Infection and Drug Resistance最新文献

{"title":"Operationalizing the WHO Blueprint for Fungal Disease and Antifungal Resistance in Fragile Health Systems: Insights from Somalia.","authors":"Deka Ahmed Abdi, Abdullahi Abdi Yusuf, Aden Mohamed Hirsi, Ayan Mohamed Hassan, Khalid Hussein Ulusow, Abdihamid Hirsi Abdulle, Mohamed Mustaf Ahmed","doi":"10.2147/IDR.S642785","DOIUrl":"10.2147/IDR.S642785","url":null,"abstract":"<p><p>The World Health Organization (WHO) Blueprint for Strengthening Responses to Fungal Disease and Antifungal Resistance provides a global framework for improving national responses to fungal diseases and antifungal resistance. However, translating these recommendations into routine practice remains challenging in fragile and resource-constrained health systems, where weak governance, limited laboratory capacity, workforce shortages, constrained financing, and fragile supply chains may hinder implementation. Using Somalia as an illustrative context, this narrative policy commentary examines how such health-system constraints may affect operationalization of the WHO Blueprint. Somalia specific evidence on fungal disease burden and antifungal resistance remains limited; therefore, the country is used as an implementation context rather than as an evaluated fungal disease program. Drawing on the WHO Blueprint, established health-system strengthening concepts, and implementation constraints relevant to fragile settings, we propose a phased approach built around five interconnected priorities: strengthening governance and coordination, expanding laboratory and surveillance capacity, ensuring sustainable access to essential antifungal medicines, developing the health workforce, and integrating fungal disease services within existing health-system platforms. Rather than establishing new vertical programs, fragile health systems should leverage existing antimicrobial-resistance initiatives, laboratory networks, procurement mechanisms, and clinical training structures to improve feasibility and sustainability. Although derived from the Somalia context, these considerations may also be relevant to other settings facing similar resource and system constraints. The success of the WHO Blueprint will ultimately depend on the ability of health systems to adapt global recommendations into feasible and sustainable national action.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"642785"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060539","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":"Recent Advances and Future Perspectives in the Detection of Carbapenem-Resistant <i>Acinetobacter Baumannii</i>.","authors":"Qiuping Ye, Yaqun Liu, Kang Zhang, Maoqing Tian, Zhenxia Zhang, Min Lin, YuZhong Zheng","doi":"10.2147/IDR.S612634","DOIUrl":"10.2147/IDR.S612634","url":null,"abstract":"<p><p>Carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) is a major global public health threat. The World Health Organization (WHO) has classified CRAB as a critical priority pathogen. This threat is mainly attributed to its multidrug resistance, efficient nosocomial transmission, and limited therapeutic options. Timely and accurate detection is essential for early diagnosis, targeted antimicrobial therapy, and effective infection control. This review summarizes recent advances in CRAB detection technologies, including conventional phenotypic methods, nucleic acid amplification-based assays, genomic and AI-assisted diagnostics, mass spectrometry-based methods, and biosensor platforms. Conventional antimicrobial susceptibility testing (AST) remains the reference standard. However, it requires bacterial culture and isolation before testing, and the process usually takes 18-24 h after bacterial colony growth. This delay may limit its value for early therapeutic decision-making. Phenotypic carbapenemase assays provide complementary information on carbapenemase activity and resistance mechanisms, but their sensitivity, specificity, and clinical applicability vary across methods. Molecular methods substantially shorten turnaround times, with PCR and qPCR generally producing results within approximately 2-3 h. Isothermal amplification platforms further accelerate detection. LAMP-based assays report turnaround times of approximately 21-60 min, whereas RPA-based assays complete detection within approximately 40-90 min, supporting their potential application in point-of-care testing (POCT). Emerging genomic approaches, including whole-genome sequencing, nanopore sequencing, and metagenomic sequencing, enable comprehensive resistance profiling, outbreak investigation, and surveillance, while AI-assisted diagnostics may enhance resistance prediction and clinical interpretation. Mass spectrometry-based methods enable high-throughput species identification and can support resistance profiling in selected assay formats, with some assays detecting resistance-associated features within 15-90 min. Biosensor-based and CRISPR-integrated platforms offer highly sensitive, rapid, and portable detection, although challenges remain in multiplexing, standardization, cost, and clinical validation. Overall, this review highlights the transition of CRAB diagnostics from culture-based susceptibility testing toward integrated, automated, and clinically adaptable platforms, emphasizing the need to balance analytical performance, turnaround time, cost, and suitability for POCT.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"612634"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060472","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":"Diagnostic Performance of Bronchoalveolar Lavage Fluid Metagenomic Next‑generation Sequencing versus Conventional Microbiological Tests in Immunocompromised and Immunocompetent Patients with Pulmonary Infection.","authors":"Yongna Song, Chao Xu, Feicui Zu, Run Dong, Huanhuan Yang","doi":"10.2147/IDR.S632502","DOIUrl":"10.2147/IDR.S632502","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary infection in immunocompromised patients is challenging to diagnose. This study evaluated the detection performance of bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) in these patients.</p><p><strong>Patients and methods: </strong>A total of 86 patients with confirmed pulmonary infection (48 immunocompromised, 38 immunocompetent) were retrospectively enrolled. BALF samples were tested by both mNGS and conventional microbiological tests (CMTs). Pathogen detection rates and pathogen spectrum were compared between the two groups.</p><p><strong>Results: </strong>The positive rate of mNGS was significantly higher than that of CMTs in overall patients (87.21% vs 50.00%, <i>P</i> < 0.001), with a more prominent advantage in the immunocompromised group (97.92% vs 43.75%, <i>P</i> < 0.001). Detection rates of fungi (39.58% vs 5.26%, <i>P</i> < 0.001) and viruses (54.17% vs 28.95%, <i>P</i> = 0.018) were significantly higher in the immunocompromised group. Opportunistic pathogens including Pneumocystis jirovecii, cytomegalovirus, and Epstein-Barr virus were detected exclusively in the immunocompromised group. The mixed infection rate was also significantly higher in this group (72.92% vs 36.84%, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>BALF‑mNGS is a reliable supplementary tool for conventional detection. It effectively identifies missed opportunistic pathogens and complex mixed infections, especially in immunocompromised patients. Combined application of mNGS and conventional tests improves pathogen detection and may help inform anti-infective treatment decisions.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"632502"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060459","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":"Inappropriate Antimicrobial Regimen Leading to Recurrent <i>Listeria monocytogenes</i> Meningitis: A PK/PD-Based Case Analysis and a Literature Review.","authors":"Keying Zhang, Lili Xu, Yan Zhang, Pengtao Xu","doi":"10.2147/IDR.S632227","DOIUrl":"10.2147/IDR.S632227","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of antimicrobial agents used in the treatment of <i>Listeria monocytogenes</i> (<i>L. monocytogenes</i>) meningitis and to provide evidence-based guidance for individualized dosing regimens in clinical practice.</p><p><strong>Methods: </strong>A combined approach involving retrospective case analysis and a literature review was employed. The PK/PD characteristics of various antimicrobial agents applicable to the treatment of <i>L. monocytogenes</i> meningitis were comprehensively evaluated, and the rationality of different dosing regimens was assessed.</p><p><strong>Results: </strong>Case analysis revealed that inappropriate antimicrobial selection and insufficient dosing contributed to early disease relapse during treatment. Furthermore, a review of 43 published case reports has demonstrated that ampicillin in combination with gentamicin remains the first-line therapy for <i>L. monocytogenes</i> meningitis. However, when penicillin-based agents are contraindicated, alternative antimicrobial agents should be selected according to cerebrospinal fluid (CSF) penetration and PK/PD characteristics, with optimized and standardized dosing regimens established accordingly.</p><p><strong>Conclusion: </strong>Selection of antimicrobial therapy for <i>L. monocytogenes</i> meningitis should be guided by pharmacokinetic principles. Individualized precision therapy based on lesion-site PK/PD characteristics is essential to improve treatment success and patient prognosis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"632227"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060480","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":"Nasal Carriage Rate and Antimicrobial Susceptibility Profile of <i>Staphylococcus aureus</i> Among Healthcare Workers and Inpatients at Shahid Beheshti Hospital, Kashan, Iran (2023-2024): A Cross-Sectional Study.","authors":"Maryam Jamalan, Mehdi Nazeri, Mohamad Sadegh Sayahi, Mohammad Javad Azadchehr, Zahra Sadat Fateminasab, Hossein Sedaghat","doi":"10.2147/IDR.S639173","DOIUrl":"https://doi.org/10.2147/IDR.S639173","url":null,"abstract":"<p><strong>Objective: </strong><i>Staphylococcus aureus</i> is an opportunistic bacterial pathogen that affects humans. The objective of this study was to ascertain the prevalence of nasal carriage and antibiotic resistance profiles of isolated <i>S. aureus</i> strains among healthcare workers and patients admitted to Shahid Beheshti Hospital in Kashan, Iran.</p><p><strong>Methods: </strong>In this study, 165 and 130 nasal swabs were collected from inpatients and staff, respectively, at Shahid Beheshti Hospital from October 2023 to May 2024 in Kashan, Iran. Antibiotic sensitivity was tested using the standard disk diffusion method. The presence of <i>mecA</i> in MRSA (methicillin-resistant <i>Staphylococcus aureus</i>) isolates was confirmed by PCR.</p><p><strong>Results: </strong>The prevalence of <i>S. aureus</i> carriers among healthcare staff and hospitalized patients was 29 (22.3%) and 19 (11.5%), respectively. Among the 48 identified <i>S. aureus</i> carriers, four (13.8%) and one (5.3%) were classified as carriers of MRSA within the staff and inpatient populations, respectively. The antibiotic susceptibility profile showed the highest sensitivity to linezolid and cefoxitin, whereas erythromycin exhibited the lowest sensitivity. The <i>mecA</i> gene was detected in all MRSA isolates.</p><p><strong>Conclusion: </strong>The nasal carriage rate of <i>S. aureus</i> among healthcare workers and inpatients in our study was consistent with previous reports. Given the considerable resistance to erythromycin and clindamycin, alongside confirmation of the <i>mecA</i> gene in all MRSA isolates, we recommend implementing routine active surveillance and stringent infection control policies to limit the transmission of these potentially life-threatening strains in hospital settings.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"639173"},"PeriodicalIF":3.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038389","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":"Analysis of Plasma Biomarkers and Potential Pathogenesis in Children with <i>Mycoplasma pneumoniae</i> Pneumonia Based on Metabolomic Technology.","authors":"Qiuyan Xu, Li Shen, Lei Hong, Xiang Li, Min Lu, Shuangqin Ran","doi":"10.2147/IDR.S622829","DOIUrl":"10.2147/IDR.S622829","url":null,"abstract":"<p><strong>Background: </strong>Mycoplasma pneumoniae pneumonia (MPP) is a common cause of community-acquired pneumonia in children, yet its metabolic alterations and pathogenic mechanisms remain incompletely understood. This study aimed to characterize the plasma metabolomic profile of children with MPP and explore associated metabolic pathways.</p><p><strong>Methods: </strong>This retrospective case-control study involved 42 children including 14 MPP patients, 14 non-MPP (MPN) patients, and 14 healthy controls (HC). Clinical and laboratory data were compared across groups. Plasma metabolomic profiling was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multivariate statistical analyses, including principal component analysis (PCA), partial least squares-discriminant analysis (PLS-DA), and orthogonal partial least squares-discriminant analysis (OPLS-DA), were employed to identify metabolic differences among groups. Pathway enrichment analysis used the KEGG and Reactome databases.</p><p><strong>Results: </strong>Clinically, the MPP group exhibited significantly higher C-reactive protein (CRP) levels and neutrophil percentages, and lower lymphocyte percentages (all P<0.05), indicating enhanced inflammatory response. Distinct plasma metabolic profiles were observed in the MPP group compared with the MPN and HC groups. A total of 127 differential metabolites were identified in MPP vs MPN, and 749 in MPP vs HC. Pathway enrichment analysis revealed that downregulated metabolites in MPP vs MPN were significantly enriched in the PPAR signaling pathway, linoleic acid metabolism, and vitamin digestion/absorption pathways. In MPP vs HC, downregulated metabolites were mainly enriched in amino acid metabolism (arginine biosynthesis, alanine-aspartate-glutamate metabolism), GABAergic synapse, and glycerophospholipid metabolism. These perturbations aligned with the enhanced inflammatory responses observed in MPP.</p><p><strong>Conclusion: </strong>Childhood MPP is characterized by extensive metabolic disturbances involving amino acid, lipid, vitamin, and neurotransmitter metabolism. These metabolic disturbances may be associated with altered antioxidant defense, inflammatory signaling and neuroimmune crosstalk in MPP. The identified metabolites and dysregulated pathways may represent preliminary exploratory candidate signatures that require further validation to establish their relevance to childhood MPP.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"622829"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060432","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":"Discriminative Utility of Peripheral Blood Immune-Inflammatory Indices for Chronic Osteomyelitis: A Single-Center Retrospective Case-Control Study.","authors":"Lekai Zhu, Jiutai Chen, Changhuan Liu, Haodong Jiang, Zheng Wang, Xin Wang","doi":"10.2147/IDR.S618270","DOIUrl":"10.2147/IDR.S618270","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the clinical utility of composite immune-inflammatory indices formed from differential peripheral blood cell counts (NLR, PLR, SIRI, SII, PIV) for the early identification and risk stratification of chronic osteomyelitis, and to investigate potential clinical applications.</p><p><strong>Methods: </strong>A retrospective unmatched case-control study was conducted at Zhongnan Hospital of Wuhan University. A total of 212 patients with confirmed chronic osteomyelitis and 440 non-infected trauma controls during the same period were enrolled using convenience sampling. Routine complete blood count data and main clinical information at admission were collected. The five composite indices were calculated and compared between groups. Receiver operating characteristic (ROC) curves and area under the curve (AUC) with 95% confidence intervals (CI) were used to evaluate diagnostic performance, with pairwise AUC comparisons by DeLong's test. Multivariate logistic regression was performed to adjust for potential confounders (age, sex, diabetes, drinking history) and assess independent diagnostic value.</p><p><strong>Results: </strong>Although total white blood cell count did not differ significantly between groups, NLR, PLR, SIRI, SII, and PIV were all significantly elevated in the osteomyelitis group (all <i>P</i> < 0.001). SII and PIV showed higher AUC, sensitivity, and specificity (SII AUC = 0.800, 95% CI: 0.764-0.835; PIV AUC = 0.781, 95% CI: 0.744-0.818). After adjustment for confounders, SII (OR = 1.002, 95% CI: 1.001-1.002) and PIV (OR = 1.002, 95% CI: 1.002-1.003) remained independent predictors. DeLong's test indicated that SII had significantly better diagnostic utility than NLR, PLR, and SIRI, but not significantly different from PIV.</p><p><strong>Conclusion: </strong>Composite immune‑inflammatory indices based on peripheral blood counts are clinically accessible and cost‑effective. SII and PIV may serve as potential auxiliary tools for chronic osteomyelitis diagnosis, complementing the limitations of traditional WBC, pending further prospective validation.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"618270"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060510","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":"Application of NGS Technology in Osteomyelitis Caused by Human Bites.","authors":"Qingfang Zhao, Xiaodi Zou, Ahmad Alhaskawi, Mengmeng Luo, Kun Li, Jinghong Xu, Hui Lu","doi":"10.2147/IDR.S631065","DOIUrl":"10.2147/IDR.S631065","url":null,"abstract":"<p><p>Osteomyelitis caused by human bites is a severe and complex polymicrobial infection that is often complicated by delayed diagnosis and the high false-negative rate of conventional cultures. This case series retrospectively analyzed four cases of human bite-induced osteomyelitis to evaluate the clinical utility of next-generation sequencing (NGS) for the diagnosis of complex infections. Conventional intraoperative bacterial cultures were negative in two of the four cases, limiting pathogen-directed antimicrobial therapy. In contrast, NGS identified microbial organisms in all four patients and revealed polymicrobial profiles in several cases, including fastidious oral flora and obligate anaerobes that were not detected by conventional culture, such as <i>Prevotella, Bacteroides</i>, and <i>Porphyromonas</i> species, as well as <i>Treponema denticola</i>. All four patients achieved satisfactory wound healing without radiological evidence of recurrence, regained full range of motion, and returned to normal daily activities during follow-up. These findings support the potential value of NGS as an adjunctive diagnostic tool for identifying difficult-to-culture pathogens and providing additional microbiological information to support clinical decision-making in complex osteomyelitis.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"631065"},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060381","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 Fever with Thrombocytopenia Syndrome Complicated by Mixed Pulmonary Aspergillus and Mucorales Infection and Isavuconazole-Associated Liver Injury: A Case Report.","authors":"Shuting Liu, Haobo Kong, Yun Wang, Jingjing Pan, Hua Niu, Dahai Zhao","doi":"10.2147/IDR.S633745","DOIUrl":"10.2147/IDR.S633745","url":null,"abstract":"<p><strong>Background: </strong>Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease characterized by severe immune dysregulation and high mortality, predisposing patients to opportunistic infections.</p><p><strong>Case presentation: </strong>We report a 76-year-old male patient diagnosed with SFTS complicated by chronic hepatitis B with low-level viral replication, liver injury, and myocardial injury. After initial treatment with intravenous immunoglobulin, hepatoprotective therapy, and antiviral therapy, the patient stabilized. During hospitalization, he developed pulmonary infection. Sputum culture was positive for Aspergillus fumigatus and serum galactomannan (GM) test was positive. Initial treatment with voriconazole led to radiological improvement in the right lung lesion; however, progression of the left lung lesion was observed. Bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS) identified Rhizopus microsporus, leading to the diagnosis of invasive pulmonary Aspergillus-Mucorales coinfection. Oral isavuconazole combined with nebulized amphotericin B was administered, resulting in significant clinical and radiological improvement. Approximately one month after isavuconazole therapy, the patient developed jaundice and coagulation dysfunction. After exclusion of hepatitis B virus reactivation and other potential causes, isavuconazole-associated drug-induced liver injury was considered probable based on the clinical course and a RUCAM score of 8.</p><p><strong>Conclusion: </strong>SFTS patients are highly susceptible to invasive fungal infections due to immune dysregulation, thrombocytopenia, and endothelial injury. Clinicians should consider mucormycosis in patients with poor response to voriconazole and progressive pulmonary lesions, and early bronchoscopy with mNGS is recommended. Although isavuconazole is considered relatively safe, liver function monitoring is essential, especially in patients with underlying liver disease.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"633745"},"PeriodicalIF":3.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037763","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":"Prediction of Meropenem Target Attainment in Critically Ill Patients Using Routine Clinical Data from a Single Center: A Machine Learning Approach.","authors":"Qingliu Lu, Yinglian Wang, Ke Huang, Long Gan, Xiaoyu Chen, Zhongwen Feng","doi":"10.2147/IDR.S642373","DOIUrl":"https://doi.org/10.2147/IDR.S642373","url":null,"abstract":"<p><strong>Objective: </strong>Meropenem pharmacokinetics vary considerably among critically ill patients, resulting in uncertainty in target concentration attainment. This study aimed to develop a predictive model using real-world therapeutic drug monitoring (TDM) data to assess target attainment and provide a reference for individualized meropenem management.</p><p><strong>Methods: </strong>This single-center retrospective study included critically ill patients administered meropenem treatment and subjected to trough concentration monitoring from August 2023 to January 2026. Meropenem target attainment was defined as a trough concentration (Cmin) exceeding 8.0 mg/L. The analysis included 399 TDM samples from 333 patients, which were partitioned into training and test sets at an 8:2 ratio using a patient-level splitting approach. Following feature selection, eight machine learning algorithms were applied to build prediction models. Predictive performance was assessed primarily by the area under the receiver operating characteristic curve (AUC), with accuracy, sensitivity, specificity, F1 score, and calibration curves used as additional evaluation measures. SHapley Additive exPlanations (SHAP) analysis was then used to interpret the final model.</p><p><strong>Results: </strong>Ten features were ultimately selected, including age, CRRT, ECMO, Scr, ALP, PLT, P-LCR, APACHE II score, CrCl, and dose per body weight. In the independent test set, the random forest showed the best performance, with an AUC of 0.873 (95% CI: 0.779-0.946), followed by extreme gradient boosting with an AUC of 0.867 (95% CI: 0.763-0.942) and support vector machine with an AUC of 0.863 (95% CI: 0.771-0.935). SHAP analysis showed that CrCl, APACHE II score, and Scr were the most important predictors.</p><p><strong>Conclusion: </strong>Machine learning models developed using routine clinical variables showed good performance in predicting meropenem target attainment in critically ill patients and may help identify patients at high risk of target non-attainment, providing a reference for individualized meropenem management.</p>","PeriodicalId":13577,"journal":{"name":"Infection and Drug Resistance","volume":"19 ","pages":"642373"},"PeriodicalIF":3.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037355","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}