Clin Microbiol Rev
· 2025 Dec · PMID 40919997
·
Full text
SUMMARY spp. are members of the order and are widely found in humans, animals, and the environment. Some species, particularly are highly pathogenic and are among the most frequent causes of urinary tract and bloodstre...SUMMARY spp. are members of the order and are widely found in humans, animals, and the environment. Some species, particularly are highly pathogenic and are among the most frequent causes of urinary tract and bloodstream infections. spp. possess a variety of virulence factors, such as swarming and urease activity, leading to persistent and severe infections. An increasing resistance to antibiotics has been reported for isolates and poses a substantial threat to global health. In recent years, several new spp. have been described, but their potential as pathogens has not yet been determined. Here, we provide an update on the taxonomy, virulence factors, and antibiotic resistance of spp.
Matsumura Y, Yamamoto M, Gomi R
… +4 more, Tsuchido Y, Shinohara K, Noguchi T, Nagao M
Clin Microbiol Rev
· 2025 Dec · PMID 40910632
·
Full text
Antimicrobial resistance (AMR) poses a significant threat to global public health. Surveillance is a fundamental method for controlling AMR and guiding clinical decisions, public health interventions, and policymaking. W...Antimicrobial resistance (AMR) poses a significant threat to global public health. Surveillance is a fundamental method for controlling AMR and guiding clinical decisions, public health interventions, and policymaking. Whole-genome sequencing (WGS) provides a comprehensive and accurate understanding of AMR mechanisms, gene profiling, and transmission dynamics. Public health authorities, academic scholars, hospitals, and laboratories have increasingly employed WGS-based surveillance for retrospective, real-time, and prospective monitoring of AMR and investigations of outbreaks. WGS-based surveillance has improved the accuracy and effectiveness of disease and AMR surveillance by identifying hidden transmissions and sources missed by conventional methods and by rapidly investigating and deploying infection control interventions. However, WGS analysis involves a complex combination of workflows of next-generation sequencing and bioinformatics data analysis, making it difficult to effectively compare surveillance results. It is crucial to understand the limitations of our existing WGS analyses by implementing rigorous validation practices across different WGS analyses, developing practice guidelines, and establishing appropriate quality assurance measures. These efforts will aid in the development of reliable and robust WGS systems, the harmonization and standardization of surveillance programs, and the development of public data sharing and governance frameworks. Despite these challenges, the expansion of WGS-based AMR surveillance is expected to be driven by technological advances, standardization efforts, and the recognition of its advantages among stakeholders. The integration of genomic data with nongenomic information, as well as interdisciplinary collaborations will further enhance knowledge regarding AMR and promote the development of countermeasures.
Clin Microbiol Rev
· 2025 Dec · PMID 40910631
·
Full text
SUMMARYDengue is an acute mosquito-borne viral disease that is highly prevalent throughout the tropical world. The geographic footprint of the four dengue viruses (DENV-1 to -4) that cause this disease and their mosquit...SUMMARYDengue is an acute mosquito-borne viral disease that is highly prevalent throughout the tropical world. The geographic footprint of the four dengue viruses (DENV-1 to -4) that cause this disease and their mosquito vector is expanding, extending into North America and Mediterranean Europe. Furthermore, although dengue has historically been a disease that disproportionately affects children, changing population demographics and increasing travel to and from the tropics have contributed to a growing incidence in adults. Dengue in adults, particularly older adults, brings fresh and complex challenges to case management. Although dengue is now a vaccine-preventable disease, the efficacy profiles of licensed vaccines as well as those in late-stage clinical development suggest that vaccination alone would not fully retard the global expansion of dengue. Other countermeasures, including antiviral drugs, will be needed. This paper reviews the molecular interplay underlying dengue pathogenesis, including from virological and immunological perspectives, which are foundational for developing antiviral therapies and new vaccines. It also reviews the hurdles facing antiviral development and discusses new insights on dengue immunity that can guide the deployment of imperfect vaccines to begin reversing the global burden of dengue.
Francisco EC, Caceres DH, Brunelli JGP
… +9 more, Garcia-Effron G, Arastehfar A, Ribeiro FdC, de Almeida MN, Gonçalves SS, Nóbrega de Almeida J, Lass-Flörl C, Boekhout T, Colombo AL
Clin Microbiol Rev
· 2025 Dec · PMID 40900145
·
Full text
SUMMARYMany yeast species causing life-threatening invasive infections that were formerly classified in the genus have been reclassified due to their evolutionary and phylogenetic relationships elucidated by DNA sequenc...SUMMARYMany yeast species causing life-threatening invasive infections that were formerly classified in the genus have been reclassified due to their evolutionary and phylogenetic relationships elucidated by DNA sequencing methods that are increasingly using whole genomes. This review explores the evolving taxonomy, epidemiology, and clinical implications of clinically relevant, rare, emerging and Saccharomycotina yeasts that have recently been reclassified from . This article highlights the urgent need for intensified research efforts to enhance knowledge and improve outcomes in the management of infections caused by these yeasts. Communicating results from molecular phylogenetic studies of yeasts, which lead to their reclassification, is of great importance to the medical mycology community to implement such results in clinical practice.
Clin Microbiol Rev
· 2025 Dec · PMID 40899846
·
Full text
SUMMARYThe penem and carbapenem antibiotics provide some of the broadest spectrum coverage available and generally should only be used when narrower options are unavailable. The majority of available carbapenems can only...SUMMARYThe penem and carbapenem antibiotics provide some of the broadest spectrum coverage available and generally should only be used when narrower options are unavailable. The majority of available carbapenems can only be administered parenterally, but two orally administered penems (faropenem and sulopenem) and one orally administered carbapenem (tebipenem) are in increased use due to approvals in new markets. These oral agents have a spectrum of activity similar to widely used parenteral carbapenems but are simpler to administer than intravenous agents and will likely experience rapid increases in their rates of use as they are approved in new markets. In this review, we discuss their spectra of activity, pharmacokinetics, pharmacodynamics, clinical efficacy, toxicity, antimicrobial stewardship considerations, and potential clinical applications.
Butel-Simoes G, Moso MA, Ramachandran P
… +3 more, Graham M, Williamson DA, Lim CK
Clin Microbiol Rev
· 2025 Dec · PMID 40879203
·
Full text
SUMMARYLaboratory-acquired infections (LAIs), particularly those from high-risk viruses, pose significant threats to exposed individuals and to the general public. In this review, we evaluate the existing evidence for vi...SUMMARYLaboratory-acquired infections (LAIs), particularly those from high-risk viruses, pose significant threats to exposed individuals and to the general public. In this review, we evaluate the existing evidence for viral LAI prevention, including available vaccinations, post-exposure prophylaxis (PEP), and follow-up procedures following occupational exposure to Risk Group 3 and 4 viral infectious agents within clinical testing laboratories. This review provides guidance on the therapeutic options and follow-up, all essential for preparedness planning and timely management in the event of exposure.
Clin Microbiol Rev
· 2025 Dec · PMID 40844293
·
Full text
SUMMARYViral infections remain a significant and predictable challenge in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Although antiviral drugs are commonly used for prophylaxis...SUMMARYViral infections remain a significant and predictable challenge in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Although antiviral drugs are commonly used for prophylaxis or early treatment, their long-term use is limited by toxicity, high costs, and the emergence of drug-resistant viral strains, often leading to treatment failure. Cellular immune therapies, particularly adoptive transfer of virus-specific T cells (VSTs), have emerged as a promising alternative, with proven efficacy in controlling hematological malignancies and severe viral infections. While donor-derived VSTs can effectively suppress viral replication in HSCT and SOT recipients, this approach is not feasible when donors are seronegative or inaccessible. A novel single-platform technology now allows for the rapid generation of multi-virus-specific T cells from healthy donors, broadening the applicability of this strategy. In addition, immune monitoring tools can help identify high-risk patients, enabling earlier and more targeted interventions. Emerging data suggest that adoptive T-cell therapy may be used not only therapeutically but also prophylactically, potentially replacing conventional antivirals and reducing adverse effects in immunocompromised patients. This review provides historical foundations and recent advancements in the use of adoptive T-cell therapies for virus-associated complications in transplant recipients.
Clin Microbiol Rev
· 2025 Sep · PMID 40787933
·
Full text
SUMMARY has emerged as a formidable global health concern and is a major contributor to infection-related mortality in critically ill patients worldwide. This versatile Gram-negative bacterium is notorious for its highly...SUMMARY has emerged as a formidable global health concern and is a major contributor to infection-related mortality in critically ill patients worldwide. This versatile Gram-negative bacterium is notorious for its highly plastic genome, which enables the rapid emergence and dissemination of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, severely limiting the available treatment options. The genetic flexibility of underpins its arsenal of molecular mechanisms, enabling it to resist a range of antibiotics, from traditional agents to the latest therapeutic advancements available. With the progress made in treatments against infections and various drugs undergoing clinical trials, the effectiveness of these treatments is often outpaced by the pathogen's swift evolution of resistance, resulting in alarmingly high rates of treatment failure. In this systematic review of literature spanning 2004-2024, we highlight the high mortality rates associated with infections caused by XDR strains and carbapenem-resistant (CRAB). This review provides a comprehensive examination of the resistance mechanisms deployed by , encompassing both conventional antibiotics and novel agents used in global healthcare settings. In addition, we discuss emerging druggable targets and the inherent challenges in their development, offering strategic insights into next-generation therapeutic programs. A deep profound understanding of the pathogen's molecular defenses is essential to guide the design of innovative therapies aimed at mitigating the escalating threat posed by .
Foley DA, Smith DW, Barr I
… +3 more, Moore HC, Nicol M, Blyth CC
Clin Microbiol Rev
· 2025 Sep · PMID 40748057
·
Full text
SUMMARYRespiratory syncytial virus and human metapneumovirus are major causes of respiratory illness globally, particularly affecting children and older adults. Despite their clinical significance, substantial gaps persi...SUMMARYRespiratory syncytial virus and human metapneumovirus are major causes of respiratory illness globally, particularly affecting children and older adults. Despite their clinical significance, substantial gaps persist in understanding the determinants of their transmission. This review examines the multifaceted factors shaping RSV and hMPV transmission, including viral structure and evolution, host behaviors and viral shedding dynamics, the influence of environmental conditions on viral survival, the roles of population- and community-level transmission networks, and the impact of SARS-CoV-2. Additionally, we explore prevention strategies, including immunizations and non-pharmaceutical interventions, to reduce transmission in high-risk settings.
Bonnin RA, Jousset AB, Jacquemin A
… +4 more, Emeraud C, Girlich D, Naas T, Dortet L
Clin Microbiol Rev
· 2025 Sep · PMID 40748056
·
Full text
SUMMARYMetallo-beta-lactamases are an ever-growing problem. Since the discovery of the beta-lactamase of in the late 1960s, many class B beta-lactamases have been reported, with three main families being NDM-, IMP-, and...SUMMARYMetallo-beta-lactamases are an ever-growing problem. Since the discovery of the beta-lactamase of in the late 1960s, many class B beta-lactamases have been reported, with three main families being NDM-, IMP-, and VIM-like. IMP- and VIM-like carbapenemases have been identified in a wide variety of Gram-negative bacteria. VIM-type carbapenemases are widely distributed, primarily represented by two main clusters, VIM-1 and VIM-2, and have been found in both Enterobacterales and non-fermenters. IMP-type carbapenemases are characterized by a significant genetic diversity and low identity between subgroups. This carbapenemase is more prevalent in Asia but has been identified globally, in both Enterobacterales and non-fermenters, as observed for VIM-type carbapenemases. The genetic diversity of IMP- and some VIM-type carbapenemases limits their detection. This review aims to discuss the genetic diversity, epidemiology, and biochemical characteristics of VIM- and IMP-type carbapenemases. It also evaluates the efficacy of commercially available detection tests and the activity of recently developed inhibitors.
Clin Microbiol Rev
· 2025 Sep · PMID 40742145
·
Full text
SUMMARY () is a major human pathogen that can cause severe diseases such as meningitis and bacteremia. β-lactam antibiotics are the most essential antimicrobial agents for treating infections, but the resistance has bec...SUMMARY () is a major human pathogen that can cause severe diseases such as meningitis and bacteremia. β-lactam antibiotics are the most essential antimicrobial agents for treating infections, but the resistance has become a significant challenge in clinical therapy. Analyses reveal notable regional disparities in the prevalence of β-lactam resistance in . The use of pneumococcal conjugate vaccines effectively reduces the spread of highly resistant clones, indirectly improving resistance patterns. Interestingly, resistance is inversely correlated with bacterial invasiveness, suggesting mutual selective pressures. Additionally, the COVID-19 pandemic may have influenced the evolution of resistance by altering host immune states and healthcare resource allocation. Immunocompromised patients face a higher risk of invasive pneumococcal disease, driving increased antimicrobial use that fuels the rise of resistance. Beyond the single-molecular mechanism, the resistance gene acquisition order plays a critical role in the successful resistance evolution. Analyzing the dynamic principles and key nodes involved in the evolution of drug resistance could offer novel insights for developing precise antibacterial treatment strategies. Current research efforts focus on the development of novel antibiotics, antimicrobial peptides, lysins, and other innovative therapeutic agents. Artificial intelligence shows immense potential in the screening of antimicrobial drugs and the prediction of resistance mechanisms. This review synthesizes recent advances in the epidemiology, molecular mechanisms, and management of β-lactam resistance in , with the aim of informing evidence-based antimicrobial stewardship and accelerating the development of innovative therapeutics to combat this evolving public health threat.
Janas PP, Rozario C, Lucas CD
… +3 more, Hiemstra PS, Schwarze J, Chauché C
Clin Microbiol Rev
· 2025 Sep · PMID 40704759
·
Full text
SUMMARYRespiratory viral infections cause extensive cell death in the lung epithelium, resulting from both direct viral action and exuberant immune responses. Recovery following viral infection requires rapid and coordin...SUMMARYRespiratory viral infections cause extensive cell death in the lung epithelium, resulting from both direct viral action and exuberant immune responses. Recovery following viral infection requires rapid and coordinated repair programs, ensuring the replacement of the damaged tissue through proliferation, migration, and differentiation of respiratory epithelial progenitor cells. Viral infection and the resulting inflammatory milieu alter host gene expression. Notably, growing evidence indicates that these infections can induce long-term changes in epithelial progenitor cells, which persist even after the infection has resolved. These alterations may play a key role in the development of post-viral lung disease (PVLD). In this review, we discuss current knowledge regarding respiratory viral infections and how these may alter the gene expression and function of epithelial progeny cells arising from the surviving progenitors. We do so by exploring the influenza virus as an example and comparing it with what is known about other important respiratory viruses, such as respiratory syncytial virus (RSV), rhinovirus (HRV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). We highlight the impact of respiratory viral infection and ensuing inflammation on lung epithelial memory, considering the importance of viral strains, and discuss potential new therapeutic strategies that could maximize long-term lung health.
Clin Microbiol Rev
· 2025 Sep · PMID 40689619
·
Full text
SUMMARYThe pathogenesis of ulcerative colitis (UC) is heterogeneous; the causes are considered to be external factors such as stress, infections, antibiotics, and other medications, diet, and intrinsic factors such as ge...SUMMARYThe pathogenesis of ulcerative colitis (UC) is heterogeneous; the causes are considered to be external factors such as stress, infections, antibiotics, and other medications, diet, and intrinsic factors such as genetic predisposition. The aim of this narrative review is to analyze data on intestinal flora and bacteria-derived metabolites in inflammatory bowel diseases and ulcerative colitis in particular. The main focus is on proteolytic, saccharolytic, mucin-degrading, and bile acid-metabolizing bacteria. What types of metabolites are beneficial for intestinal integrity and the patient's health? How can dietary preferences trigger disease and cause complications? What kind of changes in the microbiome promote the disease? We consider what targets/receptors metabolites act on and their physiological role. The knowledge accumulated over the past years on the gut metagenome, metabolome, and signaling mechanisms may allow, in the future, modulating the composition of the intestinal microbiome and suppressing the growth of pathogenic flora without the use of antibiotics, but due to pro- and prebiotics, products of bacterial metabolism, including quorum sensing molecules.
Slifka MK, Thomas A, Gao L
… +2 more, Amanna IJ, Orenstein WA
Clin Microbiol Rev
· 2025 Sep · PMID 40662744
·
Full text
SUMMARYVaccines against tetanus and diphtheria are known as "legacy" vaccines because they were developed in the 1920s, long before the establishment of modern immunology and at a time when the Food & Drug Administration...SUMMARYVaccines against tetanus and diphtheria are known as "legacy" vaccines because they were developed in the 1920s, long before the establishment of modern immunology and at a time when the Food & Drug Administration (FDA) was still in its infancy. Despite lacking the technological advances of today, these medical interventions represent two of the most successful vaccines ever developed, as indicated by the incidence of disease falling to less than one case of tetanus per 10 million person-years and approximately one case of diphtheria per 1 billion person-years in the U.S. population. Here, we compare the success of the tetanus and diphtheria vaccination programs to that of other common childhood vaccines and review an evidence-based approach to adult booster vaccination schedules. These findings indicate that after completing the childhood vaccination series, decennial booster vaccinations may no longer be needed to maintain protective immunity in the general population. Moreover, updating the current vaccination program to remove adult decennial booster doses will not only harmonize the U.S. recommendations with the guidelines of the World Health Organization (WHO) but may also further improve the risk:benefit ratio for vaccination while providing up to $1 billion annually in healthcare savings.
Clin Microbiol Rev
· 2025 Sep · PMID 40626643
·
Full text
SUMMARYSchistosomiasis occurs in 80 primarily tropical and subtropical countries. It is transmitted to humans and animals by cercariae during freshwater contact. Parasite stages adapt and switch between molluscs, water,...SUMMARYSchistosomiasis occurs in 80 primarily tropical and subtropical countries. It is transmitted to humans and animals by cercariae during freshwater contact. Parasite stages adapt and switch between molluscs, water, and mammals, where worms sustain parasitism. We reviewed research on larvae encountering humans published in PubMed, Embase, and Web of Science until May 2024. Larvae perform intermittent active/tail-first and passive/body-first swimming with arc-like re-encountering upon host approaches. Skin contacts occur spontaneously or through stimulants. , expressing chemokinesis, lingers in upper-middle warm clear water. , showing negative photo-orientation, remains in upper-lower, cooler, clear-muddy freshwater. stays stimuli-wise non-responsive in shallow muddy habitats. Attachment triggers of and are amino acids and temperature, respectively. adheres at random. Temperature gradient, ceramides, and acylglycerols stimulate the epidermal remaining of ; solid hydrophobic surfaces trigger and . Temperatures of ≥36°C, ≥40°C, and 37°C guide , , and creeping for entering. Permeation aligns with schistosomula transformation by glycocalyx removal, heptalaminate membrane conversion, and tail stripping off and advances mechanically and enzymatically through acetabular glands. Skin and bloodstream navigation follows increasing L-arginine and D-glucose and parasite adjustment ventral-wards. Head gland enzymes facilitate epidermal-dermal transitioning for cutaneous exiting and vasculature accessing. Skin responds with anti-parasitic, anti-inflammatory edematous infiltrations. reacts by evasion through hormones, neurotransmitters, enzymes, and specialized proteins, among others. The findings, building largely on experiments, aim to facilitate the development of field-suitable prevention and control measures in support of the World Health Organization 2021-2030 Roadmap on Neglected Tropical Diseases.
Lopez-Alamillo S, Padyala P, Carey M
… +2 more, Duffey MM, Weatherhead JE
Clin Microbiol Rev
· 2025 Sep · PMID 40621999
·
Full text
SUMMARYHuman toxocariasis is a globally prevalent zoonotic parasitic infection caused by larvae of species, primarily and . Toxocariasis is commonly transmitted to humans through the ingestion of embryonated eggs foun...SUMMARYHuman toxocariasis is a globally prevalent zoonotic parasitic infection caused by larvae of species, primarily and . Toxocariasis is commonly transmitted to humans through the ingestion of embryonated eggs found in contaminated soil, water, or on surfaces contaminated with animal feces. Unlike in dogs and cats, humans are not definitive hosts for spp., and, as a result, larvae do not complete their life cycle in humans. Instead, following accidental oral ingestion of embryonated eggs, larvae undergo an aberrant larval migratory cycle to various organs including the lungs, liver, muscles, and central nervous system, and do not return to the intestines to develop into mature adult worms. As the larvae do not complete their life cycle in the human host, they will ultimately die in human tissue. This comprehensive systematic review of human toxocariasis analyzes and synthesizes existing research to provide a detailed and updated understanding of this zoonotic parasitic infection of global importance. This review provides an in-depth analysis of various aspects of toxocariasis, including its epidemiology, microbiology, pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies.
Marshall EM, Barzon L, Koopmans M
… +1 more, Rockx B
Clin Microbiol Rev
· 2025 Sep · PMID 40590537
·
Full text
SUMMARYMosquito-borne orthoflaviviruses pose an ever-increasing risk to public health. A prime example is West Nile virus (WNV), which continues to expand its geographical distribution, leading to new outbreaks of severe...SUMMARYMosquito-borne orthoflaviviruses pose an ever-increasing risk to public health. A prime example is West Nile virus (WNV), which continues to expand its geographical distribution, leading to new outbreaks of severe disease in humans and animals. In contrast, the closely related Usutu virus (USUV) has rarely been associated with neurological disease despite its wide distribution in Europe where human cases of WNV-associated disease largely outnumber those of USUV. Thus, the risk to human health posed by USUV appears to be lower compared with WNV. However, considering their close relation and similarities in ecology, it is still not known why the clinical impact differs for these viruses. In this review, we explore the potential pathogenesis of USUV in human infection by comparing the clinical presentations reported in the few cases of USUV-associated disease with the extensive clinical and pathological data available for WNV. With such a comparison, we aim to determine the clinical significance of USUV and identify key differences between WNV and USUV, which could explain the disparity in the incidence of neurological disease. We identify that while the clinical reports of USUV infection do indicate involvement of similar brain regions as WNV, clinical presentations are not as severe and not as frequent and do not seem to progress to the same extent as many cases of WNV-related neuroinvasive disease. Additionally, we highlight the urgent need to standardize reporting of (arbo)viral meningoencephalitis cases to allow for a better comparison and understanding of viral pathogenesis and the risks posed by new and emerging arboviruses.
Wolk DM, Parrott JS, Babady NE
… +9 more, Mochon AB, Tom R, Diel C, Dien Bard J, Harrington A, Hata DJ, Roberts AL, Boyce L, Johnson JK
Clin Microbiol Rev
· 2025 Sep · PMID 40522178
·
Full text
SUMMARYBloodstream infections (BSIs) are a significant cause of mortality and morbidity. Rapid identification of pathogens and detection of a few resistance markers from positive blood cultures are now possible through t...SUMMARYBloodstream infections (BSIs) are a significant cause of mortality and morbidity. Rapid identification of pathogens and detection of a few resistance markers from positive blood cultures are now possible through the increased availability of commercial rapid diagnostic tests, including nucleic acid amplification tests and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. This document describes the clinical utility of rapid diagnostics performed on positive blood cultures and provides evidence-based laboratory medicine guidelines for using rapid tests to diagnose BSIs in hospitalized adult and pediatric patients. This guideline was developed for use by medical (a.k.a. clinical) microbiologists, medical laboratory professionals, infectious disease clinicians, pharmacists, hospital administrators, healthcare providers, and other stakeholders associated with BSIs. A panel of experts, including medical microbiologists and experts in systematic literature review, was assembled to formulate the Population-Intervention-Comparison-Outcome (PICO) question, review the literature, and provide recommendations for using rapid tests to diagnose BSI and improve patient outcomes. A comprehensive literature search of four electronic bibliographic databases (MEDLINE, Embase, CINAHL, and Cochrane) was conducted to identify studies with measurable outcomes. The panel followed a systematic process, which included a standardized methodology for rating the certainty of the evidence and strength of recommendations using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. The panel evaluated the literature to answer the question: Does using rapid diagnostic tests improve clinical outcomes in adult and pediatric patients hospitalized with a BSI? Peer-reviewed literature was available to address three outcomes, including time to targeted therapy, mortality, and length of hospital stay. In general, the quality of the evidence was low to moderate due to the paucity of controlled, randomized clinical trial studies. However, eight recommendations were made based on evidence derived from the systematic review of the published literature. To answer the PICO question, the expert committee recommended using rapid diagnostic tests combined with active communication to decrease the time to targeted therapy and length of stay (strong recommendation). While the strength of the evidence for the impact on mortality is low, the panel supports using rapid tests to impact these outcomes. A summary of the recommendations is listed in the Executive Summary, which includes a detailed description of the background, methods, evidence summary, and rationale that supports each recommendation in the full text.
Masters J, Goodman-Meza D, Russell D
… +9 more, Marks L, McCreary E, Jacka B, Seear K, Davis JS, Matthews G, Martinello M, Tong SYC, Dore GJ
Clin Microbiol Rev
· 2025 Sep · PMID 40511913
·
Full text
SUMMARYPersons who inject drugs are at increased risk of bacterial and fungal injecting-related infections due to many physiological, societal, and structural factors. An estimated 15 million persons inject drugs worldwi...SUMMARYPersons who inject drugs are at increased risk of bacterial and fungal injecting-related infections due to many physiological, societal, and structural factors. An estimated 15 million persons inject drugs worldwide, with recent increases in the burden of injecting-related infections. Acquisition of these infections has distinct pathophysiology and microbiology related to drug supply, drug composition, and the process of injecting. Clinical management of these infections is complicated by usual factors such as the need for source control and effective antibiotics, as well as the complex challenges faced by persons who inject drugs while in hospital. These challenges include drug withdrawal, difficult pain control related to opioid tolerance, stigma, discrimination, and lack of access to outpatient parenteral antibiotic therapy, which can lead to high rates of patient-directed discharge and non-completion of treatment with subsequent poor outcomes. This review seeks to provide an evidence-based summary of what is known about the risks, epidemiology, microbiology, and presentation of injecting-related bacterial and fungal infections, as well as provide recommendations for treatment, including pharmacological considerations, opportunistic screening, multidisciplinary team care, and approaches to outpatient therapy. It also provides insight into the medicolegal and ethical considerations of care for persons who inject drugs and a first-person perspective of someone with lived experience.