Expert Review Of Anti-infective Therapy[JOURNAL]
Sun
200 papers
Treatment of pulmonary mucormycosis: current concepts.
Muthu V, Sehgal IS, Agarwal R
Expert Rev Anti Infect Ther · 2026 Jan · PMID 41575183 · Publisher ↗
INTRODUCTION: Pulmonary mucormycosis (PM) is a rapidly progressive angioinvasive fungal infection with high mortality. Despite therapeutic advances, optimal management remains uncertain. AREAS COVERED: We review the evid...
INTRODUCTION: Pulmonary mucormycosis (PM) is a rapidly progressive angioinvasive fungal infection with high mortality. Despite therapeutic advances, optimal management remains uncertain. AREAS COVERED: We review the evidence on managing PM. We emphasize aggressive host factor optimization (glycemic control, immunosuppression reduction) and outline the evidence-based antifungal strategy: liposomal amphotericin B (L-AMB) for induction, followed by oral maintenance (posaconazole or isavuconazole). We discuss critical nuances, including LAMB dosing, timing, and duration of therapy, drug interactions, and therapeutic drug monitoring. We review the role of combination antifungals, newer agents, and adjunctive modalities (inhaled antifungals, immunomodulation, bronchoscopic interventions, and iron chelation), assessing their appropriate use. The timing, indications, feasibility, and perioperative risk of surgery are discussed. We provide practical guidance for PM in special populations, including children, pregnant women, individuals with chronic liver or renal disease, and transplant recipients. EXPERT OPINION: Optimal care of PM requires early recognition, prompt LAMB induction with rigorous host factor optimization, multidisciplinary surgical assessment, followed by oral triazole maintenance. Combination antifungal therapy lacks definite evidence and should be reserved for severe or refractory cases. Future research priorities include prospective evaluation of treatment strategies, host-directed therapies, emerging antifungals (oral nanocrystal amphotericin, fosmanogepix, etc.), and systematic assessment of adjunctive modalities.
Evaluating long-acting injectable HIV treatment: an update on cabotegravir and rilpivirine.
Loi G, Castagna A, Muccini C
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41503930 · Publisher ↗
INTRODUCTION: Antiretroviral therapy has transformed HIV into a chronic manageable condition; however, lifelong daily oral therapy remains a barrier to adherence and quality of life. Long-acting cabotegravir (CAB) and ri...
INTRODUCTION: Antiretroviral therapy has transformed HIV into a chronic manageable condition; however, lifelong daily oral therapy remains a barrier to adherence and quality of life. Long-acting cabotegravir (CAB) and rilpivirine (RPV) provide the first complete regimen administered by intramuscular injections every 4 or 8 weeks, enabling virologic maintenance without daily pills. AREAS COVERED: This review summarizes the pharmacological properties of CAB+RPV and the evidence supporting their long-acting use. Phase II (LATTE, LATTE-2) and phase III (FLAIR, ATLAS, ATLAS-2 M, SOLAR) trials demonstrated that CAB+RPV long-acting is non-inferior to oral therapy, showing durable viral suppression. Safety data confirm a favorable profile, with injection site reactions as the most common adverse events, usually mild, transient, and declining over time. Pharmacokinetic and pharmacodynamic studies support sustained inhibitory drug levels. EXPERT OPINION: CAB+RPV represents a paradigm shift in HIV management, offering a valuable alternative for virologically suppressed individuals seeking freedom from daily dosing. Its successful implementation requires careful patient selection, robust systems to support timely injections, and strategies to mitigate pharmacokinetic challenges. Future directions include expanding eligibility to broader populations, optimizing ultra-long-acting formulations, and integrating injectables into differentiated care models to ensure equity of access.
Diagnosis of urinary tract infections in the pediatric population - current practices, advances and progress.
Bitsori M, Poulaki RI, Galanakis E
Expert Rev Anti Infect Ther · 2026 Jan · PMID 41489264 · Publisher ↗
INTRODUCTION: One of the most controversial issues surrounding the management of urinary tract infection (UTI) in children remains that of diagnosis, which is paramount for successful therapeutics and overall management,...
INTRODUCTION: One of the most controversial issues surrounding the management of urinary tract infection (UTI) in children remains that of diagnosis, which is paramount for successful therapeutics and overall management, due to lack of specific symptoms, sampling difficulties and debatable diagnostic criteria, all characteristics that differentiate pediatric from adult UTI. The current diagnostic strategy, based on urine culture, lacks specificity and entails considerable delay until the availability of the results. AREAS COVERED: This narrative review includes current diagnostics and their future perspectives with the integration of new technologies, novel host-based and pathogen-directed diagnostic methods and prediction models. Literature search was performed using Pubmed, focusing on recent publications about diagnostics of UTI and their use in children. EXPERT OPINION: Novel diagnostics include ultra-sensitive biosensors at point-of-care level and light-scattering, advanced microscopy and molecular techniques at laboratory level and have achieved reliable pathogen identification and provision of antibiotic susceptibility testing within hours instead of days. Less progress has been made in host-response approaches, based mostly on urine biomarkers, which nevertheless remain a promising field. Prediction models based on artificial intelligence (AI) methods are developing fast and with the combination of all information relevant to UTI can significantly contribute to individualized patient-tailored predictions.
Nucleos(t)ide analogue treatment in hepatitis B: to stop or not to stop?
Papatheodoridi M, Papatheodoridis G
Expert Rev Anti Infect Ther · 2026 Jan · PMID 41479278 · Publisher ↗
INTRODUCTION: Monotherapy with a nucleos(t)ide analogue (NA), namely entecavir and tenofovir, represents the mainstay of hepatitis B virus (HBV) treatment, which achieves potent viral suppression and subsequently improve...
INTRODUCTION: Monotherapy with a nucleos(t)ide analogue (NA), namely entecavir and tenofovir, represents the mainstay of hepatitis B virus (HBV) treatment, which achieves potent viral suppression and subsequently improved major outcomes, but it rarely leads to functional cure (i.e. 10-year cumulative rate of <3%). Current guidelines recommend NA discontinuation in all chronic hepatitis B patients who achieve HBV surface antigen (HBsAg) loss. Before HBsAg loss, NA discontinuation is recommended with caution only in non-cirrhotics with normal ALT who have remained in long-term on-therapy remission for various periods depending on their initial HBeAg status and agree to close post-treatment monitoring. AREAS COVERED: This review explores the current landscape of the concept of NA discontinuation, examining benefits, risks, criteria for stopping, and patient selection and monitoring according to international guidelines, and biomarkers that may be helpful in decision-making. EXPERT OPINION: In the absence of novel antivirals leading to HBsAg clearance, accumulating data suggests that stopping NA therapy in carefully selected HBeAg negative patients may increase the probability of HBsAg loss and reduce long-term treatment burden, eventually improving patients' outcome. However, there are risks of post-treatment relapses and flares that need to be considered, while other critical parameters should be fitted to tailor patient selection.
Pharmacokinetics-pharmacodynamics perspective to optimizing therapy with beta-lactams in critically ill patients: an update.
Gatti M, Pea F
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41437777 · Publisher ↗
INTRODUCTION: Several unmet clinical needs regarding the role of pharmacokinetic/pharmacodynamic (PK/PD) target attainment of beta-lactams still remains to be addressed in critically ill patients. AREAS COVERED: This rev...
INTRODUCTION: Several unmet clinical needs regarding the role of pharmacokinetic/pharmacodynamic (PK/PD) target attainment of beta-lactams still remains to be addressed in critically ill patients. AREAS COVERED: This review provides an updated critical reappraisal focused at optimizing the loading dose (LD) and the maintenance dose (MD) for attaining an aggressive PK/PD target. A literature search was carried out on PubMed-MEDLINE. Challenging pathophysiological conditions impacting on volume of distribution (septic shock, major burns, polytrauma) and clearance (i.e. sepsis-associated acute kidney injury [AKI], continuous renal replacement therapy [CRRT] associated or not with special hemoadsorption filters, and augmented renal clearance [ARC]) were comprehensively reviewed. EXPERT OPINION: Evidence on the PK/PD perspective to optimizing antimicrobial therapy with beta-lactams in critically ill patients is ever growing. Some unmet clinical needs still require further investigation by means of well-designed prospective studies. Specifically, defining appropriate strategies focused on aggressive PK/PD target attainment of novel beta-lactams in some challenging scenarios, namely major burns, polytrauma, ARC, sepsis-associated transient AKI, would be fundamental in helping intensivists to optimize treatment in different special critical populations. In this regard, population PK/PD studies could represent the starting point on which the TDM-guided approaches and could add further value to providing a tailored 'patient-centric' therapy.
Point-of-care tests for HIV drug resistance monitoring: an update of the literature and future viewpoints.
Osahan G, Ji H
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41401032 · Publisher ↗
INTRODUCTION: HIV drug resistance (HIVDR) threatens global antiretroviral therapy (ART) success, especially as treatment scales up in resource-limited settings (RLS). Conventional genotypic HIVDR testing relies on comple...
INTRODUCTION: HIV drug resistance (HIVDR) threatens global antiretroviral therapy (ART) success, especially as treatment scales up in resource-limited settings (RLS). Conventional genotypic HIVDR testing relies on complex instrumentation and often involves long turnaround time, creating critical gaps in managing virologic failure. Point-of-care test (POCT) technologies offer the potential of same-day resistance detection and immediate treatment optimization at the site of care. AREAS COVERED: This review examines potential HIVDR POCT technologies, with primary focus on advances from 2022 to 2025. It evaluates both established platforms and emerging approaches. Each technology is assessed against WHO REASSURED criteria for point-of-care diagnostics. It also summarizes the relevant clinical validation data, early field implementation experiences, and their feasibility of integration into existing laboratory systems in low- to middle-income countries (LMICs). EXPERT OPINION: While no single platform currently fulfills all REASSURED criteria, several show strong potentials for near-term implementation, particularly OLA-Simple. Multi-country validation studies support its utility; however, PCR dependence still limits POC usage. Key challenges remain, including limited HIVDR mutations coverage, reliance on complex lab instrumentation, and high costs that hinder scalability and long-term sustainability. By 2030, routinized HIVDR POCT could transform HIV care by enabling real-time treatment decisions, even in RLS or LMICs.
Risk of HIV viral rebound after SARS-CoV-2 infection among people living with HIV on antiretroviral therapy: a retrospective matched cohort study.
He Q, Guo Z, Ni Y … +14 more , Cui Z, Feng Y, Ni Z, He X, Zhang N, Zhang Y, Dai J, He M, Cao W, Wang K, Tang N, Wang K, Zhao S, Ni M
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41332328 · Publisher ↗
BACKGROUND: There are few studies that describe the impact of SARS-CoV-2 infection on HIV outcomes. We aimed to assess the viral adverse changes associated with SARS-CoV-2 infection in PLHIV. RESEARCH DESIGN AND METHODS:...
BACKGROUND: There are few studies that describe the impact of SARS-CoV-2 infection on HIV outcomes. We aimed to assess the viral adverse changes associated with SARS-CoV-2 infection in PLHIV. RESEARCH DESIGN AND METHODS: This retrospective cohort study enrolled 3327 PLHIV on ART. Baseline information was collected through questionnaires and electronic health records. PLHIV with and without SARS-CoV-2 infection (reference) were propensity score matched. The association between SARS-CoV-2 infection and HIV viral rebound was assessed by using log-binomial regression models, with relative risks estimated. RESULTS: We included 446 PLHIV without SARS-CoV-2 infection and 446 PLHIV with SARS-CoV-2 infection after matching. Compared to PLHIV without SARS-CoV-2 infection, PLHIV with SARS-CoV-2 infection had relatively higher HIV VLs (75th percentile: 105 versus 51 copies per mL; 80th percentile: 257 versus 196 copies per mL; 90th percentile: 5170 versus 2360 copies per mL). PLHIV infected with SARS-CoV-2 had a significantly increased risk of viral rebound (RR of 1.32, 95% confidence interval [CI]: 1.25, 1.40). The risk was higher among males than females but was comparable across age groups. Similar patterns were observed for secondary outcomes. CONCLUSIONS: These findings suggest that SARS-CoV-2 infection is a risk factor for viral rebound in PLHIV on ART.
Treatment of malaria in the nonendemic setting: a narrative review of toxicity, failure, and emerging resistance.
Bottieau E, Mutsaers M, Balerdi-Sarasola L … +2 more , Yansouni CP, Rosanas-Urgell A
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41328670 · Publisher ↗
INTRODUCTION: For more than 15 years, artemisinin-based combination therapy (ACT) and atovaquone-proguanil have been recommended for treatment of malaria in most nonendemic countries. However, new challenges have emerge...
INTRODUCTION: For more than 15 years, artemisinin-based combination therapy (ACT) and atovaquone-proguanil have been recommended for treatment of malaria in most nonendemic countries. However, new challenges have emerged that complicate the management of travelers with malaria, including the occurrence of artemisinin-related hemolysis and the increasing numbers of treatment failures possibly related to drug resistance. AREAS COVERED: We reviewed the epidemiology, pattern, and risk factors for artemisinin-related hemolysis and for treatment failure with ACT or atovaquone-proguanil among travelers with malaria diagnosed in nonendemic countries. We collected detailed information on clinical features, pharmacokinetic parameters, or mutations conferring resistance observed in failing cases. EXPERT OPINION: Several factors (e.g. lack of prior immunity, older age, overweight, comorbidities, and comedication) distinguish travelers from people residing in malaria-endemic areas. Yet, current uniform treatment recommendations across settings do not address many considerations that predominantly affect nonimmune travelers with malaria. This population may also be more vulnerable to complications of malaria, as reduced susceptibility to key antimalarial drugs is spreading. We propose specific adaptations to the management of malaria in travelers, with a focus on structured clinical follow-up to detect toxicity and failure, and on systematic genomic surveillance in concert with existing initiatives in endemic countries.
Advances and updates in antibiotic combination therapy.
Bartalucci C, Sepulcri C, Portunato F … +3 more , Briano F, Dentone C, Bassetti M
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41292268 · Publisher ↗
INTRODUCTION: While antibiotic combination therapy remains a common clinical practice, its scientific foundation is fragile. The available evidence is fragmented, biased, and fails to capture the complexity of modern inf...
INTRODUCTION: While antibiotic combination therapy remains a common clinical practice, its scientific foundation is fragile. The available evidence is fragmented, biased, and fails to capture the complexity of modern infectious disease scenarios. This perspective reinterprets the role of combination therapy through a critical lens, challenging current dogmas and proposing a pathogen-specific approach, focusing also on severe acute infections. AREAS COVERED: This Critical Perspective focused on selected studies from 2018 to 2025 identified through a focused PubMed search on the place in therapy and efficacy of antibiotic combinations on main gram-positive ( spp. spp. and ) and gram-negative (, , ) pathogens. EXPERT OPINION: After reviewing the current available literature, in our opinion, a strong indication to use antibiotic combination therapy can be only for specific situations and clinical syndromes (such as endocarditis, toxic shock syndrome due to , or persistent bacteremia due to and few others). However, especially in severe infections due to gram negatives, clinical trial and strong data are insufficient to draw definite clinical indications. Consequently, further randomized clinical trial should be performed, and they should include new antibiotics to define the potential role of combination therapy.
Sepsis management in the antimicrobial resistance era.
Esposito S, Salzano F, Ascione T … +5 more , D'Amore C, Spera AM, Conti V, Franci G, Pagliano P
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41285675 · Publisher ↗
INTRODUCTION: Sepsis is a leading cause of death worldwide. Its lethality, along with the complexity of diagnosis and treatment, is worsened by rising antibiotic resistance. Managing sepsis and septic shock is challengin...
INTRODUCTION: Sepsis is a leading cause of death worldwide. Its lethality, along with the complexity of diagnosis and treatment, is worsened by rising antibiotic resistance. Managing sepsis and septic shock is challenging, as underlying conditions can limit the reliability of many biomarkers used for early diagnosis. AREAS COVERED: This review comprehensively overviews the epidemiologic characteristics of sepsis, with particular emphasis on the key biomarkers used to support early diagnosis. Additionally, it explores emerging techniques for rapid microbiological identification of sepsis caused by multidrug- resistant organisms and evaluates the effectiveness of newly introduced antibiotics. EXPERT OPINION: In severe cases progressing to septic shock, timely and accurate diagnosis is critical. It is mandatory to make every effort to shorten the time to diagnosis in order to enable appropriate supportive care and targeted antibiotic therapy. In this context, novel microbiological diagnostic methods should be considered to facilitate early detection of multidrug-resistant organisms and promote the initiation of effective empiric antibiotic treatment. Furthermore, the development of new molecules with innovative mechanisms of action, alongside therapeutic strategies targeting specific patterns of the immune response, is expected to improve the patient survival rates.
Early recognition of sepsis should be an integral part of antimicrobial stewardship programs.
Strålin K, Knutsson U, Linder A
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41275516 · Publisher ↗
Abstract loading — click title to view on PubMed.
Visited India? Metronidazole may not cure your infection.
Tipu JH, Mørch K, Hanevik K
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41249865 · Publisher ↗
Abstract loading — click title to view on PubMed.
Viral hemorrhagic fevers - therapeutic trial advances and challenges.
Güllü D, Keske Ş, Ergönül Ö
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41243891 · Publisher ↗
INTRODUCTION: Viral hemorrhagic fevers (VHFs) represent a group of severe diseases caused by RNA viruses with high fatality rates, posing significant global health threats. These diseases are prioritized by the World Hea...
INTRODUCTION: Viral hemorrhagic fevers (VHFs) represent a group of severe diseases caused by RNA viruses with high fatality rates, posing significant global health threats. These diseases are prioritized by the World Health Organization due to their epidemic potential, geographical restrictions, and limited therapeutic options. AREAS COVERED: This review discusses the current state of therapeutic advancements, challenges in treatment, and post-exposure prophylaxis for various VHFs. Relevant literature on VHFs and therapeutic interventions was identified through searches of PubMed, Scopus, Web of Science, WHO and CDC databases, and ClinicalTrials.gov from database inception to November 2025. Key therapies like ribavirin for Crimean-Congo hemorrhagic fever and Lassa fever, along with monoclonal antibodies for Ebola and Marburg virus disease, have demonstrated clinical efficacy. However, gaps remain in effective antivirals and vaccines for many VHF pathogens. EXPERT OPINION: Notable challenges in therapeutic development include ethical concerns in randomized controlled trials, logistical barriers in endemic areas, and the evolving immune response in late-stage disease. The role of cytokine modulation and the growing potential of monoclonal antibodies offer new directions for treatment. Strengthening observational studies and expanding international collaboration are critical for improving patient outcomes and advancing therapeutic options for these deadly diseases.
HIV postnatal prophylaxis: how long is long enough?
Van de Perre P, Moles JP, Nagot N
Expert Rev Anti Infect Ther · 2025 Nov · PMID 41216942 · Publisher ↗
INTRODUCTION: Despite improvements in the prevention of HIV mother-to-child transmission in recent years, the elimination of pediatric HIV remains elusive. Extended postnatal prophylaxis (ePNP) could be key to achieving...
INTRODUCTION: Despite improvements in the prevention of HIV mother-to-child transmission in recent years, the elimination of pediatric HIV remains elusive. Extended postnatal prophylaxis (ePNP) could be key to achieving this goal. AREA COVERED: Key questions surrounding timing of ePNP administration are: How long should ePNP be administered for? Should antiretroviral drugs with a long half-life be favored? Could ePNP be improved using long-acting injectable products adapted for use with neonates, infants, and children? In the search strategy (four databases), only articles published in English between 1990 and 2025 were included. EXPERT OPINION: As there is a risk of HIV transmission throughout breastfeeding, if ePNP is initiated - guided or not by maternal HIV viral load -, it should be administered until breastfeeding has ceased completely. Determining the plasma/tissue level of antiretroviral drugs or broadly neutralizing HIV antibodies (bNAbs) required to protect against HIV acquisition through breastfeeding is a research priority. Long-acting antiretroviral drugs are currently unavailable for prophylaxis or treatment in neonates and children. Several studies are currently evaluating the safety and pharmacokinetics of bNAbs in neonates and children exposed to HIV. These bNAbs could represent a significant advance in the prevention of postnatal HIV acquisition in the future.
Current insights into urogenital tuberculosis in clinical settings.
Figueiredo AA, Lopes HE, de Azevedo Barreto A … +3 more , Fanni VSS, Kefler FS, Netto JMB
Expert Rev Anti Infect Ther · 2025 Nov · PMID 41213826 · Publisher ↗
INTRODUCTION: Urogenital tuberculosis (UGT) is a common manifestation of extrapulmonary tuberculosis and can affect all organs of the urinary tract and male genital tract. The actual main problem of UGT is late diagnosis...
INTRODUCTION: Urogenital tuberculosis (UGT) is a common manifestation of extrapulmonary tuberculosis and can affect all organs of the urinary tract and male genital tract. The actual main problem of UGT is late diagnosis and a high prevalence of urogenital organ destruction. Little progress has been made in preventing the disease from progressing to more destructive forms. Knowledge diffusion of critical insights of UGT is the objective of this revision. AREAS COVERED: A narrative review of urogenital tuberculosis was performed in the databases of PubMed, Embase, and Scielo without time and language restriction. Terms used in the review were: 'Tuberculosis'; 'Urogenital Tuberculosis'; 'Prostate tuberculosis'; 'Kidney Tuberculosis' and 'Bladder tuberculosis.' EXPERT OPINION: The actual problem of UGT is late diagnosis and the evolution to destructive forms of disease with high proportion of kidney loss, surgeries, chronic infection of the urinary tract and urologic related chronic renal failure. This problem solution is based on three key actions: 1) correct UGT features knowledge; 2) creation of diagnostic guidelines and 3) knowledge diffusion. The knowledge of UGT features and the knowledge diffusion are the main objectives of this review. The creation of liable guidelines is a task in progress and the objective of further studies.
A 96-week efficacy and safety of BIC/FTC/TAF in ART-naïve HIV-1 infected patients in China.
Lv S, Li Q, Du P … +8 more , Ling X, Zhong H, Hou H, Chen J, Chen L, Lan Y, Tang X, Li L
Expert Rev Anti Infect Ther · 2025 Dec · PMID 41199141 · Publisher ↗
BACKGROUND: To evaluate 96-week virologic, immunologic, resistance and metabolic outcomes of bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) in antiretroviral therapy (ART)-naïve people living wit...
BACKGROUND: To evaluate 96-week virologic, immunologic, resistance and metabolic outcomes of bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) in antiretroviral therapy (ART)-naïve people living with HIV (PLWH). METHODS: Retrospective cohort of ART-naïve PLWH initiating BIC/FTC/TAF between January 2020 and December 2022. Primary outcome was HIV-1 RNA <50 copies/mL at week 96. Secondary outcomes included drug resistance and changes in CD4 T cell count, CD4/CD8, body weight, lipid profile, liver and renal function by week 96. RESULTS: We enrolled 228 patients; median age 32 years, 92.1% male, homosexual intercourse 57.0%. Virologic suppression did not differ by baseline HIV-1 RNA levels, CD4 T cell counts, or opportunistic infection (OI), and immune reconstitution was similarly consistent across subgroups. One patient developed V179E mutation. Median body mass index increased from 21.7 (20.0-23.7) to 23.1 (21.2-25.1) by week 48 and then stabilized. Lipid levels increased early and remained stable, liver function remained stable after week 48, and renal function showed a slight decline before stabilizing by week 48. CONCLUSION: BIC/FTC/TAF demonstrated strong efficacy in patients with high baseline HIV-1 RNA and OIs, with no patient developing drug-related resistance mutations and minimal impact on metabolism, liver and renal function, supporting its use in broader populations as a first-line regimen.
Systemic and local antimicrobial strategies to prevent Periprosthetic joint infection.
Yoon SJ, Jutte PC, Soriano A … +2 more , Zijlstra WP, Wouthuyzen-Bakker M
Expert Rev Anti Infect Ther · 2025 Nov · PMID 41186490 · Publisher ↗
INTRODUCTION: Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty and necessitates comprehensive strategies for prevention. One of the key features in infection prevention is the opt...
INTRODUCTION: Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty and necessitates comprehensive strategies for prevention. One of the key features in infection prevention is the optimal selection of antimicrobial strategies. AREAS COVERED: This review evaluates systemic and local antimicrobial approaches to PJI prevention, including systemic antibiotic prophylaxis, nasal and skin decolonization of , local antimicrobial delivery into the joint space, and antimicrobial modification of the implant surface. We conducted a literature search of the MEDLINE, Web of Science, Cochrane and ClinicalTrials.gov databases for recent evidence from randomized and observational studies, as well as current orthopedic guidelines concerning these topics. EXPERT OPINION: Further reductions in the incidence of PJI through antimicrobial strategies will require: (1) the adoption of alternative trial designs such as registry-nested and adaptive platform trials to study outcomes with low event rates; (2) improved adherence to established best practices, particularly in systemic antibiotic prophylaxis; (3) precision prevention informed by validated risk stratification tools; and (4) novel interventions targeting emerging biological mechanisms such as the gut microbiome.
Bacterial vaginosis: an overlooked STI?
George SD, Van Gerwen OT, Muzny CA
Expert Rev Anti Infect Ther · 2025 Nov · PMID 41159595 · Full text
INTRODUCTION: Despite 70+ years of research, the etiology of bacterial vaginosis (BV), the most common vaginal infection, is unknown. Numerous studies suggest that BV-associated bacteria (BVAB) are sexually transmitted....
INTRODUCTION: Despite 70+ years of research, the etiology of bacterial vaginosis (BV), the most common vaginal infection, is unknown. Numerous studies suggest that BV-associated bacteria (BVAB) are sexually transmitted. Additionally, a recent male partner treatment trial found that the addition of combination oral and topical antimicrobial therapy for regular male sexual partners to treatment of women with BV resulted in a lower rate of recurrence at 12 weeks. However, unlike other common sexually transmitted infections such as chlamydia and trichomoniasis, no sole infectious pathogen has been identified as the causative agent of BV. In addition, non-sexual factors (e.g. smoking, copper intrauterine device use, douching, and testosterone use) have been associated with an increased risk of BV in some studies. These findings underscore the complexity of BV pathogenesis and make it challenging to counsel patients on infection acquisition and prevention of recurrent disease. AREAS COVERED: This work summarizes the evidence for and against sexual transmission of BVAB. EXPERT OPINION: A large body of data provide substantial evidence suggesting that sexual activity is the predominant mode of initial BV acquisition. There are no data showing a direct causal association between non-sexual factors and BV development. Additional research investigating BV etiology is imperative.
An update on antimicrobial selection and duration for intra-abdominal infections.
Lee YL, Hsueh PR
Expert Rev Anti Infect Ther · 2025 Nov · PMID 41147138 · Publisher ↗
INTRODUCTION: Intra-abdominal infections (IAIs) pose significant challenges to clinicians. The increasing prevalence of multidrug-resistant (MDR) organisms with evolving resistance patterns adds to the difficulty in mana...
INTRODUCTION: Intra-abdominal infections (IAIs) pose significant challenges to clinicians. The increasing prevalence of multidrug-resistant (MDR) organisms with evolving resistance patterns adds to the difficulty in managing IAIs. AREAS COVERED: This review synthesizes the latest evidence and recommendations from major global guidelines. Key topics include novel antimicrobial agents, empirical and targeted therapy strategies, and the role of antimicrobial stewardship in optimizing antibiotic use. Furthermore, advances in diagnostic tools, such as metagenomic next-generation sequencing and rapid resistance detection assays, are highlighted. Updates in therapy duration, emphasizing shorter courses guided by biomarkers and source control, are critically analyzed. EXPERT OPINION: The management of IAIs has advanced significantly, with updated guidelines highlighting the importance of early and appropriate antimicrobial therapy tailored to the infection's severity and resistance patterns, along with effective source control. Novel antibiotics such as ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam, eravacycline, and cefiderocol have broadened treatment options for MDR pathogens. Shorter antibiotic courses, guided by source control and biomarkers, have shown to be as effective as traditional longer regimens. Future research should focus on understanding of global resistance patterns, expanding real-world evidence for novel antibiotics, refining biomarker-guided strategies, enhancing rapid diagnostics, and applying artificial intelligence for more personalized and precise management of IAIs.
Cytomegalovirus antiviral stewardship considerations in solid organ transplant patients.
Kleiboeker HL, Jorgenson MR
Expert Rev Anti Infect Ther · 2026 Mar · PMID 41144232 · Publisher ↗
INTRODUCTION: There is a growing acknowledgment of the importance of stewardship initiatives in solid organ transplant given the increased potential for morbidity and mortality. Antiviral stewardship, particularly as it...
INTRODUCTION: There is a growing acknowledgment of the importance of stewardship initiatives in solid organ transplant given the increased potential for morbidity and mortality. Antiviral stewardship, particularly as it pertains to cytomegalovirus (CMV), has been most extensively studied. AREAS COVERED: This review outlines the history and development of stewardship interventions in the solid organ transplant population with a focus on antiviral stewardship of CMV. Obstacles and proposed solutions to these obstacles from the vantage point of the UW Health experience are shared. Proposed future applications of the antiviral stewardship framework and structure are discussed. A systematic review of English language studies published since 2000 was performed. Search terms included solid organ transplant, antimicrobial stewardship, antiviral stewardship, post-transplant viral infections, and cytomegalovirus. EXPERT COMMENTARY: Antimicrobial stewardship has a role in the immunocompromised host, and CMV antiviral stewardship is a unique application in solid organ transplant. Utilization of this initiative can improve outcomes related to CMV, particularly in the high-risk population providing a proactive, dedicated effort with a well-established infrastructure for effective surveillance after prophylaxis. Targeted quality improvement initiatives can further personalize the initiative to address issues unique to each transplant center. Large scale or all-encompassing efforts are not required to obtain substantial benefit.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe