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Emerging Strategies in Infection Control and Antimicrobial Therapy

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Infectious Disease".

Deadline for manuscript submissions: closed (31 March 2026) | Viewed by 4203

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Prof. Dr. Doina Azoicai

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Guest Editor

Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
Interests: epidemiology; fundamental biological and biomedical sciences

Prof. Dr. Carmen Manciuc

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Guest Editor Assistant

Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
Interests: infectious diseases

Special Issue Information

Dear Colleagues,

Infectious diseases have remained a significant global health burden despite remarkable advancements in medical science. The historical reliance on antimicrobial agents since the mid-20th century has revolutionized infection management, saving countless lives. However, the overuse and misuse of antibiotics have led to the rapid emergence of antimicrobial resistance (AMR), threatening to undermine decades of medical progress. Hospital-acquired infections, community outbreaks of resistant pathogens, and the slow pace of new antibiotic development underscore the urgency for innovative and multidisciplinary approaches in infection control and antimicrobial therapy.

This Special Issue aims to highlight novel, evidence-based strategies designed to tackle these pressing challenges. The scope includes both preventive and therapeutic dimensions, ranging from advanced diagnostics, personalized medicine, and surveillance systems to next-generation antimicrobials, host-targeted therapies, and infection prevention protocols. We are particularly interested in bridging fundamental research with clinical applications, encouraging collaborations across microbiology, pharmacology, epidemiology, and healthcare policy.

We invite cutting-edge research articles, comprehensive reviews, and short communications that explore innovative methods in infection control and antimicrobial therapy. Topics of interest include (but are not limited to)

Novel antimicrobial agents and drug delivery systems;
Strategies to combat antimicrobial resistance (AMR);
Rapid diagnostic tools and point-of-care technologies;
Infection prevention and control practices in healthcare settings;
Bacteriophage therapy and alternative therapeutics;
Immunomodulatory and host-directed therapies;
Surveillance programs and AI-driven predictive models;
Microbiome manipulation and probiotic interventions.

By assembling contributions from leading experts and emerging voices in the field, this Special Issue seeks to foster a deeper understanding of current trends and catalyze transformative solutions to one of the most critical health threats of our time.

Prof. Dr. Doina Azoicai
Guest Editor

Prof. Dr. Carmen Manciuc
Guest Editor Assistant

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

microbial resistance
antibiotherapy
infections
control
host-directed therapies

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Published Papers (7 papers)

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Research

16 pages, 1146 KB

Open AccessArticle

Changing Epidemiology, Healthcare-Associated Infections, and Outcomes in Infective Endocarditis: A Five-Year Retrospective Study from a Tertiary Cardiovascular Center

by Adelina Matei, Grigore Tinică, Alberto Bacușcă, Mihail Enache, Andrei Țăruș, Mihaela Cătălina Luca, Gabriela Jugănariu and Doina Azoicăi

Medicina 2026, 62(6), 1028; https://doi.org/10.3390/medicina62061028 - 26 May 2026

Viewed by 190

Abstract

Background and Objectives: Infective endocarditis (IE) remains a major clinical challenge. It carries high morbidity and mortality, despite advances in diagnostic and therapeutic methods. This study aimed to evaluate the epidemiological profile, microbiological characteristics, complications, and predictors of adverse outcomes among patients with IE treated at a tertiary cardiovascular center in Romania over 5 years. Materials and Methods: We conducted a retrospective study including 156 patients diagnosed with IE between January 2020 and December 2024. We analyzed demographic data, comorbidities, microbiological findings, treatment strategies, complications, and in-hospital outcomes. Results: The cohort was predominantly male (76.3%), with a mean age of 58.5 years. Native valve endocarditis was the most frequent form (80.1%). Streptococci were the most commonly identified pathogens, followed by enterococci and staphylococci. Complications occurred in 74.4% of patients. Heart failure (70.5%), acute kidney injury (37.2%), and embolic events (32.7%) were most frequent. Healthcare-associated infective endocarditis (HAIE) was seen in 10.3% of patients. Additional healthcare-associated infections (HAIs) occurred in 26.9% of patients and were associated with longer hospital stays (21.7 vs. 13.5 days; p < 0.001). Use of a central venous catheter independently predicted HAI development (adjusted OR, 3.89; 95% CI, 1.08–14.06; p = 0.038). The in-hospital mortality rate was 16.7%. Acute kidney injury and sepsis were the strongest factors associated with in-hospital mortality. Conclusions: IE remains associated with a high burden of complications and in-hospital mortality. HAIs complicate the clinical course and are closely linked to invasive device use. Mortality is mainly driven by systemic disease severity, especially acute kidney injury and sepsis. These findings highlight the importance of infection prevention, prompt risk stratification, and coordinated multidisciplinary care to improve outcomes in patients with IE. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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19 pages, 1465 KB

Open AccessArticle

Clinical Outcomes and Risk Factors of Healthcare-Associated Infections in Surgical Wards: A Retrospective Cohort Study

by Andreea Mihaela Sandu, Corneliu Ovidiu Vrancianu, Marian Necula, Roxana-Elena Cristian, Ana-Catalina Tantu, Alina Păunescu, Daniel Diaconescu and Monica Marilena Tantu

Medicina 2026, 62(5), 995; https://doi.org/10.3390/medicina62050995 - 20 May 2026

Viewed by 290

Abstract

Background and Objectives: Healthcare-associated infections (HAIs) remain a major cause of morbidity and mortality among hospitalized patients. During the COVID-19 pandemic, SARS-CoV-2 infection emerged as a major contributor to HAIs, alongside Clostridioides difficile infection (CDI) and other bacterial infections. This study aimed to evaluate the clinical characteristics and outcomes of HAIs in surgical departments and to identify factors associated with in-hospital mortality. Materials and Methods: We conducted a retrospective observational study including 170 patients with documented HAIs admitted between July 2018 and June 2022 in surgical departments of a county emergency hospital. Patients were categorized into SARS-CoV-2 infection (n = 85), CDI (n = 73), and other bacterial infections (n = 12), the latter being included for descriptive purposes only due to limited sample size. Clinical variables, comorbidities, prior antibiotic exposure, length of hospital stay, and in-hospital mortality were analyzed. Survival analysis and logistic regression were performed to identify predictors of mortality. Results: SARS-CoV-2 infection represented the largest subgroup, followed by CDI. Overall, in-hospital mortality was 15.9%, with comparable rates between SARS-CoV-2 infection (17.6%) and CDI (16.4%), while no deaths were observed in the small subgroup of other bacterial infections. CDI patients had a significantly higher burden of comorbidities (p = 0.004). Kaplan–Meier analysis did not show a statistically significant difference in survival between SARS-CoV-2 and CDI groups (log-rank p = 0.28). In univariate analysis, acute respiratory failure (OR ≈ 13.5, p < 0.001), chronic kidney disease (OR ≈ 4.4, p = 0.018), and number of comorbidities (p = 0.019) were associated with mortality, but none remained significant in multivariable analysis. Conclusions: In-hospital mortality was similar between SARS-CoV-2 infection and CDI, highlighting the persistent clinical impact of CDI in hospitalized patients. Comorbidity burden and acute complications, particularly respiratory failure, were key determinants of mortality. These findings highlight the persistent clinical impact of CDI and the role of comorbidity burden and acute complications, particularly respiratory failure, in shaping in-hospital mortality. The absence of independent predictors in multivariable analysis should be interpreted cautiously given the limited sample size. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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13 pages, 623 KB

Open AccessArticle

Distinct Clinical and Laboratory Features of Measles in Adults and Children During the 2024 Epidemic: A Retrospective Study from a Romanian Tertiary Infectious Diseases Center

by Andrei Vâţă, Ionela-Larisa Miftode, Maria Gabriela Grigoriu, Ioana Mihuta, Ioana Maria Onofrei, Alexandru Florinel Oancea, Mihaela Catalina Luca and Egidia Gabriela Miftode

Medicina 2026, 62(5), 836; https://doi.org/10.3390/medicina62050836 - 28 Apr 2026

Cited by 1 | Viewed by 393

Abstract

Background and Objectives: Romania reported the highest measles incidence in the European Union during the 2023–2024 epidemic, largely driven by declining vaccination coverage. We aimed to characterize the epidemiological, clinical, and laboratory profile of hospitalized measles patients and to identify age-related differences, with particular emphasis on systemic and hepatic involvement. Materials and Methods: We conducted a retrospective observational study including 360 consecutive patients with laboratory-confirmed measles admitted to a tertiary infectious disease hospital in northeastern Romania between 1 January and 31 December 2024. Demographic, clinical, laboratory, therapeutic, and outcome data were collected. Pediatric (<15 years) and adult patients were compared using appropriate statistical tests. Results: Children accounted for 71.4% of cases, including 16.1% infants under one year. Over 90% of patients were unvaccinated or incompletely vaccinated. Household transmission represented the most frequent identifiable source. Adults presented significantly higher inflammatory markers and more pronounced hepatic involvement than children. ALT elevation occurred in 63.1% of adults versus 34.2% of children (p < 0.001), with moderate-to-severe cytolysis predominantly observed in adults (34.9% vs. 1.9%, p < 0.001). Pulmonary complications were documented in 28% of cases, mainly viral interstitial pneumonia. Thrombocytopenia was significantly more frequent in adults (p < 0.001). Overall mortality was 0.27%, occurring in an unvaccinated infant with secondary bacterial pneumonia. Conclusions: The 2024 measles epidemic in our area was characterized by sustained transmission among unvaccinated individuals and frequent systemic involvement. Hepatic dysfunction emerged as a prominent feature in adults, suggesting a shifting clinical phenotype in contemporary outbreaks. Strengthening vaccination coverage and early recognition of systemic complications remain critical to reducing measles-related morbidity and mortality. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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13 pages, 498 KB

Open AccessArticle

Inappropriate Antimicrobial Dosing in Regard to Renal Function in a Tertiary Hospital in Greece—A Single-Center Point Prevalence Study

by Petros Ioannou, Andria Papazachariou, Stamatis Karakonstantis and Diamantis Kofteridis

Medicina 2026, 62(4), 743; https://doi.org/10.3390/medicina62040743 - 13 Apr 2026

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Abstract

Background and Objectives: Appropriate antimicrobial dosing according to kidney function is essential to ensure therapeutic efficacy while minimizing toxicity and antimicrobial resistance. Despite established dosing guidelines and electronic prescribing systems, errors in renal dose adjustment of antimicrobials, particularly in the setting of acute kidney injury, remain common among hospitalized patients. Materials and Methods: A point-prevalence study was conducted on 31 October 2024 at a tertiary-care hospital in Greece to evaluate the appropriateness of antimicrobial dosing in relation to renal function. Patient characteristics, renal parameters, and antimicrobial prescriptions were extracted from electronic medical records. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Comparative analyses were performed between correctly and incorrectly dosed cases, and between overdosing and underdosing episodes. Results: A total of 235 hospitalized patients were evaluated (mean age 64.8 ± 18.6 years; 43.4% female). Overall, 15.7% (37/235) received at least one antimicrobial dose inappropriate for their renal function. Among 37 patients where dosing errors were identified, overdosing was noted in 23 (62.2%), underdosing in 16 (43.2%), adding up to 39 prescriptions, while in 2 patients (5.4%), both mistakes were noted in different prescribed antimicrobials. Drug-specific error rates varied considerably: ceftazidime and cefuroxime showed the highest rates of inappropriate dosing (40% each), followed by colistin (33.3%) and acyclovir (33.3%). Piperacillin/tazobactam, the most frequently prescribed agent (n = 50), had a 14% error rate, mainly due to underdosing (10%). Patients with dosing errors were significantly older (71.5 vs. 64.1 years, p = 0.0220) and had worse renal function, including higher serum creatinine (1.68 vs. 1.19 mg/dL, p = 0.0174), lower GFR (58.5 vs. 75.9 mL/min/1.73 m², p = 0.0009), and more frequent dialysis (13.5% vs. 4.3%, p = 0.0422). They also received a higher median number of antimicrobials (2 vs. 1, p = 0.0185). Conclusions: Inappropriate antimicrobial dosing based on kidney function remains common in hospitalized patients, particularly among older individuals and those with impaired renal function or polypharmacy. Targeted antimicrobial stewardship strategies focusing on renal dose adjustment and agents that are more frequently dosed inappropriately, such as colistin, acyclovir, cefuroxime, and ceftazidime, as well as agents that are frequently prescribed despite a relatively lower rate of inappropriate dose, such as piperacillin/tazobactam, are needed to enhance prescribing safety and optimize therapeutic outcomes. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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19 pages, 695 KB

Open AccessArticle

Static and Dynamic Eosinophil Measures and In-Hospital Mortality in Patients with Sepsis: A Retrospective Cohort Study

by Florentina Mușat, Octavian Andronic, Alexandra Bolocan, Cosmin-Alexandru Palcău, Alina Mihaela Dobre, Daniel Ion and Dan Nicolae Păduraru

Medicina 2026, 62(4), 640; https://doi.org/10.3390/medicina62040640 - 27 Mar 2026

Viewed by 468

Abstract

Backgroundand Objectives: Reliable prognostic biomarkers in sepsis that are inexpensive and universally available remain limited. Eosinophil counts decrease in systemic illness, but the prognostic value of static versus dynamic eosinophil measures in sepsis is uncertain. We investigated the association between eosinophil measurements, including early trajectories, and in-hospital mortality in a large sepsis cohort. Materials and Methods: We conducted a retrospective observational study of adult patients hospitalized with sepsis between 2021 and 2024 at a tertiary referral center. Absolute eosinophil counts were assessed at admission, at eosinophil nadir, and dynamically at approximately 48 and 72 h. Eosinophil trajectories were categorized as persistently undetectable, decrease, non-decrease, or rise from undetectable. Multivariable logistic regression models adjusted for demographic factors, comorbidities, and markers of disease severity were used to evaluate associations with in-hospital mortality. Results: Among 3932 patients, in-hospital mortality was 48.5%. Static eosinophil measures at admission and at eosinophil nadir were lower in non-survivors but were not independently associated with mortality after adjustment. Pancytopenia at eosinophil nadir was independently associated with increased mortality (OR 1.65, 95% CI 1.37–1.99). In contrast, eosinophil dynamics provided additional prognostic information. A decrease in eosinophil counts at 72 h was independently associated with higher mortality (OR 1.43, 95% CI 1.08–1.91), while 48 h changes were not. Persistently undetectable eosinophil trajectories were associated with the highest mortality, whereas recovery from undetectable levels was associated with lower risk. Conclusions: In sepsis, static eosinophil counts lack independent prognostic value, whereas delayed eosinophil decline and persistently suppressed trajectories are associated with increased in-hospital mortality. Eosinophil dynamics were associated with in-hospital mortality and may provide additional information on the host response during sepsis. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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11 pages, 241 KB

Open AccessArticle

Impact of Metagenomic Next-Generation Sequencing on Antibiotic Management in Pediatric Patients

by Ariel Gonzalez, Jill Argotsinger, Ronda J. Oram and Jessica L. Miller

Medicina 2026, 62(3), 482; https://doi.org/10.3390/medicina62030482 - 4 Mar 2026

Viewed by 542

Abstract

Background and Objectives: Metagenomic next-generation sequencing (mNGS) is an emerging diagnostic tool used to guide the management of infectious diseases. However, clinical criteria in which there is a clear benefit have not been identified, and more real-world clinical experience is needed to identify patient populations in which mNGS testing may have the most benefit. The aim of this article is to evaluate the utilization of mNGS to determine the impact on clinical practice for pediatric patients. Materials and Methods: This retrospective analysis included pediatric patients that had a mNGS test performed between January 2020 and September 2024. The primary outcome was the clinical impact of the mNGS test on patient management defined as either a positive impact or no impact. Secondary outcomes included test turnaround time, agreement or discordance between conventional testing and mNGS, and hospital length of stay. Results: Forty-six mNGS tests in 42 patients were evaluated. Of 60 organisms identified from the 46 tests, 27 organisms (45%) were considered clinically significant. mNGS had a positive clinical impact in 18 (39.1%) patients, primarily due to antimicrobial modifications (16, 34.8%) and new diagnoses (6, 13.0%). The majority of patients with a positive clinical impact were immunosuppressed (15/18, 83.3%). Conclusions: mNGS demonstrated utility in a subset of pediatric patients, particularly those considered immunosuppressed. Its ability to confirm or exclude infections, particularly fungal infections in this patient population, contributed to its impact. However, its limited benefit in immunocompetent patients underscores the importance of careful patient selection to optimize diagnostic and antimicrobial stewardship. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

13 pages, 936 KB

Open AccessArticle

The Change in Healthcare-Associated Infections in Intensive Care Units Associated with the Coronavirus Disease 2019 in Taiwan

by Chien-Ying Wang, Yu-Hsuan Chen, Chih-Chun Hsiao, Chun-Gu Cheng and Chun-An Cheng

Medicina 2025, 61(11), 1971; https://doi.org/10.3390/medicina61111971 - 3 Nov 2025

Viewed by 940

Abstract

Background and Objectives: Changes in the incidence of healthcare-associated infections (HAIs) during the coronavirus disease 2019 (COVID-19) pandemic and during periods with fewer or more COVID-19 cases have been inconclusively studied. Compared with 2015, in 2019, the abundances of the microorganisms Klebsiella pneumoniae and Enterococcus faecium increased in intensive care units (ICUs) in Taiwan. The trend in the incidence of HAIs in ICUs in Taiwan during the emergence of new infectious diseases is worth studying. Materials and Methods: We surveyed the incidence densities of different types of HAIs, device-associated HAIs, pathogens, and antimicrobial resistance in a dataset from the Taiwan Healthcare-associated Infection and Antimicrobial Resistance Surveillance System from 2015 to 2022. The change in incidence density trends was evaluated via Poisson regression, and the change in proportion trends was checked via the Mantel–Haenszel chi-square test. Results: The incidence of HAIs decreased from 5.7 to 5.17 episodes per 1000 person-days from the pre-COVID-19 period to the post-COVID-19 period. The incidences of healthcare-acquired pneumonia (HAP), device-associated HAIs decreased. However, the incidences of bloodstream infections (BSIs) increased. The percentages of patients with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii infections significantly decreased. The percentage of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection decreased, but that of patients with carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus faecium infections increased. The antimicrobial consumption related to CRKP increased and MRSA decreased. Conclusions: Overall, HAIs, HAP, and VAP decreased in incidence after the COVID-19 pandemic. These results revealed decreases in MRSA infection incidence under infection control protocols with more antimicrobial use. However, the proportion of CRKP among HAIs increased with broad-spectrum antimicrobial agent use. Based on the recent incidence of HAIs in ICUs, the quality of infection control in medical units can be enhanced to decrease HAI incidence. Full article

(This article belongs to the Special Issue Emerging Strategies in Infection Control and Antimicrobial Therapy)

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