This study aimed to evaluate the effectiveness and safety of cefazolin prophylactic regimen versus standard penicillin treatment in pregnant women colonized with GBS(Group B Streptococcus), and further analyzed the timing of intrapartum antibiotic prophylaxis. We retrospectively analyzed the singleton pregnant women with GBS colonization at 35–37 weeks of gestation in Shenzhen Baoan Women’s and Children’s Hospital between September 2018 and January 2024. 2653 pregnant women received standardized penicillin prophylaxis and 2418 pregnant women received alternative cefazolin prophylaxis in labor. Maternal and neonatal outcomes were compared between the two different intrapartum antibiotic prophylaxis (IAP) groups. No significant differences were found in postpartum hemorrhage, amniotic fluid fecal contamination, delivery assistance, neonatal sepsis, neonatal asphyxia and Apgar score between Penicillin group and Cefazolin group (P > 0.05). In terms of chorioamnionitis, neonatal pneumonia, cesarean section, neonatal jaundice and NICU admission, the cefazolin group showed significantly lower rates than that of penicillin group(P < 0.05). The incidence of chorioamnionitis, transfer to cesarean section and NICU admission in both penicillin and cefazolin IAP subgroup of more than 4 h were lower than that of less than or equal 4 h, however with no significantly difference when using cefazolin about chorioamnionitis. Our study shows that cefazolin is effective and safe as penicillin in preventing maternal-fetal GBS infection and may be used as an alternative antibiotics. In addition, it is supposed that IAP should be administered during labor for at least 4h prior to delivery.
Persistent candidemia remains incompletely understood, with inconsistent definitions and conflicting evidence on outcomes. We aimed to identify factors associated with persistent candidemia and to assess its impact on complications and 30-day mortality in a single-centre cohort. We conducted a retrospective matched cohort study including patients aged ≥ 14 years with at least one positive peripheral blood culture for Candida species (September 2014-September 2024) at a 900-bed tertiary hospital in Valencia, Spain. Persistent candidemia was defined as isolation of the same Candida species from blood cultures obtained ≥ 5 days after initiation of appropriate antifungal therapy. A total of 105 patients with persistent candidemia were compared with 105 with non-persistent candidemia, matched by Charlson comorbidity index. Multivariable logistic regression identified factors independently associated with persistence and 30-day mortality. Persistent candidemia was identified in 105/515 (20.4
Invasive group A Streptococcus (iGAS) disease is associated with substantial morbidity and mortality. This study aimed to assess the outcomes of iGAS infection and associated risk factors in Northern Queensland, Australia. A retrospective cohort study was conducted using linked hospital data from 2000 to 2020. iGAS cases were identified using ICD-10-AM diagnosis codes in administrative health datasets. Mortality and disease burden were analysed, and risk factors for adverse outcomes were assessed using logistic regression and competing risks regression. Disability-Adjusted Life Years (DALYs) were estimated to quantify disease burden. A total of 933 iGAS related hospitalisations were identified among 870 individuals. The mean age of the cohort was 45 years (SD = 24), with a median age of 61 years (IQR: 48–77 years). Hospitalised case fatality rate was 5.2
Invasive fungal and nontuberculous mycobacterial (NTM) infections are important complications following TNF-α inhibitor initiation, but the contribution of additional immunosuppressive medication exposure remains incompletely defined. We evaluated their incidence and spectrum and associations with time-varying immunosuppressive medication exposure. We conducted a retrospective cohort study using Merative MarketScan data (2018–2022) among adults initiating TNF-α inhibitors. Invasive fungal and NTM infections were identified using ICD-10-CM codes. Systemic glucocorticoid and non-glucocorticoid immunosuppressant exposures were modeled as time-varying variables. Cox proportional hazards models evaluated associations between immunosuppressive medication exposure and infection risk. Among 62,772 adults, 238 (0.4
Infective endocarditis (IE) often presents with non-specific symptoms, which may delay diagnosis and treatment. Previous studies exploring symptom duration have been limited by small cohorts or single-centre studies. We aimed to investigate patient characteristics, microbial aetiology, treatment, and all-cause mortality of patients with IE according to symptom duration prior to diagnosis. We included all patients with first-time IE from the NatIonal Danish Endocarditis StUdies (NIDUS) registry (2016–2021). Patients with left-sided IE and available symptom duration were stratified as short, intermediate, or prolonged (≤ 7, 8–29, or ≥ 30 days). The primary outcome was six-month mortality. Among 2,938 patients with left-sided IE, median symptom duration was 8 days [IQR:4–20], and 17.6
Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function. A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function. Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), P < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), P < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), P < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), P = 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7
To evaluate the association between time to positivity (TTP) and 30-day mortality, and to assess species-specific differences in TTP among Candida isolates. This single-center, retrospective study included adult patients (≥ 18 years) with candidemia between July 2022 and October 2024. Patients were grouped as survivors and non-survivors, and TTP was compared between the groups. Variables associated with mortality in univariate analysis (p < 0.10) and clinically relevant factors, including Candida species, were included in multivariate logistic regression to assess the independent effect of TTP on 30-day mortality. Species-specific TTP differences were also evaluated. A total of 392 patients with candidemia were included. In multivariate analysis, older age, solid tumor malignancy, chronic cardiac disease, use of total parenteral nutrition, inappropriate antifungal therapy, and higher SOFA scores were independently associated with 30-day mortality (p < 0.05). Time to positivity was not independently associated with mortality (OR 0.989, 95
Active Tuberculosis (TB) had the challenge in early detection. Our pilot study showed four novel diagnostic biomarkers had high value of TB diagnosis. The aim of the study was to further verify the diagnosis value of these biomarkers for active pulmonary TB (PTB) from non-TB through clinical trial with large scale samples. The prospective, large scale, multicenter, diagnostic clinical trial was performed from 2022 Jan to 2024 Dec in Eastern China. PTB suspects met inclusion criteria were enrolled the study, taken RNA abstract from the Peripheral venous blood for RNA examination of BATF2, UBE2L6, SERPING1, VAMP5 and tested by QFT-GIT as well, the diagnosis value of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and AUC for active TB by single and fixed groups of biomarkers were calculated and evaluated. 890 cases were finally included the study, containing 564 cases of PTB (365 had definite and 199 had probable TB) and 326 cases of non-PTB. Any single biomarker from BATF2, UBE2L6, SERPNG1 or VAMP5 has advantage diagnosis values over QFT-GIT, UBE2L6 had the best value of the diagnosis (AUC 0.84) of active TB. Combination of UBE2L6/SERPING1/VAMP5 had best diagnosis value of active PTB (sensitivity of 70.5
Invasive Group A Streptococcus (iGAS) is an important cause of severe bacterial infection with increasing incidence and substantial socioeconomic disparities. This study quantified long-term trends, spatial distribution, and determinants of iGAS incidence in Northern Queensland, Australia. A population-based retrospective cohort study was conducted using linked hospital data linkage from 2000–2020. Incidence rates were calculated per 100,000 person-years and temporal trends were assessed. Spatial clustering was evaluated using Moran’s I statistic for spatial autocorrelation. Determinants of incidence were examined using a negative binomial generalized additive model (GAM). A total of 933 iGAS events were identified among 870 individuals. Incidence increased substantially over time, with the highest rates observed among older adults and a secondary peak among infants. Age-standardised incidence was approximately nine-fold higher among Indigenous compared with non-Indigenous populations for both males and females. Spatial analysis demonstrated significant clustering of incidence (Moran’s I = 0.19, p < 0.001), with the greatest burden occurring in remote and very remote regions. In multivariable analysis, Indigenous status (IRR = 8.97, p < 0.001) and male sex (IRR = 1.28, p < 0.001) were independently associated with higher incidence. Smooth terms showed significant nonlinear effects of age (edf = 7.45, p < 0.001) and calendar year (edf = 8.04, p < 0.001), indicating heterogeneous age patterns and temporal acceleration in incidence. iGAS incidence in Northern Queensland increased markedly over two decades and was characterised by pronounced geographic and Indigenous health inequities, highlighting the need for targeted prevention strategies in high-risk populations and regions.
Dengue can manifest as a mild febrile illness to life-threatening haemorrhagic fever. The early identification of patients at risk of disease progression remains challenging, particularly in non-severe cases. Therefore, this study aims to investigate the capability of extracellular vesicle plasma microRNA (miRNA) expression as a biomarker in dengue infection. A total of 52 dengue patients (26 dengue with warning signs and 26 dengue without warning signs) were enrolled. Microarray analysis was utilised to profile miRNA derived from plasma extracellular vesicles to identify potential biomarkers associated with disease progression. Target genes were predicted bioinformatically to construct a miRNA–mRNA interaction network and identify key hub genes. The expression levels of miRNAs were validated through quantitative reverse-transcription polymerase chain reaction (RT-qPCR), and their diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curve analysis. Additional functional enrichment analysis, gene ontology, and co-expression studies were conducted. An in vitro experiment using THP-1 cells investigated how hsa-miR-107 regulates P2RY12 expression, with further validation of P2RY12 levels through RT-qPCR using GAPDH as a reference. Microarray profiling identified 24 upregulated miRNAs in dengue patients with warning signs, notably hsa-miR-107 and hsa-miR-6879-5p, which were selected as potential biomarkers. Correlation analysis revealed that platelet count exhibited a statistically significant, moderate positive correlation with the hsa-miR-107 expression value. ROC analysis demonstrated strong diagnostic performance, linking these miRNAs to the platelet dysfunction and altered vascular permeability associated with disease severity. Furthermore, functional analysis supported the involvement of these pathways in dengue pathogenesis, and in vitro transfection confirmed that hsa-miR-107 actively decreases P2RY12 expression. This study highlights the expression of hsa-miR-107 and hsa-miR-6879-5p as candidate biomarkers associated with clinical warning signs in dengue infection. These findings could pave the way for improved diagnostic and monitoring strategies.
Hospital-acquired infections (HAIs) continue to pose a significant challenge to patient safety, partly because traditional microbiological methods slow down the identification of pathogens and outbreak detection. Near-real-time whole-genome sequencing (WGS) and point-of-care (POC) sequencing workflows offer the potential for quicker pathogen characterization and tracking of transmission, which could lead to better infection control and improved use of antibiotics. To review rapid and POC WGS technologies and workflows used in hospital settings, and to summarize evidence on typical turnaround times, impacts on outbreak detection, and implications for clinical decision-making. A narrative review was conducted using literature retrieved from major biomedical databases, including PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies addressing whole-genome sequencing, rapid/near-real-time sequencing, healthcare-associated infections, outbreak investigation, and hospital infection control were identified and reviewed. Streamlined WGS workflows cut turnaround times from several days (typical of traditional methods) to between 13.5 and 48 h in many rapid implementations. Some nanopore-based protocols report initial species identification in minutes and complete genomic data within a few hours. Faster sequencing and real-time analytics lead to earlier identification of resistance markers and quicker detection of transmission chains. Several studies indicate outbreak detection is easier than with traditional epidemiological methods. This allows for more timely targeted therapy and can enhance the responsible use of antibiotics when combined with clinical decision processes. Near-real-time and point-of-care whole-genome sequencing significantly reduces the time needed to identify pathogens and speeds up outbreak detection. However, it requires consistent reporting of turnaround metrics, and careful evaluation of how faster genomic data affects clinical decisions and patient outcomes.
Although China has successfully eliminated neonatal tetanus, non-neonatal tetanus, particularly among older adults, remains a persistent clinical and public health challenge. This narrative review synthesizes the current landscape of tetanus in China—covering epidemiology, pathophysiology, prevention, diagnosis, and treatment—and compares it with World Health Organization (WHO) guidance and practices in other countries to identify gaps and optimization strategies. A comprehensive narrative review was conducted across five core domains: epidemiology, pathogen and pathophysiology, prevention strategies, diagnostic advances, and therapeutic interventions. Data were integrated from the WHO, the Chinese Center for Disease Control and Prevention, national guidelines, and relevant clinical studies, with comparative analysis against global best practices. Epidemiological trends show a clear shift in disease burden from neonates to older adults, predominantly in rural areas, with high case fatality rates (10–40
Plasmodium vivax is the predominant malaria species in Southeast Asia, yet diagnosis may be delayed in non-endemic urban settings where clinicians encounter malaria infrequently. This study described patient characteristics and identified factors associated with delayed diagnosis of P. vivax malaria at the Hospital for Tropical Diseases (HTD), Bangkok, Thailand. A retrospective study was conducted among patients admitted with P. vivax malaria at HTD between 2010 and 2024. Data collected included demographics, travel history, illness and healthcare-seeking history prior to admission, clinical manifestations, laboratory findings, and outcomes. Characteristics of patients with and without delayed diagnosis were compared. Logistic regression was used to identify factors independently associated with delayed diagnosis. Among 384 patients, 58.3
Antimicrobial resistance (AMR) represents a growing challenge across human, animal, and environmental health sectors. Bacteriophage therapy is a potential strategy against methicillin-resistant Staphylococcus aureus (MRSA), one of the most significant contributors to AMR-associated morbidity and mortality globally. One Health promotes coordinated action across sectors to address AMR. This scoping review directly compares the therapeutic potential of bacteriophage therapy to antibiotic treatment for MRSA infections using bacterial load as the primary outcome measure and examines the implications of these findings within a One Health framework for combatting AMR. PubMed, CINAHL, and Scopus were searched for articles published from 2010 to 2026. Inclusion criteria were studies comparing bacteriophage therapy with antibiotics regimens for MRSA infections and reporting quantifiable bacterial load outcomes. Out of 2,160 articles identified, 29 met the inclusion criteria. Nine studies demonstrated significant bacterial load reduction with phages compared to antibiotics alone; 20 did not demonstrate phage superiority, and 19 demonstrated possible synergistic and/or additive bacterial load reduction when phages were combined with antibiotics. Phages show promise as both monotherapy and adjunctive treatment for resistant MRSA infections, with phage-antibiotic combination therapy demonstrating superior outcomes in the majority of studies. Heterogeneity in infection models and phage selection limits direct comparisons across studies. No included studies explicitly addressed One Health. This highlights an important gap in the literature. While integration using a One Health framework is theoretically promising, further clinical investigations are needed to clarify the role of phage therapy within One Health strategies addressing AMR.
The 2019 EUCAST redefinition of the “susceptible, increased exposure” (I) category aimed to optimize antimicrobial therapy and reduce unnecessary carbapenem prescribing. However, concerns remain that misinterpretation may promote carbapenem overuse. We evaluated clinical and resistance outcomes associated with I-category agents compared to meropenem in wild-type (WT) Pseudomonas aeruginosa infections. In this retrospective cohort study, adult inpatients with microbiologically confirmed WT P. aeruginosa infections between January 2020 and March 2024 were included. Eligible isolates were susceptible to meropenem and categorized as “I” to at least one antipseudomonal agent (piperacillin–tazobactam, ceftazidime, cefepime, or ciprofloxacin). Patients received either I-category agents or meropenem as definitive therapy. Primary outcomes were clinical failure and all-cause mortality. Secondary outcomes included emergence of carbapenem-resistant microorganisms within one year. A total of 411 patients were included (I group n = 152; meropenem group n = 259). Clinical failure (9.2
BACKGROUND:The 2019 EUCAST redefinition of the "susceptible, increased exposure" (I) category aimed to optimize antimicrobial therapy and reduce unnecessary carbapenem prescribing. However, concerns remain that misinterpretation may promote carbapenem overuse. We evaluated clinical and resistance outcomes associated with I-category agents compared to meropenem in wild-type (WT) Pseudomonas aeruginosa infections. METHODS:In this retrospective cohort study, adult inpatients with microbiologically confirmed WT P. aeruginosa infections between January 2020 and March 2024 were included. Eligible isolates were susceptible to meropenem and categorized as "I" to at least one antipseudomonal agent (piperacillin-tazobactam, ceftazidime, cefepime, or ciprofloxacin). Patients received either I-category agents or meropenem as definitive therapy. Primary outcomes were clinical failure and all-cause mortality. Secondary outcomes included emergence of carbapenem-resistant microorganisms within one year. RESULTS:A total of 411 patients were included (I group n = 152; meropenem group n = 259). Clinical failure (9.2% vs. 6.9%, p = 0.409) and mortality at all time points were comparable between groups. However, meropenem use was independently associated with the development of carbapenem-resistant P. aeruginosa (CRPA) within one year (OR 2.38, 95% CI 1.02-5.57; p = 0.046). In contrast, emergence of any carbapenem-resistant organism was associated with prior antibiotic exposure and disease severity, but not treatment group. CONCLUSION:In WT P. aeruginosa infections, treatment with EUCAST I-category agents achieved clinical outcomes comparable to meropenem. However, meropenem use was independently associated with subsequent CRPA isolation. These findings support carbapenem-sparing strategies and highlight the long-term resistance implications of antimicrobial selection following the EUCAST redefinition.
Artificial intelligence (AI) is increasingly being applied in the field of infectious diseases. This study aimed to characterize publication trends, collaboration networks, and thematic patterns among AI-related original articles published between 2016 and 2025 in journals assigned to the Web of Science Core Collection (WoSCC) “Infectious Diseases” category. A systematic bibliometric analysis was performed using the WoSCC. The query combined AI-related terms (machine learning, deep learning, neural networks, large language models, and allied concepts) restricted to the WoSCC category of “Infectious Diseases” and an English-language filter, yielding 1,252 original articles published between January 2016 and December 2025. Bibliometric computations and visualizations were conducted using the Bibliometrix R package, VOSviewer, and Scimago Graphica. Keyword co-occurrence network analysis and temporal trend mapping were employed to identify thematic clusters and emerging research foci. The 1,252 articles were contributed by 9,160 authors from 124 countries across 2,850 institutions and published in 125 journals. Annual output grew more than 30-fold between 2016 and 2025, with 84.7
High-consequence infectious diseases (HCID) are rare in Europe but require rapid evaluation due to the risk of transmission. Suspected cases often involve resource-intensive high-level isolation. Point-of-care multiplex PCR may shorten unnecessary isolation by enabling faster rule-out. We developed a decision-analytic model comparing the BioFire® FilmArray® Global Fever Panel (RUO) plus standard diagnostics (strategy 1) versus standard diagnostics alone (strategy 2). Costs were assessed from the hospital perspective from blood sampling to the standard diagnostic result, plus contact isolation after unprotected exposure following false-negative multiplex results. Two scenarios were analysed separately: the patient is HCID infected vs. not infected. We performed a base case deterministic analysis using the baseline parameter values and a probabilistic sensitivity analysis (PSA; 10,000 simulations). In the base case deterministic analysis, strategy 1 increased costs by € 406.35 per infected patient and reduced costs by € 2,009.31 per non-infected patient compared to strategy 2. Concerning the PSA, strategy 1 remained more costly for infected patients (mean Δinf € 408.75; range € 207.4 – € 1,083.9) and cost-saving for non-infected patients (mean Δnot € 2,098.40; range € 1,097.0 – € 3,371.9). Key drivers were multiplex sensitivity (infected scenario) and isolation costs during standard diagnostics and the multiplex pcr (non-infected scenario). Multiplex PCR increased costs in true HCID cases but reduced costs in non-infected suspects by shortening isolation. Given the very low frequency of true HCID among suspected cases in Europe, overall cost savings appear plausible, depending on local workflows and isolation costs.
Clinical course of Chagas disease (CD), caused by the protozoan parasite Trypanosoma cruzi, usually progresses from an acute to an indeterminate phase, both characterized by the lack of specific symptoms. Only one third of patients develop life-threatening manifestations associated with the chronic infection. This fact draws attention of the scientific community to understanding the role of the immune response in the course of the disease, which is the aim of this review. On the one hand, both innate and adaptive immune cells exert antiparasitic effects by respectively releasing nitric oxide and antibodies, as well as activating perforin/granzyme or Fas/FasL pathways. Moreover, nature of secreted cytokines (i.e., pro- or anti-inflammatory) polarizes the response towards Th1 or Th2: according to the phase of CD, these profiles can be detrimental or beneficial to the host. On the other hand, the parasite has developed strategies to escape from the immune system and successfully establish the chronic disease. Also, parasite persistence, together with the immunopathology generated by the infection, seems to be important for the onset of such symptomatic phase. Since the immune response evolves through CD progression and has close relationship with the severity of the disease, study of immune mediators deserves special attention, to identify intervention points for preventing CD evolution and developing more effective therapies.
Infections caused by resistant pathogens represent a global public health challenge. In the current study we aimed to assess the effects on prescription quality and the economic impact of implementing an automated email alert system for last-resort antibiotics, followed by mandatory indication review by infectious diseases (ID) specialists. A prospective single-centre economic and processual evaluation study of orders of last-resort antibiotics at a large tertiary care university hospital (2210 beds) in Germany was performed. Orders of ceftazidime/avibactam, ceftolozane/tazobactam, or cefiderocol triggered an indication review by ID specialists with subsequent recommendations to the primary treating physicians. Expected medication costs of continued therapy were compared to projected costs with adherence to ID recommendations. The spectrum of infections for which last-resort antibiotics were prescribed was broad, with respiratory, intraabdominal, skin and soft tissue infections representing > 60
