Search Results (229)

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 conjugates have attracted considerable interest in addressing the threat of antimicrobial resistance by minimising the likelihood of resistance onset. Antimicrobial peptide mimic–antibiotic conjugates offer a unique strategy to revitalise current clinical agents through increased membrane permeabilisation, prolonging the longevity of traditional antibiotics while broadening the spectrum of activity of the AMP mimic. Methods: This study explored non-cleavable, enzyme-cleavable, and pH-cleavable linked conjugates between an anthranilamide-based peptide mimic and current clinically available antibiotics to assess the viability of conjugation in enhancing antimicrobial activity as measured through MIC assays. Cleavage studies were conducted to assess the stimulus susceptibility of relevant compounds. Results: Four amide-linked non-cleavable conjugates were synthesised. Of these, a primary amide-linked conjugate between ciprofloxacin and the peptidomimetic had the most significant activity with an MIC of 15.6 µM towards Gram-positive Staphylococcus aureus and Gram-negative Pseudomonas aeruginosa, and an MIC of 7.8 µM towards Gram-negative Escherichia coli. A hydrazone-based pH-sensitive linker system was synthesised and had an MIC of 15.6 µM towards Gram-negative E. coli. Finally, an enzyme-cleavable cephalosporin conjugate system was investigated, which offered a unique method for the specific treatment of resistant bacterial strains. Cleavage studies of this conjugate suggested rapid degradation of the β-lactam ring and release of the subunit. Conclusions: This work presents conjugate systems between peptide mimics and antibiotics as a new, promising strategy to broaden the antimicrobial spectrum of novel antimicrobial agents. Full article

Carbapenems comprise a class of β-lactam antibiotics with broad-spectrum hydrolytic activity and are often reserved as last-line agents for the treatment of serious multidrug-resistant (MDR) bacterial infections. Clinically important nosocomial MDR Gram-negative bacteria (GNB) include Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Carbapenem resistance among these organisms is predominantly mediated by the production of β-lactamases called carbapenemases, such as K. pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), and selected oxacillinase (OXA)-type carbapenemases. These enzymes degrade carbapenems, significantly compromising their clinical efficacy. To address escalating antimicrobial resistance, novel next-generation β-lactamase inhibitors (BLIs), partnered with established β-lactams (BLs), have been approved or are currently under development to inhibit carbapenemase activity. The present narrative review aims to synthesize the most current information on the major carbapenemases and discusses recently approved and investigational BL/BLI combination therapies in terms of their mechanisms of action, spectrum of activity, gaps in coverage, and available clinical and in vitro evidence. Development of resistance to novel BL/BLI combinations is also examined. Comparative analysis of inhibitory spectra and microbiological coverage indicates a continued need for metallo-β-lactamase inhibitors with direct pan-inhibitory activity, pathogen-specific BL/BLI regimens for carbapenem-resistant A. baumannii, and carbapenemase-targeted agents effective in the context of non-enzymatic resistance mechanisms. Treatment-emergent resistance to novel BL/BLIs and limitations in activity profiles underscore the critical need for continued innovation in pipeline development, vigilant global and local surveillance of carbapenemase epidemiology, and robust antimicrobial stewardship strategies to aid in preserving the efficacy of the antibacterial drug armamentarium. Full article

Background/Objectives: The WHO has identified carbapenem-resistant Acinetobacter baumannii (CRAb) and carbapenem-producing Enterobacterales (CPE) as the “critical priority” group of multidrug-resistant (MDR) organisms for which new therapeutic strategies are urgently needed. Here, we evaluated the in vitro synergistic activity of eugenol, cinnamaldehyde, and carvacrol in combination with β-lactams, gentamicin, or colistin against MDR Gram-negative bacteria (GNB). Methods: We selected seven MDR-GNB clinical isolates including CRAb, ESBL-producing and CPE clinical isolates displaying different antimicrobial susceptibility profiles. The genomes of clinical isolates were characterized by whole-genome sequencing and synergy testing was performed with checkerboard assay. Results: Our results demonstrate that eugenol, cinnamaldehyde, and carvacrol in combination with colistin exhibited synergistic activity (FICI < 0.5) against MDR-GNB clinical isolates ranging from 37.5 to 50%, while the effect was almost indifferent in combination with different β-lactam molecules or gentamicin against 87.5–100% of MDR-GNB strains. The synergistic interaction of eugenol, cinnamaldehyde, and carvacrol with colistin induced a statistically significant reduction (p < 0.05) in the MIC values compared with the molecules tested alone. Conclusions: Our data demonstrate that this synergistic interaction was not affected by different antimicrobial resistance genes and/or different antimicrobial susceptibility profiles. In conclusion, our results suggest that eugenol, cinnamaldehyde, and carvacrol in combination with colistin represent a potential strategy for the treatment of MDR-GNB pathogens and limit their diffusion. Full article

Carbapenem-resistant Gram-negative infections have become one of the most formidable challenges in intensive care units (ICUs). Critically ill patients—often exposed to invasive procedures, prolonged hospitalization, and broad-spectrum antibiotics—are highly susceptible to infections by carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB). These pathogens are associated with mortality exceeding 40%, prolonged ICU stays, and increased healthcare costs. Therapeutic advances have reshaped management in recent years. New β-lactam/β-lactamase inhibitor combinations—ceftazidime–avibactam, meropenem–vaborbactam, imipenem–relebactam, and sulbactam–durlobactam—along with cefiderocol, have provided safer and more effective alternatives to previously used regimens. Yet, none are universally effective, particularly against carbapenemase-producing organisms, especially metallo-β-lactamase (MBL) producers, and resistance may still emerge during treatment. Rapid molecular and phenotypic diagnostics, when integrated into antimicrobial stewardship, have improved early therapy alignment and reduced unnecessary broad-spectrum use. Beyond antibiotics, colonization surveillance and infection control remain pivotal, as colonization often precedes invasive infection. Biofilm formation on devices such as endotracheal tubes and catheters further promotes persistence and relapse. Strategies targeting biofilm disruption, improved dosing guided by pharmacokinetic/pharmacodynamic optimization, and therapeutic drug monitoring are crucial in ICU practice. The future of managing these infections will depend on integrating precision tools—rapid diagnostics, mechanism-based therapy, and stewardship-guided decisions—with emerging treatments and adjunctive options such as immunomodulators, bacteriophages, and AI-driven decision support. Continued research in ICU-specific populations, especially regarding pharmacokinetics in patients on ECMO or CRRT, is urgently needed. In summary, while the therapeutic landscape for carbapenem-resistant Gram-negative infections has evolved substantially, sustained success will rely on a multifaceted strategy combining innovation, precision, and prevention to improve outcomes for the most vulnerable patients. Full article

Wound healing is a complex process essential for maintaining skin integrity; however, the rise of antibiotic-resistant bacteria limits therapeutic options, highlighting the critical need for new antimicrobial agents. In this context, this research focused on the synthesis of new azole derivatives and their biological evaluation, specifically targeting antimicrobial, antioxidant, and biocompatible properties relevant to wound infections. In the present work, ketoconazole derivatives were obtained through an initial reaction with an excess of hydrazine hydrate, followed by condensation with benzaldehydes and cyclization with chloroacetyl chloride to form a β-lactam ring. These compounds were evaluated in vitro for antioxidant activity using FRAP, DPPH, and TAC assays, and for antimicrobial activity against a variety of microorganisms. Additionally, the cytotoxicity was assessed using the MTT assay on a normal mouse fibroblast cell line (NCTC, clone L929) for evaluating the biocompatibility of the obtained compounds. Derivative K1 exhibited the highest antioxidant activity, a finding confirmed by all three assays. Regarding antimicrobial properties, all compounds demonstrated notable activity, with K1, K4 and K5 displaying superior efficacy. Significantly, the MTT assay revealed that the derivatives exhibit dose-dependent cytotoxicity but maintain favorable safety profiles at therapeutic concentrations, supporting their suitability for topical application. In conclusion, these findings suggest that the synthesized derivatives may serve as promising leads for infected wound therapy. Future research will further explore the therapeutical potential of these compounds, together with their incorporation into polymeric films designed for chronic wound treatment. Full article

Methicillin-resistant Staphylococcus aureus (MRSA), a major global public health threat due to its broad resistance, urgently requires the development of new antibiotic alternatives. (‒)‒Epigallocatechin-3-gallate (EGCG) is considered a natural bioactive compound with anti-MRSA properties. The L-Lectin module of serine-rich adhesin for platelets (SraP) is considered an important target for blocking MRSA-infected hosts. This study aims to investigate the mechanism of action of EGCG against MRSA. Surface plasmon resonance (SPR), cell adhesion and invasion, biofilm formation, checkerboard assays, RNA sequencing (RNA-seq) and quantitative real-time polymerase chain reaction (qRT-PCR) were performed. The results showed that EGCG bound to SraP L Lectin with high affinity and effectively inhibited MRSA colonization. Additionally, EGCG significantly suppressed pyrimidine metabolism and downregulated related genes, thereby potentially inhibiting bacterial growth. It also markedly reduced the expression of multiple genes associated with β-lactam resistance and inhibited biofilm formation. A strong synergistic effect was observed between EGCG and the bactericidal agent ceftriaxone (CRO). When combined with 10 μg/mL EGCG, CRO required 75% less dosage and exhibited a prolonged antimicrobial effect. In conclusion, EGCG exerts anti-MRSA effects through multiple pathways and represents a promising candidate as an alternative therapeutic agent against MRSA infections. Full article

The Bactericidal action of β-lactam antibiotics is related to covalent modification of transpeptidases, enzymes that take part in the synthesis of bacterial cell wall. The β-lactam moiety mimics the transpeptidase substrate and irreversibly inhibits the enzyme. In penicillin and cephalosporin, the β-lactam ring is coupled with a five-membered thiazolidine ring or a six-membered dihydrothiazine ring, respectively. In the case of penicillins, such conjunction causes higher tension of this bicyclic moiety; therefore, the β-lactam ring can be hydrolyzed in certain conditions, inactivating the antibiotic. Serum albumin is known for its drug binding capabilities, which enable it to transport pharmaceuticals through the circulatory system. Penicillins and cephalosporins are no exception in this aspect, and they are also carried by serum albumin in the bloodstream. In this study, we structurally investigate the ability of three serum albumins—equine (ESA), caprine (CSA), and ovine (OSA)—to bind two penicillins, ampicillin (Amp) and oxacillin (Oxa), and two cephalosporins, cefaclor (Cef) and cephalosporin C (Csc). The crystal structures of these mammalian serum albumin complexes shed new light on the albumin binding properties of β-lactam antibiotics, showing one common binding site for Amp, Oxa, and Cef in Fatty Acid Site 6 (FA6), and a second cefaclor molecule bound in domain I of the equine serum albumin. It was surprising that these antibiotics are not bound in the main drug binding site. However, cephalosporin C is bound in OSA Drug Site 1 (DS1). Full article

Antimicrobial resistance (AMR) continues to represent a significant global public health concern. Gram-negative bacilli (GNB) are the primary causative agents of severe nosocomial infections and possess a notable capacity to develop resistance mechanisms that restrict therapeutic options. The objective of this study was to characterize the antimicrobial susceptibility profiles of GNB isolated at a secondary-level hospital in Guadalajara, Mexico, with the aim of identifying predominant resistance patterns and the most effective therapeutic alternatives. A descriptive, retrospective, cross-sectional study was conducted using clinical isolates of Acinetobacter spp., Pseudomonas spp., Escherichia coli, Klebsiella spp., Morganella morganii, Proteus spp., and Enterobacter spp. collected during 2024. The identification and susceptibility testing were carried out using the VITEK^® 2 automated system, and the results were interpreted in accordance with CLSI guidelines. High resistance rates were observed in Acinetobacter spp. and Pseudomonas spp., particularly to carbapenems (>50% and >40%, respectively). Escherichia coli and Klebsiella spp. demonstrated resistance to third-generation cephalosporins and trimethoprim/sulfamethoxazole, exhibiting high susceptibility to amikacin and carbapenems (>90%). New-generation β-lactam/β-lactamase inhibitor combinations, such as ceftazidime/avibactam and ceftolozane/tazobactam, have demonstrated high efficacy against resistant strains. Overall, GNB isolates in this secondary-level hospital demonstrated elevated resistance levels, particularly to β-lactams and carbapenems, which pose a significant therapeutic challenge. Nevertheless, amikacin, carbapenems, and new-generation β-lactams persist as valuable therapeutic options. In order to contain the spread of multidrug-resistant organisms, it is imperative to strengthen local surveillance, optimize antibiotic stewardship, and reinforce infection control measures. Full article

Emerging antimicrobial resistance (AMR) in companion animals represents a global health concern as they serve as potential reservoirs for multidrug-resistant (MDR) bacteria, which can be transmitted to humans. Herein, we provide comprehensive surveillance data on resistance patterns in veterinary hospital settings, focusing on urinary tract infection. A total of 23 bacterial strains were isolated from urine specimens of hospitalized companion animals suspected of urinary tract infections (UTIs) between 2022 and 2024. 16S rRNA sequencing analysis revealed that Escherichia coli (47.8%), Klebsiella pneumoniae (21.7%), and Pseudomonas aeruginosa (8.7%) were predominant uropathogens. Minimum inhibitory concentration and minimum bactericidal concentration tests were employed to analyze AMR patterns across different classes of antibiotics. Moreover, antimicrobial susceptibility test exhibited 73.91% MDR according to the standard definition given by the Clinical and Laboratory Standards Institute (CLSI) M100 guidelines. Most Gram-negative bacteria have been shown to be resistant to beta-lactam antibiotics, especially carbapenems. Notably, an E. coli strain was confirmed to possess the bla_NDM-1 gene encoding the carbapenemase New Delhi metallo-β-lactamase. These findings support the implementation of targeted infection control measures and evidence-based treatment protocols to preserve antimicrobial efficacy in companion animal medicine to minimize potential public health risks through the One Health approach. Full article

The environmental persistence of antibiotic residues in aquatic systems represents a critical global challenge, with photolysis serving as a primary abiotic degradation pathway. Traditional approaches to studying antibiotic photodegradation and transformation product (TP) identification face significant limitations, including complex reaction mechanisms, multiple concurrent pathways, and analytical challenges in characterizing unknown metabolites. The integration of artificial intelligence (AI) and machine learning (ML) technologies has begun to transform this field, offering new capabilities for predicting photodegradation kinetics, elucidating transformation pathways, and identifying novel metabolites. This comprehensive review examines current applications of AI/ML in antibiotic photolysis research, analyzing developments from 2020 to 2025. Key advances include quantitative structure–activity relationship (QSAR) models for photodegradation prediction, deep learning approaches for automated mass spectrometry interpretation, and hybrid computational–experimental frameworks. Machine learning algorithms, particularly Random Forests, support vector machines, and Neural Networks, have demonstrated capabilities in handling multi-dimensional environmental datasets across diverse antibiotic classes, including fluoroquinolones, β-lactams, tetracyclines, and sulfonamides. Despite progress in this field, challenges remain in model interpretability, standardization of datasets, validation protocols, and integration with regulatory frameworks. Future directions include machine-learning-enhanced quantum dynamics for improving mechanistic understanding, real-time AI-guided experimental design, and predictive tools for environmental risk assessment. Full article

LD-Transpeptidases (LDTs) are a widely conserved class of peptidoglycan (PG) crosslinking enzymes in bacteria. They are sometimes overlooked as they often act secondary to penicillin binding proteins (PBPs) under standard conditions. However, LDTs are essential in key pathogens such as Clostridioides difficile and are responsible for β-lactam resistance in Mycobacterium tuberculosis and Enterococcus faecium due their low affinity for penicillins and cephalosporins, allowing them to form LD-crosslinks when DD-crosslinking PBPs are inactivated. This role makes LDTs a promising target when developing new treatments for these pathogens. LDTs can perform different enzymatic reactions. Most commonly they reinforce the PG with 3,3-LD-crosslinks or, in a few cases, 1,3-LD-crosslinks, during stationary phase or stress responses. Some LDTs also incorporate endogenous and exogenous non-canonical D-amino acids into the PG. In many Gram-negative bacteria, specialised LDTs tether lipoproteins or outer membrane proteins (OMPs) to the PG to maintain cell envelope integrity; in some cases this regulates virulence factors. Specialised LDTs have also been implied to have roles in polar growth, toxin secretion, and symbiotic colonisation. Recent discoveries include novel subgroups of the major YkuD family and the identification of the VanW family; this has opened new research directions surrounding LDTs. We aim to understand LDTs and their roles to expand our knowledge of PG synthesis and modification and how these enzymes can be targeted for antibiotic treatment. Full article

Non-cephem drugs with 1,3-thiazine-derived rings are very rare, although a number of bioactive 1,3-thiazine derivatives are known. Similarly, 1,4-thiazepine-derived drugs are rare, but many 1,4-thiazepine derivatives show interesting biological activities. Therefore, our aim was the synthesis of such N,S-heterocycles using a versatile and short (1–3 steps) literature method. First, a three-component reaction of a cycloalkene, a thioamide, and an aldehyde provided 5,6-dihydro-4H-1,3-thiazines. Afterwards, Staudinger ketene–imine cycloaddition with chloroketene resulted in β-lactam-fused 1,3-thiazinanes. Finally, treatment with sodium methoxide induced ring expansion, yielding 4,5,6,7-tetrahydro-1,4-thiazepines. This synthetic pathway generates 3–5 new chiral centers with the help of pericyclic reactions, and almost every cycloaddition proceeded in a diastereoselective manner. Two-dimensional NOESY as well as single-crystal X-ray diffraction enabled unequivocal determination of the stereochemistry of all synthesized compounds. Full article

The emergence and global dissemination of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) represent a major public health concern. However, the characterization and capacity for horizontal gene transfer (HGT) of ESBL-E. coli in captive black bears remain substantially understudied. In the present study, 19 ESBL-E. coli strains were successfully identified (13.38%, 19/142). A total of 11 sequence types (STs) were identified from 19 ESBL-E. coli strains using MLST. This included eight known types (ST10, ST2690, ST208, ST695, ST4160, ST540, ST3865 and ST2792) and three new STs. Antimicrobial susceptibility testing demonstrated that all 19 ESBL-E. coli exhibited high resistance to KZ (100.00%), CRO (78.95%), and CTX (73.68%). Polymerase chain reaction (PCR) screening for 14 β-lactam antibiotic resistance genes (ARGs) and their variants revealed that bla_CTX-M was the most prevalent, followed by bla_SHV, bla_TEM, and bla_DHA. Furthermore, eight β-lactamase variants were detected, including five bla_CTX-M variants (bla_CTX-M-15, bla_CTX-M-3, bla_CTX-M-14, bla_CTX-M-55, and bla_CTX-M-27) and one variant each of bla_SHV-1, bla_TEM-1, and bla_DHA-14. Conjugation assays revealed that eight ESBL-E. coli strains were capable of conjugative transfer. Five plasmid types (IncFII, IncW, IncFrepB, IncY, and IncHI1) and three mobile genetic elements (MGEs) (IS26, ISEcp1, and trbC) were identified as co-transferred with bla_CTX-M. ESBL-E. coli poses a potential threat to captive black bears and may lead to further transmission. Consequently, the implementation of continuous surveillance and targeted interventions is imperative to prevent the transmission of ESBL-E. coli. Full article

New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales represent a major therapeutic challenge due to their resistance to nearly all β-lactams and frequent co-resistance to other antibiotic classes, leaving clinicians with few effective options. These challenges are amplified in orthopedic infections with hardware involvement, where biofilm formation and the need for prolonged antimicrobial therapy limit success. We describe a 55-year-old female with a history of right type 3 open pilon fracture complicated by hardware failure and revision, who presented with septic tibial nonunion and chronic drainage. During this admission, she underwent irrigation and debridement with hardware removal and intramedullary nail placement. Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime–avibactam, meropenem–vaborbactam, and cefiderocol, as well as Candida parapsilosis. Molecular testing confirmed NDM production, while reference testing showed susceptibility to aztreonam–avibactam (ATM-AVI). The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days. Due to outpatient administration barriers with ATM-AVI, the patient was transitioned to eravacycline and micafungin. At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management. Full article