should watch for <i>V. vulnificus</i> infection in patients with these risk factors who present with septic shock or rapidly progressive soft tissue infections, regardless of exposure history.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"644649"},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109162","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":"Prospective Molecular and Phenotypic Characterization of <i>bla</i>CTX-M and <i>bla</i>TEM ESBL Genes in Uropathogenic <i>Escherichia coli</i> from ICU Patients at Three Tertiary-Care Hospitals in Tabriz, Iran.","authors":"Mahdieh Sedghi, Shiva Ahmadishoar","doi":"10.2147/IDR.S637114","DOIUrl":"https://doi.org/10.2147/IDR.S637114","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing <i>Escherichia coli</i> have become a major therapeutic challenge worldwide, especially in intensive care units. In northwestern Iran, the molecular epidemiology of the key resistance genes <i>bla</i>CTX-M and <i>bla</i>TEM, along with their potential co-carriage on plasmids, remains poorly understood. This gap limits the development of effective local empirical treatment guidelines and infection control strategies.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at three tertiary-care hospitals in Tabriz, Iran (2025). We identified 100 non-duplicate Escherichia coli isolates recovered from ICU patients with UTIs using standard microbiological methods. Antimicrobial susceptibility testing was performed by the disk diffusion method according to CLSI 2024 guidelines. ESBL phenotype was confirmed using the combined disk test with Ceftazidime and Clavulanic acid. Genotypic detection of <i>bla</i>TEM and <i>bla</i>CTX-M was performed by conventional PCR. Chi-square and Fisher's exact tests were used to assess statistical associations.</p><p><strong>Results: </strong>Among 135 culture-positive urine specimens, <i>E. coli</i> was the predominant pathogen (74.07%), followed by <i>Klebsiella pneumoniae</i> (11.85%). Universal resistance to Cefotaxime (100%) and high resistance to Ceftazidime (95%) were observed. Imipenem retained the highest in vitro activity (82% susceptibility). Phenotypic ESBL production was detected in 48/100 (48%) isolates. Among ESBL producers, <i>bla</i>TEM was present in 28 (58.3%), <i>bla</i>CTX-M in 20 (41.7%), and both genes co-occurred in 18 isolates (37.5%). The observed co-occurrence significantly exceeded expected values under independence (observed: 18 vs. expected: 11.7; Chi-square p = 0.0005; Fisher's exact p = 0.00025), demonstrating non-random co-occurrence consistent with, but not proof of, plasmid-mediated co-carriage.</p><p><strong>Conclusion: </strong>ESBL-producing <i>E. coli</i> carrying both <i>bla</i>TEM and <i>bla</i>CTX-M are highly prevalent among ICU-associated UTI in Tabriz. The statistically significant non-random co-occurrence of these genes has direct implications for surveillance strategies, necessitating simultaneous genotyping of both genes. Carbapenems remain effective, underscoring the urgency of their stewardship to prevent the emergence of carbapenem-resistant Enterobacterales (CRE) in this setting.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"637114"},"PeriodicalIF":3.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109182","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 Characteristics and Machine Learning-Based Severity Classification of <i>Chlamydia psittaci</i> Pneumonia: A Retrospective Cohort Study.","authors":"Xiao Lei, Liyuan Zhao, Ziwei Zhong, Haiyan Lin, Zhiting Xie, Yaping Guo, Sufeng Zhang, Chengsheng Zhang, Tian Gong","doi":"10.2147/IDR.S622689","DOIUrl":"10.2147/IDR.S622689","url":null,"abstract":"<p><strong>Background: </strong><i>Chlamydia psittaci</i> infection can cause severe community-acquired pneumonia with significant mortality. Distinguishing severe from non-severe disease remains challenging. This study used clinical data from patients with <i>C. psittaci</i> pneumonia and multiple machine-learning methods to develop a model for severity classification.</p><p><strong>Methods: </strong>We retrospectively analyzed 231 hospitalized patients with <i>C. psittaci</i> pneumonia, including 84 severe cases, between January 2022 and April 2025 in Jiangxi Province, China. Severe pneumonia was defined according to the IDSA/ATS and Chinese adult community-acquired pneumonia criteria. The model outcome was the composite clinical label of severe versus non-severe pneumonia rather than mortality. A comprehensive machine-learning framework incorporating 11 algorithms and six feature-selection strategies was used to develop the severity-classification model.</p><p><strong>Results: </strong><i>C. psittaci</i> pneumonia cases were sporadic and widely distributed across Jiangxi Province. Elderly patients, especially those with cardiovascular disease or diabetes, had an increased risk of severe illness. Laboratory tests in severe cases showed higher neutrophils, D-dimer, CRP, PCT, IL-6, IL-8, and IL-10, with lower lymphocytes, NK cells, albumin, and serum calcium. CT commonly showed large patchy opacities in the lower lung lobes. Additional microorganisms were co-detected by mNGS in 74.03% of patients. In the internal hold-out test set (n = 69), the RF+SVM model achieved an area under the receiver operating characteristic curve (AUC) of 0.845 (95% CI, 0.754-0.935) for distinguishing severe from non-severe pneumonia. The final RF+SVM severity-classification model incorporated nine laboratory predictors.</p><p><strong>Conclusion: </strong>This study identified key clinical and laboratory differences between non-severe and severe <i>C. psittaci</i> pneumonia and developed a predictive model using comprehensive machine learning approaches. The model may support admission-based severity stratification and identify patients who may warrant closer monitoring. This is a single-center retrospective study, and the model needs further validation in prospective multicenter cohorts.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"622689"},"PeriodicalIF":3.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080688","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":"Estimated Glomerular Filtration Rate and Associated Factors Prior to Anti-Tuberculosis Initiation Among Tuberculosis Patients at Bale Zone Hospitals Southeast Ethiopia: A Cross-Sectional Study Design.","authors":"Habtamu Gezahegn, Gemeda Abebe, Kebebe Bekele, Samuel Tadesse, Hiwot Berhanu, Andualem Mossie","doi":"10.2147/IDR.S638674","DOIUrl":"10.2147/IDR.S638674","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is a major public health concern and is mostly associated with systemic complications, like renal impairment. Tuberculosis patients with reduced renal function experience unfavorable outcomes of tuberculosis treatment. In Ethiopia, there are limited studies on glomerular filtration rate. Therefore, early assessment and identification of factors associated with abnormal glomerular filtration rate are paramount for the prevention of renal dysfunction and proper management.</p><p><strong>Objective: </strong>To determine the magnitude of abnormal glomerular filtration rate in patients with tuberculosis before the initiation of anti-tuberculosis therapy.</p><p><strong>Methods: </strong>A facility-based cross-sectional study was conducted from July 1 to November 1, 2025. All newly diagnosed adult tuberculosis patients were included from each hospital. Glomerular filtration was determined using the 2021 chronic kidney disease-epidemiology creatinine level equation, and if it is less than 60 mL/min, it is described as a reduced glomerular filtration rate. Descriptive data were reported using frequency tables, graphs, and pie charts. Binary logistic regression analysis with a <i>p</i>-value of < 0.25 was used to select candidates for the multiple logistic regression analysis. Finally, multiple logistic regression analyses were carried out, and a <i>P</i>-value <0.05 were considered as statistically significant.</p><p><strong>Results: </strong>In this study, 7.99% (23/288) with a 95% confidence interval of 5.13%-11.74% were tuberculosis patients with abnormal glomerular filtration rate. The magnitude of abnormal glomerular filtration rate among tuberculosis patients with anemia was 10.4%. Factors associated with abnormal glomerular filtration rate among patients with tuberculosis before anti-tuberculosis therapy were nausea (AOR=3.4; 1.01-11.1) and cough (AOR=3.3; 1.2-9.2).</p><p><strong>Conclusion: </strong>Abnormal glomerular filtration was higher in patients with tuberculosis and anemia. Anemia can result in a reduction in the glomerular filtration rate due to vasoconstriction of the renal artery, which shifts blood flow to vital organs. Therefore, the renal glomeruli become hypoxic, and their function reduced. Nausea and cough were factors associated with abnormal glomerular filtration rate prior to anti-tuberculosis initiation among tuberculosis patients.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"638674"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080703","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}