Expert Review of Anti-infective Therapy最新文献

Introduction: The COVID-19 pandemic has intensified global health challenges, including a silent but escalating crisis: multidrug-resistant organisms (MDROs). As healthcare systems strained under viral outbreaks, infection control and antimicrobial stewardship efforts suffered, accelerating the spread of antimicrobial resistance (AMR).

Areas covered: This review examines the indirect effects of the COVID-19 pandemic on AMR, emphasizing changes in antibiotic utilization, healthcare-associated infections, and resistance trends. Global and regional epidemiological data are presented, with a special focus on Taiwan's evolving MDROs landscape, clinical burden, and strategic responses.

Expert opinion: COVID-19 has both exposed and intensified vulnerabilities in AMR control. While the pandemic fostered certain infection control practices, it also disrupted antimicrobial oversight, leading to surges in MDROs prevalence. Taiwan's experience underscores the value of coordinated guidelines, real-time diagnostics, and artificial intelligence-driven stewardship. Rebuilding and future-proofing AMR responses requires integrated global policies, sustained surveillance, and innovation in diagnostics and therapeutics. Unless comprehensive action is taken, MDROs may emerge as the defining post-pandemic threat to modern medicine.

Introduction: Pulmonary mucormycosis (PM) is a rapidly progressive angioinvasive fungal infection with high mortality. Despite therapeutic advances, optimal management remains uncertain.

Areas covered: We review the evidence on managing PM. We emphasize aggressive host factor optimization (glycemic control, immunosuppression reduction) and outline the evidence-based antifungal strategy: liposomal amphotericin B (L-AMB) for induction, followed by oral maintenance (posaconazole or isavuconazole). We discuss critical nuances, including LAMB dosing, timing, and duration of therapy, drug interactions, and therapeutic drug monitoring. We review the role of combination antifungals, newer agents, and adjunctive modalities (inhaled antifungals, immunomodulation, bronchoscopic interventions, and iron chelation), assessing their appropriate use. The timing, indications, feasibility, and perioperative risk of surgery are discussed. We provide practical guidance for PM in special populations, including children, pregnant women, individuals with chronic liver or renal disease, and transplant recipients.

Expert opinion: Optimal care of PM requires early recognition, prompt LAMB induction with rigorous host factor optimization, multidisciplinary surgical assessment, followed by oral triazole maintenance. Combination antifungal therapy lacks definite evidence and should be reserved for severe or refractory cases. Future research priorities include prospective evaluation of treatment strategies, host-directed therapies, emerging antifungals (oral nanocrystal amphotericin, fosmanogepix, etc.), and systematic assessment of adjunctive modalities.

Introduction: One of the most controversial issues surrounding the management of urinary tract infection (UTI) in children remains that of diagnosis, which is paramount for successful therapeutics and overall management, due to lack of specific symptoms, sampling difficulties and debatable diagnostic criteria, all characteristics that differentiate pediatric from adult UTI. The current diagnostic strategy, based on urine culture, lacks specificity and entails considerable delay until the availability of the results.

Areas covered: This narrative review includes current diagnostics and their future perspectives with the integration of new technologies, novel host-based and pathogen-directed diagnostic methods and prediction models. Literature search was performed using Pubmed, focusing on recent publications about diagnostics of UTI and their use in children.

Expert opinion: Novel diagnostics include ultra-sensitive biosensors at point-of-care level and light-scattering, advanced microscopy and molecular techniques at laboratory level and have achieved reliable pathogen identification and provision of antibiotic susceptibility testing within hours instead of days. Less progress has been made in host-response approaches, based mostly on urine biomarkers, which nevertheless remain a promising field. Prediction models based on artificial intelligence (AI) methods are developing fast and with the combination of all information relevant to UTI can significantly contribute to individualized patient-tailored predictions.

Introduction: Monotherapy with a nucleos(t)ide analogue (NA), namely entecavir and tenofovir, represents the mainstay of hepatitis B virus (HBV) treatment, which achieves potent viral suppression and subsequently improved major outcomes, but it rarely leads to functional cure (i.e. 10-year cumulative rate of <3%). Current guidelines recommend NA discontinuation in all chronic hepatitis B patients who achieve HBV surface antigen (HBsAg) loss. Before HBsAg loss, NA discontinuation is recommended with caution only in non-cirrhotics with normal ALT who have remained in long-term on-therapy remission for various periods depending on their initial HBeAg status and agree to close post-treatment monitoring.

Areas covered: This review explores the current landscape of the concept of NA discontinuation, examining benefits, risks, criteria for stopping, and patient selection and monitoring according to international guidelines, and biomarkers that may be helpful in decision-making.

Expert opinion: In the absence of novel antivirals leading to HBsAg clearance, accumulating data suggests that stopping NA therapy in carefully selected HBeAg negative patients may increase the probability of HBsAg loss and reduce long-term treatment burden, eventually improving patients' outcome. However, there are risks of post-treatment relapses and flares that need to be considered, while other critical parameters should be fitted to tailor patient selection.

Introduction: While antibiotic combination therapy remains a common clinical practice, its scientific foundation is fragile. The available evidence is fragmented, biased, and fails to capture the complexity of modern infectious disease scenarios. This perspective reinterprets the role of combination therapy through a critical lens, challenging current dogmas and proposing a pathogen-specific approach, focusing also on severe acute infections.

Areas covered: This Critical Perspective focused on selected studies from 2018 to 2025 identified through a focused PubMed search on the place in therapy and efficacy of antibiotic combinations on main gram-positive (Streptococcus spp. Enterococcus spp. and Staphylococcus aureus) and gram-negative (Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia) pathogens.

Expert opinion: After reviewing the current available literature, in our opinion, a strong indication to use antibiotic combination therapy can be only for specific situations and clinical syndromes (such as endocarditis, toxic shock syndrome due to S. pyogenes, or persistent bacteremia due to S. aureus and few others). However, especially in severe infections due to gram negatives, clinical trial and strong data are insufficient to draw definite clinical indications. Consequently, further randomized clinical trial should be performed, and they should include new antibiotics to define the potential role of combination therapy.

Background:  To evaluate 96-week virologic, immunologic, resistance and metabolic outcomes of bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) in antiretroviral therapy (ART)-naïve people living with HIV (PLWH).

Methods: Retrospective cohort of ART-naïve PLWH initiating BIC/FTC/TAF between January 2020 and December 2022. Primary outcome was HIV-1 RNA <50 copies/mL at week 96. Secondary outcomes included drug resistance and changes in CD4⁺ T cell count, CD4⁺/CD8⁺, body weight, lipid profile, liver and renal function by week 96.

Results: We enrolled 228 patients; median age 32 years, 92.1% male, homosexual intercourse 57.0%. Virologic suppression did not differ by baseline HIV-1 RNA levels, CD4⁺ T cell counts, or opportunistic infection (OI), and immune reconstitution was similarly consistent across subgroups. One patient developed V179E mutation. Median body mass index increased from 21.7 (20.0-23.7) to 23.1 (21.2-25.1) by week 48 and then stabilized. Lipid levels increased early and remained stable, liver function remained stable after week 48, and renal function showed a slight decline before stabilizing by week 48.

Conclusion: BIC/FTC/TAF demonstrated strong efficacy in patients with high baseline HIV-1 RNA and OIs, with no patient developing drug-related resistance mutations and minimal impact on metabolism, liver and renal function, supporting its use in broader populations as a first-line regimen.

Introduction: Sepsis is a leading cause of death worldwide. Its lethality, along with the complexity of diagnosis and treatment, is worsened by rising antibiotic resistance. Managing sepsis and septic shock is challenging, as underlying conditions can limit the reliability of many biomarkers used for early diagnosis.

Areas covered: This review comprehensively overviews the epidemiologic characteristics of sepsis, with particular emphasis on the key biomarkers used to support early diagnosis. Additionally, it explores emerging techniques for rapid microbiological identification of sepsis caused by multidrug- resistant organisms and evaluates the effectiveness of newly introduced antibiotics.

Expert opinion: In severe cases progressing to septic shock, timely and accurate diagnosis is critical. It is mandatory to make every effort to shorten the time to diagnosis in order to enable appropriate supportive care and targeted antibiotic therapy. In this context, novel microbiological diagnostic methods should be considered to facilitate early detection of multidrug-resistant organisms and promote the initiation of effective empiric antibiotic treatment. Furthermore, the development of new molecules with innovative mechanisms of action, alongside therapeutic strategies targeting specific patterns of the immune response, is expected to improve the patient survival rates.

Introduction: HIV drug resistance (HIVDR) threatens global antiretroviral therapy (ART) success, especially as treatment scales up in resource-limited settings (RLS). Conventional genotypic HIVDR testing relies on complex instrumentation and often involves long turnaround time, creating critical gaps in managing virologic failure. Point-of-care test (POCT) technologies offer the potential of same-day resistance detection and immediate treatment optimization at the site of care.

Areas covered: This review examines potential HIVDR POCT technologies, with primary focus on advances from 2022 to 2025. It evaluates both established platforms and emerging approaches. Each technology is assessed against WHO REASSURED criteria for point-of-care diagnostics. It also summarizes the relevant clinical validation data, early field implementation experiences, and their feasibility of integration into existing laboratory systems in low- to middle-income countries (LMICs).

Expert opinion: While no single platform currently fulfills all REASSURED criteria, several show strong potentials for near-term implementation, particularly OLA-Simple. Multi-country validation studies support its utility; however, PCR dependence still limits POC usage. Key challenges remain, including limited HIVDR mutations coverage, reliance on complex lab instrumentation, and high costs that hinder scalability and long-term sustainability. By 2030, routinized HIVDR POCT could transform HIV care by enabling real-time treatment decisions, even in RLS or LMICs.

Introduction: Viral hemorrhagic fevers (VHFs) represent a group of severe diseases caused by RNA viruses with high fatality rates, posing significant global health threats. These diseases are prioritized by the World Health Organization due to their epidemic potential, geographical restrictions, and limited therapeutic options.

Areas covered: This review discusses the current state of therapeutic advancements, challenges in treatment, and post-exposure prophylaxis for various VHFs. Relevant literature on VHFs and therapeutic interventions was identified through searches of PubMed, Scopus, Web of Science, WHO and CDC databases, and ClinicalTrials.gov from database inception to November 2025. Key therapies like ribavirin for Crimean-Congo hemorrhagic fever and Lassa fever, along with monoclonal antibodies for Ebola and Marburg virus disease, have demonstrated clinical efficacy. However, gaps remain in effective antivirals and vaccines for many VHF pathogens.

Expert opinion: Notable challenges in therapeutic development include ethical concerns in randomized controlled trials, logistical barriers in endemic areas, and the evolving immune response in late-stage disease. The role of cytokine modulation and the growing potential of monoclonal antibodies offer new directions for treatment. Strengthening observational studies and expanding international collaboration are critical for improving patient outcomes and advancing therapeutic options for these deadly diseases.