Therapeutic Advances in Infectious Disease最新文献

{"title":"<i>Magnusiomyces clavatus</i> fungemia treated with combination antifungals including isavuconazole in an immunocompromised pediatric patient: a case report.","authors":"Amanda Z McPherson, Matthew Miller, Kacie Rytlewski, Samantha Bacon, Kira E Frappa","doi":"10.1177/20499361261457479","DOIUrl":"10.1177/20499361261457479","url":null,"abstract":"<p><p><i>Magnusiomyces clavatus</i>, formerly <i>Saprochaete clavata</i> or <i>Geotrichum clavatum</i>, is an ascomycetous yeast found in the environment as well as the gastrointestinal and respiratory tracts of humans. It has been described as an emerging, albeit rare, cause of invasive fungal disease affecting immunocompromised patients. Intrinsic resistance to fluconazole and echinocandins has been theorized; however, little else is known regarding optimal treatment regimens for this opportunistic pathogen. To our knowledge, only 13 infectious cases have been described in pediatric patients, all of which utilized a combination of antifungals including liposomal amphotericin B (LAmB) and voriconazole with or without flucytosine (5-FC). Here we report a case of a 4-year-old, 12.3 kg, female patient who immigrated from Ukraine and was admitted to our institution for an allogeneic umbilical cord blood transplant in the setting of bone marrow failure secondary to Fanconi anemia. On day +6 after cell transplantation, the patient developed febrile neutropenia found to be because of invasive <i>M. clavatus</i> fungemia on day +7. The patient was empirically treated with LAmB, micafungin, and posaconazole (POS), the latter of which failed to reach therapeutic levels. Ultimately, our patient defervesced and cleared blood cultures after transitioning LAmB to 5-FC, followed by definitive treatment with isavuconazole (ISA) monotherapy. To our knowledge, this is the first case of pediatric <i>M. clavatus</i> ultimately treated with 5-FC plus POS followed by ISA alone.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261457479"},"PeriodicalIF":3.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic <i>Fasciola hepatica</i> infection in a patient with cutaneous visceral loxoscelism: paediatric case report.","authors":"Blanca Salazar-Mesones, Laura Melissa Mori-Llontop, Alfredo Chiappe-Gonzalez, Claudia Lazarte-Rantes, Shaila Contreras-Alvitez, Cecilia Peñaloza-Ore, Luis A Marcos, José W López","doi":"10.1177/20499361261430150","DOIUrl":"10.1177/20499361261430150","url":null,"abstract":"<p><p>We present the case of a 9-year-old girl from the Peruvian Andean Region (Ancash), diagnosed with fascioliasis, who was also suffering from severe malnutrition. Initially, she was referred for treatment of skin necrosis caused by cutaneous visceral loxoscelism, but during hospitalisation she developed persistent vomiting and pancreatitis. Magnetic resonance cholangiography showed dilation of the intrahepatic and common bile ducts. Endoscopic retrograde cholangiopancreatography identified an adult <i>Fasciola</i> spp. specimen. She also expelled adult worms of <i>Ascaris lumbricoides</i> during vomiting. Delivery of triclabendazole was initiated via a nasogastric tube initially and subsequently via the rectal route, although absorption was limited due to persistent oral intolerance. The patient later developed upper gastrointestinal bleeding and sepsis of abdominal origin and died. During this period, the patient remained on broad-spectrum antibiotic therapy, although sepsis was attributed to persistent biliary obstruction. Fascioliasis and ascariasis should remain in the differential diagnosis for pancreatitis and cholestasis in paediatric patients from endemic areas. Oral triclabendazole is the treatment of choice for fascioliasis, but surgical management should be considered in cases of persistent biliary obstruction or treatment failure, usually seen in complicated chronic infections.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261430150"},"PeriodicalIF":3.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C virus seroprevalence among people with sickle cell disease in Uganda: a cross-sectional study.","authors":"Winnie Kibone, Conrad Muzoora, Felix Bongomin, Amelia Margaret Namiiro, Samuel Ssenkungu, Sam J Gebeh, Heavenlight A Paulo, Philip Kasirye, Davidson H Hamer","doi":"10.1177/20499361261467160","DOIUrl":"10.1177/20499361261467160","url":null,"abstract":"<p><strong>Background: </strong>Viral hepatitis is a major cause of chronic liver disease, including cirrhosis and hepatocellular carcinoma, with significant morbidity and mortality. Individuals with sickle cell disease (SCD) are at increased risk of hepatitis C virus (HCV) infection due to frequent transfusions. Despite the high burden of HCV in Uganda, recent data on HCV seroprevalence among individuals with SCD are limited.</p><p><strong>Objective: </strong>To determine HCV seroprevalence and describe characteristics among patients with SCD receiving care at Mulago National Referral Hospital (MNRH), Kampala, Uganda.</p><p><strong>Design: </strong>Hospital-based cross-sectional study.</p><p><strong>Methods: </strong>Individuals with SCD attending the MNRH outpatient SCD clinic in Kampala, Uganda, were recruited between July and September 2025. Sociodemographic, clinical, and behavioral data were collected using a structured questionnaire. Anthropometric measurements were taken using standardized scales. HCV, hepatitis B surface antigen (HBsAg), and HIV rapid tests were performed. Data were analyzed using the SAS statistical package version 9.4.</p><p><strong>Results: </strong>There were 119 participants with SCD enrolled, with a mean age of 13.1 years, and 55.5% (<i>n</i> = 66) were male. Most participants had a SCD diagnosis for 6 years or longer. HCV seroprevalence was 12.6% (<i>n</i> = 15). All HCV-seropositive participants were less than 18 years, with nearly two-thirds of those aged 9-17 years (66.7%, <i>n</i> = 10). Nearly all HCV-seropositive participants had a history of blood transfusion (<i>n</i> = 14, 93.3%), with 53.3% (<i>n</i> = 8) reporting three or more transfusions. Only one participant (0.84%) tested positive for HIV, and none tested positive for HBsAg.</p><p><strong>Conclusion: </strong>This study revealed a high seroprevalence of HCV among individuals with SCD in Uganda. Strengthening routine HCV screening, linkage to care, and infection prevention, including within blood transfusion services, is needed. Larger studies incorporating HCV RNA testing are recommended to assess the true burden of active infection and risk factors among patients with SCD to inform targeted prevention, screening, and treatment strategies.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261467160"},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Aedes albopictus</i> in the department of Magdalena, Colombia: spread to the northernmost of the country and implications for arboviral disease transmission.","authors":"Erik Perdomo-Balaguera, Katiuska Ariza-Campo, Libardo Atencio, José A Usme-Ciro, Gabriel Parra-Henao","doi":"10.1177/20499361261465558","DOIUrl":"10.1177/20499361261465558","url":null,"abstract":"<p><strong>Background: </strong><i>Aedes albopictus</i> is widely distributed throughout the world. It was introduced into the Americas in 1985 and has been incriminated as secondary vector for arboviruses. In Colombia, this species has been reported in 15 of the 32 departments, mainly in lowlands of the central and southern part of the country.</p><p><strong>Objective: </strong>To describe the presence of <i>A. albopictus</i> in the department of Magdalena, Colombia.</p><p><strong>Design: </strong>A descriptive and cross-sectional entomological study was performed in the department of Magdalena, Colombia, between June and December 2025.</p><p><strong>Methods: </strong>Larvae and adult mosquitoes were collected in the intra-, peri-domicile, and surrounding area of six municipalities, as part of the routine entomological surveillance. Subsequently, the specimens were mounted and used for species identification through classical taxonomy.</p><p><strong>Results: </strong>Entomological specimens (larvae and adults) collected in all six municipalities were identified as <i>A. albopictus</i> at the entomology unit of the Public Health Laboratory of Magdalena and confirmed by the national health authorities.</p><p><strong>Conclusion: </strong>The detection of <i>A. albopictus</i> in this department highlights the importance of continuous entomological surveillance, especially in hyperendemic areas where several dengue virus serotypes and other arboviruses cocirculate and constitute a high disease burden.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261465558"},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute respiratory infections and associated factors among under-five children in sub-Saharan Africa: a multilevel modified Poisson regression analysis of the latest DHS data.","authors":"Temesgen Gebeyehu Wondmeneh","doi":"10.1177/20499361261467151","DOIUrl":"10.1177/20499361261467151","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory infections (ARIs) are the leading cause of morbidity and mortality among children under 5 years of age, particularly in sub-Saharan Africa. Although several individual- and household-level factors have been associated with ARI, previous studies in the region have largely been limited to single-country analyses, older datasets, or conventional regression approaches that did not account for the hierarchical structure of Demographic and Health Surveys (DHS) data. Furthermore, evidence based on recent multicountry data collected after COVID-19 pandemic remains limited.</p><p><strong>Objectives: </strong>To assess the prevalence of ARI and associated factors among children under 5 years of age in sub-Saharan Africa.</p><p><strong>Design: </strong>A cross-sectional study was conducted using nationally representative DHS data collected between 2021 and 2024 from 11 sub-Saharan African countries.</p><p><strong>Methods: </strong>A weighted sample of 67,134 children aged 0-59 months with complete information on ARI was included in the analysis. Missing data were handled using multiple imputation. Given the hierarchical structure of DHS data, a multilevel modified Poisson regression model with robust variance estimation was employed to identify individual- and community-level factors associated with ARI. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported.</p><p><strong>Results: </strong>The prevalence of ARI among under-five children in sub-Saharan Africa was 31.0% (95% CI: 30.6-31.5). ARI prevalence was higher among children of mothers aged 35-49 years (APR = 1.13; 95% CI: 1.02-1.25) and wasted children (APR = 1.23; 95% CI: 1.05-1.50), and in households using polluted cooking fuels (APR = 1.22; 95% CI: 1.05-1.42). Lower prevalence was observed among children from rich households (APR = 0.86; 95% CI: 0.75-0.98), with household media exposure (APR = 0.85; 95% CI: 0.78-0.93), delivered in health institutions (APR = 0.89; 95% CI: 0.79-0.99), and residing in communities with high media exposure (APR = 0.90; 95% CI: 0.83-0.98).</p><p><strong>Conclusion: </strong>ARI remains highly prevalent among children under five in sub-Saharan Africa. Individual and household factors, including maternal age, child nutritional status, household wealth, type of cooking fuel, place of delivery, and media exposure, are significantly associated with ARI, highlighting the need for targeted interventions to reduce its burden.</p><p><strong>Trail registration: </strong>Not applicable.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261467151"},"PeriodicalIF":3.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical presentation, management, and outcomes of aortic endograft infections: a retrospective descriptive study.","authors":"Haitham Alaithan, Sarwat Khalil, Gustavo Oderich, Larry M Baddour, Muhammad Rizwan Sohail","doi":"10.1177/20499361261465761","DOIUrl":"10.1177/20499361261465761","url":null,"abstract":"<p><strong>Background: </strong>Aortic endograft infection (AEGI) is a rare complication of abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). Surgical explantation with reconstruction is recommended, but data on medical management remain limited. We present our institutional experience with AEGI.</p><p><strong>Objective: </strong>To describe the clinical presentation, microbiology, management strategies, and outcomes of patients with AEGI, with the aim of addressing current gaps in the literature and informing future research to improve patient outcomes.</p><p><strong>Design: </strong>Retrospective descriptive study.</p><p><strong>Methods: </strong>Adult patients admitted with AEGI at our institution between January 2017 and August 2024 were identified using ICD-10 codes and confirmed using the Management of Aortic Graft Infection Collaboration (MAGIC) diagnostic criteria. Clinical, microbiological, radiographic, treatment, and outcome data were collected and analyzed.</p><p><strong>Results: </strong>We screened 517 patients, and 46 met AEGI criteria (EVAR 54%, TEVAR 46%). Most (63%) presented with late-onset infections (⩾3 months). Fever (54%) and sepsis (48%) were common presenting symptoms. Computed tomography (CT) (85%) was the primary imaging modality. Blood cultures were positive in 54% of the cases, with <i>Staphylococcus aureus</i> being the most common monomicrobial pathogen (24%), and 24% of cases were polymicrobial. The majority (67%) received combined medical and surgical therapy. Chronic antibiotic suppressive therapy was used in 34 (74%), most often tetracyclines (33%). Overall, treatment success rates were similar between surgical and medical groups (58% vs 60%, <i>p</i> = 0.250) with comparable mortality. However, relapses were more frequent in the medical-only group (33% vs 16%, <i>p</i> = 0.185).</p><p><strong>Conclusion: </strong>Most patients presented with late-onset AEGI. Fever was absent in nearly half of cases, and blood cultures were positive in only 54%. Overall, surgical and medical therapy had similar success, though relapses were more frequent in those treated medically alone.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261465761"},"PeriodicalIF":3.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The HIV/AIDS landscape in Bangladesh: an updated review of epidemiological trends, prevention gaps, and key population engagement.","authors":"Tahsin Waseqa, Sumaiya Haque, Ramisa Anjum, Mohammad Shahriar, Mohiuddin Ahmed Bhuiyan","doi":"10.1177/20499361261459589","DOIUrl":"10.1177/20499361261459589","url":null,"abstract":"<p><p>HIV/AIDS in Bangladesh has historically remained below 0.01% prevalence in the general population; however, recent provisional epidemiological data indicate a concerning shift, with the highest annual increase recorded between November 2024 and October 2025 (1891 new cases; 254 AIDS-related deaths), signaling evolving transmission dynamics. Despite an overall low national prevalence, the epidemic remains highly concentrated among key populations, including people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), transgender individuals, and migrant workers, where prevention and service coverage gaps have been documented. This narrative review synthesizes evidence published between 2015 and 2025 on HIV epidemiology, prevention strategies, testing infrastructure, treatment outcomes, and structural barriers in Bangladesh. Data were drawn from peer-reviewed studies identified through systematic searches of PubMed/MEDLINE, Google Scholar, and Bangladesh-specific repositories, supplemented by national surveillance reports (National AIDS/STD Programme; Integrated Biological and Behavioral Surveys), international agency documents (UNAIDS, WHO, Global Fund), and recent programmatic reports. Both peer-reviewed and grey literature sources were included to capture the full range of available evidence. Findings reveal significant deficiencies across the HIV response cascade. Geographic availability of testing services is limited to 23 of 64 districts, and prevention coverage is suboptimal, reaching just 26% of MSM and male sex workers. Progress along the treatment cascade shows 82% of people living with HIV diagnosed (approximately 14,334 of an estimated 17,480), 74% of those diagnosed receiving antiretroviral therapy, and 91% of those on ART achieving viral suppression, all falling short of global 95-95-95 targets. Behavioral indicators highlight ongoing vulnerabilities; only 14.4% of MSM report condom use with commercial partners in the past 6 months and 27% of female sex workers reporting no condom use at last sexual encounter. Stigma and discrimination continue to undermine the response, with 68% of people living with HIV reporting feelings of shame and 54% reporting guilt related to their diagnosis, adversely affecting testing, disclosure, and care engagement. Despite these challenges, harm reduction programs and a pilot pre-exposure prophylaxis (PrEP) initiative demonstrate substantial promise. Strengthening targeted prevention, expanding testing and treatment access, and addressing stigma, funding constraints, and structural barriers are essential to sustaining Bangladesh's low-prevalence status and advancing toward the goal of ending AIDS as a public health threat by 2030.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261459589"},"PeriodicalIF":3.8,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D receptor <i>BsmI</i> haplotype <i>BB</i> confers lower 25(OH)D levels during tuberculosis: a pilot cross-sectional study.","authors":"Dilcia Sambrano, Sandra Martín-Peláez, Kharla Salazar, Priya Patel, Fermín Acosta, Johanna Elizabeth Ku, Anabel Argelis García, Emilio Romero, Yaracelis Cuadra, Stephanie Hawkins, Isolina Martínez, Odemaris Luque, Laura Solís, Geydi Cañate, Mariela Vergara, Lizbeth Garibaldi, Julio Jurado, Amador Goodridge","doi":"10.1177/20499361261458154","DOIUrl":"10.1177/20499361261458154","url":null,"abstract":"<p><strong>Background: </strong>Adequate micronutrient absorption remains key for tuberculosis control.</p><p><strong>Objective: </strong>To evaluate the frequency of vitamin D receptor polymorphisms, <i>FokI</i>, <i>TaqI</i>, and <i>BsmI</i>, and their relationship with total vitamin D and cathelicidin levels in patients with pulmonary tuberculosis (PTB) and healthy controls (HC) in the province of Colon, Panama.</p><p><strong>Design: </strong>Pilot cross-sectional study, PTB (<i>n</i> = 80) and HC (<i>n</i> = 50).</p><p><strong>Methods: </strong>We measured total vitamin D (25-OH-vitamin D, 25(OH)D) and cathelicidin (LL-37) levels by enzyme-linked immunosorbent assays and analyzed vitamin D receptor (VDR) polymorphisms by PCR-RFLP. We compared the total 25(OH)D and cathelicidin levels across participant demographics and explored the associations with vitamin D receptor polymorphisms.</p><p><strong>Results: </strong>We observed no significant difference in vitamin D levels between PTB and HC (median (IQR) = 36.6 (27.6-48.7) ng/mL and 32.5 (18-46.3) ng/mL, respectively, <i>p</i> = 0.067). In terms of sex, vitamin D levels in women were higher in the PTB group compared to HC (median (IQR) = 33.9 (26.8-48.1) versus 19.5 (11.8-33.4) ng/mL, <i>p</i> = 0.002). Regarding LL-37, PTB unemployed participants showed higher levels compared to HC (median (IQR) = 59.4 (42.4-79.3) versus 28.2 (13.9-42.8) ng/mL, <i>p</i> = 0.048), as well as Hispanic PTBs (59.6 (48.2-71.41) versus 38.9 (19.5-49.2) ng/mL, <i>p</i> = 0.014). As for the treatment phase, vitamin D levels in PTB within 1 month of treatment were higher than HC (median (IQR) = 39.9 (28.5-50.51) versus 32.5 (18-46.3) ng/mL, <i>p</i> = 0.06). When stratifying by sex, these differences were observed only in women (median (IQR) = 41.4 (27.9-55.5) versus 19.5 (11.8-33.4) ng/mL for PTB and HC, respectively; <i>p</i> = 0.01). A statistically significant association was observed between the <i>BsmI</i> VDR polymorphism and serum 25-hydroxyvitamin D levels, with a significant difference between PTB and HC (<i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>The observed associations between VDR polymorphisms, vitamin D levels, and cathelicidin levels highlight the need for further studies to clarify the role of host genetic and sociodemographic factors in pulmonary tuberculosis susceptibility and immune response.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261458154"},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable machine learning models for pre- and postoperative prediction of early intra-abdominal infections after liver transplantation: a multicenter retrospective cohort study.","authors":"Shuang Cao, Hua-Bin Peng, Xin-Zhe Wei, Lei Wang, Ying Liu, Wei Qu, Zhi-Gui Zeng, Hai-Ming Zhang, Lin Wei, Hao-Feng Xiong, Fei Hou, Zhi-Jun Zhu, Wei Gao, Li-Ying Sun","doi":"10.1177/20499361261453152","DOIUrl":"10.1177/20499361261453152","url":null,"abstract":"<p><strong>Background: </strong>Early intra-abdominal infections (EIAIs) are among the most frequent and life-threatening complications following liver transplantation (LT). Early identification of high-risk patients remains challenging, and no standardized risk stratification tool is currently available.</p><p><strong>Objective: </strong>To develop and externally validate interpretable machine learning (ML) models for preoperative and postoperative prediction of EIAIs after LT.</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Methods: </strong>A total of 363 adult LT recipients were included (Center 1: <i>n</i> = 285; Center 2: <i>n</i> = 78). EIAIs were defined as intra-abdominal infections occurring within 30 days after LT. From 120 candidate variables, predictors were selected using random forest, LASSO regression, and univariate logistic regression. Seven ML algorithms were evaluated, and stacking ensemble models were selected as the final preoperative (pre-liver transplantation early intra-abdominal infection forecast tool (LIFT)) and postoperative (post-LIFT) models. Internal testing and external validation were performed. Model interpretability was assessed using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>The stacking models demonstrated superior performance. For pre-LIFT, the areas under receiver operator characteristic curve (ROC) curves (AUCs) were 0.995 ± 0.004 (training), 0.818 ± 0.056 (testing), and 0.796 ± 0.024 (external validation). For post-LIFT, AUCs were 0.996 ± 0.003, 0.847 ± 0.055, and 0.858 ± 0.026, respectively. Both models significantly outperformed model for end-stage liver disease and Child-Turcotte-Pugh scores (all <i>p</i> < 0.05). SHAP analysis revealed that baseline liver dysfunction, inflammatory markers, and immune status were key determinants in the pre-LIFT model, whereas perioperative factors such as intraoperative blood loss, ICU stay, and drainage duration predominated in the post-LIFT model.</p><p><strong>Conclusion: </strong>We developed and externally validated interpretable ML-based models (LIFT) for predicting EIAIs after LT. These models enable individualized risk stratification at both preoperative and postoperative stages and may support personalized infection surveillance and management strategies. Prospective validation is warranted.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261453152"},"PeriodicalIF":3.8,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment gaps and risk factors for multidrug-resistant Enterobacterales in Belize: a 6-year (2018-2023) nationwide retrospective analysis.","authors":"Innocent Nwachukwu, Camryn Linares, Griseidy Alcoser, Nivi Novelo, Danladi C Husaini","doi":"10.1177/20499361261458469","DOIUrl":"10.1177/20499361261458469","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) in <i>Escherichia coli</i>, <i>Klebsiella pneumoniae</i>, and <i>Enterobacter cloacae</i> is a global threat, yet data from Belize and the wider Caribbean are scarce. Understanding local resistance patterns is critical for effective treatment and stewardship.</p><p><strong>Objectives: </strong>To determine antibiotic susceptibility patterns, quantify multidrug resistance (MDR) in outpatient and inpatient settings, identify predictors of empirical treatment failure for urinary tract infections (UTIs), and analyze temporal and geographic trends.</p><p><strong>Design: </strong>Nationwide retrospective analysis of clinical isolates from Belize's public health system (2018-2023).</p><p><strong>Methods: </strong>We analyzed 4591 clinical isolates. MDR was defined as non-susceptibility to ⩾3 drug categories. Multivariable logistic regression identified predictors of the risk of empirical treatment failure for UTIs. Joinpoint regression analyzed temporal trends. Geospatial analysis mapped hotspots of incidence and resistance.</p><p><strong>Results: </strong><i>E. coli</i> was predominant (68%). Among 3005 urinary isolates, 1247 (41.5%) were resistant to both first-line oral antibiotics (ciprofloxacin and trimethoprim-sulfamethoxazole). Extended-spectrum β-lactamase (ESBL) production (adjusted odds ratio (aOR) 8.91, 95% CI 7.40-10.73), infection with <i>K. pneumoniae</i> (aOR 2.85, 95% CI 2.32-3.51) or <i>E. cloacae</i> (aOR 4.12, 95% CI 2.78-6.11), and older age were key predictors. Ciprofloxacin resistance in <i>E. coli</i> increased significantly post-2020 (Annual Percent Change 9.8%, <i>p</i> = 0.02). MDR was prevalent in outpatient settings (42.1% for <i>E. coli</i>, 61.2% for <i>K. pneumoniae</i>). Geospatial analysis revealed the Belize District as the incidence hotspot, while the Toledo District was the ESBL prevalence hotspot (29.5%).</p><p><strong>Conclusion: </strong>Belize faces a notable AMR crisis characterized by a high community burden of MDR Enterobacterales, a critical empirical treatment gap for UTIs, and accelerating resistance trends.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"13 ","pages":"20499361261458469"},"PeriodicalIF":3.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}