Expert Review of Anti-infective Therapy最新文献

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.

Introduction: Candida (Candidozyma) auris is an emerging fungal pathogen that poses a significant threat to immunocompromised patients. Its high mortality rates, resistance to multiple antifungal classes, and ability to spread rapidly in healthcare settings underscore the need for timely and accurate diagnosis to guide effective clinical management.

Areas covered: This special report provides an updated overview of C. auris infections in immunocompromised hosts. It discusses current phenotypic and molecular diagnostic tools, antifungal susceptibility testing methods, and infection control strategies. Emerging therapies, including investigational antifungals and combination regimens, are also examined in light of evolving resistance patterns and clinical challenges.

Expert opinion: Despite notable advances in diagnostics and treatment, major obstacles remain in the clinical management of C. auris, particularly in vulnerable populations. Barriers to guideline implementation, lack of standardized screening protocols, and limited access to novel antifungal agents continue to hinder effective response. Future efforts should focus on expanding diagnostic capacity, developing innovative therapies, and implementing targeted surveillance strategies to reduce the global burden of C. auris.

Introduction: Despite the crucial importance of effective AFS in resource-limited settings, such settings remain comparatively underserved and underrepresented in terms of resource-setting-specific guidance and research. Further practical contextualization and application of current AFS best practices is thus necessary.

Areas covered: A panel of leading experts from diverse countries (India, Nigeria, Spain, and the US) was brought together to provide recommendations for practical and effective implementation of AFS in resource-limited settings. We have adapted and contextualized the Centers for Disease Control and Prevention's (CDC) seven core elements and the Mycoses Study Group Education and Research Consortium's (MSGERC) recommendations for facilities in resource-limited settings through a resource-stratified approach. Where relevant to facilities based on their context and respective resources across multiple dimensions, facilities may choose to prioritize certain recommendations that may be more immediately actionable before implementing others.

Expert opinion: We recommend future studies to examine the efficacy, cost-effectiveness, and practicality of our recommendations in resource-limited settings to enable them to effectively prioritize, channel or gradually increase resource capacity at hand. AFS interventions should be integrated within a larger systemic framework (e.g. city, state, national, regional, international) with collaboration among institutional leadership, ID specialists, healthcare workers, public, policymakers, and pharmaceutical industry.

Introduction: Intra-abdominal candidiasis (IAC) is a serious complication in critically ill patients, particularly after abdominal surgery or trauma. Differentiating Candida colonization from invasive infection is crucial, as misdiagnosis can lead to inappropriate antifungal use, increased resistance, and worse outcomes. However, IAC remains underrecognized due to the limitations of conventional culture-based diagnostics. Relevant literature was identified through a non-systematic search of the PubMed database.

Areas covered: This review highlights the challenges in diagnosing and managing IAC, focusing on the limitations of traditional culture methods and the potential of non-culture-based diagnostics. Biomarkers such as 1-3-β-D-glucan (BDG) and Candida albicans germ tube antibody (CAGTA), along with molecular assays, improve diagnostic accuracy but have varying sensitivity and specificity, requiring a multimodal approach. Management involves early diagnosis, source control, and targeted antifungal therapy. Current guidelines, largely based on candidemia, recommend echinocandins as first-line therapy, with fluconazole for stable patients and amphotericin B for resistant strains.

Expert opinion: Despite advances, IAC-specific research is lacking, necessitating improved diagnostic tools and tailored therapies. There is a need for more targeted studies to refine diagnostic algorithms and therapeutic strategies. Future efforts should focus on developing rapid, high-sensitivity and specific diagnostic tools, optimizing antifungal stewardship, and individualizing treatment approaches.