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Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections:...
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Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections: Current Knowledge and Future Approaches

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: 30 June 2026 | Viewed by 6771

Special Issue Editors

Dr. Alessio Facciolà

E-Mail Website
Guest Editor
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
Interests: antimicrobial resistance; epidemiology; healthcare-associated infections; microbiology; preventive medicine; public health
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Laganà

E-Mail Website
Guest Editor Assistant
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
Interests: epidemiology of infectious diseases; vaccinations; public health; environmental health; climate change and infectious diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Healthcare-associated infections (HAIs) are currently one of the most important public health challenges worldwide. It is estimated that in Europe, 6.5% of patients admitted to an acute care hospital develop an HAI. Moreover, there is growing concern within the scientific community regarding the increasingly widespread and consistent phenomenon of antibiotic resistance. Indeed, microorganisms have gradually developed resistance mechanisms against almost all of the available antibiotics. Specifically, besides classic pathogens already known and studied for a long time, so-called ‘ESCAPE’ microorganisms, new pathogens, such as Candida auris and other new bacteria, are also spreading worldwide. These pathogens are widely spread in hospital environments and surfaces on which they are able to survive for a long period of time; therefore, they can cross-contaminate medical devices with a high risk of passing to patients. Within this cross-contamination, healthcare workers (HCWs) and their behaviours definitely play a leading role.

A remarkable global public health effort is required to confront this ever-growing phenomenon. Current strategies to fight this crucial public health issue especially involve active surveillance, good practises in healthcare, and antimicrobial stewardship. However, novel strategies, such as the study of new materials with intrinsic antimicrobial properties for potential use in the manufacturing of medical devices and hospital surfaces, are receiving great attention from the international scientific community.

In this perspective, the present Special Issue "Classic and emerging pathogens as a cause of Healthcare-Associated Infections: current knowledge and future approaches" aims to collect high-quality, rigorous scientific papers in order to summarize the current knowledge on this pressing public health challenge.

Dr. Alessio Facciolà
Guest Editor

Dr. Antonio Laganà
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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. Pathogens 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

  • antimicrobial resistance
  • epidemiology
  • healthcare-associated infections
  • microbiology
  • preventive medicine
  • public health

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Published Papers (4 papers)

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Review

22 pages, 720 KB  
Review
Innovations in Biofilm Prevention and Eradication in Medical Sector: An Integrative Review
by Konrad Niedźwiadek, Magdalena Polak-Berecka and Adam Waśko
Pathogens 2025, 14(12), 1242; https://doi.org/10.3390/pathogens14121242 - 4 Dec 2025
Viewed by 308
Abstract
Background: Biofilm-associated infections remain a major challenge in modern medicine due to their high resistance to antibiotics and immune defences. Advances in materials science, chemistry, and nanotechnology have led to the development of innovative, non-antibiotic approaches to prevent or eradicate biofilms. Methods: This [...] Read more.
Background: Biofilm-associated infections remain a major challenge in modern medicine due to their high resistance to antibiotics and immune defences. Advances in materials science, chemistry, and nanotechnology have led to the development of innovative, non-antibiotic approaches to prevent or eradicate biofilms. Methods: This review summarises antibiofilm strategies reported between 2020 and 2025, grouped into chemical, enzymatic, physical–photonic, nanomaterial-based, and biological hybrid categories. Results: Chemical methods such as silver-based chemical systems, nitric oxide donors, and biosurfactants disrupt bacterial membranes, generate reactive oxygen species, and inhibit quorum sensing. Enzymatic coatings with DNase I or lysostaphin effectively reduce Staphylococcus aureus and S. epidermidis biofilms, showing stability after sterilisation and high biocompatibility. Physical–photonic techniques, including photocatalytic and light-activated coatings, provide controllable and renewable antibacterial activity. Nanomaterials such as silver nanomaterials, chitosan-based carriers, magnetic ferrites, and catalytic nanozymes enable targeted, ROS-mediated biofilm disruption. Biologically derived systems, including bacteriophage hydrogels and plant metabolites, offer eco-friendly, biocompatible alternatives. Conclusions: Recent antibiofilm innovations mark a transition from conventional antibiotics to multifunctional and adaptive systems integrating chemical, enzymatic, and physical mechanisms for effective biofilm control on medical surfaces. Full article
(This article belongs to the Special Issue Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections: Current Knowledge and Future Approaches)
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24 pages, 2468 KB  
Review
The Paradox of Healthcare in the ‘Superbugs’ Era: Current Challenges and Future Directions
by Elenoire Sole, Marilena Trinchera, Silvia De Gaetano, Angelina Midiri, Giovanni Piccolo, Giuseppe Mancuso, Giovanni Schepici and Carmelo Biondo
Pathogens 2025, 14(12), 1199; https://doi.org/10.3390/pathogens14121199 - 24 Nov 2025
Viewed by 597
Abstract
Antibiotic-resistant microbes represent a growing problem for modern medicine and public health. Projections indicate that deaths from such infections could reach 10 million per year by 2050. Healthcare associated infections (HAI) are among the most significant causes of mortality and morbidity in hospitals, [...] Read more.
Antibiotic-resistant microbes represent a growing problem for modern medicine and public health. Projections indicate that deaths from such infections could reach 10 million per year by 2050. Healthcare associated infections (HAI) are among the most significant causes of mortality and morbidity in hospitals, impacting millions of patients globally. The emergence of HAI is associated with resistance to antimicrobials, rapidly worsening the patient’s condition. Antimicrobial resistance determines unresponsiveness to treatment, which can ultimately lead to severe complications such as sepsis and shock. It is estimated that one in every ten patients are susceptible to infection during their stay in hospital, with the microorganism responsible for the infection frequently proving resistant to antibiotics. Among the latter, CRE (carbapenem-resistant Enterobacteriaceae), CRAB (carbapenem-resistant Acinetobacter baumannii), CRPA (carbapenem-resistant Pseudomonas aeruginosa), vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus (MRSA), commonly referred to as ‘superbugs’, are a major cause of HAIs. The aim of the present study is to provide a comprehensive overview of the global epidemiology of healthcare-associated infections, with particular emphasis on their incidence, distribution over time, and correlation with the socioeconomic status of different countries. Furthermore, the review aims to evaluate the effectiveness of current preventive strategies in reducing the incidence and mortality associated with HAIs. Full article
(This article belongs to the Special Issue Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections: Current Knowledge and Future Approaches)
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17 pages, 510 KB  
Review
Optimizing Surgical Antibiotic Prophylaxis in the Era of Antimicrobial Resistance: A Position Paper from the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS)
by Massimo Sartelli, Francesco M. Labricciosa, Beatrice Casini, Francesco Cortese, Monica Cricca, Alessio Facciolà, Domitilla Foghetti, Matteo Moro, Angelo Pan, Daniela Pasero, Giuseppe Pipitone and Giancarlo Ripabelli
Pathogens 2025, 14(10), 1031; https://doi.org/10.3390/pathogens14101031 - 11 Oct 2025
Viewed by 2961
Abstract
Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: [...] Read more.
Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article
(This article belongs to the Special Issue Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections: Current Knowledge and Future Approaches)
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33 pages, 788 KB  
Review
Phage to ESKAPE: Personalizing Therapy for MDR Infections—A Comprehensive Clinical Review
by Andrea Marino, Stefano Stracquadanio, Federica Cosentino, Alberto Enrico Maraolo, Agnese Colpani, Andrea De Vito, Nicholas Geremia, Alice Nicolosi, Alessandra Oliva, Bruno Cacopardo and Giuseppe Nunnari
Pathogens 2025, 14(10), 1011; https://doi.org/10.3390/pathogens14101011 - 7 Oct 2025
Viewed by 2237
Abstract
The proliferation of multidrug-resistant (MDR) ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.—constitutes a critical global health crisis, rendering conventional antibiotics increasingly ineffective. This comprehensive review evaluates the re-emerging potential of [...] Read more.
The proliferation of multidrug-resistant (MDR) ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.—constitutes a critical global health crisis, rendering conventional antibiotics increasingly ineffective. This comprehensive review evaluates the re-emerging potential of bacteriophage therapy as a personalized treatment for infections caused by these organisms. Phages, being viruses that specifically infect and lyse bacteria, offer significant advantages, including high specificity that spares host microbiota, self-replication at the infection site, and potent activity against biofilms. This paper synthesizes current preclinical and clinical evidence, including compassionate-use cases, for phage therapy against each of the ESKAPE pathogens. While case reports and small studies demonstrate considerable success, particularly in salvage therapy for otherwise untreatable infections, significant challenges remain. These include the narrow host range of phages, the potential for bacterial resistance, unpredictable pharmacokinetic and pharmacodynamic parameters, and a complex, non-harmonized regulatory landscape. The review highlights that phage–antibiotic synergy and the use of phage cocktails are promising strategies to overcome some of these limitations. Future progress in phage therapy will depend on standardized manufacturing, robust clinical trials to establish dosing and efficacy, and the development of adaptive regulatory pathways. Phage therapy is positioned not as a replacement for antibiotics but as a vital adjunctive tool in the armamentarium against MDR infections, heralding a move towards a more personalized approach to infectious disease management. Full article
(This article belongs to the Special Issue Classic and Emerging Pathogens as a Cause of Healthcare-Associated Infections: Current Knowledge and Future Approaches)
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