PURPOSE:To describe four-year diagnostic-distribution, burden, and antimicrobial-resistances of major Enterobacterales and Pseudomonas aeruginosa in a tertiary-care surveillance framework. PATIENTS AND METHODS:We retrospectively studied first non-duplicate-isolate per/patient/organism between 2022-2025 at a Saudi tertiary-care. Diagnostics used automated-platforms with GeneXpert-Carba-R employed parallel to cultures. Susceptibility interpretations used CLSI-breakpoints relevant to test-year. Annual-trends were assessed with grouped-binomial logistic-regression, and Benjamini-Hochberg false-discovery-rate correction was applied within prespecified analysis. RESULTS:Among 1,857 isolates, Klebsiella pneumoniae was most frequent (36.2%), followed by P. aeruginosa (33.4%), Escherichia coli (17.9%), and Enterobacter cloacae (12.3%). Mean patient age was 64.8 years, 51.3% isolates were from intensive-care, 37.4% from urine, and 80.8% records had comorbidity. K. pneumoniae showed overall ESBL (76.6%), CRE (59.9%), MDR (69.3%), panel-defined XDR (64.7%), and panel-defined PDR (15.2%) frequencies. Enterobacterales ESBL-positivity increased (58.1% to 76.8%;q <0.001), whereas meropenem non-susceptibility decreased (52.6% to 33.2%;q <0.001). In P. aeruginosa, ceftazidime non-susceptibility increased (55.2% to 78.6%;q <0.001), meropenem decreased (46.8% to 32.9%;q = 0.031), and tobramycin increased (22.2% to 45.7%;q = 0.030). Crude-comorbidity differences remained insignificant after false-discovery-rate correction. CONCLUSION:We show a persistent species-specific Gram-negative resistance burden, led by K. pneumoniae and accompanied by substantial P. aeruginosa non-susceptibility. This supports organism-specific detections, antibiograms and continued multicenter-surveillance linked to antimicrobial exposure, genomic-data, and patient outcomes.
OBJECTIVE:This retrospective cohort study aims to assess associations of delayed Intravenous (IV)-to-Oral switch after 72-hours versus early switch within 72-hours with switch failure within 7-days and with adjusted post switch clinical outcomes in hospitalized adults. METHODS:Adult admissions with an IV-antibiotic regimen followed by an oral regimen in the same hospitalization were included. Early-switch occurred within 72-hours of admission and delayed-switch occurred after 72-hours. Switch failure within 7-days was defined as IV restart/antibiotic escalation within 7-days after the switch. Adjusted models estimated associations with post switch length of stay (LOS), in-hospital mortality, ICU transfer and vasopressor initiation within 7-days. RESULTS:The cohort included 3898 admissions with 2002 delayed-switches and 1896 early switches. Switch failure within 7-days occurred in 14.7% after delayed switching and 6.4% after early-switching. Delayed-switching was associated with longer post switch LOS with adjusted ratio 1.94 (1.70-to-2.22) and higher odds of in-hospital mortality with aOR = 2.29 (1.21-to-4.34). Vasopressor initiation within 7-days was higher with delayed switching with aOR = 9.68 (2.28-to-41.04). ICU transfer within 7-days didn't show a clear adjusted difference. Delayed-switching was also associated with higher odds of IV restart within 7-days with aOR = 2.24 (1.79-to-2.81). CONCLUSION:Delayed switching after 72 hours was associated with more 7-day events and worse adjusted outcomes. However, switch timing is a clinician-, policy-, and resource-dependent surrogate for underlying clinical status rather than a direct measure of disease severity or a cause of deterioration. Clinical interpretation should therefore rely on direct measures of physiologic stability, infection severity, source control, microbiology, and oral-treatment feasibility.
INTRODUCTION:Vietnam bears a substantial burden of methicillin-resistant Staphylococcus aureus (MRSA), yet neonatal data on epidemiology, antimicrobial resistance, treatment, and prevention remain limited and fragmented across regions and healthcare settings. AREAS COVERED:This review summarizes MRSA epidemiology, risk factors, treatment, and prevention in neonatal intensive care units (NICUs), identifies key knowledge gaps, and highlights priorities for clinical practice, antimicrobial stewardship, and future research to support more effective management and control strategies. MRSA comprises 73% of S. AUREUS:isolates nationally, with notable regional variation. Antibiotic overuse is common, affecting roughly 67.4% of hospitalized patients, and up to 90% of pediatric prescriptions are inappropriate, driving resistance. Vancomycin remains the first-line therapy for severe MRSA infections. Alternative agents - including linezolid, daptomycin, ceftaroline, clindamycin, and adjunctive rifampin - have limited roles, underscoring the importance of local antibiogram-guided therapy. EXPERT OPINION:Optimizing vancomycin use through AUC-guided dosing, therapeutic drug monitoring, and de-escalation is critical to balance efficacy and toxicity. Although MRSA remains largely susceptible to vancomycin, the emergence of vancomycin-resistant enterococci (up to 34%) threatens last-line treatment sustainability. Effective strategies to reduce MRSA burden include infection prevention bundles, surveillance cultures, targeted decolonization, and antimicrobial stewardship programs. These interventions must be tailored to Vietnam's healthcare.
INTRODUCTION:Invasive candidiasis remains one of the most challenging infections in the intensive care unit (ICU) because diagnosis is complicated by nonspecific clinical manifestations, frequent colonization, altered host immunity, complex anatomical sources and unstable pharmacokinetics. Distinguishing true invasive disease from colonization is fundamental to optimizing patient outcomes while avoiding unnecessary antifungal exposure. AREAS COVERED:This narrative review examines invasive candidiasis in critically ill adults from an ICU perspective, based on a structured PubMed/MEDLINE, Embase and Cochrane Library search of English-language literature (January 2005-May 2026). We discuss contemporary epidemiology, updated fungal nomenclature, risk factors and disease phenotypes, together with diagnostic stewardship using cultures, beta-D-glucan and molecular assays. Current evidence regarding source control, catheter management, empirical and targeted antifungal therapy, therapeutic drug monitoring, pharmacokinetic challenges during extracorporeal support, emerging agents and Candida auris is reviewed. EXPERT OPINION:The principal challenge in ICU fungal infections is not delayed antifungal therapy alone but accurate attribution of invasive disease. Positive fungal cultures or biomarkers should be interpreted within their clinical and anatomical context rather than as independent indications for treatment. Future management should integrate rapid diagnostics, host immune profiling, optimized pharmacokinetics and effective source control into phenotype-driven strategies that improve outcomes while strengthening antifungal stewards.
INTRODUCTION:Antimicrobial resistance (AMR) is a major health-system challenge in Uganda. Western Uganda has documented inappropriate antibiotic prescribing and local resistance patterns, but evidence on routine antimicrobial stewardship (AMS) implementation remains fragmented. AREAS COVERED:This structured narrative policy and implementation review synthesizes evidence on AMR and antimicrobial stewardship (AMS) implementation in Western Uganda, drawing on Western Uganda-specific studies, Uganda-wide evidence, national policy documents, and broader low- and middle-income country implementation literature. Evidence was identified through targeted PubMed searches, World Health Organization resources, and Ugandan Ministry of Health repositories focused on AMR, AMS, antibiotic use, diagnostics, surveillance, community pharmacies, drug shops, One Health, and low-resource settings. EXPERT OPINION:The strongest immediate case for stewardship in Western Uganda is supported by local prescribing studies, national hospital point-prevalence data, and Uganda's current policy framework. A feasible minimum package should combine named facility responsibility, Uganda Clinical Guideline and AWaRe-informed prescribing support, small-sample prescription review, laboratory referral and feedback, private pharmacy engagement, and district supervision. The phased framework proposed in this review is an author-developed implementation synthesis; it has not yet been adopted or evaluated.
INTRODUCTION:Pathogenic free-living amoebae, including Naegleria fowleri, Acanthamoeba spp. and Balamuthia mandrillaris, are rare but frequently fatal opportunistic pathogens associated with severe central nervous system and ocular infections, and cutaneous infections. Despite advances in understanding their biology and pathogenesis, therapeutic options remain limited, mortality rates remain high, and delayed diagnosis continues to compromise clinical outcomes and public health responses. AREAS COVERED:Recent literature, with emphasis on studies published during the past decade, was reviewed using PubMed and Google Scholar, focusing on therapeutic advances against pathogenic free-living amoebae, including novel antiamoebic compounds, drug repurposing, nanotechnology-enabled delivery systems, and emerging diagnostic approaches. Recent progress in high-throughput screening, artificial intelligence-assisted drug discovery, and predictive therapeutic modeling is highlighted. The impact of climate change and environmental adaptation on the expanding geographic distribution of amoebic infections is also discussed. EXPERT OPINION:Given the rarity of these infections and the limited clinical datasets available, artificial intelligence-assisted approaches may become particularly important for accelerating antiamoebic drug discovery, therapeutic prediction, and precision treatment strategies. Emerging advances in nanotechnology-enabled drug delivery systems, theranostics, and computational therapeutic modeling may provide promising opportunities to improve management of these devastating infections.
INTRODUCTION:Healthcare systems use decolonization, screening, patient placement, environmental cleaning and stewardship to prevent Methicillin-Resistant Staphylococcus aureus (MRSA), Carbapenem-Resistant Enterobacterales (CRE) and Candida auris transmission and infection. These interventions share an Infection Prevention and Control (IPC) foundation but differ in evidence, operational demands and the reservoirs they target. AREAS COVERED:This critical narrative review compares pathogen-targeted and universal (horizontal) strategies, including topical decolonization, antiseptic bathing, surveillance-linked containment, environmental/source control and antimicrobial stewardship. It examines study design, endpoint directness, diagnostic intensity, implementation fidelity, feasibility and local resource constraints. EXPERT OPINION:The three pathogen pathways are analytical emphases rather than mutually exclusive models. MRSA has the most developed trial evidence for topical decolonization in selected settings, although chlorhexidine effects may also be horizontal. CRE and C. auris prevention generally requires universal IPC measures combined with targeted screening, placement, environmental control or emerging adjunctive decolonization according to local epidemiology and capacity.
INTRODUCTION:Conflict-related injuries create a unique environment for the emergence of antimicrobial-resistant pathogens. METHODS:To clarify the burden and dynamics of resistance in this high-risk population, we investigated the genomic and clinical profiles of 63 Gram-negative bacterial isolates recovered exclusively from conflict-trauma cases in Southern Lebanon during the 2024 war. RESULTS:Whole-genome sequencing revealed Acinetobacter baumannii (31.7%) and Escherichia coli (20.6%) as the predominant species, marking a significant epidemiological shift toward A. baumannii compared to pre-conflict baselines. Acquired antimicrobial resistance genes were detected in 66.7% of isolates, with a high prevalence of determinants and mutations targeting aminoglycosides (87%), fluoroquinolones (74.6%), and carbapenems (54%). Carbapenem resistance was primarily driven by acquired blaOXA carbapenemases and blaNDM variants; notably, we report the first detection of blaNDM-40 in Lebanon, alongside blaNDM-1 and blaNDM-5. Minimum spanning tree analysis highlighted clonal, healthcare-associated transmission for A. baumannii and Klebsiella pneumoniae, contrasted by polyclonal distributions for E. coli and Pseudomonas aeruginosa. CONCLUSION:Extensive broad-spectrum antibiotic exposure and acute trauma care within compromised healthcare infrastructures accelerate the selection of multidrug-resistant (MDR) genotypes. Mitigating this dissemination in conflict settings requires integrating genomic surveillance with targeted antimicrobial stewardship and infection control.
BACKGROUND:Nonlinear analyses show promise for determining antibiotic use thresholds linked to antimicrobial resistance (AMR). An approach that allows aggregation of results from multiple models to capture context-specific AMR dynamics is needed to improve predictive accuracy and define realistic antibiotic use thresholds to reduce AMR. METHODS:We conducted TARGET-A, a retrospective multicentre ecological modeling study in four UK hospitals (2020-2024), applying a threshold-logistic ensemble consensus modeling approach to identify hospital-level antibiotic use thresholds and risk scores associated with increasing hospital-onset, healthcare-associated Clostridioides difficile infection (HOHA-CDI) incidence. RESULTS:Analysis set the cutoffs for critically high HOHA-CDI incidence at: Antrim Area Hospital (AAH), 75th percentile; Craigavon Area Hospital (CAH), 80th percentile; Pinderfields General Hospital (PGH), 82.5th percentile; St James's University Hospital (SJUH), 77.5th percentile. Antibiotic use thresholds (defined daily doses (DDD)/1000 occupied bed-days (OBD)) were identified: AAH- fluoroquinolones 62.3, macrolides 254.6; CAH- co-amoxiclav 75.8, carbapenems 16.1; PGH- co-amoxiclav 251.3, macrolides 129.2; SJUH- clindamycin 14.2, fluoroquinolones 128.3. Risk scores for exceeding high HOHA-CDI incidence were determined, supporting early warning alerts. A consensus approach was developed to establish attainable antibiotic use thresholds. CONCLUSIONS:This approach provides a framework to define hospital-level quantitative antibiotic use targets to control HOHA-CDI incidence. Further validation is needed in prospective interventional studies.
INTRODUCTION:Antimicrobial resistance (AMR) represents one of the greatest global public health challenges and is intensified by inappropriate antimicrobial use, mobility, and limited availability of novel therapeutic options. Digital health technologies have emerged as strategies to improve surveillance, prevention, clinical decision-making, and antimicrobial stewardship in hospital settings. AREAS COVERED:This study mapped health technologies applied to AMR management through a scoping review combined with bibliometric analysis and technological prospecting. The review followed PRISMA-ScR guidance and included peer-reviewed studies published between 2000 and 2025. The approach identified not only implemented digital interventions but also publication trends, collaboration networks, and patent-stage innovation. Clinical decision-support systems, electronic surveillance platforms, and artificial intelligence applications were the most reported technologies, while patent analysis revealed innovations concentrated in diagnostics, predictive analytics, automated monitoring, and precision antimicrobial management. EXPERT OPINION/COMMENTARY:Digital technologies are becoming important components of AMR management; however, the evidence remains heterogeneous and mostly descriptive. Key barriers include limited interoperability, unequal infrastructure, insufficient real-world clinical validation, data governance concerns, and restricted implementation beyond hospital environments. Future research should prioritize validated, explainable, interoperable, and scalable digital ecosystems, with One Health integration considered a direction rather than a conclusion directly demonstrated by the hospital-based evidence mapped here.
INTRODUCTION:Preterm and high-risk infants are at increased risk of severe respiratory syncytial virus (RSV) infection, leading to prolonged hospitalization, intensive care unit admissions, respiratory support and death. Although, RSV prevention is a major health priority in Qatar, national guidelines for RSV prophylaxis are currently lacking. AREAS COVERED:This expert opinion summarizes the burden of RSV in Qatar and the Gulf Cooperation Council (GCC) along with current immunoprophylaxis practices and real-world evidence on the effectiveness of palivizumab in high-risk infants. Evidence from a literature review was supplemented by expert insights relevant to Qatar and the GCC to address data gaps and heterogeneity in RSV prophylaxis. The integrated findings support context-specific recommendations. EXPERT OPINION:A steering committee with 16 experts was convened in December 2024 to review the available evidence and discuss challenges in RSV prevention among high-risk infants. The experts reviewed the literature and reached consensus for the recommendations. Palivizumab, supported by established effectiveness and long-term safety data, remains the cornerstone of RSV prophylaxis for preterm and high-risk pediatric population. It also acknowledges the necessity to collaborate with other GCC countries and develop a regional protocol to further strengthen the RSV prevention efforts.
INTRODUCTION:Surgical site infections (SSIs) in vascular surgery remain a major source of morbidity, mortality, graft failure, limb loss, and healthcare costs. Although many vascular procedures are classified as clean surgery, the frequent use of prosthetic material, high-risk anatomical sites such as the groin, and comorbid patient populations make infections particularly consequential. AREAS COVERED:This review summarizes the epidemiology, risk factors, microbiology, classification, diagnosis, prevention, and treatment of SSIs in vascular surgery. It discusses procedure-specific infection risks, including those associated with open and endovascular interventions, and examines current preventive strategies such as patient optimization, perioperative antibiotic prophylaxis, skin antisepsis, intraoperative measures, and incisional negative pressure wound therapy. Treatment approaches, including antimicrobial therapy, surgical debridement, graft explantation, reconstruction, and multidisciplinary care, are reviewed. Key challenges include antimicrobial resistance, inconsistent surveillance definitions, underreporting after discharge, diagnostic uncertainty, and limited evidence on cost-effectiveness and endovascular SSI management. EXPERT OPINION:Future progress requires vascular-specific risk stratification, standardized and objective surveillance systems, stronger post-discharge follow-up, and high-quality randomized trials on antibiotic prophylaxis duration and advanced wound therapies. Transparent reporting and interdisciplinary collaboration are essential to reduce SSI-related complications and improve patient outcomes.
INTRODUCTION:Hematopoietic stem cell transplantation (HSCT) is considered the treatment of choice for various malignant and nonmalignant hematologic disorders. HSCT patients are commonly subject to polypharmacy and receive multiple therapeutic regimens during the pre-, peri-, and post-transplantation periods. Administration of various antimicrobial agents as prophylactic or therapeutic regimens is essential in HSCT patients. AREAS COVERED:This comprehensive review, focuses mainly on the pharmacokinetic (PK) aspects and therapeutic drug monitoring (TDM) of commonly administered antimicrobial agents including antibacterial, antiviral, and antifungal agents in HSCT patients. Additionally, alterations in PK parameters and specific recommendations for TDM are discussed in detail. EXPERT OPINION:Since HSCT patients often have altered PK characteristics and require multiple concomitant medications, individualized dosing based on their PK and pharmacogenetic profiles is crucial. Close monitoring of potential drug-drug interactions (PDDIs) and plasma concentrations are essential to achieve optimal clinical response, minimize drug-related toxicities, and improve post-transplant survival. In general, many of the commonly administered antibiotics in HSCT patients showed increased volume of distribution and clearance, decreased half-lives, and therefore decreased area under the curve (ACU) values compared to the normal population. Therefore, higher doses of these antibiotics should be administered along with close patient monitoring and assessment of plasma concentrations.
BACKGROUND:To describe the utilization patterns and therapeutic indications of antivirals used for herpesvirus infections in Colombian patients. RESEARCH DESIGN/METHODS:A cross-sectional study on the use of antivirals for treating outpatients with herpesviruses between November 2023 and January 2024 in a Colombian population database. The Micromedex® database was used to identify Food and Drug Administration (FDA)-approved indications, off-label uses, and potentially inappropriate indications. RESULTS:A total of 14,816 individuals were included (median age:53.0 years [IQR:35.0-65.0]; 60.5% women). Acyclovir was the most frequently prescribed antiviral (oral:77.3%; topical:43.4%). Overall, 56.1% received oral therapy only, 25.2% combined oral and topical therapy, and 18.7% topical therapy only. FDA-approved indications accounted for 29.1% of use (herpes zoster), off-label use for 26.9% (mainly prophylaxis in immunocompromised patients), and potentially inappropriate use for 25.3% (primarily topical treatment of herpes zoster). Acyclovir use (OR:5.93; 95%CI:4.60-7.64) and specialist care (OR:2.17; 95%CI:1.73-2.71) were associated with off-label use. CONCLUSIONS:Antiviral prescribing for herpesvirus infections in a group of patients in Colombia is largely driven by acyclovir, with a substantial proportion of off-label and potentially inappropriate use, particularly involving topical therapies for herpes zoster. These findings highlight significant gaps in adherence to evidence-based recommendations and underscore the need for targeted interventions to optimize prescribing practices.
