Expert Review of Anti-infective Therapy最新文献

Introduction: HIV and hepatitis B continue to be global public health challenges. Each virus causes 1.2 million new infections annually. By 2025, roughly 40 million people live with HIV, and over 250 million have chronic hepatitis B.

Areas covered: Using PubMed, we analyzed approaches to control HIV and HBV epidemics. Whereas no vaccine exists to prevent HIV acquisition, successful protective HBV vaccines are available. The high incidence of HBV is largely explained by low immunization coverage and poor HBV screening. Linkage to care and sustained provision of antivirals remain suboptimal for HBV. New potent antiviral drugs and combinations are being developed. Long-acting formulations have shown clinical efficacy in HIV but remain untested for HBV.

Expert opinion: The WHO has called for eliminating both HIV and HBV as public health threats by 2030. Whereas the cascade of care for HIV is well rolled out at 80-80-80%s (diagnosed- treated-suppressed), rates are significantly lower for chronic hepatitis B (13-3-?), with only 7 million people treated. Major gaps exist at different stages of the hepatitis B cascade. There is a need to expand HBV vaccination and screening, as well as improve linkage to care and monitoring. Antiviral treatment should be provided earlier.

Introduction: Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty and necessitates comprehensive strategies for prevention. One of the key features in infection prevention is the optimal selection of antimicrobial strategies.

Areas covered: This review evaluates systemic and local antimicrobial approaches to PJI prevention, including systemic antibiotic prophylaxis, nasal and skin decolonization of Staphylococcus aureus, local antimicrobial delivery into the joint space, and antimicrobial modification of the implant surface. We conducted a literature search of the MEDLINE, Web of Science, Cochrane and ClinicalTrials.gov databases for recent evidence from randomized and observational studies, as well as current orthopedic guidelines concerning these topics.

Expert opinion: Further reductions in the incidence of PJI through antimicrobial strategies will require: (1) the adoption of alternative trial designs such as registry-nested and adaptive platform trials to study outcomes with low event rates; (2) improved adherence to established best practices, particularly in systemic antibiotic prophylaxis; (3) precision prevention informed by validated risk stratification tools; and (4) novel interventions targeting emerging biological mechanisms such as the gut microbiome.

Introduction: Urogenital tuberculosis (UGT) is a common manifestation of extrapulmonary tuberculosis and can affect all organs of the urinary tract and male genital tract. The actual main problem of UGT is late diagnosis and a high prevalence of urogenital organ destruction. Little progress has been made in preventing the disease from progressing to more destructive forms. Knowledge diffusion of critical insights of UGT is the objective of this revision.

Areas covered: A narrative review of urogenital tuberculosis was performed in the databases of PubMed, Embase, and Scielo without time and language restriction. Terms used in the review were: 'Tuberculosis'; 'Urogenital Tuberculosis'; 'Prostate tuberculosis'; 'Kidney Tuberculosis' and 'Bladder tuberculosis.'

Expert opinion: The actual problem of UGT is late diagnosis and the evolution to destructive forms of disease with high proportion of kidney loss, surgeries, chronic infection of the urinary tract and urologic related chronic renal failure. This problem solution is based on three key actions: 1) correct UGT features knowledge; 2) creation of diagnostic guidelines and 3) knowledge diffusion. The knowledge of UGT features and the knowledge diffusion are the main objectives of this review. The creation of liable guidelines is a task in progress and the objective of further studies.

Introduction: Despite 70+ years of research, the etiology of bacterial vaginosis (BV), the most common vaginal infection, is unknown. Numerous studies suggest that BV-associated bacteria (BVAB) are sexually transmitted. Additionally, a recent male partner treatment trial found that the addition of combination oral and topical antimicrobial therapy for regular male sexual partners to treatment of women with BV resulted in a lower rate of recurrence at 12 weeks. However, unlike other common sexually transmitted infections such as chlamydia and trichomoniasis, no sole infectious pathogen has been identified as the causative agent of BV. In addition, non-sexual factors (e.g. smoking, copper intrauterine device use, douching, and testosterone use) have been associated with an increased risk of BV in some studies. These findings underscore the complexity of BV pathogenesis and make it challenging to counsel patients on infection acquisition and prevention of recurrent disease.

Areas covered: This work summarizes the evidence for and against sexual transmission of BVAB.

Expert opinion: A large body of data provide substantial evidence suggesting that sexual activity is the predominant mode of initial BV acquisition. There are no data showing a direct causal association between non-sexual factors and BV development. Additional research investigating BV etiology is imperative.

Introduction: Pegylated interferon alpha-2a (PEG-IFN) has been used off-label as chronic hepatitis delta (CHD) treatment since the 1990s. However, it has not received formal approval for this indication. Bulevirtide (BLV), a first-in-class entry inhibitor, is the first drug approved for the treatment of compensated CHD. Since its conditional approval in 2020, data from clinical trials and real-world studies have emerged. Literature search included PubMed (last accessed July 2025), European Medicines Agency official reports, and international conference abstract books.

Areas covered: Several evidence gaps remain unmet, including the definition of treatment endpoints, the impact of therapy on clinical outcomes, optimal therapy duration, and the potential benefits of combination with PEG-IFN. This review aims to provide a comprehensive overview of the current evidence regarding the use of BLV, both as monotherapy and in combination with PEG-IFN.

Expert opinion: Bulevirtide 2 mg is an effective treatment for CHD in patients with and without advanced chronic liver disease, as demonstrated in clinical trials and real-world cohorts. In addition, long-term therapy appears to enhance response rates and may even promote the loss of HDV-infected hepatocytes, potentially leading to a sustained off-therapy response. However, new therapeutic strategies are needed for patients who do not respond.

Introduction: Intra-abdominal infections (IAIs) pose significant challenges to clinicians. The increasing prevalence of multidrug-resistant (MDR) organisms with evolving resistance patterns adds to the difficulty in managing IAIs.

Areas covered: This review synthesizes the latest evidence and recommendations from major global guidelines. Key topics include novel antimicrobial agents, empirical and targeted therapy strategies, and the role of antimicrobial stewardship in optimizing antibiotic use. Furthermore, advances in diagnostic tools, such as metagenomic next-generation sequencing and rapid resistance detection assays, are highlighted. Updates in therapy duration, emphasizing shorter courses guided by biomarkers and source control, are critically analyzed.

Expert opinion: The management of IAIs has advanced significantly, with updated guidelines highlighting the importance of early and appropriate antimicrobial therapy tailored to the infection's severity and resistance patterns, along with effective source control. Novel antibiotics such as ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam, eravacycline, and cefiderocol have broadened treatment options for MDR pathogens. Shorter antibiotic courses, guided by source control and biomarkers, have shown to be as effective as traditional longer regimens. Future research should focus on understanding of global resistance patterns, expanding real-world evidence for novel antibiotics, refining biomarker-guided strategies, enhancing rapid diagnostics, and applying artificial intelligence for more personalized and precise management of IAIs.