Expert Review of Anti-infective Therapy最新文献

Introduction: Postoperative Staphylococcus aureus (S. aureus) infections are associated with increased morbidity and mortality. This systematic review and meta-analysis aimed to summarize the incidence of postoperative S. aureus infections.

Methods: We searched MEDLINE, CENTRAL, and Embase (2008-2023) for studies reporting S. aureus infections after hip or knee replacement, spinal surgery, craniotomy, coronary artery bypass surgery (CABG), open colon surgery, abdominal hysterectomy, cesarean section, peripheral vascular bypass, or elective plastic surgery in selected developed countries were considered. We conducted meta-analysis with a generalized linear mixed model and assessed risk of bias. This study is registered with PROSPERO,CRD42023416876.

Results: Data from 224 studies indicated a cumulative incidence of deep S. aureus infection after hip surgery 5.05 infections/1000 procedures (95% CI 3.29-7.74), 5.59 (95% CI 3.62-8.63) after knee surgery, 11.74 (95% CI 9.08-15.16) after spinal surgery, and 7.23 (95% CI 1.63-31.86) after CABG surgery. S. aureus infections were associated with increased all-cause mortality among CABG, hip, knee, and spinal surgeries. Patients cohorts who received antibiotic prophylaxis and/or underwent decolonization demonstrated lower incidence of S. aureus infections.

Conclusions: The incidence of S. aureus infections varies by procedure, with highest rates seen after spinal surgeries and hysterectomies. Findings highlight the importance of standardized prevention across surgical settings.

Introduction: Cryptococcal meningitis (CM) is the second leading cause of AIDS-related mortality where the burden of advanced HIV disease is concentrated. Advances in diagnostics and treatment, including cryptococcal antigen (CrAg) screening and short-course antifungal regimens, have improved clinical outcomes in trials, but replicating these same benefits in routine care has proven more difficult.

Areas covered: This review outlines the biological rationale for CrAg screening and examines the major operational barriers to effective CM diagnosis in low-income countries. An exploratory literature review identified peer-reviewed articles published before May 2025. We assess challenges for CD4 testing, CrAg screening, lumbar puncture (LP) performance, and routine surveillance. Novel approaches, including risk stratification with semi-quantitative CrAg testing are also described.

Expert opinion: The impact of recent diagnostic and treatment advances for cryptococcal disease has been constrained by gaps in implementation. Closing the diagnostic gap requires strengthening decentralized CD4 testing; expanding reflex and point-of-care CrAg, including use of semi-quantitative CrAg assays to prioritize those at highest risk for urgent LP and/or enhanced antifungal treatment; strengthening healthcare provider training, referral systems, LP access, and enhancing community engagement. Integration of these measures into national HIV programs alongside operational research could reduce mortality for patients and costs for health systems.

Introduction: Candidiasis comprises a spectrum of infections ranging from superficial mucosal to life-threatening systemic infections caused by the opportunistic yeast, Candida, a genus containing several species of heterogeneous behavior and unique pathogenesis in the human host. Candida albicans is the most prevalent species. The aim of this review is to provide an update on pathogenesis, resistance and emerging therapeutic strategies in candidiasis, with a focus on C. albicans.

Areas covered: We discuss recent advancements that have deepened our understanding of Candida pathogenesis, particularly the roles of morphological plasticity, metabolic flexibility, biofilm formation, multidrug resistance and gut dysbiosis. We interrogated three major databases, mainly PubMed, Scopus and Google Scholar for the latest (with emphasis on the works published in the last 5 years) developments in antifungal resistance trends, diagnostic innovations, and novel therapeutic strategies, including next-generation antifungals, combination therapies and nanopharmaceuticals. Additionally, we explore emerging strategies, such as probiotics, vaccines, and antifungal stewardship, and discuss the impact of post-COVID-19 immunosuppression, cancer therapies, and climate change on candidiasis epidemiology.

Expert opinion: The future of C. albicans management lies in personalized approaches, leveraging genomics, host-pathogen interactions and advanced drug-delivery platforms to combat resistance, overcome the limitations of current systemic therapy and improve patient outcomes.

Introduction: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of infection due to immunosuppression, prompting routine use of prophylactic and broad-spectrum antibiotics for treatment. However, emerging evidence suggests that gut microbiome disruption (dysbiosis), partly caused by antibiotic use, is associated with poorer transplant outcomes, including graft-versus-host disease (GVHD), infection, and mortality.

Areas covered: This narrative review discusses antibiotic use to prevent and treat febrile neutropenia in allo-HSCT recipients, including effectiveness, impacts on microbiome and GVHD, antimicrobial resistance and Clostridioides difficile infection (CDI). It also reviews available strategies to reduce unnecessary antibiotic use and proposes potential future interventions. A comprehensive PubMed search was conducted through 2024 using terms related to HSCT, antimicrobials, microbiome, resistance, and CDI.

Expert opinion: Improving outcomes while minimizing emergence of antibiotic resistance and CDI requires personalized, risk-adaptive antimicrobial stewardship (AMS). Tailored AMS approaches, including patient risk stratification and early de-escalation, could limit unnecessary antibiotic use and mitigate adverse effects. In the future, microbiome preservation and restoration may reduce transplant complications by maintaining colonization resistance and immune balance. Integrating these strategies into allo-HSCT care is essential for optimizing both clinical and microbiological outcomes.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent hospital-acquired infections, posing a serious clinical and economic burden, particularly in the context of rising antibiotic resistance. Biofilm formation on indwelling catheters by multidrug-resistant uropathogens further complicates treatment and prevention, underscoring the urgent need for alternative, non-antibiotic solutions.

Areas covered: This article explores the potential of bacteriophage- and enzybiotic-coated urinary catheters as an innovative strategy to prevent recurrent bacterial infections. We review the clinical significance of biofilm formation on the surface of urinary catheters, the role of phages and their lytic enzymes in disrupting biofilms, and the clinical evidence supporting the efficacy of phage therapy. The reference list was compiled through a structured search of peer-reviewed studies and case reports, particularly from recent years, available in the PubMed database.

Expert opinion: Phage- and enzybiotic-functionalized catheters represent a promising non-antibiotic approach to CAUTI prevention. These biological agents offer targeted antibacterial activity, disrupt biofilms, and reduce the risk of drug resistance development. Their integration into catheter design may significantly improve infection control, reduce antibiotic use, and align with global antimicrobial stewardship goals. However, clinical standardization and regulatory clarity are crucial for advancing their implementation in routine clinical practice.

Introduction: Central nervous system (CNS) infections are a health concern, leading to high morbidity and mortality. Community-acquired and nosocomial meningitis are distinct entities with potentially different pathogens involved. Prompt antibiotic therapy is crucial. However, challenges arise due to the emergence of multidrug-resistant bacteria and the poor CNS penetration of most antibiotics.

Areas covered: This review summarizes the pathogenesis of bacterial CNS infections, the pharmacokinetics, and pharmacodynamics of several classes of antibiotics within the cerebrospinal fluid (CSF) and the optimal treatment of these infections in adults. A literature search was performed in PubMed and Embase including all available articles up to February 2025.

Expert opinion: The selection of antibiotics with proven CNS penetration and activity against the suspected or confirmed pathogens is essential, particularly in the context of emerging resistance. Higher daily doses and continuous or extended infusions (CI/EI) help maintain therapeutic concentrations in critically ill patients, while intrathecal (IT) administration of antibiotics should be considered when systemic therapy alone is insufficient. Therapeutic drug monitoring (TDM) is crucial for optimizing dosing, especially for drugs with narrow therapeutic indices. Although CSF TDM remains uncommon and challenging, it should be performed in specialized centers with experience in antibiotic pharmacokinetics.

Introduction: Mpox (formerly monkeypox), a systemic infection caused by the mpox virus (MPXV), has become a global problem of increasing concern. There are currently no antiviral treatments that have been shown to be safe and effective for the treatment of mpox.

Areas covered: Brincidofovir is a lipid-modified acyclic nucleotide with in vitro and in vivo activity against multiple DNA viruses, including MPXV. It is licensed in the US and Canada for the treatment of human smallpox disease in adults and children, including neonates. It has been used under FDA-authorized emergency use for patients in the US with severe mpox. The authors review the antiviral activity, clinical development, pharmacokinetics, safety and efficacy of brincidofovir and its potential as an mpox treatment. A comprehensive review was conducted in PubMed, Science Direct, Embase and Google Scholar.

Expert opinion: Research is needed to better understand mpox epidemiology, natural history, antiviral therapy and vaccines. Brincidofovir is being evaluated in a randomized, double-blind, placebo-controlled trial under the Mpox Study in Africa (MOSA) protocol. Additional studies will assist in clarification of single vs. combination therapy, safety and populations most likely to benefit, as well as the management of treatment complications such as immune reconstitution inflammatory syndrome (IRIS).

Introduction: Naegleria fowleri is a rare but fatal free-living ameba with > 97% mortality rate. Despite advances in clinical and scientific understanding, therapeutic options remain limited, and diagnosis is often delayed, presenting significant public health challenges.

Areas covered: We reviewed recent literature from the last decade, using Google Scholar and PubMed  on N. fowleri treatment, emerging drug candidates, repurposed therapeutics, and innovative delivery strategies. Advancements in drug screening are highlighted, unveiling novel therapeutic targets and mechanisms of action. Additionally, the role of climate change and environmental factors in geographic expansion and increased incidence of infections is explored, posing a growing public health risk.

Expert opinion: Effective management of N. fowleri infections hinges on early detection and addressing research gaps, particularly in understanding transmission/disease mechanisms. Recent advances in therapeutics, diagnostics, and water treatment to reduce environmental contamination by N. fowleri show promise for lowering infection risk and improving outcomes for primary amebic meningoencephalitis. Collaboration among academic institutions, pharmaceutical companies, and water industries is essential, with research advancing treatments and vaccines, and water industries contributing by reducing environmental contamination/human exposure to N. fowleri. A combination of treatment strategies and stringent surveillance will be crucial to limit future outbreaks and improve patient prognosis.

Introduction: HIV late presentation, defined as a CD4+ cell count below 350 cells/μL or the presence of an AIDS-defining condition at diagnosis, represents a significant global challenge, accounting for approximately 50% new HIV diagnoses worldwide. This phenomenon is associated with suboptimal clinical outcomes, increased morbidity and mortality, and elevated transmission risks due to prolonged undiagnosed infection.

Areas covered: This review examines the definitions, risk factors, epidemiology, and clinical implications of late presentation in HIV. It highlights evidence supporting the timely initiation of antiretroviral therapy (ART), discusses the choice of optimal therapeutic regimens, and addresses the management of opportunistic infections in late presenters. Special attention is given to challenges posed by advanced disease, including immune reconstitution inflammatory syndrome, and drug-drug interactions in the context of opportunistic infections.

Expert opinion: Late HIV presenters face unique clinical and therapeutic challenges. High-risk groups, including older individuals, women, people who inject drugs, and migrants, require tailored prevention efforts to improve early diagnosis and care access. While INSTI-based ART regimens are preferred due to their efficacy and tolerability, evidence gaps persist regarding optimal ART strategies and timing in severe opportunistic conditions, such as cryptococcal and tuberculous meningitis. Further studies are needed to address these gaps.

Introduction: Human babesiosis is an emerging tick-borne disease caused by intraerythrocytic Babesia protozoa. Most cases are due to Babesia microti, which is endemic in the northeastern and upper Midwestern United States. Other Babesia spp. cases are endemic in China and/or sporadically reported in the United States, Europe, Asia, and elsewhere in the Northern Hemisphere. Cases in immunocompetent hosts are typically mild to moderate, while disease in immunocompromised hosts is often severe.

Areas covered: A historical perspective of compounds that are effective against Babesia spp. is provided. The current management of mild, moderate, and severe babesiosis is discussed, as is the genetic basis of antimicrobial resistance associated with relapsing babesiosis. The use of red blood cell exchange transfusion is reviewed.

Expert opinion/commentary: Most cases of human babesiosis are successfully treated with atovaquone plus azithromycin or clindamycin plus quinine. A major research topic is the management of immunocompromised hosts, especially those experiencing severe or relapsing babesiosis. Two immediate goals are, (i) to develop new antimicrobial agents that target Babesia spp. through novel mechanisms and can overcome resistance to currently recommended antimicrobial agents and, (ii) to gain a better understanding of the efficacy of red blood cell exchange transfusion and indications for its use.