Search Results (1,138)

Object: Postoperative infection is a severe complication after pediatric cardiac surgery, which is closely associated with sepsis, multiple organ dysfunction, prolonged mechanical ventilation, extended ICU stay and increased mortality. Conventional microbiological tests (CMT) are limited by low sensitivity, long turnaround time, and poor capacity for detecting viruses and polymicrobial infections. This study aimed to compare the diagnostic efficacy of mNGS with that of CMT, and to explore the impact of polymicrobial infection on clinical outcomes in this high-risk pediatric population. Methods: A retrospective cohort study was conducted on 4889 pediatric patients admitted to the PICU after cardiac surgery from January 2025 to March 2026. A total of 510 patients were diagnosed with postoperative infections, including 879 CMT specimens and 86 mNGS specimens enrolled for analysis. Pathogen detection rates, pathogen spectrum and antimicrobial resistance profiles were compared between the two detection methods. Clinical prognostic indicators including mechanical ventilation duration, PICU length of stay and the requirement for continuous renal replacement therapy (CRRT) were further compared between patients with polymicrobial infection and monomicrobial infection. Results: Respiratory tract infection accounted for 87.8% of all postoperative infections, and Gram-negative bacteria were the predominant pathogens, accounting for 65.9%. The overall pathogen detection rate of mNGS was significantly higher than that of CMT (79.1% vs. 56.5%, p < 0.001). Notably, mNGS exhibited significantly better performance in detecting viruses (37.2% vs. 5.8%, p < 0.001), anaerobic pathogens and polymicrobial infections (38.2% vs. 5.4%, p < 0.001). Patients with polymicrobial infections had significantly longer mechanical ventilation time, longer PICU stay, and higher CRRT utilization rate (all p < 0.05), indicating a poorer clinical prognosis. Gram-negative bacteria showed high resistance to penicillins and early-generation cephalosporins, but remained susceptible to carbapenems and β-lactamase inhibitor combination agents. Gram-positive bacteria showed a high resistance rate to penicillin, while maintaining 100% susceptibility to vancomycin and linezolid. Conclusions: mNGS serves as a more sensitive and comprehensive tool for pathogen detection in children with post-cardiac surgery infections, especially for viral and polymicrobial infections. Polymicrobial infection is an independent risk factor for adverse clinical outcomes. Routine application of mNGS in critically ill children may help guide targeted antimicrobial therapy and improve prognosis. Full article

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an increasing concern within the One Health framework, particularly regarding opportunistic pathogens such as Klebsiella spp. This retrospective study evaluated the epidemiology, antimicrobial susceptibility profiles, and temporal resistance trends of Klebsiella spp. infections in dogs and cats across the Iberian Peninsula. Methods: A total of 809 clinical isolates collected between 2016 and 2024 and submitted to a private diagnostic laboratory in Barcelona were analysed. Results: Klebsiella pneumoniae was the predominant species (70%), more frequently identified in cats (76%) than in dogs (68%). Dermatological and respiratory samples exhibited the highest prevalence of multidrug-resistant (MDR) isolates. Overall MDR prevalence was high, particularly in cats (51.1%; 95% CI 41.1–60.9%) compared with dogs (38.4%; 95% CI 34.1–42.8%) although it was not statistically significant. K. pneumoniae generally exhibited higher resistance rates than K. oxytoca, particularly to amoxicillin/clavulanic acid, first-/second-generation cephalosporins, third-/fourth-generation cephalosporins (3/4th GC), fluoroquinolones, and tetracyclines. In both bacterial species, resistance rates were consistently higher among feline isolates. In contrast, aminoglycosides and phenicols retained high activity against most isolates. Temporal analysis revealed a significant increasing resistance trend to amoxicillin/clavulanic acid, which is particularly concerning given the widespread use of this antimicrobial as a first-line treatment in small animal practice. However, resistance trend to aminoglycosides showed a significant decline. No significant temporal changes were detected for 3/4th GC and fluoroquinolones, suggesting the persistence of resistant populations within companion animals. Resistance to aminoglycosides and phenicols remained comparatively low in this study. Whereas critically important category B antimicrobials, such as 3/4th GC and fluoroquinolones, exhibited low to moderate effectiveness, raising concerns about their empirical use. Conclusions: These findings highlight the substantial AMR and MDR burden of K. pneumoniae in companion animals in the Iberian Peninsula and reinforce the need for prudent antimicrobial use, routine susceptibility testing, and integrated One Health surveillance strategies. Full article

Antimicrobial resistance (AMR) is a global health crisis addressed through a One Health framework. However, recent European Union (EU) surveillance data reveals a marked divergence in progress between the human and animal sectors. This study analyzes the most recent monitoring reports (European Surveillance of Antimicrobial Consumption Network and European Sales and Use of Antimicrobials for Veterinary Medicine, 2024) to compare the effectiveness of mitigation strategies across sectors. The findings expose a clear paradox: while the veterinary sector has achieved a structural 24.3% reduction in antimicrobial sales in the EU since 2018, human medicine has recorded a 2% increase in overall consumption, diverging from established reduction targets. From a qualitative perspective, veterinary medicine has nearly eliminated the use of critically important antimicrobials in the AntiMicrobial Expert Group (AMEG) (category B), including polymyxins and third-generation cephalosporins, which now account for only 0.24% of total sales. In contrast, human medicine continues to struggle to contain antimicrobial resistance in key sentinel pathogens, notably Klebsiella pneumoniae and Escherichia coli. Furthermore, companion animals, representing 97.9% of non-food-producing animal biomass, emerge as a reservoir of antimicrobial-resistant bacteria due to the intensive use of broad-spectrum oral formulations. The results indicate that the veterinary regulatory model, centered on binding volume reduction and preventive strategies, has been more effective in reducing overall antimicrobial consumption compared to the voluntary, guideline-based stewardship approaches currently used in human medicine. Achieving meaningful control of antimicrobial resistance will require human medicine to adopt the same level of structural rigor already implemented in animal production systems. Full article

Background/Objectives: Endophthalmitis is a devastating, vision-threatening intraocular infectious disease. Given the scarcity of long-term cohort data in Asian populations, appropriate empirical antibiotic therapy is essential to prevent irreversible vision loss. The present study aimed to identify the culture-positive pathogen profiles and antimicrobial susceptibility in endophthalmitis. Methods: This retrospective study included 90 culture-positive isolates from patients with endophthalmitis treated between January 1990 and October 2020. The etiology, clinical presentation, and antibiotic susceptibility profiles of the isolates were analyzed. Results: Forty-three isolates were Gram-positive cocci, 23 were Gram-negative bacilli, and 24 were fungi. Postoperative infections were dominated by Gram-positive cocci (72.1%). Furthermore, 47.8% (11/23) of Gram-negative bacilli and 66.7% (16/24) of fungi were recovered from endogenous endophthalmitis isolates. In patients with endophthalmitis caused by Gram-negative bacilli, visual acuity was numerically inferior at both initial presentation and final follow-up visit (p = 0.051 and p = 0.018). All isolates of Gram-positive cocci exhibited full susceptibility to vancomycin and teicoplanin, while linezolid yielded a susceptibility rate of 96.9% (31/32). For Gram-negative bacilli, over 80% of isolates were susceptible to amikacin, aztreonam, and third-generation cephalosporins, whereas carbapenems and fluoroquinolones achieved susceptibility rates exceeding 90%. Among staphylococcal isolates, ciprofloxacin resistance was significantly higher in patients older than 55 years compared with those aged 55 years or younger (71.4% versus 12.5%; exact p = 0.013). Conclusions: Postoperative infection was the leading cause of Gram-positive cocci endophthalmitis. Antimicrobial susceptibility profiles validated intravitreal vancomycin combined with ceftazidime as a rational regimen for empirical antibacterial coverage. Elevated fluoroquinolone resistance among Gram-positive cocci, particularly in elderly patients, underscores the necessity of sustained regional antimicrobial resistance surveillance and periodic reassessment of conventional topical antibiotic prophylatic protocols. Full article

This scoping review evaluates the role of vector-associated dissemination in contaminating the Philippine food supply chain with antimicrobial-resistant (AMR) Salmonella, an emerging infectious disease threat, using a One Health perspective to map the mechanisms through which insects and rodents bridge environmental reservoirs to human food systems. This scoping review was conducted and reported in accordance with the PRISMA-ScR guidelines. From 1969 records identified through systematic database searches, 52 studies met the inclusion criteria. These comprised 21 primary Philippine studies, 28 non-Philippine studies (including ASEAN-based historical baseline reports), and 3 policy/gray literature studies, prioritized to reflect tropical ecological and agricultural settings. Results suggest that intensive swine and poultry farming may contribute to the emergence of multidrug resistance (MDR) linked to genes such as bla_TEM and qnr. Evidence suggests that Salmonella persists in environmental matrices, such as manure and irrigation water, and that synanthropic vectors, including Rattus rattus and various fly species, potentially serve as biological and mechanical bridges in transmission. Clinical data reveal an alarming trend toward invasive non-typhoidal salmonellosis (iNTS) showing reduced susceptibility to cephalosporins and fluoroquinolones. Despite these findings, major evidence gaps remain, particularly regarding the prevalence of vector-borne Salmonella in pre-harvest produce. Consequently, mitigation requires a One Health framework that integrates non-antibiotic interventions, pest management to disrupt transmission pathways, and rapid diagnostic tools, such as loop-mediated isothermal amplification (LAMP), to enhance market surveillance. Full article

Objectives: Surgical site infections (SSIs) represent a significant postoperative challenge. Although timely perioperative prophylaxis with cephalosporins is essential to prevention, adherence to the recommended 30–60 min administration window may be challenging with traditional intravenous infusion (IVI) in settings with high surgical turnover, as is the case in China. Intravenous push (IVP) has been proposed as a more time-efficient alternative. This scoping review aims to map the available evidence comparing IVP with IVI for perioperative cephalosporin administration across four domains: safety, pharmacokinetics/pharmacodynamics (PK/PD), efficacy, and economic impact. Methods: A systematic search was conducted across PubMed, Embase, Web of Science, the Cochrane Library, and gray literature up to February 2026. Data were systematically charted and extracted using a standardized form. Results: Of the 14 included sources, only 3 were peer-reviewed comparative studies; the remaining 11 (78.6%) were gray literature documents. Among the gray literature, 72.7% (8/11) permitted or recommended IVP for cephalosporin prophylaxis; however, this proportion reflected practice patterns of heterogeneous methodological rigor. The 3 peer-reviewed studies focused on the safety, PK/PD, and economic outcomes. Two studies—in orthopedic and bariatric surgery, respectively—found no significant difference in adverse event rates between IVP and IVI, though both were limited by small samples. A single small study suggested similar PK/PD target attainment between IVI and IVP cefazolin. No study directly compared SSI rates between the two routes. One study suggested potential cost savings with IVP, but the evidence was dated and based on limited patient numbers. Conclusions: The available evidence for IVP is predominantly derived from gray literature, while peer-reviewed articles suggest that safety and PK/PD profiles do not differ markedly from IVI in the limited populations, surgical procedures, and agents studied; economic data are suggestive but dated. Direct comparative data on clinical efficacy outcomes, such as SSI rates, are absent. Well-powered, multi-center comparative studies comparing IVP and IVI with SSI as a primary endpoint are needed. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major burdens in tertiary care hospitals. Repeated point prevalence surveys (PPSs) offer a pragmatic approach to monitor temporal changes and guide infection prevention. Objectives: Characterize healthcare-associated infections (HAI) prevalence trends, microbiological profiles, antimicrobial resistance (AMR) patterns, and risk factors to refine prevention strategies and hospital policy. Methods: Four annual cross-sectional PPSs were conducted between 2022 and 2025 using the standardized ECDC protocol. Data from all eligible inpatients present at 08:00 on survey days were collected through systematic medical record review. Multivariable logistic regression was used to identify factors independently associated with HAI, with additional sensitivity analyses evaluating invasive device burden and hospital ward type. Results: Across the surveys, 3314 patients were included. Overall HAI prevalence was 11.3%. Infections were most frequent in intensive care units (31.2%), followed by medical (14.6%) and surgical (14.2%) wards. Bloodstream infections (25.7%) and lower respiratory tract infections (19.8%) were the most common. Multivariable analysis identified invasive device exposure as the strongest predictor, with central venous and urinary catheters showing robust independent associations and a clear dose–response relationship according to the number of devices. Pathogens were predominantly Gram-positive cocci (40.5%) and Enterobacterales (30.8%), with Klebsiella pneumoniae being the most frequent isolate (13.0%). Notably, 57.6% of K. pneumoniae isolates were resistant to third-generation cephalosporins. All tested Acinetobacter baumannii isolates were resistant to carbapenems. Conclusions: This repeated PPS reveals a persistently high HAI burden, associated with invasive device exposure and resistant pathogens. Because of the repeated cross-sectional design, causal inference cannot be established. Hospital-wide device stewardship and integrated surveillance are essential for guiding targeted prevention measures, refining antimicrobial policies, and adapting local responses to evolving resistance profiles. Full article

For nearly a century, since the discovery of penicillin by Alexander Fleming, we have used covalent inhibitors as antimicrobial drugs. The success of penicillin in treating microbial infections led to numerous other antibiotics containing β-lactam, the reactive warhead that forms the covalent adduct, exemplified by later-generation cephalosporins with approvals into 2020. In parallel, early non-β-lactam covalent agents also emerged, extending covalent mechanisms beyond β-lactam antibacterials to antifungal, antiparasitic, and antiviral applications. Despite the successes of covalent mechanisms of action, there are still considerable safety concerns due to the possibility of off-target covalent adducts which may lead to significant side effects. This review provides an overview of non-β-lactam covalent antimicrobials across all major pathogen classes, organized by their warhead class, covalency, and resistance mechanisms, and outlines design and clinical-level mitigation strategies. We trace the field from the serendipitous discovery of penicillin to the intentional design of new drugs, with a discussion of changes in perception and evolution of technology that enable modern covalent drug design. Full article

The rapid hemostasis of deep and irregular wounds is of great clinical significance. In this study, an injectable hemostatic hydrogel based on bioorthogonal conjugation was developed. This gel uses thrombin (TMB) as the hemostatic active substance and 4ARM-PEG-N₃ as the crosslinking agent, which undergo orthogonal conjugation via the classic azide–alkyne click reaction to form an injectable hydrogel (TMB-PEG). The resulting hydrogel exhibited a transparent, injectable gel state. TEM images revealed that the hydrogel comprised sheet-like structures and interwoven fibers with a diameter of approximately 100 nanometers. In a puncture bleeding wound model, hemostasis with the TMB-PEG hydrogel required only 25 s, with a blood loss of 1.9 ± 1.3 mg, both approximately one-sixth of that of the control group. Moreover, the hemostatic performance of the TMB-PEG hydrogel was far superior to that of three other commonly used hemostatic materials. Furthermore, cephalosporin antibiotics were conjugated to the hemostatic gel via orthogonal reactions, endowing it with significant broad-spectrum antibacterial activity, achieving over 99% antibacterial efficacy against both Gram-negative and Gram-positive bacteria. Full article

Background: Creating antibiograms solely for adults may overestimate resistance of antimicrobials for certain pathogens in children. The Canadian Paediatric Society comments that areas with no cephalosporin-resistant Streptococcus pneumoniae cases should consider ceftriaxone or cefotaxime monotherapy for meningitis, despite most experts recommending adding vancomycin. The present study created age-specific antibiograms using LifeLabs data to report incidences of resistant bacterial meningitis pathogens at the regional level to determine the need for duo-coverage. Methods: Data of common bacterial meningitis pathogen susceptibility was collected from 1 January 2023 to 31 December 2024, in the LifeLabs community laboratory on Vancouver Island. Results: Most Streptococcus pneumoniae isolates (78/83) were susceptible to ceftriaxone using the meningitis breakpoint; the remaining five isolates showed intermediate susceptibility to ceftriaxone. There was a significant difference when comparing S. pneumoniae susceptibility using penicillin-meningitis and penicillin-non-meningitis breakpoints (82% vs. 99%, respectively; p < 0.05). There was a significant difference between the three age groups (<18 years, 18–50 years, >50 years) when analyzing ciprofloxacin susceptibility of isolates [82% (n = 462), 77% (n = 2452), 75% (n = 8352), respectively, p < 0.05]. Conclusions: Ceftriaxone should remain the drug of choice for community-acquired bacterial meningitis and might be sufficient as a monotherapy for pneumococcal meningitis on Vancouver Island. The age-specific differences in E. coli susceptibilities to ciprofloxacin showed the importance of age-specific antibiograms. Full article

Background/Objectives: Cefiderocol (FDC) is a siderophore-containing cephalosporin that retains activity against many β-lactamase-producing bacteria, such as New Delhi metallo-β-latamase-producing (NDM) K. pneumoniae. Its use in critically ill patients is still limited, since the recommended dosing regimens are mainly derived from studies on healthy subjects, while critical illness is often associated with critical alterations in drug pharmacokinetics. Therefore, the aim of this study was to investigate FDC pharmacokinetic/pharmacodynamic (PK/PD) parameters in real-life patients based on their body weight and renal function. Methods: Patients with K. pneumoniae infections and indications for FDC were enrolled. Drug quantification in plasma was performed at the steady state at different timings. PK/PD targets of fCmin > 4 mg/L (most common) and more stringent targets of fCmin > 8 and 12 mg/L (4× and 6× the EUCAST breakpoint MIC) were considered in relation to patients’ characteristics, 14 days of microbiological eradication and 30-day mortality. Results: Ten patients were enrolled in this study. Mortality, as well as the failure to achieve microbiological eradication, increased with BMI. In a PK/PD point of view, all patients reached the PK/PD targets of fCmin > 4 mg/L and > 8 mg/L, while only 20% reached a fCmin > 12 mg/L, with a key influence of renal function. However, no significant association was found between PK/PD target attainment and treatment outcomes. Conclusions: Our study may be useful for the real-world use of FDC, highlighting the impact of renal function on the achievement of ideal PK/PD thresholds. Nevertheless, the lack of a significant association between PK/PD and outcomes, partially due to the small sample size, highlights the complex impact of patients’ clinical conditions other than drug PK. Full article

Background/Objectives: Antimicrobial resistance in pediatric infections presents a worsening global public health challenge, with antimicrobial resistance (AMR) accounting for more than one million deaths annually and disproportionately affecting children younger than 5 years of age. Neonates and critically ill children face heightened risk owing to immature immunity, frequent healthcare exposures, and limited therapeutic options. This review synthesizes evidence on the epidemiology, mechanisms of resistance, clinical outcomes, and management of AMR across the full pediatric age range. Methods: PubMed/MEDLINE and Google Scholar were searched for literature from 2014 to 2026 using terms covering antibiotic resistance, pediatric populations, and key pathogens. Approximately 1840 records were screened; 69 sources met all inclusion criteria. A narrative synthesis approach was used, given heterogeneity across study designs and outcomes. Results: Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant pathogens, and methicillin-resistant Staphylococcus aureus drive substantial morbidity and mortality in children. Approximately one in five pediatric Gram-negative bloodstream isolates are resistant to third-generation cephalosporins, a phenotype independently associated with a roughly three-fold increase in adjusted mortality. Carbapenem-resistant Klebsiella pneumoniae bacteremia carries a 30-day mortality approaching 40%, and isolates in low- and middle-income countries (LMICs) frequently harbor multiple resistance genes. Pneumococcal conjugate vaccine implementation was associated with absolute reductions of 7–11% in the proportion of pediatric pneumococcal isolates that were penicillin-non-susceptible or penicillin-resistant, largely by preventing infections caused by resistant serotypes and by reducing antibiotic selection pressure, rather than through a direct effect on resistance mechanisms; global AMR mortality in children younger than 5 years of age fell by more than 50% between 1990 and 2021. Conclusions: Pediatric AMR reflects intersecting microbiological, clinical, and health-system challenges. Priority actions include scaling antimicrobial stewardship programs, expanding access to rapid molecular diagnostics, integrating whole-genome sequencing into surveillance, conducting pediatric-inclusive randomized trials, and deploying vaccines as primary prevention tools, with particular emphasis on LMICs where the burden is greatest. Full article

Background/Objectives: The present study aimed to analyze systemic antibiotic prescription patterns in the Salerno Local Health Authority (ASL Salerno) during 2024. The objective was to describe territorial antibiotic consumption and monitor prescribing appropriateness from epidemiological, pharmacological, and antimicrobial stewardship perspectives, using the World Health Organization (WHO) AWaRe classification system as a reference. Methods: A retrospective analysis of antibiotic prescriptions was conducted across ASL Salerno in 2024. Total prescription and associated expenditures were assessed, along with distribution across districts and pharmacological classes. Antibiotics were categorized according to the Anatomical Therapeutic Chemical (ATC) system and further classified using the WHO AWaRe framework (Access, Watch, Reserve) to evaluate prescribing appropriateness and potential patterns of antimicrobial resistance. Results: More than 1 million antibiotic prescriptions were recorded, totaling approximately €15 million in expenditure. Prescribing patterns showed a predominance of penicillins and cephalosporins, followed by macrolides, fluoroquinolones, and J01X class. A substantial proportion of prescriptions belonged to the Watch category, particularly third-generation cephalosporins, fluoroquinolones, and fosfomycin. Some districts demonstrated a higher reliance on Watch antibiotics, while others showed increased use of Access agents such as amoxicillin, doxycycline, and amikacin. Conclusions: The surveillance analysis highlights significant variability in antibiotic prescribing practices within ASL Salerno and a substantial use of Watch-group antibiotics. These findings suggest the need for strengthened antimicrobial stewardship interventions, such as targeted education, auditing, and decision-support tools. Continuous monitoring of prescribing trends is essential to encourage appropriate antibiotic use and contribute to the containment of antimicrobial resistance. Full article

Bacterial infections in equine wounds are common and can complicate treatment and healing. This five-year retrospective study examined 2844 samples from wounds and abscesses from horses in Germany (2019–2023), analyzing bacterial prevalence by care setting and geographical region. A total of 4464 bacterial isolates were identified, with β-hemolytic streptococci (20.6%), Escherichia coli (15.6%), and Staphylococcus aureus (13.0%) being the most common. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 35.9% of Staphylococcus aureus isolates. Resistance to third- and fourth-generation cephalosporins was detected in 15.2% of Escherichia coli isolates. Samples from clinics showed a significantly higher MRSA rate, while primary care samples more often contained environmental bacteria. Regional differences in pathogen prevalence and statistically significant temporal changes were observed. The results highlight the importance of continuous microbiological surveillance and underscore the need for targeted antimicrobial stewardship in veterinary facilities. These findings have implications for infection control, empirical treatment strategies, and zoonotic risk mitigation in equine medicine. Full article

Background/Objectives: Oral and maxillofacial infections present polybacterial profiles, including both aerobic and anaerobic bacteria. Increasing antibiotic resistance poses a significant challenge to pharmacological treatment of these infections. The aim of this study was to present a bacterial profile and assess antibiotic resistance found in these infections. Methods: This retrospective analysis is based on medical records of 224 patients affected with maxillofacial infections. Microbiological cultures and antibiotic susceptibility testing were performed for all patients. Results: In 78.57% of the patients, a positive microbiological culture was obtained. A total of 72.72% of culture-positive patients showed multi-bacterial cultures (128/176). Predominant bacteria included Streptococcus, detected in 156 cases (39%), followed by Staphylococcus, found in 64 cases (16%), and Prevotella, detected in 56 of 400 total bacterial isolates (14%). The most often isolated aerobic strains were Streptococcus mitis/oralis detected in 64 (16%) cases and Staphylococcus epidermidis detected in 48 cases (12%), while the most common anaerobic strains were Prevotella buccae detected in 14 cases (3.5%). Streptococcus and Staphylococcus exhibited the greatest resistance to clindamycin, accounting for 51.74% and 47.63%, respectively. Aerobic Gram-positive cocci were more resistant to penicillin and amoxicillin than to cephalosporins. Among obligate anaerobes, the lowest antibiotic resistance seen was to metronidazole. The obligate anaerobes except Prevotella were sensitive to clindamycin. Conclusions: A high rate of clindamycin resistance among aerobic and facultatively anaerobic Gram-positive cocci indicates the need to reassess the use of clindamycin in empirical therapy. The bacterial composition of infections suggests the need to use combined antibiotic therapy. First- and second-generation cephalosporins may be an effective alternative to penicillin and its derivatives. Full article