Bio-inspired biomaterial coating for enzyme responsive release of antimicrobial peptides.

BackgroundProphylactic antibiotics for Gustilo-Anderson type III open fractures are cefazolin plus gentamicin (CG) at many institutions. Adverse effects such as nephrotoxicity make gentamicin a less appealing drug, particularly in trauma patients. The purpose of our study was to compare piperacillin-tazobactam (PT) with conventional antibiotics in preventing surgical site infections (SSIs) in lower extremity type III open fractures.MethodsThis was a single-center, retrospective analysis of 164 patients with lower extremity type III open fractures at the University of North Carolina at Chapel Hill, a large academic level one trauma center in Chapel Hill, North Carolina. They were treated with three different antibiotic regimens that comprised the cohort. Patients were separated into three groups: those receiving PT, CG, or cefazolin plus gentamicin plus injected tobramycin (CGT), depending on current protocols or the surgeon's discretion. Primary outcomes are deep (requiring return to OR) and superficial (requiring antibiotics only) SSIs, as well as nonunions, during a postoperative period of 12 months.ResultsOur retrospective analysis from 2008 to 2019 revealed 164 type III open fractures. Seventy-two fractures were treated with PT, 44 with CG, and 48 with CGT. There was not a statistically significant difference in deep or superficial infections among the three groups (p = 0.41, p = 0.52, respectively). Nonunion rates were also not significantly different.ConclusionsThe results of this study demonstrate no significant difference in SSIs or nonunion rate between PT, CG, and CGT when used for infection prophylaxis in type III open fractures. We believe prophylaxis with PT may be equivalent to traditional regimens, potentially with fewer adverse effects, particularly in polytraumatized patients.

Surgical site infections (SSIs) are a common cause of morbidity and mortality in both adults and children. In paediatric surgery, evidence on specific prevention measures is lacking, and practices mainly depend on local guidelines and the preferences of the treating team. To investigate current practices for children undergoing surgery with respect to SSI prevention using a standardized surveillance tool. Nine Swiss paediatric surgery centres participated in a standard period prevalence study. SSI prevention measures were recorded in these hospitals over 7 consecutive days in October 2022 for any paediatric surgical procedure resulting in a surgical wound. The SSI prevention measures of interest were drawn from the most recent World Health Organization guidelines. In total, 351 procedures were included. All Swiss language regions were represented. Traumatologic/orthopaedic surgeries were most common. Surgical antibiotic prophylaxis was administered in 161/351 (46%) cases, although in 33/161 (21%) cases, there was no indication for the administration of antibiotics. Alcohol-based or iodine-based solutions were most often used for surgical skin preparation. Antimicrobial-coated sutures were only used in 84/351 (24%) cases. Regional differences in prevention measures were noted between participating centres for skin preparation solution, suture material, wound dressing, and implementation of warming devices. This study provides an overview of current SSI prevention practices in Swiss paediatric surgery centres, identifies targets for improvement, and highlights areas of clinical uncertainty requiring further investigation. The findings underscore the need for standardized guidelines to ensure consistent and evidence-based SSI prevention strategies in paediatric surgery.

Amoxicillin is frequently prescribed to peripartum women as prophylaxis and treatment for infection. Despite frequent usage of amoxicillin in lactating women, quantitative evidence regarding its transfer between systemic circulation and breastmilk remains limited. However, such data is fundamentally essential for assessing the safety risk of medicine usage during breastfeeding. This research performed population pharmacokinetic (PopPK) modeling and simulation to characterize the pharmacokinetics of amoxicillin in plasma and breastmilk in lactating Göttingen Minipigs, a physiologically relevant animal model to humans that enables studying medication transfer during lactation. Demographic characteristics and amoxicillin concentrations in plasma and breastmilk following daily intramuscular doses (7mg/kg) in 9 minipigs from two studies were included in the PopPK analysis. The milk-to-plasma (M/P) ratio, daily infant dosage (DID), and relative infant dose (RID) were calculated based on the simulated steady-state exposure. The final model consisted of a two-compartment distribution with zero-order absorption and linear elimination. The central compartment was deemed as the plasma compartment with time-varying volume of distribution, and linked to the breastmilk compartment via bidirectional first-order transfer. No covariate was included. The developed PopPK model well described amoxicillin in plasma and breastmilk in the lactating Göttingen Minipigs. The predicted M/P ratio, DID, and RID of amoxicillin following the maximal doses were approximately 0.25, 0.11mg·kg-1·day-1, and 1.6% for Göttingen Minipigs, respectively. The model-based simulation indicated minimal amoxicillin exposure to the breastfed piglets, suggesting a low safety risk, which was reinforced by the absence of adverse events in the piglets.

The emergence of bispecific antibodies for multiple myeloma presents a critical unanswered question for solid organ transplant recipients: Can these T-cell dependent therapies overcome concurrent immunosuppression without triggering graft rejection? While teclistamab and similar agents demonstrate remarkable efficacy in immunocompetent patients, their mechanism demands functional T-cells-precisely what calcineurin inhibitors and antimetabolites suppress in transplant recipients. This creates a perilous therapeutic trilemma: (1) Maintaining standard immunosuppression risks blunting bispecific efficacy, (2) reducing immunosuppression may precipitate graft rejection, while (3) both strategies compound already elevated infection risks from dual immunosuppressive effects. Our experience treating two renal transplant recipients with teclistamab reveals these tensions in practice-one patient achieved sustained response without rejection, while another faced infectious complications preceding disease progression. These cases highlight three urgent research priorities: prospective studies to define (a) minimum effective immunosuppression levels during bispecific therapy, (b) biomarkers predicting graft rejection risk, and (c) optimal infection prophylaxis strategies. Until such data exists, clinicians navigate this high-stakes balancing act without evidence, forced to weigh theoretical risks of allograft loss against known mortality from progressive myeloma.

Adult entertainment work may be associated with increased vulnerability to sexually transmitted infections, particularly HIV. In Brazil, pre-exposure prophylaxis (PrEP) for HIV infection has been available through the Brazilian Unified Health System (SUS) since November 2017, representing a significant advancement in public sexual health policy. The objective of this study was to understand the individual and social determinants that promote PrEP use among adult entertainment workers. This was a cross-sectional, analytical, and quantitative study. A multivariate modeling approach was employed to identify factors independently associated with PrEP use. The study included 254 adult entertainment workers using oral PrEP through the SUS, predominantly young adults (141; 55.5%), SUS users (248; 97.6%), single (213; 83.9%), non-white (142; 55.9%), cisgender (148; 58.3%), and heterosexual (152; 59.8%). Factors independently associated with greater PrEP use included having adult entertainment as the main source of income (aPR: 2.69; 95% CI: 1.86–3.95), prior use of PEP (aPR: 2.49; 95% CI: 1.63–3.81), undergoing any type of health treatment (aPR: 1.56; 95% CI: 1.15–2.12), and having a history of STIs (aPR: 1.51; 95% CI: 1.10–2.08). Conclusion: PrEP use in this population was strongly influenced by structural and contextual factors, indicating that the availability of the technology alone does not ensure its effectiveness.

Bispecific antibodies (BsABs) have become a new standard of treatment of refractory/relapsed patients with diffuse large B-cell lymphoma and follicular lymphoma, being also intensively studied in other types of B-cell non-Hodgkin lymphoma (B-NHL). Since the therapy with BsABs results in profound B-cell depletion and T-cell exhaustion, it is associated with significantly increased risk of infections. Additional risk factors involve immune disorders caused by lymphoma itself and previous lines of therapy. In this review, we focus on the infectious complications in B-NHL patients treated BsABs, presenting their incidence in clinical trials, admittedly performed to a large extent during the COVID-19 pandemic, as well as the proposals of infection prophylaxis.

This article describes the creation of a post-transplantation patient education game geared toward the adolescent kidney transplant population, led by a pediatric transplant pharmacist and pharmacy students, that was implemented at a medium-sized pediatric kidney transplant program in a large academic health system. The program was designed to address gaps in adolescent transplant education by integrating interactive gamification techniques using Blooket, a free electronic platform that employs an engaging quiz-style format with games and in-game rewards to enhance user engagement. Pharmacy students actively participated in developing and refining the educational content to engage adolescent transplant patients in learning about their medications. The creation and implementation of the game, patient feedback, challenges encountered, and lessons learned during the pilot phase are discussed, highlighting the potential for gamification to improve knowledge of and adherence to immunosuppression and infection prophylaxis medications among adolescent transplant patients. Gamification offers a novel approach to enhancing medication education for adolescent transplant patients. The involvement of pharmacists and pharmacy students in developing and delivering gamified education can support patient engagement and transition to adult care. Future research is needed to evaluate the impact of gamification on clinical outcomes, including adherence and graft survival rates.

Use of antibiotic-impregnated discs in breast reconstruction among the obese population: A retrospective propensity score-matched analysis.

Abstract Background: Intensive chemotherapy used to treat acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is most likely to cause invasive fungal infection (IFI). The use of echinocandins and broad-spectrum azoles for prophylaxis is growing; however, the outcomes are not always consistent. The objective of this study was to evaluate the effectiveness and safety of micafungin and fluconazole for the prevention of IFIs in patients with ALL and AML, who underwent intensive chemotherapy. Materials and Methods: A retrospective cohort study was conducted on adult patients with AML and ALL who were hospitalized between January 2010 and June 2023 at King Fahad Specialist Hospital-Dammam, who received intensive chemotherapy. The data were collected from the hospital information system (HIS). Results: Out of 95 patients, 57 (60%) patients were treated with micafungin group and 38 (40%) patients were with fluconazole. The two groups were comparable in terms of outcome, mortality and hepatotoxicities. The percentages of patients who experienced IFIs did not differ significantly between the micafungin and fluconazole groups (P = 0.309). During prophylactic treatment, micafungin-treated group had numerically higher rate treatment success 63.24% n = 43/68 than fluconazole-treated group 36.76% n = 25/68. In spite of this, the two treatment groups did not differ significantly in terms of treatment success and probable IFIs (P = 0.309). The onset of fungal infection was 21.5 days and 23.69 days in the fluconazole and micafungin group, respectively. The duration of onset of fungal infection did not differ between the two treatment groups (P = 0.669). The median prophylactic treatment duration was 28 days in micafungin treatment group and 32 days in fluconazole group. In terms of therapy duration, there was no difference between the two treatment groups (P = 0.826). There was no significant difference in mortality rate between the two arms, (P = 0.608). There was no significant difference in renal and liver function between two treatment arms in terms of alanine transferase (ALT) (P = 0.201), alkaline phosphate (AST) (P = 0.14), and serum creatinine (P = 0.153) elevation but the increase in total bilirubin level was observed in the micafungin group (P = 0.034). No drug-related mortality or severe adverse drug reactions were reported. Conclusion: Micafungin and fluconazole are both considered to be safe and effective in the prophylaxis of fungal infections in patients with hematological malignancies. Micafungin has a favorable safety profile, while fluconazole has shown efficacy in reducing the incidence of fungal infections and mortality. The choice of these agents should be individualized according to the patient, renal function and the risk of specific mold pathogens.

Most common superficial fungal infection is caused by dermatophytes, which infects skin, hair, and nail in all age groups. Candida spp. is also a known causative agent for superficial mycoses. The prevalence also depends on different demographical variations. The present study was conducted to isolate and identify the fungal species by phenotypic and culture methods from patients suffering from superficial fungal infections and establish in vitro anti-fungal susceptibility testing on candida isolates. The skin scrapings, hair, nail clippings were collected from 330 patients, and KOH mount and fungal culture were performed. The culture-positive samples were subjected to lactophenol cotton blue (LPCB), slide culture and CHROM agar for species-level identification. Anti-fungal susceptibility testing was done on the candidaisolates. Out of 330 specimens collected, 161 (49%) were skin scrapings, 42 (13%) were hair samples, and 127 (30%) were nail clippings. Most commonly isolated was Candida spp. in nail and Trichophyton mentagrophyte in skin. Anti-fungal susceptibility was performed on the candida isolates, and caspofungin was found to be the most susceptible anti-fungal agent. All dermatophytes, non-dermatophyte molds (NDMs), and yeasts can cause infections of the skin, hair, and nails. The present study has highlighted the growing importance of NDMs as a cause of dermatomycoses. Among the Candida species, the most susceptible drug was caspofungin. The use of fluconazole in the prophylaxis of fungal infections in patients may be the cause of the rising fluconazole resistance rate among them and, hence, should be used cautiously.

Antibiotic allergies can complicate the treatment and prophylaxis of bacterial infections in the pediatric solid organ transplant population. This single-center retrospective study revealed that antibiotic allergy evaluations and testing could safely and effectively be performed in this population group, with a positive economic value associated with sulfonamide allergy delabeling.

Patients with neoplasms have a high predisposition to bacterial infections, due to the implemented treatment that impairs immunity and numerous risk factors. Numerous research studies have been published on this problem but epidemiological studies are insufficient, and existing data are difficult to generalize on different populations. The aim of the study was to assess the epidemiology of bacterial and fungal bloodstream infections and contaminations in cancer patients hospitalized between 2011 and 2021, with a focus on identifying predominant pathogens, resistance mechanisms, and evaluating the effectiveness of infection prophylaxis. We collected data of blood contaminations and infections epidemiology with cooperation with the Department of Clinical Microbiology UCH. Between 2011 and 2021, 7,667 blood samples were collected and 32,610 tests were performed on 1,914 patients. The analysed cultures were divided into 3 groups depending on the substrate specific for a given group of microorganisms. The number positive test result was 5.5%. The highest detection was noticed in 2021. Differences in the distribution of patients with positive and negative results in individual years were not statistically significant. The most common pathogen detected was Staphylococcus epidermidis, which was also the leader among Gram-positive microorganisms. There were not dominant species among the isolated Gram-negative microorganisms. Detection of anaerobic organisms was rare (only 4 different anaerobic organisms were isolated in single patients). The same was among the fungal observed. Mechanisms of resistance were included in the analysis of all identified strains- the most common was methicillin-resistant Staphylococcus epidermidis (MRSE). Our results confirmed that bacterial infections are still a problem and may indicate the effectiveness of prophylaxis. Most of our results are consistent with the current literature, however we were able to highlight data unique to our patient population. Our findings can be helpful for clinical practice and be base for further research.

Abstract Aim We present a case of spontaneous splenic rupture (SSR) in an 18-year-old male with acute Epstein-Barr virus (EBV) infection, illustrating the diagnostic and management challenges of this rare but life-threatening condition. The patient’s atypical presentation highlights the importance of clinical vigilance in cases of unexplained abdominal pain and emphasizes the need for early detection and timely intervention. This case underscores the critical role of imaging and serological testing in diagnosing SSR and advocates for a systematic approach to optimize outcomes. Method An 18-year-old male presented with a two-week history of generalized abdominal and chest pain radiating to the neck and shoulder, preceded by flu-like symptoms and two episodes of syncope. Clinical evaluation revealed no history of trauma. Computed tomography (CT) imaging identified a peri-splenic hematoma without evidence of laceration or active bleeding. Serological testing confirmed acute EBV infection. The patient was managed conservatively in the intensive therapy unit (ITU) with close monitoring, pain control, and infection prophylaxis. A literature review examined the pathophysiology, diagnostic challenges, and management strategies for SSR associated with EBV infection. Results The patient remained hemodynamically stable and underwent conservative management. Follow-up imaging confirmed a stable hematoma and repeat imaging for persistent pain showed no progression. Literature highlights that SSR in EBV infection often presents non-specifically, delaying diagnosis. Key diagnostic indicators include splenomegaly, elevated IgM antibodies, and CT findings. Conclusions This case underscores the importance of early recognition, timely imaging, and serological testing in managing SSR, particularly in EBV-associated cases. Proactive diagnostic and management strategies are essential to improving outcomes.

Abstract Aim Gentamicin is frequently administered to surgical patients for both prophylaxis and treatment of infections. Proper dosing and administration are crucial to maximize its therapeutic efficacy and minimize adverse effects. Local guidelines have been established to standardize dosing and monitoring practices. This audit aims to assess the appropriateness of gentamicin prescriptions in a surgical unit. Method This audit was conducted in a tertiary care hospital surgical unit over two months. Data were collected from gentamicin charts of surgical patients. The parameters assessed include the accuracy of initial dosages and the adherence to monitoring serum levels in accordance with these guidelines. Initial dosage accuracy was determined by comparing prescribed dosages to guideline-recommended values. Results In the first cycle, a total of 48 patients were reviewed throughout a one-week period. Initial dosage accuracy was high, with 70% of prescriptions aligning with recommended weight-based dosing protocols. However, adherence to serum level monitoring guidelines was suboptimal with only 55% of patients having serum levels measured within the appropriate timeframe. After implementing targeted interventions, including poster displays and departmental teaching, a reaudit at one and two months demonstrated substantial improvements. 92% of initial gentamicin dosages were accurately prescribed while adherence to monitoring serum levels has increased, with 78% of patients receiving timely measurements. Conclusions The audit demonstrated that targeted interventions such as appropriate visual reminders and departmental teaching, significantly improved adherence to guidelines for gentamicin prescribing.

The most cost-effective intravenous antibiotic prophylaxis for preventing prosthetic joint infection (PJI) in total hip arthroplasty (THA) has been a matter of debate. The aim of this study was to compare the cost differential between cefazolin and vancomycin as prophylactic options with a particular focus on costs associated with PJI management. Using previously published data on PJI rates associated with cefazolin and vancomycin, we modelled the cost of each prophylactic option. This model included unit prices for each drug obtained from our hospital's pharmacy service, as well as the labor costs associated with the hour-long period required for vancomycin administration. Cost of PJI accounted for the price of a 2-stage septic THA revision procedure. National projections were obtained to account for future THA volume. The average per-patient cost associated with cefazolin PJI prophylaxis was $1025.59, accounting for a PJI rate of 0.75%. The average per-patient cost associated with vancomycin PJI prophylaxis was $2710.82, accounting for a 1.47% PJI rate. The annual cost difference could amount to $2.4 billion by 2040 given projections of THA incidence. The per-patient cost associated with vancomycin PJI prophylaxis is 164% higher than that associated with cefazolin due to increased cost of primary treatment, labor costs associated with prolonged infusion time, and most importantly differential PJI rates (number needed to treat = 1.39). In an era of value-based care, the use of cefazolin has been consistently shown to be the gold standard for THA PJI prophylaxis and is associated with significant cost advantages.

Strategies to prevent surgical site infection and current antibiotic prophylaxis in surgery - IJPP- Print ISSN No: - 2393-9079 Online ISSN No:- 2393-9087 Article DOI No:- 10.18231/j.ijpp.2025.016, Indian Journal of Pharmacy and Pharmacology-Indian J Pharm Pharmacol

West Nile virus (WNV) causes thousands of arboviral infections in the United States each year. Patients with immune-compromising conditions and elderly people are at higher risk of severe WNV neuroinvasive disease (WNND). Despite its broad endemicity nationwide, no U.S. Food and Drug Administration-approved vaccine or therapeutic treatments exist. We summarized existing peer-reviewed literature on the preclinical development of monoclonal antibody (MAb) prophylaxis and therapeutics for the prevention and treatment of WNND. Five bibliographical databases (CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus) were searched for applicable research studies performed from 1 January 1998 to 1 May 2025. In total, 2347 titles and abstracts were screened, 263 full-text publications reviewed, and 25 studies included. Studies included detailed preclinical development and evaluations of MAbs targeting the envelope (E) protein (n = 13), other viral proteins (n = 3), flaviviral cross-protective monoclonal antibodies (n = 4), and novel antibody configurations or delivery methods (n = 5). The most well-studied MAb, E16, targeting E- Domain III (E-DIII), was effective at inhibiting and treating WNND in experimental animal models. No work investigated ways to traffic therapeutic antibodies across the blood-brain barrier. This review summarizes the current research in the development of monoclonal antibody therapeutics for WNV and addresses gaps in the knowledge for future consideration.

The escalating global burden of antimicrobial-resistant bacterial infections has necessitated the exploration of innovative therapeutic modalities. Bacterial biofilms, which constitute the predominant form of microbial existence in clinical infections, exhibit extraordinary recalcitrance to conventional antimicrobial interventions. This comprehensive review synthesizes emerging evidence regarding the therapeutic utility of Lactobacillus species as novel antimicrobial agents targeting biofilm-mediated pathogenicity. We analyzed current literature on Lactobacillus antimicrobial mechanisms, strain-specific activities, and clinical applications against multidrug-resistant pathogens. Our analysis encompasses the multifactorial mechanisms by which select Lactobacillus strains neutralize pathogenic biofilms, including metabolite-mediated toxicity, territorial competition, and host defence augmentation. Contemporary investigations reveal that specific isolates—L. plantarum, L. reuteri, L. helveticus, and L. rhamnosus—exhibit pronounced efficacy against clinically significant organisms, including carbapenem-resistant Klebsiella pneumoniae, extensively drug-resistant Escherichia coli, and device-colonizing Staphylococcus aureus. Notably, the expanding evidence base supporting postbiotic applications—specifically, acellular metabolite concentrates—presents distinct advantages for therapeutic implementation, including enhanced shelf stability, reproducible potency, and minimized safety concerns. Applications encompassing medical device surface modification, urinary tract infection prophylaxis, and oral cavity biofilm management demonstrate immediate clinical viability.

Sulfa antibiotic allergy labels (SALs) are encountered frequently in kidney transplant recipients (KTs). This often results in patients receiving second-line prophylaxis for both Pneumocystis jiroveci and urinary tract infections (UTIs). The effect of SAL on outcomes including UTIs after KT is unclear. In our single-center retrospective cohort study, we investigated the effect of SALs on bacteriuria after KT. We identified patients with pre-KT SALs from 2011 to 2022. A matched cohort was then created using KT with no pretransplant SALs. The groups were compared using proportional analysis and univariable and multivariable Cox proportional regression models. The primary outcome of interest was the proportion of individuals experiencing one or more episodes of bacteriuria within 1 year posttransplant. Secondary outcomes included bacteremic UTIs, acute kidney injury, and opportunistic infections. We found that the proportion of individuals experiencing bacteriuria within the first-year posttransplant was significantly greater in the SAL group versus the control group (n=21, 28%vs. n=22, 14.7%, p=0.012). This result was also seen in univariable and multivariable survival analysis. In addition, episodes of UTI with associated bacteremia (n=11, 14.7%vs. n=5, 3.3%, p=0.002) were statistically significantly higher in the SAL group. There was a significantly greater number of episodes of bacteriuria in the first-year posttransplant in subjects with pretransplant SAL. Based on our findings, we suggest that all KTs with pretransplant SALs undergo evaluation and intervention prior to transplantation.