Expert Review of Anti-infective Therapy最新文献

Introduction: Diagnostic stewardship, the optimization of diagnostic testing to improve patient outcomes, is a rapidly evolving field; however, data relating to immunocompromised hosts are scarce.

Areas covered: This review examines recent advances in diagnostic stewardship and explores best practice principles for key clinical scenarios in immunocompromised patients, including febrile neutropenia, central nervous system infections, invasive fungal infections, cytomegalovirus, and Clostridioides difficile infection.

Expert opinion: Key challenges remain, including optimizing test utilization without compromising patient safety, interpreting advanced diagnostics in the context of immunosuppression, and demonstrating cost-effectiveness. A multidisciplinary approach incorporating both diagnostic and antimicrobial stewardship principles is essential to improve outcomes in this complex patient population. Future research should focus on prospective evaluation of diagnostic stewardship interventions and their impact on clinical and economic outcomes in immunocompromised hosts.

Introduction: Neurocysticercosis remains the leading parasitic infection of the human central nervous system and a primary cause of epilepsy in low- and middle-income regions. Although advances in magnetic resonance imaging, serologic assays, and antiparasitic regimens have improved disease recognition and lesion targeting, major clinical questions remain unresolved regarding optimal diagnosis and management.

Areas covered: This Perspective critically reviews current diagnostic and therapeutic approaches in neurocysticercosis, emphasizing the role of high-resolution imaging and evolving immunologic tools. The literature search methodology included searches of PubMed and Google Scholar databases, focusing on publications related to neurocysticercosis diagnosis, clinical manifestations, treatment, and public health interventions. It discusses treatment selection based on cyst location, stage, and host immune profile, and explores the evidence supporting albendazole and praziquantel in parenchymal, ventricular, subarachnoid, and disseminated forms. Pediatric, pregnant, and immunocompromised patients are examined as distinct clinical populations.

Expert opinion: The management of neurocysticercosis demands individualized, lesion-specific strategies rather than uniform protocols. While advances in imaging and immunotherapy hold promise, implementation barriers persist in endemic areas. Future priorities include robust randomized trials for extraparenchymal disease, validation of immunologic biomarkers, and integrated public health measures to reduce the disease burden globally.

Introduction: Treatment failure is a critical outcome in community-acquired pneumonia (CAP), especially in severe cases, where it increases the risk of complications, prolonged hospital stays and mortality. Treatment failure was reported between 4% and 32% in severe CAP cases. Identifying causes and risk factors for treatment failure is crucial as it enables timely modifications to antibiotic treatment, accurate identification of patients who may require admission to the intensive care unit, and implementation of appropriate management strategies. Understanding the underlying mechanisms and host responses leading to treatment failure is essential for improving patient outcomes.

Areas covered: The authors discuss the latest scientific evidence on treatment failure focusing on definition, risk factors, causes, etiology, and the role of biomarkers. This article is based on the available literature from PubMed.

Expert opinion: Early detection and timely initiation of proper antimicrobial therapy are key elements to prevent treatment failure and complications, ultimately reducing CAP-associated mortality. However, treatment failure requires a more nuanced approach: identifying and categorizing complications, understanding its timing (early vs. late), and recognizing main risk factors and biomarkers that could help predict, diagnose and monitor treatment failure as early as possible. A multidisciplinary approach is essential in the prevention of treatment failure.

Introduction: HIV remains a major global health concern. Unexpected disruptions in antiretroviral drug supply chains carry increased mortality and transmission risks. The integrase strand transfer inhibitor dolutegravir plays an increasingly critical role in the global fight against the epidemic. Its high barrier to resistance has been extensively documented in rich countries. Recent reports of resistance cases after dolutegravir failure in resource-limited cohorts raise concerns about whether its high barrier to resistance will hold in low-income countries.

Areas covered: For this review, we performed a search on the recent published literature and conference communications focused on acquired drug resistance against dolutegravir in low- and middle-income countries.

Expert opinion: Overall, the data unsurprisingly showed that resistance against dolutegravir emerged mainly from unsuppressed individuals with treatment adherence issues. This emergence happened at a population rate below 1% despite structural challenges. Almost half of the resistance cases involved the R263K substitution, which did not always preclude re-suppression with dolutegravir. Minor adjustments in the programmatic large-scale rollout of dolutegravir could further improve these outcomes. Continued treatment adherence support and the preservation of antiretroviral drug supply chains remain crucial for the success of HIV treatment.

Background: Antimicrobial resistance threatens patients, healthcare systems, and the world's economy. Antimicrobial stewardship programs use evidence-based strategies to monitor and assess antibiotic use. This study aimed to identify prescribers' knowledge, attitudes, and behavior regarding antibiotic use and antibiotic resistance in Oman.

Research design and methods: A cross-sectional study was conducted using a questionnaire that was adapted from the European Centre for Disease Prevention and Control instruments. The survey was distributed among prescribers in Oman's Ministry of Health.

Results: The survey included a total of 371 prescribers. Most respondents were specialists, and 73% worked in hospitals. Antibiotics' effectiveness against viruses, needless use, and adverse effects were accurately answered by over 95% of prescribers. Eighty-four percent of prescribers realized the connection between their prescribing of antibiotics and the spread of antibiotic-resistant bacteria. Approximately 80% agreed that they address antibiotic resistance and consider it when treating patients. Around 70% of prescribers knew of the Oman national action plan to combat antibiotic resistance. Sixty-six percent of prescribers wanted information regarding antibiotic resistance, 49% about antibiotic use, and 40% about antibiotic prescriptions and medical problems.

Conclusion: The findings highlight the need for interventions to inform prescriber knowledge and behavior, improve antibiotic prescribing practices, and combat the spread of antimicrobial resistance.

Introduction: Diabetic foot ulcers (DFUs) are a significant health concern, often complicated by biofilm formation which delays healing and increases the risk of diabetic foot infections (DFIs). Effective management of complex biofilms is crucial for improving patient outcomes and reducing the risk of amputation and premature death.

Areas covered: This review summarizes the current state of microbiological research on DFIs, focusing on bacterial populations, biofilm interactions, and their role in antibiotic resistance development, being based on a PubMed search from 1975 to 2025. It also explores recent advances in antimicrobial therapies, including phage therapy, antimicrobial peptides, and other novel treatments.

Expert opinion: Antimicrobial stewardship, broader access to medical resources, and improved sanitation are essential to diminish the impact of diabetes on healthcare systems. Furthermore, the development of a rapid tool to detect antibiotic-tolerant cells is fundamental to avoid DFIs relapse. The biofilms dynamics and the dual relationship between biofilms and the immune system should be further understood. While traditional antibiotics are essential to treat DFIs, a multi-combinatorial strategy combining conventional compounds with alternative therapies should be more effective to overcome resistance and promote wound healing in DFUs.

Introduction: Prosthetic joint infections (PJIs) caused by mycobacteria are exceptionally rare and often underrecognized in clinical practice.

Areas covered: Although most PJIs are due to common bacterial pathogens, Mycobacterium tuberculosis and nontuberculous mycobacteria (NTM) represent a unique subset with distinct microbiological and therapeutic challenges. The presence of biofilms further complicates their management, often requiring intensive pharmacological interventions and surgical strategies. This review analyzes over 300 reported cases of mycobacterial PJIs. The findings indicate that tuberculous PJIs typically occur as late-onset infections and are managed successfully with prolonged antituberculous therapy. In contrast, NTM PJIs - predominantly caused by rapidly growing species - are more heterogeneous in onset, resistance patterns, and treatment responses. Antibiotic regimens are often complex, species-specific, and require guidance from susceptibility testing. Therapeutic decisions often rely on expert consensus and extrapolation from pulmonary disease protocols. Surgical intervention, particularly implant removal, consistently correlates with better outcomes in both groups.

Expert opinion: Clinicians must maintain a high index of suspicion in culture-negative PJIs or cases with atypical clinical presentations to reach a proper diagnosis. Once the diagnosis is established, a multidisciplinary approach is crucial for optimizing patient outcomes. Further research is warranted to develop evidence-based strategies for these rare but clinically demanding infections.

Introduction: Neonatal sepsis remains a major contributor to morbidity and mortality worldwide, with the highest burden in low- and middle-income countries (LMICs). Generating accurate estimates of disease burden is critical for setting research priorities, informing health policy, and resource allocation. However, in many LMICs, limited access to timely and reliable diagnostic tools severely limits case detection, undermines epidemiological surveillance, and impedes efforts to improve clinical outcomes.

Areas covered: This review examines the clinical, scientific, and health system implications of misdiagnosing neonatal sepsis. We describe the challenges of accurate case identification and summarize findings from prospective, multicenter studies showing marked variability in incidence across different geographic and healthcare settings. We explore the sources of this variability and discuss its impact on patient care, clinical trials interpretation, and progress toward reducing the global burden of neonatal sepsis.

Expert opinion: The lack of standardized case definition hinders neonatal sepsis research and may contribute to the growing threat of antimicrobial resistance. Addressing this requires acknowledging the substantial uncertainty in current global incidence estimates. More importantly, it demands shifting focus from passive reporting of variability to actively investigating the methodological, sociodemographic, clinical, biological, and systemic drivers that shape sepsis detection and outcomes across diverse settings.