International Journal of Antimicrobial Agents最新文献

{"title":"Genetic characterization of extensively drug-resistant blaCTX-M-27 Shigella sonnei clusters among men who have sex with men in a region of northern Spain","authors":"Domingo Fernández Vecilla ,&nbsp;Mikel Joseba Urrutikoetxea Gutiérrez ,&nbsp;María Carmen Nieto Toboso ,&nbsp;Kristina Zugazaga Inchaurza ,&nbsp;Estíbaliz Ugalde Zárraga ,&nbsp;Beatriz Ruiz Estévez ,&nbsp;José Luis Díaz de Tuesta del Arco","doi":"10.1016/j.ijantimicag.2025.107490","DOIUrl":"10.1016/j.ijantimicag.2025.107490","url":null,"abstract":"<div><h3>Objective</h3><div>The convergence of globalization with increased sexual risk behaviours has significantly facilitated the dissemination of multidrug-resistant and extensively drug-resistant clusters of <em>Shigella</em> spp. among men who have sex with men, particularly <em>Shigella sonnei</em> and <em>Shigella flexneri</em>. A cluster of <em>S. sonnei</em> carrying <em>bla</em>_CTX-M-27 caused a European outbreak in 2020–2021, with more than 30 cases in Spain, including two in our institution. In this study, we conducted a retrospective study from October 2022 to December 2023 that included five additional patients with shigellosis caused by a CTX-M-27-producing <em>S. sonnei</em>.</div></div><div><h3>Methods</h3><div>Genetic characterization was assessed by whole-genome sequencing using the MinION Mk1C device (Oxford Nanopore Technologies, Oxford, UK).</div></div><div><h3>Results</h3><div>All the isolates presented IncB/O/K/Z or IncFII plasmids, which carried genes conferring resistance to second- and third-generation cephalosporins, cotrimoxazole, azithromycin and quinolones. SNP analysis revealed that neither the strains within this study nor the UK cluster were related to each other.</div></div><div><h3>Conclusions</h3><div>Different community clusters of extensively drug-resistant <em>S. sonnei</em> strains harbouring <em>bla</em>_CTX-M-27 are spreading in our area, mainly associated with sexual transmission among men who have sex with men.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 6","pages":"Article 107490"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiomics informed mathematical model for meropenem and tobramycin against hypermutable Pseudomonas aeruginosa","authors":"J.R. Tait ,&nbsp;A.A. Agyeman ,&nbsp;C. López-Causapé ,&nbsp;D. Deveson-Lucas ,&nbsp;K.E. Rogers ,&nbsp;R. Yadav ,&nbsp;V.E. Rees ,&nbsp;B.S. Shin ,&nbsp;R.L. Nation ,&nbsp;J.D. Boyce ,&nbsp;A. Oliver ,&nbsp;C.B. Landersdorfer","doi":"10.1016/j.ijantimicag.2025.107488","DOIUrl":"10.1016/j.ijantimicag.2025.107488","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hypermutable &lt;em&gt;P. aeruginosa&lt;/em&gt; isolates frequently display resistance emergence during treatment. Mechanisms of such resistance emergence have not been explored using dynamic hollow-fiber studies and multiomics informed mathematical modeling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Two hypermutable and heteroresistant &lt;em&gt;P. aeruginosa&lt;/em&gt; isolates, CW8 (MIC&lt;sub&gt;meropenem&lt;/sub&gt;=8 mg/L, MIC&lt;sub&gt;tobramycin&lt;/sub&gt;=8 mg/L) and CW44 (MIC&lt;sub&gt;meropenem&lt;/sub&gt;=4 mg/L, MIC&lt;sub&gt;tobramycin&lt;/sub&gt;=2 mg/L), were studied. Both isolates had genotypes resembling those of carbapenem- and aminoglycoside-resistant strains. Achievable lung fluid concentration-time profiles following meropenem at 1 or 2 g every 8 h (3-h infusion) and tobramycin at 5 or 10 mg/kg body weight every 24 h (0.5-h infusion), in monotherapy and combinations, were simulated over 8 days. Total and resistant bacterial counts were determined. Resistant colonies and whole population samples at 191 h were whole-genome sequenced, and population transcriptomics performed at 1 and 191 h. The multiomics analyses informed mechanism-based modeling of total and resistant populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;While both isolates eventually displayed resistance emergence against all regimens, the high-dose combination synergistically suppressed resistant regrowth of only CW8 up to ∼96 h. Mutations that emerged during treatment were in &lt;em&gt;pmrB, ampR&lt;/em&gt;, and multiple efflux pump regulators for CW8, and in &lt;em&gt;pmrB&lt;/em&gt; and PBP2 for CW44. At 1 h, &lt;em&gt;mexB, oprM&lt;/em&gt; and &lt;em&gt;ftsZ&lt;/em&gt; were differentially downregulated in CW8 by the combination. These transcriptomics results informed inclusion of mechanistic synergy in the mechanism-based model for only CW8. At 191 h, norspermidine genes were upregulated (without a &lt;em&gt;pmrB&lt;/em&gt; mutation) in CW8 by the combination, and informed the adaptive loss of synergy in the model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Multiomics information enabled mechanism-based modeling to describe the bacterial response of both isolates simultaneously.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Importance&lt;/h3&gt;&lt;div&gt;&lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; causes serious bacterial infections in people with cystic fibrosis (pwCF), and has numerous resistance mechanisms. Current empirical approaches to informing antibiotic regimen selection have important limitations. This study exposed two &lt;em&gt;P. aeruginosa&lt;/em&gt; clinical isolates to concentration-time profiles of meropenem and tobramycin as would be observed in lung fluid of pwCF. The combination elicited different bacterial count profiles between the isolates, despite similar bacterial baseline characteristics. We found differences between the isolates in the expression of a key resistance mechanism against meropenem at 1 h, and expression that implied a loss of cell membrane permeability for tobramycin without the expected DNA mutation. This information enabled mathematical modeling to accurately describe all bacterial p","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 6","pages":"Article 107488"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply to the Letter to Editor regarding 'Renal function and its impact on the concentration of ceftazidime-avibactam: A cross-sectional study'.","authors":"Jacopo Angelini, Simone Giuliano, Simone Lanini, Sara Ferin, Luca Martini, Stella Cossettini, Jason Roberts, Massimo Baraldo, Carlo Tascini","doi":"10.1016/j.ijantimicag.2025.107480","DOIUrl":"https://doi.org/10.1016/j.ijantimicag.2025.107480","url":null,"abstract":"","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":" ","pages":"107480"},"PeriodicalIF":4.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Title Page & Editorial Board","authors":"","doi":"10.1016/S0924-8579(25)00042-1","DOIUrl":"10.1016/S0924-8579(25)00042-1","url":null,"abstract":"","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 4","pages":"Article 107485"},"PeriodicalIF":4.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new perspective on the antimicrobial mechanism of linezolid against Staphylococcus aureus revealed by proteomics and metabolomics analysis","authors":"Dan Luo ,&nbsp;Weile Xie ,&nbsp;Shiwei Ma ,&nbsp;Longlong Wang ,&nbsp;Jianguo Zhu ,&nbsp;Zhe Wang","doi":"10.1016/j.ijantimicag.2025.107470","DOIUrl":"10.1016/j.ijantimicag.2025.107470","url":null,"abstract":"<div><div>Understanding bacterial responses to antimicrobials is crucial for identifying tolerance mechanisms and for developing new therapies. Using mass spectrometry–based metabolomics and proteomics, this study examines the response of <em>Staphylococcus aureus</em> to linezolid (LZD) treatment. Under LZD stress, significant fluctuations were observed in key metabolic pathways such as amino acid biosynthesis and the TCA cycle, alongside a general increase in ribosomal protein complexes. Additionally, LZD disrupted nucleotide metabolism, particularly affecting pyrimidine pathways. Combining LZD with the pyrimidine synthesis inhibitor leflunomide enhanced bactericidal effects both in vitro and in vivo, highlighting the importance of targeting pyrimidine biosynthesis to amplify the antimicrobial efficacy of protein inhibitors. These results underscore downstream metabolic processes as viable targets for synergistic drug combinations, suggesting a strategy to potentially improve the clinical effectiveness of LZD.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 6","pages":"Article 107470"},"PeriodicalIF":4.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacodynamic interaction of apotransferrin and anti-pseudomonal antibiotics against extensively drug-resistant Pseudomonas aeruginosa in a dynamic PK/PD model","authors":"María M Montero ,&nbsp;Sandra Domene-Ochoa ,&nbsp;Núria Prim ,&nbsp;Carla López-Causapé ,&nbsp;Daniel Echeverria-Esnal ,&nbsp;Luisa Sorlí ,&nbsp;Sonia Luque ,&nbsp;Eduardo Padilla ,&nbsp;Santiago Grau ,&nbsp;Antonio Oliver ,&nbsp;Juan P. Horcajada","doi":"10.1016/j.ijantimicag.2025.107477","DOIUrl":"10.1016/j.ijantimicag.2025.107477","url":null,"abstract":"<div><div><strong>Objectives:</strong> The rise of antibiotic resistance in clinical settings poses a major challenge. Apotransferrin has emerged as a potential non-traditional therapy for combating infections, potentially preventing resistance development while enhancing bactericidal effects. This study evaluated the efficacy of apotransferrin combined with antipseudomonal antibiotics against extensively drug-resistant (XDR) <em>Pseudomonas aeruginosa</em> isolates.</div><div><strong>Methods:</strong> Twenty XDR <em>P. aeruginosa</em> clinical isolates were evaluated. Different apotransferrin concentrations were tested to determine the optimal in vitro concentration. Time-kill assays assessed the combined effects of apotransferrin with meropenem or ceftolozane/tazobactam (C/T). A chemostat model using four selected isolates validated the most effective combinations and monitored resistance emergence.</div><div><strong>Results:</strong> Apotransferrin monotherapy did not reduce bacterial load, but its combination with antipseudomonal antibiotics enhanced efficacy. Meropenem activity improved in 10/20 isolates, and C/T activity in 13/20 compared to antibiotic monotherapy. The chemostat model confirmed synergistic interactions between apotransferrin and C/T in two isolates, with additive effects in two others. This combination outperformed the most effective monotherapy in all isolates, with no emergence of new C/T-resistant strains.</div><div><strong>Conclusions:</strong> In conclusion, the combination of apotransferrin with C/T demonstrated superior in vitro efficacy against XDR <em>P. aeruginosa</em> isolates compared to either treatment alone. These findings suggest that apotransferrin could be a valuable adjunctive therapy, enhancing the antimicrobial effects of existing antibiotics and potentially extending their clinical utility.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 5","pages":"Article 107477"},"PeriodicalIF":4.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-talk between signal transduction systems and metabolic networks in bacterial antibiotics resistance and tolerance","authors":"Shuji Gao ,&nbsp;Baobao Liu ,&nbsp;Shuo Yuan ,&nbsp;Yingying Quan ,&nbsp;Shenao Song ,&nbsp;Wenjie Jin ,&nbsp;Yuxin Wang ,&nbsp;Yang Wang","doi":"10.1016/j.ijantimicag.2025.107479","DOIUrl":"10.1016/j.ijantimicag.2025.107479","url":null,"abstract":"<div><div>The comprehensive antibiotic resistance of pathogens signifies the oneset of the “post-antibiotic era”, and the myriad treatment challenges posed by “superbugs” have emerged as the primary threat to human health. Recent studies indicate that bacterial resistance and tolerance development are mediated at the metabolic level by various signalling networks (e.g., quorum sensing systems, second messenger systems, and two-component systems), resulting in metabolic rearrangements and alterations in bacterial community behaviour. This review focuses on current research, highlighting the intrinsic link between signalling and metabolic networks in bacterial resistance and tolerance.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 5","pages":"Article 107479"},"PeriodicalIF":4.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and epidemiological landscape of anaerobic bacteria in Europe, 2020–2023 (ANAEuROBE)","authors":"Matteo Boattini ,&nbsp;Gabriele Bianco ,&nbsp;Paulo Bastos ,&nbsp;Viktoria Eirini Mavromanolaki ,&nbsp;Sofia Maraki ,&nbsp;Anastasia Spiliopoulou ,&nbsp;Vasileios Kakouris ,&nbsp;Yordan Kalchev ,&nbsp;Ana Budimir ,&nbsp;Branka Bedenić ,&nbsp;Zana Rubic ,&nbsp;Monica Licker ,&nbsp;Corina Musuroi ,&nbsp;Emese Juhász ,&nbsp;Katalin Kristóf ,&nbsp;Mateja Pirs ,&nbsp;Ivana Velimirovic ,&nbsp;Michael Berktold ,&nbsp;Adriána Liptáková ,&nbsp;Adriana Krajcikova ,&nbsp;Cristina Costa","doi":"10.1016/j.ijantimicag.2025.107478","DOIUrl":"10.1016/j.ijantimicag.2025.107478","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite being implicated in a wide spectrum of community- and healthcare-acquired infections, anaerobes have not yet been incorporated into systematic surveillance programs in Europe.</div></div><div><h3>Methods</h3><div>We conducted a multicentre retrospective observational study analysing all anaerobic strains isolated from blood cultures in 44 European Hospital Centres over a 4-y period (2020–2023). Diagnostic approach, epidemiology, and antimicrobial susceptibility according to EUCAST v. 15.0 were investigated.</div></div><div><h3>Results</h3><div>Our study included 14,527 anaerobes, most of which were Gram-positive (45%) or Gram-negative (40%) bacilli. MALDI-TOF coupled to mass spectrometry was the most widely used tool for species identification (98%). Antimicrobial susceptibility testing was performed in the vast majority of centres, using mostly gradient diffusion strip (77%) and disk diffusion (45%) methods according to EUCAST guidelines. The most prevalent species were <em>Cutibacterium acnes</em> (18.7%), <em>Bacteroides fragilis</em> (16.3%), <em>Clostridium perfringens</em> (5.3%), <em>Bacteroides thetaiotaomicron</em> (4.2%), <em>Fusobacterium nucleatum</em> (3.5%), and <em>Parvimonas micra</em> (3.4%). <em>C. acnes</em> showed high resistance to benzylpenicillin (18%), clindamycin (39%), and imipenem (19% and 13% by MIC methods and disk diffusion, respectively). <em>B. fragilis</em> showed high resistance to amoxicillin/clavulanate (24%), piperacillin/tazobactam (22% and 14% by MIC methods and disk diffusion, respectively), clindamycin (22% by both MIC methods and disk diffusion), meropenem (13%), and metronidazole (10%, only by disk diffusion). A similar resistance pattern was observed in <em>B. thetaiotaomicron, Bacteroides ovatus</em>, and <em>Parabacteroides distasonis. C. perfringens</em> showed high resistance to clindamycin (69% and 45% by MIC methods and disk diffusion, respectively), while benzylpenicillin and metronidazole maintained over 90% activity. <em>F. nucleatum</em> showed high resistance to benzylpenicillin (11%), while <em>Fusobacterium necrophorum</em> showed alarming rates of resistance to clindamycin (12%), meropenem (16%) and metronidazole (11%).</div></div><div><h3>Conclusions</h3><div>This study presented an up-to-date analysis of the diagnostics and epidemiology of anaerobic bacteria in Europe, providing insights for future comparative analyses and the development of antimicrobial diagnostic and management strategies, as well as the optimization of current antibiotic treatments.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 6","pages":"Article 107478"},"PeriodicalIF":4.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical emergence of Providencia zhejiangensis sp. nov. and Providencia xihuensis sp. nov.: Genomic insights into antimicrobial resistance and geographical distribution","authors":"Xu Dong ,&nbsp;Yanghui Xiang ,&nbsp;Ping Shen ,&nbsp;Yonghong Xiao ,&nbsp;Ying Zhang","doi":"10.1016/j.ijantimicag.2025.107484","DOIUrl":"10.1016/j.ijantimicag.2025.107484","url":null,"abstract":"<div><div>Members of the genus <em>Providencia</em> are typically opportunistic pathogens that can cause severe infections in immunocompromised hosts. This study identified two <em>Providencia</em> strains, SKLX146130 and SKLX074055, representing novel species designated as <em>Providencia zhejiangensis</em> sp. nov. and <em>Providencia xihuensis</em> sp. nov., respectively. Both strains were isolated from clinical samples, with <em>P. zhejiangensis</em> displaying extensive drug resistance. Our analysis revealed that <em>P. xihuensis</em> is predominantly from China, whereas <em>P. zhejiangensis</em> has a global presence. Meanwhile, our analyses resolved <em>Providencia huashanensis</em> as a later heterotypic synonym of <em>Providencia xianensis</em>. Notably, the strain SKLX146130 from <em>P. zhejiangensis</em>, characterized by carrying multiple acquired resistance determinants including the carbapenemase gene <em>bla</em>_NDM-1, belongs to a zoonotic subclade. The genomic analyses of the <em>P. zhejiangensis</em> strain SKLX146130 and <em>Providencia xihuensis</em> strain SKLX074055 showed 79.76–84.55% and 79.85–95.85% average nucleotide identity (ANI), respectively, with other <em>Providencia</em> type strains. In silico DNA-DNA hybridization (dDDH) values ranged from 20.7 to 26.2% and 21.3–64.8%, respectively. These results, along with phenotypic characterization and phylogenetic evidence, confirm that SKLX146130 and SKLX074055 represent two distinct novel species within the genus <em>Providencia</em>. Consequently, we propose the names <em>Providencia zhejiangensis</em> sp. nov. and <em>Providencia xihuensis</em> sp. nov. for these species and call for monitoring these species in clinical infections.</div></div>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":"65 5","pages":"Article 107484"},"PeriodicalIF":4.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posaconazole effectiveness in rare invasive fungal infections: A systematic literature review.","authors":"Mark Bernauer, Hetty Waskin, Nicole Cossrow, Allysen Kaminski, Alyssa Simon, Havilland Campbell, Dipen Patel","doi":"10.1016/j.ijantimicag.2025.107482","DOIUrl":"https://doi.org/10.1016/j.ijantimicag.2025.107482","url":null,"abstract":"<p><strong>Introduction: </strong>Mucormycosis, hyalohyphomycosis, chromoblastomycosis, and fungal mycetoma are rare invasive fungal infections (IFIs) that cause significant morbidity and mortality in immunocompromised patients. Few effective treatment options are available for these IFIs.</p><p><strong>Methods: </strong>We performed a systematic literature review of MEDLINE and Embase to identify studies published from 2005 (year of posaconazole approval) to October 22, 2022, reporting the efficacy/effectiveness of posaconazole monotherapy or combination therapy for treating mucormycosis, hyalohyphomycosis, chromoblastomycosis, and mycetoma. Positive outcomes or positive clinical outcomes were defined as reporting of a positive efficacy/effectiveness measure (i.e., no relapse, response, cure, radiological improvement, clinical / symptom improvement, or survived therapy).</p><p><strong>Results: </strong>Of 3207 articles identified (after removing duplicates), 533 articles (mostly case reports) were included. Positive clinical outcomes with posaconazole therapy were observed in most patients with mucormycosis (74.8%, 1197/1601), hyalohyphomycosis (58.5%, 62/106), chromoblastomycosis (90.5%, 19/21), and mycetoma (100%, 5/5). Overall survival was around 70% or greater across the IFIs examined. Positive response was higher in second-line monotherapy than first-line monotherapy in mucormycosis and chromoblastomycosis. Higher mortality was observed with combination therapy than monotherapy in mucormycosis and hyalohyphomycosis infections (except for first-line use in mucormycosis). Positive clinical outcome was 78.6% and overall survival was 78.6% in 323 coronavirus disease (COVID)-associated mucormycosis infection cases.</p><p><strong>Conclusion: </strong>Despite the rarity of these IFIs, substantial data have been published since posaconazole was initially approved in 2005, and the real-world case reports demonstrate that posaconazole is an effective therapeutic option alone or in combination for the treatment of these rare IFIs.</p>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":" ","pages":"107482"},"PeriodicalIF":4.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}