Infection and Drug Resistance最新文献

{"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}

{"title":"Amphotericin B and Antifungal Stewardship in Somalia: Irrational Use, Misconceptions, and Emerging Challenges.","authors":"Shafie Abdulkadir Hassan","doi":"10.2147/IDR.S627131","DOIUrl":"10.2147/IDR.S627131","url":null,"abstract":"<p><p>This commentary examines the rapidly escalating global health crisis of antimicrobial resistance (AMR). While widespread attention has historically focused on antibacterial resistance, the emergence of antifungal resistance represents an underrecognized and increasingly severe threat, particularly in resource-limited and fragile health systems. Amphotericin B is a critical, last-line antifungal agent essential for treating life-threatening invasive fungal infections, including cryptococcal meningitis and visceral leishmaniasis. However, due to its severe toxicity profile including nephrotoxicity and severe infusion reactions its administration requires stringent clinical oversight. In fragile health systems such as Somalia, weak pharmaceutical regulation and the proliferation of informal medicine markets have facilitated the irrational use of prescription-only medications. Recently, there are growing concerns regarding public misconceptions surrounding injectable medications, including the potential off-label, non-medical use of high-risk antifungals for purported cosmetic or body-enhancing purposes. While these concerns are currently based on anecdotal observations rather than documented epidemiological evidence, inappropriate community access to Amphotericin B poses severe patient safety risks while potentially accelerating antifungal selection pressure. This commentary explores the clinical importance of Amphotericin B, examines the intersection of public misinformation and irrational drug use, and outlines the urgent need for targeted antifungal stewardship (AFS). Furthermore, it provides a practical framework for facility-level priorities, pharmaceutical regulation, pharmacovigilance, and public health communication. Safeguarding critical antifungal agents in low-resource settings requires immediate, coordinated stewardship and regulatory interventions.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"627131"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080664","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":"Positive Association Between the Albumin-Bilirubin (ALBI) Score and Septic Shock in Patients with <i>Escherichia coli</i> Bloodstream Infection: A Retrospective Cohort Study.","authors":"Yinying Wang, Yingxiu Huang, Ming Hu, Peng Zhen","doi":"10.2147/IDR.S628552","DOIUrl":"10.2147/IDR.S628552","url":null,"abstract":"<p><strong>Background: </strong><i>Escherichia coli</i> bloodstream infection (<i>E. coli</i>-BSI) is a common cause of sepsis and may progress to septic shock. However, the association between the albumin-bilirubin (ALBI) score and septic shock in patients with <i>E. coli</i>-BSI remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included adults with <i>E. coli</i>-BSI admitted to Beijing Luhe Hospital between 2019 and 2024. The ALBI score was calculated from serum albumin (ALB) and total bilirubin measured within 24 hours of the index blood culture. Associations between ALBI and septic shock were assessed using multivariable logistic regression, restricted cubic splines (RCS), subgroup and sensitivity analyses. Receiver operating characteristic (ROC) analysis assessed discrimination. Exploratory LASSO regression and SHAP analyses evaluated variable contributions.</p><p><strong>Results: </strong>Among 334 patients, 97 (29%) developed septic shock, with the proportions increasing across ALBI tertiles (T1: 5.4%; T2: 27%; T3: 54.5%; <i>p</i> < 0.001). Higher ALBI scores were independently associated with septic shock (adjusted OR, 5.12; 95% CI, 2.37-11.05; <i>p</i> < 0.001), with higher odds in T3 than T1 (adjusted OR, 7.40; 95% CI, 2.63-20.83; <i>p</i> < 0.001). The association remained consistent across subgroup and sensitivity analyses. ALBI showed moderate discrimination (AUC, 0.796; 95% CI, 0.745-0.847), which was inferior to SOFA (AUC, 0.909; 95% CI, 0.877-0.941; <i>p</i> < 0.001), but comparable to ALB alone (AUC, 0.816; 95% CI, 0.766-0.865; <i>p</i> = 0.22). Exploratory LASSO and SHAP analyses identified ALBI as an important contributor.</p><p><strong>Conclusion: </strong>Higher ALBI scores were independently associated with septic shock in adults with <i>E. coli</i>-BSI. ALBI showed moderate discrimination but was inferior to SOFA and not significantly better than ALB alone. These findings indicate an association between ALBI and septic shock but do not establish its predictive or clinical utility. Prospective multicenter studies are warranted to determine its clinical value for risk assessment.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"628552"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080671","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 Medical Burden of Multidrug-Resistant Organism Infection in Hospitalized Patients with Pneumonia.","authors":"Jing Dai, Yingru Xing, Jiabao Zhong, Linying Zhu, Haizhou Wang, Zhuangqing Dai, Shoukai Yu, Xiaoting Ma, Hao Wu","doi":"10.2147/IDR.S638918","DOIUrl":"10.2147/IDR.S638918","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-drug resistant organism (MDRO) infections represent a global public health challenge. Patients hospitalized with pneumonia are prone to secondary MDRO infections, which can lead to poor prognosis, significantly prolong hospital stays, and increase medical and economic burdens.</p><p><strong>Methods: </strong>This single‑center retrospective cohort study conducted at a tertiary hospital in Shanghai, China aimed to identify risk factors for MDRO infection and assess its hospitalization‑related burden, and to construct a predictive nomogram. A total of 1686 patients with pneumonia were enrolled. The data were analyzed through 1:2 manual matching. Logistic regression was used to screen independent risk factors for multidrug‑resistant organism (MDRO) infections; Generalized Linear Models (GLMs) were employed to quantify the increase in hospital stay and medical expenses caused by MDROs. A predictive nomogram was constructed and validated using ROC curves and calibration curves.</p><p><strong>Results: </strong>A total of 676 multidrug-resistant bacteria (MDRO) strains required for the study were isolated. Among them, carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for the majority, reaching 30.03% (203/676). Compared with controls, the MDRO group had markedly longer hospital stay (median 20.00 vs 9.00 days, P<0.001) and substantially higher hospitalization costs, with a 3.6‑fold higher median cost. GLM confirmed MDRO infection independently aggravated hospitalization burden. Six independent risk factors were determined. The nomogram achieved an AUC of 0.817 with good calibration and reliable predictive efficacy.</p><p><strong>Conclusion: </strong>MDRO infection substantially raises hospitalization burdens for pneumonia patients. The risk factors and validated nomogram can guide targeted hospital-based MDRO prevention and intervention.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"638918"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074537","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":"Extensively Drug-Resistant ST16 <i>Klebsiella pneumoniae</i> Co-Harboring <i>bla</i> _KPC-2, <i>bla</i> _OXA-181, and Chromosomal <i>bla</i> _NDM-4: Genomic Features and Therapeutic Challenges.","authors":"Yao Li, Haijun Li, Xiaohong Xu, Jilei Ma, Hongmei Wang, Shijun Sun, Wanhai Wang","doi":"10.2147/IDR.S628629","DOIUrl":"10.2147/IDR.S628629","url":null,"abstract":"<p><strong>Purpose: </strong>Carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) represents a major global public health threat due to its high-level antimicrobial resistance and limited therapeutic options. The emergence of CRKP isolates co-harboring multiple carbapenemase genes further complicates clinical management and infection control. This study aimed to characterize the antimicrobial resistance phenotype, complete genomic features, and carbapenemase gene environments of an extensively drug-resistant ST16 CRKP bloodstream isolate co-harboring class A, B, and D carbapenemases.</p><p><strong>Methods: </strong>A CRKP isolate, designated KPY1, was recovered from the bloodstream of an intensive care unit patient. Antimicrobial susceptibility testing was performed to determine the resistance phenotype. Whole-genome sequencing was conducted using a hybrid Illumina-Nanopore approach. Genome assembly, antimicrobial resistance gene detection, plasmid replicon typing, comparative plasmid analysis, and genetic environment analysis of carbapenemase genes were performed using established bioinformatic tools.</p><p><strong>Results: </strong>KPY1 belonged to sequence type 16 and exhibited an extensively drug-resistant phenotype, including resistance to carbapenems, β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam, and colistin. Genomic analysis revealed the coexistence of three carbapenemase genes: <i>bla</i> _KPC-2, <i>bla</i> _NDM-4, and <i>bla</i> _OXA-181. Notably, <i>bla</i> _NDM-4 was located on the chromosome and flanked by two IS26 elements, suggesting a possible IS26-associated rearrangement event. In contrast, <i>bla</i> _KPC-2 was located on an IncFII(K) plasmid within a Tn3-family transposon structure, whereas <i>bla</i> _OXA-181 was carried by a conserved ColKP3-IncX3 plasmid backbone.</p><p><strong>Conclusion: </strong>This study describes a rare and clinically challenging ST16 CRKP bloodstream isolate co-harboring class A, B, and D carbapenemases. The chromosomal integration of <i>bla</i> _NDM-4 may contribute to stable maintenance of carbapenem resistance, while the coexistence of multiple carbapenemase determinants highlights the value of complete genome sequencing for resolving complex resistance configurations and supporting surveillance of high-risk CRKP lineages.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"628629"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069416","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":"Cerebrospinal Fluid Pharmacokinetics of Tigecycline in Lumbar and Ventricular Compartments After Lumbar Intrathecal Administration: A Three-Patient Case Series.","authors":"Menglian Duan, Rong Wang, Yichen Li, Penglai Zhao","doi":"10.2147/IDR.S631435","DOIUrl":"10.2147/IDR.S631435","url":null,"abstract":"<p><strong>Background: </strong>Lumbar intrathecal administration of tigecycline has been increasingly used as a salvage treatment for multidrug-resistant (MDR) intracranial infections. However, whether lumbar administration can generate adequate tigecycline exposure in ventricular cerebrospinal fluid (CSF), remains insufficiently characterized.</p><p><strong>Case presentation: </strong>We retrospectively analyzed three patients with intracranial infections who received 5mg tigecycline through a lumbar drainage catheter and had concurrent lumbar and ventricular CSF access. The underlying conditions were postoperative primary meningioma, brain abscess, and traumatic cerebral contusions, respectively. The identified pathogens included <i>Acinetobacter johnsonii</i> (tigecycline MIC, 0.5 mg/L), <i>Aspergillus fumigatus</i>, and <i>Klebsiella pneumoniae</i> (tigecycline MIC, 2.0 mg/L). Paired lumbar and ventricular CSF samples were collected at scheduled time points after dosing, and tigecycline concentrations were quantified by liquid chromatography-tandem mass spectrometry (LC‑MS/MS). Following a 5 mg lumbar intrathecal dose, the lumbar CSF peak concentration (C_max) was reached within 1 hour across all patients (933.89, 269.07, and 256.71 mg/L). In contrast, the ventricular C_max values were substantially lower (0.67, 7.05, and 2.64 mg/L), with ventricular time to peak concentration (T_max) delayed to 4-6 hours. The ventricular‑to‑lumbar area‑under‑the‑curve ratio (V/L AUC_1-24h ratio), ranged from 0.33% to 7.13%, indicating markedly attenuated and variable ventricular exposure relative to lumbar exposure. In the two patients with bacterial infections and available tigecycline MICs, ventricular CSF concentrations exceeded the corresponding MIC for at least part of the dosing interval. No neurotoxic adverse events were observed.</p><p><strong>Conclusion: </strong>In this three-patient case series, 5 mg lumbar intrathecal tigecycline achieved measurable but markedly attenuated ventricular CSF exposure, with substantial interpatient variability, and no predefined neurotoxic adverse events were documented in this small series. Lumbar intrathecal administration may be considered when ventricular administration is unavailable or undesirable, with individualized assessment and therapeutic drug monitoring where feasible.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"631435"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069502","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}