Nocardia gipuzkoensis was first described as a novel species in 2020. To date, infections caused by N. gipuzkoensis have rarely been reported. The prevalence of N. gipuzkoensis may be severely underestimated because N. gipuzkoensis was misidentified as Nocardia abscessus with 16 S rRNA gene sequencing in a previous study. The study aimed to systematically analyze the clinical characteristics, identification, and antimicrobial susceptibility profiles of N. gipuzkoensis to improve our understanding of this pathogen. We examined 23 strains of N. gipuzkoensis that were isolated from clinical cases in China between 2017 and 2025. These isolates were identified with 16 S rRNA and whole-genome sequencing (WGS). Clinical data were collected from medical records, and the susceptibility of Nocardia species for 14 antibiotics was tested with the broth microdilution method. The 23 N. gipuzkoensis isolates and N. abscessus NBRC 100,374 shared 16 S rRNA gene sequence similarity ranging from 99.9
Severe community-acquired pneumonia (sCAP) remains a major cause of mortality in critically ill patients, Pseudomonas aeruginosa (P. aeruginosa) is a frequent pathogen associated with poor prognosis in this population. While metagenomic next-generation sequencing (mNGS) is widely used for pathogen detection, its value in quantifying pathogen abundance and linking it to lung microbiome alterations remains unclear. This study investigated the association between P. aeruginosa abundance quantified by mNGS and lung microbiome alterations and clinical outcomes in sCAP patients. This multicenter retrospective study included 130 patients with sCAP caused by P. aeruginosa from five hospitals (September 2021–June 2025). Patients were stratified into low, medium, and high abundance groups according to mNGS-derived reads per ten million (RPTM) values of P. aeruginosa. Lung microbiome diversity and community structure were analyzed, and differences between groups were assessed using appropriate statistical methods. The association between P. aeruginosa abundance and clinical outcomes was evaluated using correlation analysis, sankey diagram, receiver operating characteristic curve, grey zone analysis and logistic regression. A total of 130 patients with sCAP due to P. aeruginosa were stratified into low, medium, and high abundance groups based on mNGS-derived RPTM value. Microbial diversity decreased progressively with increasing abundance, and community structures differed significantly among groups (all P < 0.05). P. aeruginosa became increasingly dominant, accounting for up to 95.99
To assess the prevalence and genetic basis of pretomanid (Pa) resistance, further to generate additional MIC data to support ECOFF/breakpoint setting in the microdilution system. Mycobacterium tuberculosis (MTB) isolates were collected from national drug resistance surveillance regions, with no prior pretomanid exposure. All strains were sub-cultured on Löwenstein-Jensen medium and tested against 12 anti-tuberculosis drugs with the Sensititre® MYCOTB plate. Pretomanid was serially diluted in 7H9 broth supplemented with 10
This study aimed to determine the multidrug resistance (MDR) rate and multiple antibiotic resistance index (MARI) of uropathogens among diabetic and non-diabetic patients with urinary tract infections (UTIs), highlighting the global concern for empirical treatment decisions. A prospective study was conducted from August 2021 to January 2024 in Gujarat, India, involving 2,408 patients with UTI symptoms, of whom 954 tested positives for UTIs. Among these, 280 (27
Diagnosing pulmonary non-tuberculous mycobacterial (NTM) disease remains challenging, not only because its clinical manifestations often overlap with those of tuberculosis (TB), but also because its symptoms and signs—such as chronic cough, sputum production, fatigue, and weight loss—can closely resemble those of other common respiratory conditions, including chronic obstructive pulmonary disease (COPD), recurrent pulmonary infections, and chronic bronchitis. This symptomatic overlap often leads to delayed or misdiagnosis, a problem exacerbated by the time-consuming nature of confirmatory culture, which further impedes timely diagnosis.Against the backdrop of a rising incidence of NTM pulmonary disease, Nanopore Targeted Sequencing (NTS) emerges as a promising solution, enabling rapid and comprehensive pathogen detection. This study aims to evaluate the clinical utility of NTS, with a focus on its diagnostic performance, ability to delineate the pathogen spectrum, and reveal polymicrobial co-infections. In this retrospective study, we analyzed 350 patients suspected with pulmonary NTM infection at Nanjing Second Hospital between 2023 and 2025. We evaluated clinical characteristics, pathogen profiles and co-infections. Bronchoalveolar lavage fluid (BALF), sputum, and tissue specimens were subjected to NTS. The diagnostic performance of NTS was assessed by comparing it with traditional methods, including acid-fast bacillus (AFB) smear, mycobacterial species identification, and conventional culture. Among 350 enrolled patients, 293 were diagnosed with NTM pulmonary disease. The NTM group was significantly older (median age: 61.0 vs. 43.5 years) compared to the non-NTM group (n = 57). NTM patients demonstrated significant cellular immune dysfunction, including lower CD3⁺, CD4⁺ T-cell levels, and CD4⁺/CD8⁺ ratio, alongside a more protracted disease course compared to controls. No significant difference in BMI was observed between the two groups.The most common clinical symptom was productive cough, and imaging predominantly showed patchy parenchymal and nodular shadows. Evaluation of diagnostic performance demonstrated that NTS showed the highest sensitivity (95.9
Abstract Background Delamanid (DLM) is a promising drug recommended for treatment of multidrug-/rifampicin-resistant tuberculosis (MDR/RR-TB). However, there are very little data about the emergence of drug resistance in patients with the use of DLM-containing regimens. The study aimed to monitor the dynamics of susceptibility of MTB to DLM and investigate the potential mechanism conferring decreased susceptibility. Methods A prospective cohort study was conducted, enrolling MDR/RR-TB patients with culture-confirmed diagnoses across 10 study sites. Serial sputum samples were collected from participants receiving DLM-containing regimens at baseline (treatment initiation), week 2, week 4, and every 4 weeks thereafter until treatment completion. The in vitro susceptibility of Mycobacterium tuberculosis isolates to DLM was assessed using the BACTEC MGIT 960 system. Results A total of 263 MDR/RR-TB patients were included from 2020 to 2024 in the present study, favorable outcomes were recorded in 187 patients (71.1%). The distribution of minimal inhibit concentration (MIC) for a bacterial population to DLM was unimodal, and most isolates tested had a MIC value of < 0.015 µg/mL. The MIC50 and MIC90 of MTB isolates were 0.03 and 0.06 µg/mL, respectively. Using the 0.12 µg/mL as a proposed epidemiological cutoff value, the resistance to DLM was found in 0.76% (2/263) of MTB isolates and no mutations were identified within loci conferring DLM resistance. Additionally, the remaining 81 (30.8%) with serial isolates were included in our analysis. 70 out of 81 patients exhibited no change in DLM MICs. In contrast, the reduced susceptibility to DLM was noted in 11 patients, defined as no less than 2-fold increase in MIC value compared with that of baseline. Conclusions Primary DLM resistance was rare (0.76%), and resistance emergence during treatment was infrequent, though some cases of reduced susceptibility were observed.
Heteroresistance (HR) to commonly used anti-pseudomonal agents in Pseudomonas aeruginosa has been reported in cross-sectional epidemiological surveys; however, longitudinal studies investigating the long-term epidemiological dynamics and clinical correlates of this adaptive phenotype are still lacking. This retrospective time-series study aims to systematically explore the HR phenotypic profiles and temporal dynamic of clinical P. aeruginosa isolates against piperacillin/tazobactam (TZP) and meropenem (MEM), and further clarify their potential clinical correlates. We comprehensively analyzed 380 non-duplicate clinical strains collected from a tertiary hospital between 2011 and 2024. The disk diffusion and Etest gradient diffusion methods were used for the preliminary determination of HR incidence rates in clinical isolates against six anti-pseudomonal antibiotics. Population analysis profiling (PAP) assays was further performed to assess the temporal dynamics and phenotypic characteristics of HR to TZP MEM. HR was defined as the presence of resistant subpopulations with an MIC at least eightfold higher than that of the dominant population at a frequency of ≥ 1 × 10⁻⁷. Subsequently, univariate and multivariate regression analyses were performed to identify clinical factors associated with HR and non-HR strains. Preliminary screening indicated that 55
The convergence of the potent carbapenemase genes blaNDM-1 and blaOXA-23 in carbapenem-resistant Acinetobacter baumannii (CRAB) poses a critical threat. However, the dissemination patterns and evolutionary drivers of this dual-carbapenemase profile remain unclear. We performed a comprehensive genomic analysis of a global collection of 1820 high-quality public WGS-derived CRAB isolates (2001–2024) harbouring acquired non-OXA carbapenemase genes. Topological congruence between blaNDM-1- and blaOXA-23-positive phylogenies was assessed via normalized Robinson-Foulds (nRF) distance. Ecological diversity metrics (e.g., Shannon entropy) combined with Bayesian and hypergeometric models quantified host-lineage restriction. The evolutionary dynamics of a colistin-resistant ST2 sublineage (PmrB T232I) were inferred using Skygrowth coalescent analysis. Geographic divergence was assessed via PERMANOVA and genome-wide association study (GWAS). Co-occurring acquired carbapenemase genes dominated the cohort, with the combination of blaNDM-type and blaOXA-23-like genes accounting for 64.7
To determine the frequency of microbial DNA detection in patients with sterile pyuria and evaluate the association of leukocyte count and leukocyte esterase (LE) test results with physicians’ treatment decisions. This prospective cross-sectional study was conducted over two months in the microbiology laboratories of two university hospitals. Urine samples from 201 patients with sterile pyuria (≥ 10 leukocytes/ml and/or LE positivity with negative urine culture) and 180 controls (no growth in culture and no pyuria) were analyzed. Multiplex PCR targeting 14 potential pathogens was performed. Demographic data, PCR results, and physicians’ treatment decisions were recorded. Chi-square tests and logistic regression assessed associations between laboratory findings and treatment decisions. PCR detected at least one potential pathogen in 50.2
Polymyxins are regarded as the last-resort antibiotics for treating resistant Gram-negative bacteria. Colistimethate sodium (CMS) is commonly used for carbapenem-resistant organism (CRO)-induced pulmonary infection. However, the polycationic/hydrophilic structure of intravenous injection (IV-CMS) limits its penetration into lung parenchyma, whereas aerosol inhalation (AER-CMS) has high alveolar penetration and minimal systemic dispersion. Currently, post-marketing monitoring of the clinical efficacy and safety of IV + AER CMS is limited. We aimed to evaluate the efficacy and safety of IV + AER CMS (Tianyun®; Chiatai Tianqing Pharma Jiangsu, China) in the treatment of CRO-induced pulmonary infections. This is a multi-center retrospective study. Patients with CRO-induced pulmonary infection who received IV + AER CMS/IV-CMS alone between 2021 and 2023 were enrolled. The primary endpoint was clinical response rate, and secondary endpoints included clinical cure rate, length of stay, mortality, and incidence of adverse events (pigmentation, hypersensitivity, renal toxicity, neurotoxicity, and bronchospasm). There were 101 patients in IV + AER CMS group and 108 patients in IV-CMS group. The clinical response rate in IV + AER CMS group was significantly higher than that in IV-CMS group (78.57
Clostridioides difficile infection (CDI) is one of the leading infectious diarrhea worldwide. C. difficile pathogenicity is mediated by various virulence factors, including toxins and biofilm formation. This study included 313 C. difficile isolates that were previously collected from four medical centers. We aimed to investigate the prevalence, distribution, and associations of virulence factors in C. difficile strains from both healthcare-associated (HA)- and community-acquired (CA)-CDI patients across Israel from 2020 to 2022. Multi-locus sequence typing (MLST) and whole-genome sequencing (WGS) were performed for strain classification and virulence gene detection. Toxin and biofilm production were also characterized. Sequence type (ST) 42 (12.5
Abstract Background Vancomycin-resistant Enterococcus (VRE) infection poses a significant healthcare burden in intensive care units (ICUs), and is preceded by gut colonization. The gut microbiome may influence susceptibility to VRE, but its role in ICU patients remains incompletely defined. Methods We conducted a prospective study of patients admitted to a medical ICU from 2019 to 2021. Stool samples were collected for bacterial 16 S rRNA gene sequencing, anal swabs were screened for VRE by culture, and bile acids were measured in initial stool samples. Results We enrolled 108 patients. Thirty-four patients were VRE + on initial screen and remained so (VRE+/+) while 74 were initially negative, of whom 23 acquired VRE (VRE-/+) and 51 remained negative (VRE-/-). There was no difference in alpha-diversity initially between VRE-/- and VRE-/+ groups, whereas VRE+/+ patients had significantly lower alpha-diversity ( P < 0.001). VRE-/+ patients had a significantly more rapid decrease in alpha-diversity than VRE-/- patients ( P = 0.04). Beta-diversity of initial stool differed among groups ( P = 0.001), driven mainly by VRE+/+ patients. A lower Bacteroides/Enterococcus ratio ( P = 0.049) and low Clostridium scindens abundance ( P = 0.031) were associated with VRE acquisition. Initial stool from VRE-/- patients had a higher combined concentration of deoxycholic acid and lithocholic acid than that of VRE-/+ patients ( P = 0.034). Conclusions VRE acquisition in the ICU was associated with an initial gut microbiome characterized by lower Bacteroides / Enterococcus ratios, lower C. scindens abundance, and lower deoxycholic and lithocholic acid concentrations. Our findings are consistent with a possible role of these microbiome features in colonization resistance, as suggested by in vitro and animal models. However, given the single-center design, these associations should be considered hypothesis-generating and require validation before clinical application.
In this study, we aimed to evaluate the performance of different tigecycline susceptibility testing methods for CRKP and CRAB using the broth microdilution (BMD) method as the gold standard, under different breakpoint criteria. A total of 53 CRKP and 47 CRAB clinical isolates, collected from December 2021 to January 2023, were tested for tigecycline susceptibility using six clinically common methods: Vitek2 (using the Vitek2 Compact system), the Kirby–Bauer (KB) disk diffusion susceptibility test, the modified KB (mKB) test with a buffer solution, the Epsilometer test (E-test), minimum inhibitory concentration test strips (MTS) and BMD (as the reference standard). The susceptibility test results were interpreted based on the standards issued by the European Committee on Antimicrobial Susceptibility Testing(EUCAST), the United States Food and Drug Administration (FDA), and the British Society for Antimicrobial Chemotherapy(BSAC). The performance of each method was assessed through essential agreement (EA), categorical agreement (CA), error rates and Kappa (κ) values. In terms of methodology, the mKB significantly increased the inhibition zone diameter compared with the KB for both CRKP (3.2 ± 0.8 mm) and CRAB (3.6 ± 0.8 mm) (P < 0.05, respectively). Using BMD as the gold standard and following FDA criteria, the mKB demonstrated an accuracy rate significantly higher than the KB in interpreting CRKP susceptibility results (62.3
Rapid molecular tests have facilitated early diagnosis and guided treatment of tuberculosis (TB) by providing faster results than the gold-standard phenotypic drug susceptibility testing (DST). Anyplex™ II MTB/MDR is an RDT available in Thailand that simultaneously detects Mycobacterium tuberculosis (MTB) complex and mutations associated with isoniazid (INH) and rifampicin (RIF) resistance, enabling genotypic DST in various clinical specimens. However, discordance between the Anyplex™ II MTB/MDR and phenotypic DST creates a decision-making dilemma. A retrospective review was conducted on clinical and microbiological data from patients with different types of tuberculosis (TB) at King Chulalongkorn Memorial Hospital (KCMH), a referral hospital for TB in Thailand. The study focused on patients with drug-susceptible TB (DS-TB), isoniazid mono-resistant TB (Hr-TB), rifampicin mono-resistant TB (RR-TB), and multidrug-resistant TB (MDR-TB) from January 2018 to June 2023. The correlation between genotypic and phenotypic DST using the Anyplex™ II MTB/MDR and BACTEC MGIT 960 assays, respectively, was investigated using clinical specimens and MTB clinical isolates recovered from specimens collected during the same period. 836 MTB clinical isolates from 796 patients had genotypic and phenotypic DST results. 44 MTB (5.2
Abstract Objective To investigate the epidemiology, risk factors, and molecular characteristics of intestinal carbapenem-resistant Enterobacterales (CRE) colonization and subsequent secondary infections in a hospital setting, and to develop a predictive model for risk stratification. Methods A large-scale, unbiased active screening for intestinal CRE carriage was conducted among patients (including physical examination, outpatient, and inpatient populations) between August 31, 2021, and February 28, 2022. A prospective cohort design was used to follow colonized inpatients for six months. Clinical data were collected for univariate and multivariate logistic regression analysis to identify independent risk factors for infection. A nomogram prediction model was constructed and validated. Homology between colonizing and infecting isolates was assessed using WGS and MALDI-TOF MS analysis. Results The overall CRE colonization rate was 4.95% (475/9,615), with significant variation between inpatients (5.55%), outpatients (3.97%), and physical examination subjects (3.54%). Escherichia coli (49.05%) and Klebsiella pneumoniae (46.95%) were the dominant species. The overall secondary infection rate among colonized inpatients was 5.04% (18/357), with the highest rates observed in the Rehabilitation (30.00%), ICU (21.88%), and Neurology (20.00%) departments. Multivariate analysis identified ICU stay ≥ 48 h, carbapenem exposure, fecal incontinence, and tracheostomy as independent risk factors, while admission to Rehabilitation was a protective factor. The prediction model demonstrated high discriminative ability (AUC = 0.960) in this single-center derivation cohort, but external validation is required before clinical application. Molecular analysis revealed that ST11 CRKP was the predominant clone (70%), and most infections (12/18) were genetically homologous to the patient’s colonizing strain. Conclusion CRE intestinal colonization is prevalent across healthcare settings. The progression from colonization to infection is driven by specific clinical risks, which can be used to assess risk by our novel nomogram. These findings underscore the need for targeted screening in high-risk departments, enhanced antimicrobial stewardship, and focused surveillance on dominant clones like ST11 CRKP to effectively prevent CRE transmission and infection.
This study aimed to update the epidemiology and clinical characteristics of mucormycosis, a rare but life-threatening invasive fungal infection in hematopoietic stem cell transplantation (HSCT) recipients. We conducted a retrospective, single-center observational study including all consecutive HSCT recipients from November 2020 to October 2024, with follow-up through May 2025. Among 1224 HSCT recipients receiving antifungal prophylaxis, mucormycosis was diagnosed in 49 patients (4.0
Mycoplasma pneumoniae (MP) has re-emerged with a surging incidence in China following the lifting of COVID-19 non-pharmaceutical interventions, posing a critical challenge for clinical diagnosis and management of acute respiratory infections (ARI). We aimed to investigate the epidemiological characteristics of MP infection among all-age patients with ARI in China, as well as the temporal dynamics of serum MP-specific antibodies. This retrospective study was based on the data of patients detected by total MP antibodies (predominantly IgM) in Chinese PLA General Hospital, Beijing, China between December 2022 and January 2024. Blood samples were collected from patients who visited or were hospitalized due to ARI for the detection of MP antibody. Adjusted odds ratio (aOR) and its 95
BACKGROUND: Polymyxin B-resistant Klebsiella pneumoniae (PBR-KP) has been emerging as a significant concern. This study investigated the within-host mechanisms of resistance evolution in PBR-KP without prior PB exposure. METHODS: Six groups were enrolled [PB-sensitive K. pneumoniae (PBS-KP) evolved into PBR-KP from the same patient], and antimicrobial susceptibility testing was conducted using the microdilution broth method. Whole-genome sequencing was performed to analyze molecular characteristics, and to investigate the resistance mechanisms, gene expression analysis of pmrAB, phoPQ, crrAB, and eptA was performed using RT-qPCR. Fitness costs were assessed through biofilm formation, in vitro growth rate, and virulence analysis. RESULTS: All 12 strains belonged to ST11-KL64, except for PB9 and PB10, which were classified as ST11-KL47. Each resistant strain was highly related to its corresponding sensitive strain. The relative expression levels of phoPQ, eptA, and pmrAB were significantly upregulated in most PBR-KP strains. PBR-KP strains exhibited no fitness cost regarding in vitro growth rate and biofilm formation. Notably, the eptA gene was highly expressed in the four PBR-KP strains with enhanced virulence, indicating its association with virulence. Furthermore, PBR-KP strains with enhanced virulence were highly associated with KL64, whereas those without enhanced virulence were linked to KL47, except for PB12, indicating a potential relationship between virulence and serotype. CONCLUSIONS: PB resistance can develop in KP strains without prior exposure to the drug, possibly driven by upregulation of phoPQ, pmrAB, and eptA, as supported by validated transcriptomics data. These resistant strains did not exhibit fitness costs related to biofilm formation or growth rate. Enhanced virulence, found in most PBR-KP strains, may be closely associated with eptA overexpression and specific serotypes.
Abstract Background The global rise of extensively drug-resistant Acinetobacter baumannii, particularly biofilm-forming strains, has drastically limited treatment options and created an urgent need for novel therapies to restore antibiotic efficacy. This study explored p-coumaric acid (p-CA) as a potential dual-action agent to combat biofilm-associated XDR Acinetobacter baumannii infections and restore imipenem efficacy. Methods Among 100 clinical Acinetobacter baumannii isolates, 32 were identified as XDR and exhibited resistance to imipenem. The antimicrobial and antibiofilm efficacy of p-CA was systematically evaluated through comprehensive in vitro assays and an in vivo rat infection model. Minimum inhibitory concentrations were determined via the broth microdilution method, and the potential modulation effect on imipenem efficacy was investigated. To assess biofilm inhibition and disruption, quantitative analyses were performed using the crystal violet staining technique, complemented by evaluating its impact on the bacterial cell surface hydrophobicity and exopolysaccharide production. Biofilm structural changes were analyzed via light, scanning electron, and confocal laser scanning microscopy. Additionally, the expression levels of key biofilm-associated genes were quantified via quantitative reverse transcription PCR. Results The p-CA exhibited potent antimicrobial activity against the tested isolates (MIC: 512 µg/mL) and synergized with imipenem, reducing its MIC by 512-fold. At subinhibitory concentrations (¼–½ MIC), it inhibited biofilm formation (66.2–80.5%, p < 0.05) and disrupted pre-formed biofilms (45.8–71.3%, p < 0.05), likely via altered cell surface hydrophobicity and reduced EPS production. Microscopic imaging corroborated these findings, revealing substantial structural degradation of biofilms upon treatment. At the molecular level, p-CA significantly downregulated (p < 0.05) the key biofilm-associated genes (abaI, bfmR, bap, csuE, and pgaB), as quantified by RT-qPCR. In vivo, the p-CA/imipenem combination significantly enhanced the survival rates (100%, p < 0.05) and reduced the lung bacterial burden (p < 0.001). Histopathological examination showed near-complete restoration of alveolar architecture by 72 h post-treatment in the combination therapy group. Conclusion These findings position p-CA as a promising dual-action adjuvant against XDR Acinetobacer baumannii infections, particularly in biofilm-associated contexts. It combines direct antimicrobial activity, biofilm disruption, and synergy with imipenem to address critical treatment gaps.
Erythromycin-resistant Bordetella pertussis (ERBP) has increased sharply in China, posing significant challenges to clinical treatment. The lack of a standardized antimicrobial susceptibility testing (AST) system for B. pertussis makes it difficult to screen out effective antibiotics, which further aggravates the generation of drug-resistant strains and causes a vicious cycle. In this study, we modified a superior charcoal-free medium for antibiotic susceptibility testing, enabling more reliable evaluation of antibiotic efficacy. The minimum inhibitory concentrations (MICs) of erythromycin (E), trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin (LVF), and piperacillin (PIP) were determined using E-test strips on the agar plates with and without charcoal. The performance of these two media for AST was compared to establish a more accurate laboratory detection method. Subsequently, the superior charcoal-free medium was used to assess the antibiotic susceptibility of 98 B. pertussis strains isolated from clinical specimens after the COVID-19 pandemic, analyzing the sensitivity distribution of these first-line and alternative antibiotics. The MIC values of TMP-SMX and LVF were significantly higher on charcoal-containing agar plates than on charcoal-free medium. E-test results revealed that the MICs of B. pertussis strains to TMP-SMX and LVF had increased by approximately five gradient levels on the charcoal-containing agar compared to charcoal-free agar. Quality control (QC) testing demonstrated that the MICs of TMP/SMX and LVX fell outside the acceptable QC range due to adsorption by charcoal particles. Antimicrobial susceptibility of 98 B. pertussis clinical isolates showed that all strains were resistant to E with the MIC90 exceeded the maximum value (> 256 μg/mL). The overall MIC90 values for TMP-SMX, LVF and PIP were 1/0.75/<0.016 μg/mL on charcoal-containing agar and 0.023/0.008/<0.016 μg/mL on charcoal-free medium, respectively. Statistical analysis of violin plots confirmed that the MIC values of the second-line antibiotic TMP-SMX and LVF were significantly elevated on charcoal-containing agar. An accurate AST method can provide crucial guidance for optimal antibiotic selection in patients with B. pertussis infections. Our findings demonstrate that charcoal-free agar serves as an effective alternative medium for reliable AST of B. pertussis clinical isolates.
