Infection and Drug Resistance最新文献

{"title":"A Practical Nomogram Based on RDW-CV for Predicting Clinical Outcome in Elderly Septic Patients.","authors":"Chengying Hong, Zhenmi Liu, Chuanchuan Nan, Yinjing Xie, Jinquan Xia, Yichun Jiang, Xiaojun Liu, Zhikun Xu, Kangping Hui, Yihan Xiong, Wei Wang, Huaisheng Chen","doi":"10.2147/IDR.S532564","DOIUrl":"10.2147/IDR.S532564","url":null,"abstract":"<p><strong>Objective: </strong>The retrospective study established a prognostic nomogram based on red blood cell distribution width-coefficient of variation (RDW-CV) for elderly septic patients.</p><p><strong>Methods: </strong>We analyzed 1997 critically ill patients admitted between December 2016 and June 2019, and 986 elderly septic patients were included in the study and stratified into survival and non-survival groups. Using machine learning-based feature importance analysis and multivariate logistic regression, we evaluated predictors of mortality in the elderly septic patients, with particular focus on RDW-CV. We constructed a nomogram incorporating RDW-CV to predict clinical outcomes in elderly septic patients and evaluated its performance.</p><p><strong>Results: </strong>The mortality of 986 elderly sepsis patients was 27.48%. Importance analysis showed that RDW-CV demonstrated superior predictive value for mortality. The RDW-CV (17.22 ±3.98%) in the non-survival group was significantly higher than that (15.30 ±2.81%) in the survival group, p < 0.0001. The RDW-CV was used to predict the mortality of patients and the AUC was 0.65 (95% CI: 0.61, 0.69). Multivariate logistic regression showed that mechanical ventilation, drug-resistant bacterial infection, hemofiltration, and RDW-CV independently influenced mortality, a predictive nomogram was developed based on a final model that included RDW-CV and other clinical indicators, the area under the curve (AUC) was found to be 0.755 (95% CI: 0.714, 0.797), decision curve analyses (DCA) revealed superior net benefit of the nomogram across threshold probabilities of 0.30-1.00 in both derivation and validation cohorts. The calibration curve demonstrates strong agreement between the model's predicted probabilities and the validation cohort's predicted probabilities.</p><p><strong>Conclusion: </strong>Higher RDW-CV was found to have a significant association with mortality prediction, the nomogram based on RDW-CV with other clinical indicators could more accurately predict the clinical outcome of elderly septic patients, validation analysis confirmed the accuracy of the nomogram, the predictive model offered clinical applicability.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4799-4809"},"PeriodicalIF":2.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064445","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":"Characterization of High-Linezolid-MIC <i>Clostridioides difficile</i> Isolated from a Chinese Hospital: First Genomic Evidence of <i>Cfr</i>(B) Transmission and Tn<i>6218</i> Association.","authors":"Xuyan Fu, Xiajing Bi, Tao Lv, Yunbo Chen","doi":"10.2147/IDR.S523333","DOIUrl":"10.2147/IDR.S523333","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> (<i>C. difficile</i>) exhibiting high linezolid minimum inhibitory concentration (>4 µg/mL) remains infrequently reported in clinical settings. Notably, the prevalence of linezolid-resistant <i>C. difficile</i> is exceptionally low (<3% in Chinese isolates), and the underlying genetic determinants are poorly characterized.</p><p><strong>Methods: </strong>We conducted a genomic study to investigate the genetic characteristics of <i>C. difficil</i>e with high linezolid MIC. To determine the MIC of linezolid and delineate antimicrobial resistance profiles, these isolates were systematically subjected to antimicrobial susceptibility testing. Multilocus sequence typing, antimicrobial resistance genes, and the characteristics of the <i>cfr</i> gene in linezolid-resistant <i>C. difficil</i>e strains were analyzed following whole-genome sequencing. Roary was used to construct a pangenome phylogenetic tree, and a Bayesian evolutionary analysis was performed using BEAST.4.</p><p><strong>Results: </strong>Among 421 screened <i>C. difficile</i> isolates, nine isolates (2.1%) exhibited high-linezolid MICs (≥16 μg/mL), including six ST37 (A-B+) and three ST3 strains (two A-B-). All harbored <i>cfr</i>(B) on Tn<i>6218</i>, sharing homology with <i>E. faecium</i> (NG_050395.1).</p><p><strong>Conclusion: </strong>This study underscores the risk of <i>cfr</i>(B) dissemination via mobile genetic elements in clinical settings, urging surveillance of co-occurrence in <i>Enterococcus</i> and <i>C. difficile</i> to curb resistance spread.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4789-4798"},"PeriodicalIF":2.9,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12430234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064545","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":"Correlation Between Vancomycin Trough Concentrations and C-Reactive Protein in Neonates: A Retrospective Observational Study from a Tertiary Hospital in China.","authors":"Bo Guo, Hui Chen, Xiao Song, Zeyang Wei, Kai Zhao, Zhen-Guo Liu","doi":"10.2147/IDR.S537052","DOIUrl":"10.2147/IDR.S537052","url":null,"abstract":"<p><strong>Background: </strong>Low initial trough concentrations of vancomycin (TCV) are prevalent among neonatal patients receiving this medication. Prior research has identified significant correlations between initial TCV and various clinical parameters, including postnatal age, gestational age, body weight, estimated glomerular filtration rate (eGFR), and serum albumin levels. However, few studies have addressed the relationship between C-reactive protein (CRP) and initial TCV in neonates. This study aimed to explore the correlation between CRP and initial TCV in a Chinese neonatal population.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on neonates who received intravenous vancomycin at Northwest Women's and Children's Hospital, China, from October 2018 to December 2023. Clinical characteristics and laboratory data were extracted from medical records, focusing on data obtained within 24 hours prior to the first vancomycin administration. The primary outcomes measured were CRP levels and initial TCV.</p><p><strong>Results: </strong>A total of 112 neonates with available therapeutic drug monitoring (TDM) data for intravenous vancomycin treatment were included. After adjusting for potential confounders, a non-linear relationship between CRP and initial TCV was identified, with an inflection point at 88.28 mg/L. The effect sizes and corresponding confidence intervals for the regions below and above this inflection point were 0.036 (95% CI: -0.005 to 0.078) and -0.084 (95% CI: -0.142 to -0.027), respectively.</p><p><strong>Conclusion: </strong>A non-linear relationship between CRP and initial TCV was identified, with a negative correlation when CRP levels exceed 88.28 mg/L.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4777-4787"},"PeriodicalIF":2.9,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064537","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":"Thermographic Assessment of Lyme Borreliosis Without Erythema Migrans.","authors":"Mykhaylo Andreychyn, Mykhaylo Korda, Vasyl Kopcha, Maria Ivanivna Shkilna, Roman Komorovsky","doi":"10.2147/IDR.S540248","DOIUrl":"10.2147/IDR.S540248","url":null,"abstract":"<p><strong>Background: </strong>In 11-18% of patients, infection with <i>Borrelia</i> is not accompanied by the characteristic skin lesion known as erythema migrans, complicating the timely diagnosis of Lyme borreliosis. To aid in identifying this atypical presentation, we assessed the tick bite site with thermographic imaging.</p><p><strong>Aim: </strong>To determine the diagnostic value of infrared thermography in patients with Lyme borreliosis without erythema migrans.</p><p><strong>Materials and methods: </strong>We observed 16 patients with Lyme borreliosis without erythema migrans. The diagnosis was based on a history of tick bite and laboratory confirmation using two-tiered serological testing, performed 10-20 days after tick exposure. Thermographic imaging was performed with the device positioned 100-150 cm from the area of interest. Temperature differences (ΔT) were recorded.</p><p><strong>Results and discussion: </strong>Thermographic imaging revealed localized hyperthermia in all 16 patients at the site of tick attachment, presenting as annular thermal changes (ΔT = 0.6-3.8 °C) that persisted for at least two weeks, even with ongoing antibacterial therapy. Nearly one-third of patients had ΔT in the range of 0.6-1.1 °C, half showed values of 1.2-1.6 °C, and in 18.7% of cases, ΔT exceeded 1.6 °C. These measurements were obtained and quantified using software-assisted analysis of the thermograms. Therefore, the absence of visible erythema migrans does not rule out localized inflammatory changes: centrifugal spread of <i>Borrelia</i> from the bite site can still induce subclinical cutaneous inflammation detectable with infrared thermography.</p><p><strong>Conclusion: </strong>Infrared thermography of the tick bite site can reveal a \"thermal erythema migrans\" pattern, an annular zone of hyperthermia corresponding to the distribution of erythema migrans even when no rash is visible on clinical inspection. This early thermographic sign, detectable when a temperature exceeds 0.5 °C between the bite site and adjacent or symmetrical areas, may support timely initiation of etiotropic therapy to prevent long-term complications of Lyme disease.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4741-4748"},"PeriodicalIF":2.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040077","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":"Challenges in Management of Disseminated Mucormycotic Infection with Endocarditis in an Adult Patient Receiving Liver Transplantation.","authors":"Yue Wu, Xinyu Yu, Yuntao Zhang, Junfang Liu, Ying Chen, Rongrong Wang, Wei Zhang","doi":"10.2147/IDR.S534279","DOIUrl":"10.2147/IDR.S534279","url":null,"abstract":"<p><p>Mucormycosis is a rare fungal infection. With the recent advancements in diagnostic technologies, including molecular diagnostic techniques, such as PCR and metagenomic next-generation sequencing, the detection rates of mucormycosis have increased. However, its mortality rates remain alarmingly high. Although post-liver transplantation mucormycosis cases are infrequently reported (less than 1%), their mortality rate ranges from 60% to 90%, while mucormycotic endocarditis is even rarer. This article summarizes the clinical manifestations of mucormycosis in a post-liver transplantation adult patient and reviews the existing literature on mucormycotic endocarditis, with the aim of outlining its clinical features, diagnostic challenges, and therapeutic strategies.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4711-4721"},"PeriodicalIF":2.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039945","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 Impact of Yogurt, Legumes, and Coffee on Health Outcomes in HIV: You are What You Eat?","authors":"Xinrui Gao, Siyi Cen, Liang-Gen Cai, Suling Chen, Bing Li, Yuanhui Jiang, Tao Yu, Jie Peng, Guangyu Liang, Shaohang Cai","doi":"10.2147/IDR.S531390","DOIUrl":"10.2147/IDR.S531390","url":null,"abstract":"<p><strong>Background: </strong>HIV-induced immunodeficiency and comorbidities highlight the importance of nutritional support. While the World Health Organization (WHO) advocates for dietary interventions in people living with HIV (PLWH), robust clinical evidence remains limited.</p><p><strong>Methods: </strong>This study continuously enrolled 280 newly diagnosed PLWH (≥16 years) without opportunistic infections or malignancies. Participants were stratified into high- and low-consumption groups based on dietary intake: yogurt (≥300 mL/week vs <300 mL/week), legumes (≥180 g/week vs <180 g/week), and black coffee (≥3 cups/week vs <3 cups/week), excluding sugary and milk-based coffee. Clinical assessments included laboratory tests, liver fibrosis and steatosis evaluation (FibroScan, AST-to-platelet ratio index [APRI], and controlled attenuation parameter [CAP]), and physical and mental health assessments using the 36-Item Short Form Health Survey (SF-36), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS).</p><p><strong>Results: </strong>At baseline, high-yogurt consumption group had higher CD4+ (P=0.027) and higher CD8+ T-cell counts (P=0.043), lower alcohol use (P=0.001), and higher alanine aminotransferase (ALT) levels (P<0.001). Post antiretroviral therapy (ART), the T-cell count differences disappeared, but BMI and weight gain remained higher (both P<0.001). Legume consumption was not significantly associated with serum lipid profiles but was correlated with lower smoking prevalence (P=0.021), higher ALT levels (P=0.007), and higher CD4+ T-cell counts (P=0.011) at baseline. High coffee consumption was associated with lower APRI scores post-ART (P=0.025) but showed no other significant associations with clinical parameters. No significant associations were found between diet and SF-36, SAS, or SDS scores, except reduced social functioning in high legume and coffee groups.</p><p><strong>Conclusion: </strong>High yogurt consumption was associated with high baseline CD4+ and CD8+ T counts but also associated with increased BMI after ART. However, no significant interactions between dietary intake and ART outcomes were observed.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4749-4762"},"PeriodicalIF":2.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040027","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-Assisted Risk Prediction and Stratification of Infections After Kidney Transplantation: A Case Study of COVID-19.","authors":"Xin Ye, Chao Li, Zheng Zhou, Jiangnan Yang, Hao Jiang, Linkun Hu, Hao Pan, Xuedong Wei, Yuhua Huang, Yuxin Lin, Liangliang Wang","doi":"10.2147/IDR.S521111","DOIUrl":"10.2147/IDR.S521111","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, COVID-19 infection has severely damaged the transplanted kidney function and health of kidney transplant patients. This study aims to investigate the clinical characteristics, risk factors and predictors of severe COVID-19 in patients after kidney transplantation.</p><p><strong>Material and methods: </strong>The clinical data of patients with COVID-19 after kidney transplantation were collected from December 2022 to January 2023 at the First Affiliated Hospital of Soochow University. Logistic regression analysis was performed to identify risk factors for severe disease and to construct a nomogram model. Concurrently, metagenomic next-generation sequencing (mNGS) was employed to detect the sputum microbiome.</p><p><strong>Results: </strong>A total of 58 patients were enrolled and were categorized into the common group (n=35) and the severe group (n=23) based on infection severity. The common group comprised 23 males with a mean age of 45.60 ± 9.11 years, while the severe group included 16 males with a mean age of 48.22 ± 9.95 years. Multivariate logistic analysis revealed that days of fever before hospitalization, C-reactive protein (CRP) and interleukin-10 (IL-10) on admission were significantly independent risk factors for severity, with an area under the ROC curve at 0.906. Comparison of the sputum microbiome revealed that there were no significant differences in α and β diversity between the two groups. <i>Streptococcus parasanguinis</i> was significantly more abundant in the specimens from the severe group, while <i>Gemella sanguinis</i> and <i>Gemella haemolysans</i> were significantly more abundant in the common group.</p><p><strong>Conclusion: </strong>The severity of COVID-19 in kidney transplant patients is associated with days of fever before hospitalization, and the levels of CRP and IL-10 at admission, which also alter the abundance of certain species in the sputum microbiome. Therefore, it is necessary to actively monitor the clinical indicators of kidney transplant patients admitted with COVID-19 to reduce the risk of progression to severe disease.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4763-4776"},"PeriodicalIF":2.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040104","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":"Sulbactam Concentration in Critically Ill Patients with Hospital-Acquired Pneumonia: A Comparisons Stratified by Normal and Augmented Renal Clearance.","authors":"Lin Zhang, Juan Zeng, Wenying Zhu, Jing Sha, Yue Tang, Bing Leng, Nan Guo, Jinjiao Jiang","doi":"10.2147/IDR.S538120","DOIUrl":"10.2147/IDR.S538120","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the impact of varying renal function on serum sulbactam concentrations and antibiotic efficacy in critically ill patients with hospital-acquired pneumonia (HAP) who exhibit no elevation in serum creatinine levels.</p><p><strong>Patients and methods: </strong>A prospective observational study was conducted on 23 adult HAP patients in the ICU of Shandong Provincial Hospital who received intravenous cefoperazone/sulbactam, from January 2021 to January 2023. Renal function was estimated using serum creatinine (eGFRcreat) and cystatin C (eGFRcys). An eGFRcreat >130 mL/min or eGFRcys >80 mL/min indicated augmented renal clearance. Serum sulbactam levels were measured at 0 min (pre-dose) and 15, 30, 60, 120, 180, 360, and 480 min after the >6th dose using HPLC-MS/MS.</p><p><strong>Results: </strong>Among all the 23 patients, 10 had an eGFRcreat above 130 mL/min and 9 had an eGFRcys above 80 mL/min. Additionally, 13 patients exhibited an eGFRcreat ranging from 47 to 123 mL/min, and 14 patients had an eGFRcys in the range of 22 to 75 mL/min. In patients with higher estimated glomerular filtration rate (eGFR), regardless of whether it was based on creatinine or cystatin C, the serum sulbactam concentration tend to decrease more rapidly after the end of administration. Patients with higher eGFR also tend to have a shorter half time and lower drug exposure (AUC). Five patients experienced antibiotic treatment failure. The median eGFRcreat and eGFRcys of these 5 patients were both higher than those patients who responded positively to antibiotic therapy, although not statistically significant.</p><p><strong>Conclusion: </strong>Patients with higher eGFR demonstrated decreased levels of sulbactam. Despite the discrepancy in GFR estimated by creatinine and cystatin C, both the two biomarkers yielded similar predictions of variability in serum sulbactam concentration. Currently, there is no evidence in this study indicating that differences in renal function affect treatment outcomes in critically ill patients without elevated creatinine levels. Further research is warranted to explore the influence of varying renal function-related pharmacokinetic fluctuations on antibiotic efficacy.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4731-4739"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040074","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 Efficacy and Safety of Omadacycline Versus Tigecycline in Treating Severe Pneumonia Caused by Carbapenem-Resistant Gram-Negative Bacilli: A Retrospective Cohort Study.","authors":"Ye Zhang, Fei Wang, Min Wang, Wenhui Xu, Aiping Wang, Yueping Ding","doi":"10.2147/IDR.S541192","DOIUrl":"10.2147/IDR.S541192","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical efficacy and safety of intravenous omadacycline compared to intravenous tigecycline in patients with severe pneumonia caused by carbapenem-resistant gram-negative bacilli (CRGNB), and to explore the factors influencing 28-day all-cause mortality.</p><p><strong>Methods: </strong>Our retrospective analysis was conducted on adult patients with CRGNB-associated severe pneumonia who received intravenous omadacycline or tigecycline for at least 72 hours in the intensive care unit (ICU) between April 1, 2023, and March 31, 2025. The primary outcome was 28-day all-cause mortality, while secondary endpoints included clinical efficacy and microbiological clearance rates. Safety was also assessed. Logistic regression analysis was used to identify factors associated with 28-day all-cause mortality.</p><p><strong>Results: </strong>A total of 80 patients with CRGNB-associated severe pneumonia were enrolled, including 43 in the omadacycline group and 37 in the tigecycline group. Compared with the tigecycline group, there was no statistically significant difference in 28-day mortality (χ² = 2.882, p = 0.090) or microbiological clearance rate (58.14% vs 48.65%, p = 0.501) in the omadacycline group. However, the omadacycline group showed a significantly higher clinical efficacy rate (72.09% vs 43.24%, p = 0.012) and a markedly lower incidence of adverse events (4.65% vs 24.32%, p = 0.020). Multivariate logistic regression analysis revealed that combination therapy with β-lactams was an independent predictor of reduced 28-day mortality, whereas central venous catheterization and baseline C-reactive protein (CRP) levels were independently associated with increased 28-day mortality.</p><p><strong>Conclusion: </strong>Our study found that omadacycline is comparable to tigecycline in clinical effectiveness for the treatment of CRGNB-associated severe pneumonia, while exhibiting a better safety profile. Novel tetracyclines may be used in combination with β-lactams for the treatment of severe pneumonia caused by CRGNB.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4699-4710"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029796","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 Exchange Combined with Intrathecal Antibiotic Injection for the Management of Severe Intracranial Infection Caused by Hypervirulent <i>Klebsiella pneumoniae</i>: A Case Report.","authors":"Hong Wei, Lifan Xu, Lu Li, Yong Shen, Sijie Yu, Haiyan Huang, Xin Huang","doi":"10.2147/IDR.S546360","DOIUrl":"10.2147/IDR.S546360","url":null,"abstract":"<p><p>Hypervirulent <i>Klebsiella pneumoniae</i> is a recently identified pathotype characterized by high virulence and rapid dissemination. It is associated with invasive infections at multiple anatomical sites, including liver abscesses, necrotizing fasciitis, meningitis, myositis, and endophthalmitis. It has emerged as a significant threat to public health due to its aggressive clinical course and high mortality rate. This case presents a 63-year-old female diabetic patient who developed lung abscess, liver abscess, and bacterial meningitis. Typical clinical manifestations confirmed through imaging, microbiological culture analysis, and whole-genome sequencing (ST65-K1) revealed Hypervirulent <i>Klebsiella pneumoniae</i> infection. The patient was comatose with purulent cerebrospinal fluid and obstructed drainage. Such severe cases of Hypervirulent <i>Klebsiella pneumoniae</i> intracranial infection are extremely rare. Early cerebrospinal fluid exchange, combined with intrathecal amikacin injection, was initiated. After one month of active treatment, the patient exhibited improved clinical outcomes and was subsequently discharged. This case highlights that patients with diabetes, particularly those presenting with high-risk comorbidities, are predisposed to developing triggering factors for <i>Klebsiella pneumoniae</i> invasive syndrome <i>Klebsiella pneumoniae</i> invasive syndrome. Early identification and implementation of individualized cerebrospinal fluid exchange therapy combined with intrathecal antibiotic therapy in critically ill meningitis patients infected with <i>Klebsiella pneumoniae</i> invasive syndrome are pivotal for improving prognosis. Collectively, these findings provide novel insights and a valuable framework for developing future therapeutically efficacious strategies for the management of Hypervirulent <i>Klebsiella pneumoniae</i>. However, this regimen does not standard-of-care, and further evidence is required to establish its safety and clinical effectiveness.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"18 ","pages":"4723-4730"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029725","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}