Effective Antibiotic Treatment Research Articles

Review Article on Typhoid Fever

Typhoid fever is primarily found in impoverished countries with inadequate sanitation on a global scale. In the United States, the incidence of typhoid fever has been steadily decreasing since 1900 due to improvements in sanitation and effective antibiotic treatments. While typhoid fever is widespread, 80% of cases occur in the Americas, the Caribbean, Oceania, Bangladesh, China, India, Indonesia, Laos, and Nepal. Each year, approximately 200,000 individuals succumb to typhoid fever, and 21.6 million people are infected with the disease. When treated, the chance of death is 0.2% and there are rarely long-term symptoms. Untreated typhoid fever can lead to fatality and persist for multiple weeks. Lasting complications may involve central nervous system damage. 54 percent of reported typhoid fever cases in the United States between 1999 and 2006 included. One can receive fluids and electrolytes via a vein. For the treatment of typhoid fever, the patient can receive an antibiotic and, in rare circumstances, steroid medications. When prescribed antibiotics, most patients start feeling better after two days, and fatalities are rare. Typhoid cases are generally treated with specific antibiotics such ciprofloxacin, ampicillin, or chloramphenicol. Important public health measures include proper water purification, proper waste disposal, and safeguarding the food supply from contamination. Typhoid carriers should not be permitted to handle food in any capacity. If treatment is not received, patients may have a fever for weeks or months, and up to 20% of them may pass away from infection-related problems. The hospital setting is where those with infections are treated.

A Retrospective Analysis of Broad-Range Microbial PCR-Sequencing Findings and Culture Results in 101 Bronchoalveolar Lavage Specimens

Abstract Introduction/Objective Pneumonia is a significant cause of illness and death, identifying its cause is challenging and critical for effective antibiotic treatment and for reducing the length of stay. Bronchoalveolar lavage is commonly performed to obtain high-quality lower respiratory tract samples. While traditional culture methods have been the standard for pathogen detection, microbial rRNA broad-range polymerase chain reaction (BR-PCR) has emerged as an alternative method. Methods/Case Report A retrospective analysis was conducted on 101 patients suspected of severe pulmonary infections at Oregon Health and Science University (OHSU). Results (if a Case Study enter NA) When important microbial etiology is considered, culture detected 26%, while BR- PCR detected 20%. Both methods proved effective in detecting common pathogens; however, culture demonstrated superiority in detecting fungal pathogens due to potential sampling biases associated with PCR. Furthermore, culture holds the advantages of being faster and more cost-effective, although it may fail to detect difficult to non-cultivable organisms, like Legionella spp. Culture is indispensable for susceptibility testing and strain typing purposes. More often than not, BR-PCR captures airway microbiota indiscriminately with minimal clinical significance, potentially confusing clinical interpretation. Conclusion Novel technologies like Biofire Pneumonia Panel (BPP), a multiplex PCR, have shown promise in the rapid detection of pneumonia pathogens including bacteria, viruses, and resistance genes (< 2 hours), complementing the traditional culture methods for microbiological diagnosis. Based on this analysis we recommend introducing BPP at OHSU.

Antibiotic-Loaded Hydrogel for the Treatment of Lower-Limb Fracture-Related Infections: A Single Center's Multidisciplinary Experience.

A fracture-related infection (FRI) is a severe complication of an orthopedic trauma, often leading to challenging treatments and poor outcomes. The surgical strategies are typically categorized into one-stage or two-stage procedures, with the use of systemic and local antibiotics being crucial for infection management. This study assessed the efficacy of an antibiotic-loaded hydrogel (ALH) applied over the internal fixation devices for treating FRIs, comparing the outcomes between the one-stage (OS) and two-stage (TS) reconstructions. This retrospective study included 17 patients with an FRI treated using the ALH at a single center. The patients were divided into OS and TS reconstruction groups. The data on demographics, surgical procedures, antibiotic regimens, and outcomes were collected. The primary and secondary outcomes included the infection cure rate, bone union, complications, and reoperation rates. Among the 17 patients (mean age 48.5 years, 16 males), infections were predominantly in the tibia, with 12 chronic and 5 acute cases. Seven patients had monomicrobial infections, and nine had multidrug-resistant pathogens. No significant differences were found between the OS and TS groups in terms of the infection cure rate, bone union, or complications. One patient in the OS group experienced an infection recurrence, and bone healing was achieved in all but one case. Additional complications included delayed wound closure in two cases and implant failure in one case, requiring a reoperation. The ALH demonstrated potential as an effective local antibiotic treatment for FRIs, particularly in the one-stage reconstructions, allowing for a safe application of internal fixation devices. However, further research with larger sample sizes and longer follow-ups is needed to validate these findings.

Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species-A Meta-Analysis.

Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the relatively low incidence of infections caused by Elizabethkingia spp. and the lack of published systematic evaluations of the risk factors for mortality. The aim of the present study was to investigate risk factors for mortality in patients with infections caused by Elizabethkingia spp. by conducting a meta-analysis of existing studies on these infections. Materials and Methods: Studies comparing patients who died from infections caused by Elizabethkingia spp. with patients who survived were considered for inclusion. Studies that reported one or more risk factors for mortality were considered. Clinical predisposing variables, predisposing comorbidities, and clinical outcomes of antibiotic treatment were among the risk factors for mortality. Results: The meta-analysis included twenty studies with 990 patients, and 298 patients (30.1%) died. The following risk factors for mortality were identified: intensive care unit admission, the need for mechanical ventilation, immunosuppressive or steroid therapy use, pneumonia, comorbid liver disease, and the use of inappropriate antimicrobial therapy. Conclusions: The use of appropriate antimicrobial therapy is critical for the effective management of infections caused by Elizabethkingia spp. Antimicrobial susceptibility testing would be a more reliable means of guiding treatment. The identification of the best antimicrobial drugs is needed to ensure optimal treatment recommendations for treating Elizabethkingia-related infections.

Assessment of Bacterial Contamination in Used Cosmetic Contact Lenses Among Women Visiting Beauty Salons in Sabratha City

This study aimed to assess bacterial contamination in cosmetic contact lenses used by women visiting beauty salons in Sabratha city and to evaluate the antibacterial susceptibility of the isolated bacteria. A total of 50 used soft cosmetic contact lenses and 5 new (unused) lenses were collected in April 2023. The lenses were swabbed, and samples were incubated in nutrient broth for bacterial isolation, followed by streaking on different agar plates (nutrient agar, MacConkey agar, and blood agar). Antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method, with various antibiotics. The results showed that all 5 unused lenses were free from contamination, while 43 out of 50 used lenses (86%) exhibited microbial contamination. The most commonly isolated bacteria were Pseudomonas aeruginosa (35%), Staphylococcus epidermidis (25%), and Staphylococcus aureus (15%), along with other species (11%). Antibiotic susceptibility testing revealed that Ciprofloxacin, Cefotaxime, Ceftriaxone, and Imipenem had the highest antibacterial effectiveness, with inhibition zones ranging from 26 mm to 30 mm. Gentamycin, Amikacin, and Tobramycin showed moderate effectiveness, while Cefuroxime and Augmentin had lower effectiveness. Cloxacillin showed no antibacterial activity. The findings emphasize the high risk of bacterial contamination in cosmetic contact lenses, stressing the importance of maintaining strict hygiene practices to prevent eye infections. Proper disinfection and storage in sterile solutions are crucial for ensuring lens safety and longevity, while effective antibiotic treatments are necessary to control bacterial contamination.

Early identification and diagnosis, pathophysiology, and treatment of sepsis-related acute lung injury: a narrative review.

Sepsis is a life-threatening organ dysfunction, and the most common and vulnerable organ is the lungs, with sepsis-related acute respiratory distress syndrome (ARDS) increasing mortality. In recent years, an increasing number of studies have improved our understanding of sepsis-related ARDS in terms of epidemiology, risk factors, pathophysiology, prognosis, and other aspects, as well as our ability to prevent, detect, and treat sepsis-related ARDS. However, sepsis-related lung injury remains an important issue and clinical burden. Therefore, a literature review was conducted on sepsis-related lung injury in order to further guide clinical practice in reducing the acute and chronic consequences of this condition. This study conducted a search of the MEDLINE and PubMed databases, among others for literature published from 1991 to 2023 using the following keywords: definition of sepsis, acute lung injury, sepsis-related acute lung injury, epidemiology, risk factors, early diagnosis of sepsis-related acute lung injury, sepsis, ARDS, pathology and physiology, inflammatory imbalance caused by sepsis, congenital immune response, and treatment. This review explored the risk factors of sepsis, sepsis-related ARDS, early screening and diagnosis, pathophysiology, and treatment and found that in view of the high mortality rate of ARDS associated with sepsis. In response to the high mortality rate of sepsis-related ARDS, some progress has been made, such as rapid identification of sepsis and effective antibiotic treatment, early fluid resuscitation, lung-protective ventilation, etc. Sepsis remains a common and challenging critical illness to cure. In response to the high mortality rate of sepsis-related ARDS, progress has been made in rapid sepsis identification, effective antibiotic treatment, early fluid resuscitation, and lung-protective ventilation. However, further research is needed regarding long-term effects such as lung recruitment, prone ventilation, and the application of neuromuscular blocking agents and extracorporeal membrane oxygenation.

Efficacy of Tedizolid Phosphate in Treating Mastitis: A Clinical Outcome Analysis

Background: Mastitis is a common inflammatory condition of the breast, often requiring effective antibiotic treatment. This study evaluates the efficacy of tedizolid phosphate in treating mastitis among patients in an outpatient setting. Methods: A total of 100 patients diagnosed with mastitis at the OPD of Prime Hospital, Maijdee, Noakhali, were enrolled in this study between July 1, 2023, and June 30, 2024. Patients received tedizolid phosphate, and outcomes were assessed through clinical examination and follow-up. The study focused on symptom resolution, duration of antibiotic course, and adjunctive treatments. Result: The majority of patients (45.0%) were aged 21-30 years. The most common symptoms were breast pain (60.0%), breast lump (40.0%), and nipple discharge (25.0%). All participants underwent imaging, with 45.0% showing mastitis in the right breast and 30.0% in the left. Tedizolid phosphate was prescribed to 100% of patients, with completing a 6-day course. Symptom improvement was observed in 85.0% of cases, with partial improvement in 15.0%. No cases of non-improvement or worsening were recorded. Conclusion: Tedizolid phosphate demonstrated high efficacy in treating mastitis, with a significant proportion of patients achieving full symptom resolution. The findings support its use as a reliable treatment option, though further studies with longer follow-up and microbiological analyses are recommended to confirm these results.

Microbiological Profiles of Patients with Spondylodiscitis.

Spondylodiscitis is a severe spinal infection that requires an effective antibiotic treatment. Therefore, we sought to analyse the causative pathogens from intraoperative specimen in patients with spondylodiscitis and a need for surgery. To this end, we performed a retrospective study of all patients with spondylodiscitis and a need for operative treatment admitted to our hospital between January 2020 and December 2022. A total of 114 cases with spondylodiscitis were identified. A total of 120 different pathogens were detected. Overall, 76.7% of those microorganisms were Gram-positive bacteria. The most common causative pathogen was Staphylococcus aureus (n = 32; 26.6%), followed by coagulase-negative staphylococci (n = 28; 23.4%), of which Staphylococcus epidermidis (n = 18; 15%) was the most frequently detected, as well as enterococci (n = 10; 8.4%) and Streptococcus spp. (n = 11; 9.2%). Moreover, 19.1% (n = 22) and 3.4% (n = 4) of all detected isolates were Gram-negative pathogens or fungi, respectively. Overall, 42.8% of all coagulase-negative staphylococci were oxacillin-resistant, while none of them were vancomycin-resistant. In summary, 50% of the pathogens could be identified as staphylococci. The results of our study highlight the important burden of oxacillin-resistant Gram-positive bacteria as an aetiological cause of spondylodiscitis, providing a relevant finding for antimicrobial stewardship programmes.

Clinical, Microbiological Profile, and Treatment Outcomes of Carbapenem-Resistant Urinary Tract Infections in a Tertiary Care Hospital

Background Carbapenem-resistant urinary tract infections (CR-UTIs) are a major global health threat. Many factors contribute to the increasing incidence of CR-UTI. Owing to the limited availability of treatment options, CR-UTIs are highly challenging to treat. Materials and Methods This was a single-center, hospital-based, observational, retrospective cohort study. We investigated the treatment results, microbiological profiles, and clinical manifestations of CR-UTI at our institution between January 2017 and December 2021. All patients exhibiting clinical signs and symptoms of urinary tract infection (UTI) and a urine culture that showed growth of a single organism greater than 105 colony-forming units/ml were included. All patients were considered for a 1-year follow-up. Results From January 2017 to December 2022, 3016 (31%) CR-UTI episodes were noted. Approximately, 75% of CR-UTI episodes were caused by the most prevalent urinary pathogens, Escherichia coli and Klebsiella pneumoniae. Within 28 days, 308 patients (12.59%) died. Enterobacteriaceae treated for a minimum of 7–10 days showed a greater response to Aminoglycosides, Fosfomycin, Ceftizoxime, Colistin with Carbapenem, Tigecycline with Carbapenem, and Ceftazidime/avibactam. Within a year, 994 CR-UTI episodes were identified in patients who were available for follow-up; and 38% of these episodes were the result of relapse. Three-quarters of the remaining incidents were recurrent, accounting for a higher mortality rate (14.2%) within a year. Conclusion Despite effective antibiotic treatment, CR-UTIs are associated with early relapse and recurrence. Newer effective treatment and preventive strategies are required to address this pandemic.

MOFs meet wood with enlarged pores: A high-capacity and efficient removal of ciprofloxacin from water

The abuse of ciprofloxacin (CIP) has caused considerable worry because it not only seriously contaminates the environment but also endangers the ecology. Thus, effective antibiotic wastewater treatment technologies should be explored. In this paper, Hypericum residues were first pretreated with acidic deep eutectic solvents (DES) to remove lignin and hemicellulose (DH1 and DH2). Then, zeolite imidazolate frameworks (ZIF-8 and ZIF-67) were loaded on the wood to obtain four composites (collectively referred to as DH/ZIF), which were used for CIP removal from wastewater. The enlarged pore size of the wood's provided sufficient attachment sites for ZIF-8 and ZIF-67, which facilitated the efficient adsorption of CIP by the composites. The adsorption of CIP by all four composites (DH1/ZIF-8, DH2/ZIF-8, DH1/ZIF-67, DH2/ZIF-67) was above 1400 mg/g. The results of characterization, data fitting and parameterization suggest that pore filling, hydrogen bonding, electrostatic interactions and π-π stacking are the main mechanisms of CIP adsorption. In summary, DESs show great potential and broad utility in modifying waste biomass and compounding it with MOF to remove antibiotic contaminants.

Pre- and Post-debridement Wound Cultures in Gustilo Type III Open Tibial Fractures to Predict Wound Infection at a Tertiary Care Hospital.

Gustilo type III open tibial fractures are difficult injuries that carry a higher risk of infection and other consequences. Open-fracture wound microbiology is dynamic and responsible for change over time. Effective antibiotic treatment plans are required, as detrimental microorganisms are often linked to these types of lesions. The study aimed to determine whether pre- and post-debridement wound cultures could predict wound infection in Gustilo type III open tibial fractures. This prospective study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, Bangladesh, on 344 patients who presented to the emergency department with a Gustilo type III open tibial fracture within 24 hours of injury from June 2018 to October 2019. Three successive cultures were carried out: one in the emergency room (surveillance culture), the second at the emergency theater after debridement, and the third in the ward after one week (seven to 10 days). Statistical analyses of the results were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY). The study included 344 patients with an average age of 37.15 years, with motor vehicle accidents being the primary cause (78.2%). Gustilo type IIIA fractures made up the majority (48.5%), followed by type IIIB fractures (44.8%). A significant reduction in contamination rates was observed from initial admission (48.8%) to post-debridement (36.6%) (p =.001). There was a significant positive correlation between pre-debridement cultures and wound infections (r =.311), as well as between post-debridement cultures and wound infections. The infection rate increased to 61.6% in ward samples, indicating a high rate of hospital-acquired infections. Pseudomonas and Klebsiella species were the most prevalent multidrug-resistant bacteria that caused these infections. The present study provides information on the relationship between contamination and infection. Gram-negative pathogens were dominant in this study, and the results of the antibiograms showed an alarming pattern of resistance. Nosocomial infection demands further urgent study.

Prevalence and Antibiogram of Escherichia coli Isolated from Children Under Five Years of Age Presented with Acute Diarrhoea: Cross Sectional Study from a Tertiary Care Centre in South India

Aim: The study aimed to analyze the prevalence and antibiogram of E. coli isolated from stool sample cultures collected from children below five years of age who were presented with acute diarrhoea in a tertiary care centre. Background: Multidrug-resistant strains of diarrheagenic E. coliremain a major public health concern for greater morbidity and mortality. Antibiotic resistance and susceptibility patterns of E. coli were found to vary with geographical location. Objective: To determine the prevalence and antibiogram of E. coli isolated from cultures of diarrhoea stool samples collected from children below five years of age from laboratory records. Methods: A cross-sectional study was designed to analyze the report on stool culture of children (aged below five years) presented with acute diarrhea during the period between 2017 and 2020. The prevalence of E. coli and its antibiogram were analyzed. The data were subjected to statis-tical analysis. Results: A total of 245 diarrhoea stool samples results were analyzed. E. coli was confirmed in 176 samples (72%). More number of isolates (51/176, 28.9%) were found in children below one year of age with male dominance. Amoxicillin resistance was found in all the E. coli strains isolated with no significant difference (p=0.2233) between genders and age groups below and above one year. A significant difference (p=0.0001) was found between male and female chil-dren of age below and above one year for cefotaxime and ciprofloxacin resistance. Polymyxin B (72%) followed by imipenem (69%) sensitivity was exhibited by the isolated E. coli strains. Conclusion: E. coli isolates were more sensitive to polymyxin B and imipenem while they were most resistant to amoxicillin. Effective antibiotic treatment strategies should be developed to control E. coli infections in children.

Impact of timing of antimicrobial therapy on outcome and mortality in severe sepsis and septic shock

Even though new antimicrobial treatments have been available for over 60 years, the fatality rate from septic shock has not decreased. Evolutionary pressure on microbial pathogens has, as expected, led to selection towards resistant species as a consequence of the creation of ever more broad-spectrum and strong antimicrobials. The ineffectiveness of antibiotic treatment of septic shock un the decades that followed may have been a result of this phenomena. The treatment of septic shock has traditionally focused on resuscitative measures. The management of these serious illnesses has not prioritised the prompt provision of effective antibiotic treatment.

Efficacy of Fecal Microbiota (REBYOTA) in Recurrent Clostridium difficile Infections: A Systematic Review and Meta-Analysis.

Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated diarrhea, and recurrent infections are common despite effective antibiotic treatments. Recurrent CDI causes a significant burden to the patient and healthcare system, which has led to efforts to find an effective treatment to prevent recurrent CDI. Recent studies have shown the efficacy and safety of orally and rectally administered microbiota treatment to prevent recurrent Clostridium difficile. This study systematically reviewed the data on the efficacy and safety of RBX2660 (REBYOTA®), the first rectally administered microbiota product to prevent recurrent Clostridium difficile infections approved by the United States Food and Drug Administration (FDA). Our analysis showed that RBX2660 (REBYOTA) effectively prevented recurrent CDI. Patients who received RBX2660 (REBYOTA) were significantly less likely to have recurrent Clostridium difficile than controls eight weeks after treatment. This effect is seen in both those who got one or two doses of RBX2660 (REBYOTA), although the FDA currently approves one dose.

Immune recovery uveitis in Whipple’s disease: an unusual ocular presentation

PurposeTo describe an unusual case of Whipple’s disease (WD) complicated by uveitis, and subsequent paradoxical worsening after effective antibiotic treatment targeting Tropheryma whipplei (TW).MethodsCase report.ResultsA 53-year-old male presented with bilateral knee arthritis, weight loss, chronic low-grade fever, and cognitive disorders. He was under treatment with tumor necrosis factor α inhibitors (TNFi) for seronegative spondyloarthritis. Given this unusual clinical presentation, further investigations were performed and revealed blood, saliva, stool, synovial fluid and cerebrospinal fluid positivity for TW, confirming the diagnosis of systemic WD. Ophthalmologic examination revealed bilateral posterior uveitis and an aqueous humor sample confirmed the presence of intraocular TW. TNFi were stopped, and the patient was subsequently treated with adequate antibiotics (ceftriaxone, followed by doxycycline and hydroxychloroquine), and subconjunctival corticosteroid injections. After a transient improvement of the ocular symptoms, he presented a recurrence of posterior segment inflammation, leading to repeated PCR testing for TW which were negative. Therefore, paradoxical worsening of the inflammation in the context of immune recovery uveitis (IRU) was thought to be the culprit. The patient was treated with systemic corticosteroid therapy, allowing for rapid improvement of the ocular findings.ConclusionsThis case underlines the possibility of IRU complicating WD. Ophthalmologists, rheumatologists, and internists should be aware of this rare complication, particularly in the context of previous immunosuppressive therapy.

Simulated drug disposition in critically ill patients to evaluate effective PK/PD targets for combating Pseudomonas aeruginosa resistance to meropenem.

Bacterial infections, including those caused by Pseudomonas aeruginosa, often lead to sepsis, necessitating effective antibiotic treatment like carbapenems. The key pharmacokinetic/pharmacodynamic (PK/PD) index correlated to carbapenem efficacy is the fraction time of unbound plasma concentration above the minimum inhibitory concentration (MIC) of the pathogen (%fT > MIC). While multiple targets exist, determining the most effective one for critically ill patients remains a matter of debate. This study evaluated meropenem's bactericidal potency and its ability to combat drug resistance in Pseudomonas aeruginosa under three representative PK/PD targets: 40% fT > MIC, 100% fT > MIC, and 100% fT > 4× MIC. The hollow fiber infection model (HFIM) was constructed, validated, and subsequently inoculated with a substantial Pseudomonas aeruginosa load (1 × 108 CFU/mL). Different meropenem regimens were administered to achieve the specified PK/PD targets. At specified intervals, samples were collected from the HFIM system and subjected to centrifugation. The resulting supernatant was utilized to determine drug concentrations, while the precipitates were used to track changes in both total and drug-resistant bacterial populations over time by the spread plate method. The HFIM accurately reproduced meropenem's pharmacokinetics in critically ill patients. All three PK/PD target groups exhibited a rapid bactericidal response within 6 h of the initial treatment. However, the 40% fT > MIC and 100% fT > MIC groups subsequently showed bacterial resurgence and resistance, whereas the 100% fT > 4× MIC group displayed sustained bactericidal activity with no evidence of drug resistance. The HFIM system revealed that maintaining 100% fT > 4× MIC offers a desirable microbiological response for critically ill patients, demonstrating strong bactericidal capacity and effective prevention of drug resistance.

Considering kidney stones and the bidirectional relationship between nephrolithiasis and urinary Tract Infection (UTIs): a systematic review of the literature on cause and effect

Urinary tract infections (UTIs) and kidney stones also known as nephrolithiasis, it have complicated and reciprocal interaction that makes both conditions worse. We conducted an extensive study to ascertain the connection between “kidney stone disease (KSD)” and recurrent “Urinary Tract Infection (UTIs)”, as well as to evaluate the impact of kidney stone treatment on UTI resolution. We found that there is a strong correlation between KSD and UTI in several studies after evaluating 15 publications. Though the technique resolves UTIs, there is conflicting information about the likelihood of recurrence following kidney stone removal surgery. Our understanding of the potential role of bacteria in the genesis of "metabolic" stones can improve with the aid of vitro research. Our study shows that KSD and UTIs coexist and have an influence on one another. Consequently, individuals with a history of urinary tract infections (UTIs) or other risk factors can be advised to pursue prophylactic measures such kidney stone removal, regardless of the kind of stone. A stone culture test should be conducted to determine the specific bacteria causing the UTI to reduce the likelihood of recurring episodes and to enable more precise and effective antibiotic treatment strategy.

Sepsis Stewardship: The Puzzle of Antibiotic Therapy in the Context of Individualization of Decision Making.

The main recent change observed in the field of critical patient infection has been universal awareness of the need to make better use of antimicrobials, especially for the most serious cases, beyond the application of simple and effective formulas or rigid protocols. The increase in resistant microorganisms, the quantitative increase in major surgeries and interventional procedures in the highest risk patients, and the appearance of a significant number of new antibiotics in recent years (some very specifically directed against certain mechanisms of resistance and others with a broader spectrum of applications) have led us to shift our questions from "what to deal with" to "how to treat". There has been controversy about how best to approach antibiotic treatment of complex cases of sepsis. The individualized and adjusted dosage, the moment of its administration, the objective, and the selection of the regimen are pointed out as factors of special relevance in a critically ill patient where the frequency of resistant microorganisms, especially among the Enterobacterales group, and the emergence of multiple and diverse antibiotic treatment alternatives have made the appropriate choice of antibiotic treatment more complex, requiring a constant updating of knowledge and the creation of multidisciplinary teams to confront new infections that are difficult to treat. In this article, we have reviewed the phenomenon of the emergence of resistance to antibacterials and we have tried to share some of the ideas, such as stewardship, sparing carbapenems, and organizational, microbiological, pharmacological, and knowledge tools, that we have considered most useful and effective for individualized decision making that takes into account the current context of multidrug resistance. The greatest challenge, therefore, of decision making in this context lies in determining an effective, optimal, and balanced empirical antibiotic treatment.

Inorganic Polyphosphate Affects Biofilm Assembly, Capsule Formation, and Virulence of Hypervirulent ST23 Klebsiella pneumoniae.

The emergence of hypervirulent Klebsiella pneumoniae (hvKP) strains poses a significant threat to public health due to high mortality rates and propensity to cause severe community-acquired infections in healthy individuals. The ability to form biofilms and produce a protective capsule contributes to its enhanced virulence and is a significant challenge to effective antibiotic treatment. Polyphosphate kinase 1 (PPK1) is an enzyme responsible for inorganic polyphosphate synthesis and plays a vital role in regulating various physiological processes in bacteria. In this study, we investigated the impact of polyP metabolism on the biofilm and capsule formation and virulence traits in hvKP using Dictyostelium discoideum amoeba as a model host. We found that the PPK1 null mutant was impaired in biofilm and capsule formation and showed attenuated virulence in D. discoideum compared to the wild-type strain. We performed a proteomic analysis to gain further insights into the underlying molecular mechanism. The results revealed that the PPK1 mutant had a differential expression of proteins involved in capsule synthesis (Wzi-Ugd), biofilm formation (MrkC-D-H), synthesis of the colibactin genotoxin precursor (ClbB), as well as proteins associated with the synthesis and modification of lipid A (ArnB-LpxC-PagP). These proteomic findings corroborate the phenotypic observations and indicate that the PPK1 mutation is associated with impaired biofilm and capsule formation and attenuated virulence in hvKP. Overall, our study highlights the importance of polyP synthesis in regulating extracellular biomolecules and virulence in K. pneumoniae and provides insights into potential therapeutic targets for treating K. pneumoniae infections.

Intestinal Tuberculosis with Small Bowel Perforation in a Patient with AIDS: A Case Report

Tuberculosis is an infection that continues to be a global health problem, mainly in underdeveloped countries. Intestinal presentation is rare but increases in immunocompromised patients. Its symptoms are variable and can mimic chronic inflammatory diseases, leading to a difficult initial diagnosis, complications, and increased mortality. We present the case of a young and recently diagnosed HIV patient with chronic and nonspecific condition of diarrhea and abdominal pain, which was complicated by intestinal perforation triggered by an extrapulmonary infection and Mycobacterium tuberculosis. It was resolved by surgery, leading to a pathological diagnosis by biopsy, followed by effective antibiotic treatment.