Jamil R, Prodger JL, Galiwango RM
… +3 more, Liu CM, Tobian AAR, Kaul R
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40728279
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HIV remains a major global health issue, particularly in Sub-Saharan Africa, with treatment and prevention programs under increasing threat. Although pre-exposure prophylaxis (PrEP) is highly effective, barriers to uptak...HIV remains a major global health issue, particularly in Sub-Saharan Africa, with treatment and prevention programs under increasing threat. Although pre-exposure prophylaxis (PrEP) is highly effective, barriers to uptake include stigma, cost and limited accessibility, highlighting the need for additional scalable prevention strategies. This review discusses the microbiomes of the male urethra and coronal sulcus, and their role in penile HIV acquisition. Key bacterial components of the coronal sulcus microbiome cause penile inflammation and enhance HIV susceptibility, and the latter is reduced after microbiome modification via penile circumcision or topical antibiotics. Similar to the coronal sulcus microbiome, the urethral microbiome is also shaped by sexual activity and also modulates local inflammation, although impacts on HIV susceptibility have not been defined. Importantly, the penile urethra may also serve as a reservoir for non-optimal vaginal bacteria, predisposing to bacterial vaginosis in female sexual partners. These insights highlight the potential of penile microbiome-targeted approaches to reduce HIV transmission and improve reproductive health.
INTRODUCTION: Neonatal sepsis remains a major contributor to morbidity and mortality worldwide, with the highest burden in low- and middle-income countries (LMICs). Generating accurate estimates of disease burden is crit...INTRODUCTION: Neonatal sepsis remains a major contributor to morbidity and mortality worldwide, with the highest burden in low- and middle-income countries (LMICs). Generating accurate estimates of disease burden is critical for setting research priorities, informing health policy, and resource allocation. However, in many LMICs, limited access to timely and reliable diagnostic tools severely limits case detection, undermines epidemiological surveillance, and impedes efforts to improve clinical outcomes. AREAS COVERED: This review examines the clinical, scientific, and health system implications of misdiagnosing neonatal sepsis. We describe the challenges of accurate case identification and summarize findings from prospective, multicenter studies showing marked variability in incidence across different geographic and healthcare settings. We explore the sources of this variability and discuss its impact on patient care, clinical trials interpretation, and progress toward reducing the global burden of neonatal sepsis. EXPERT OPINION: The lack of standardized case definition hinders neonatal sepsis research and may contribute to the growing threat of antimicrobial resistance. Addressing this requires acknowledging the substantial uncertainty in current global incidence estimates. More importantly, it demands shifting focus from passive reporting of variability to actively investigating the methodological, sociodemographic, clinical, biological, and systemic drivers that shape sepsis detection and outcomes across diverse settings.
BACKGROUND: Antimicrobial resistance threatens patients, healthcare systems, and the world's economy. Antimicrobial stewardship programs use evidence-based strategies to monitor and assess antibiotic use. This study aime...BACKGROUND: Antimicrobial resistance threatens patients, healthcare systems, and the world's economy. Antimicrobial stewardship programs use evidence-based strategies to monitor and assess antibiotic use. This study aimed to identify prescribers' knowledge, attitudes, and behavior regarding antibiotic use and antibiotic resistance in Oman. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted using a questionnaire that was adapted from the European Centre for Disease Prevention and Control instruments. The survey was distributed among prescribers in Oman's Ministry of Health. RESULTS: The survey included a total of 371 prescribers. Most respondents were specialists, and 73% worked in hospitals. Antibiotics' effectiveness against viruses, needless use, and adverse effects were accurately answered by over 95% of prescribers. Eighty-four percent of prescribers realized the connection between their prescribing of antibiotics and the spread of antibiotic-resistant bacteria. Approximately 80% agreed that they address antibiotic resistance and consider it when treating patients. Around 70% of prescribers knew of the Oman national action plan to combat antibiotic resistance. Sixty-six percent of prescribers wanted information regarding antibiotic resistance, 49% about antibiotic use, and 40% about antibiotic prescriptions and medical problems. CONCLUSION: The findings highlight the need for interventions to inform prescriber knowledge and behavior, improve antibiotic prescribing practices, and combat the spread of antimicrobial resistance.
INTRODUCTION: Diabetic foot ulcers (DFUs) are a significant health concern, often complicated by biofilm formation which delays healing and increases the risk of diabetic foot infections (DFIs). Effective management of c...INTRODUCTION: Diabetic foot ulcers (DFUs) are a significant health concern, often complicated by biofilm formation which delays healing and increases the risk of diabetic foot infections (DFIs). Effective management of complex biofilms is crucial for improving patient outcomes and reducing the risk of amputation and premature death. AREAS COVERED: This review summarizes the current state of microbiological research on DFIs, focusing on bacterial populations, biofilm interactions, and their role in antibiotic resistance development, being based on a PubMed search from 1975 to 2025. It also explores recent advances in antimicrobial therapies, including phage therapy, antimicrobial peptides, and other novel treatments. EXPERT OPINION: Antimicrobial stewardship, broader access to medical resources, and improved sanitation are essential to diminish the impact of diabetes on healthcare systems. Furthermore, the development of a rapid tool to detect antibiotic-tolerant cells is fundamental to avoid DFIs relapse. The biofilms dynamics and the dual relationship between biofilms and the immune system should be further understood. While traditional antibiotics are essential to treat DFIs, a multi-combinatorial strategy combining conventional compounds with alternative therapies should be more effective to overcome resistance and promote wound healing in DFUs.
INTRODUCTION: is a rare but fatal free-living ameba with > 97% mortality rate. Despite advances in clinical and scientific understanding, therapeutic options remain limited, and diagnosis is often delayed, presenting si...INTRODUCTION: is a rare but fatal free-living ameba with > 97% mortality rate. Despite advances in clinical and scientific understanding, therapeutic options remain limited, and diagnosis is often delayed, presenting significant public health challenges. AREAS COVERED: We reviewed recent literature from the last decade, using Google Scholar and PubMed on treatment, emerging drug candidates, repurposed therapeutics, and innovative delivery strategies. Advancements in drug screening are highlighted, unveiling novel therapeutic targets and mechanisms of action. Additionally, the role of climate change and environmental factors in geographic expansion and increased incidence of infections is explored, posing a growing public health risk. EXPERT OPINION: Effective management of infections hinges on early detection and addressing research gaps, particularly in understanding transmission/disease mechanisms. Recent advances in therapeutics, diagnostics, and water treatment to reduce environmental contamination by show promise for lowering infection risk and improving outcomes for primary amebic meningoencephalitis. Collaboration among academic institutions, pharmaceutical companies, and water industries is essential, with research advancing treatments and vaccines, and water industries contributing by reducing environmental contamination/human exposure to . A combination of treatment strategies and stringent surveillance will be crucial to limit future outbreaks and improve patient prognosis.
INTRODUCTION: Prosthetic joint infections (PJIs) caused by mycobacteria are exceptionally rare and often underrecognized in clinical practice. AREAS COVERED: Although most PJIs are due to common bacterial pathogens, and...INTRODUCTION: Prosthetic joint infections (PJIs) caused by mycobacteria are exceptionally rare and often underrecognized in clinical practice. AREAS COVERED: Although most PJIs are due to common bacterial pathogens, and nontuberculous mycobacteria (NTM) represent a unique subset with distinct microbiological and therapeutic challenges. The presence of biofilms further complicates their management, often requiring intensive pharmacological interventions and surgical strategies. This review analyzes over 300 reported cases of mycobacterial PJIs. The findings indicate that tuberculous PJIs typically occur as late-onset infections and are managed successfully with prolonged antituberculous therapy. In contrast, NTM PJIs - predominantly caused by rapidly growing species - are more heterogeneous in onset, resistance patterns, and treatment responses. Antibiotic regimens are often complex, species-specific, and require guidance from susceptibility testing. Therapeutic decisions often rely on expert consensus and extrapolation from pulmonary disease protocols. Surgical intervention, particularly implant removal, consistently correlates with better outcomes in both groups. EXPERT OPINION: Clinicians must maintain a high index of suspicion in culture-negative PJIs or cases with atypical clinical presentations to reach a proper diagnosis. Once the diagnosis is established, a multidisciplinary approach is crucial for optimizing patient outcomes. Further research is warranted to develop evidence-based strategies for these rare but clinically demanding infections.
INTRODUCTION: Neurocysticercosis remains the leading parasitic infection of the human central nervous system and a primary cause of epilepsy in low- and middle-income regions. Although advances in magnetic resonance imag...INTRODUCTION: Neurocysticercosis remains the leading parasitic infection of the human central nervous system and a primary cause of epilepsy in low- and middle-income regions. Although advances in magnetic resonance imaging, serologic assays, and antiparasitic regimens have improved disease recognition and lesion targeting, major clinical questions remain unresolved regarding optimal diagnosis and management. AREAS COVERED: This Perspective critically reviews current diagnostic and therapeutic approaches in neurocysticercosis, emphasizing the role of high-resolution imaging and evolving immunologic tools. The literature search methodology included searches of PubMed and Google Scholar databases, focusing on publications related to neurocysticercosis diagnosis, clinical manifestations, treatment, and public health interventions. It discusses treatment selection based on cyst location, stage, and host immune profile, and explores the evidence supporting albendazole and praziquantel in parenchymal, ventricular, subarachnoid, and disseminated forms. Pediatric, pregnant, and immunocompromised patients are examined as distinct clinical populations. EXPERT OPINION: The management of neurocysticercosis demands individualized, lesion-specific strategies rather than uniform protocols. While advances in imaging and immunotherapy hold promise, implementation barriers persist in endemic areas. Future priorities include robust randomized trials for extraparenchymal disease, validation of immunologic biomarkers, and integrated public health measures to reduce the disease burden globally.
INTRODUCTION: Mpox (formerly monkeypox), a systemic infection caused by the mpox virus (MPXV), has become a global problem of increasing concern. There are currently no antiviral treatments that have been shown to be saf...INTRODUCTION: Mpox (formerly monkeypox), a systemic infection caused by the mpox virus (MPXV), has become a global problem of increasing concern. There are currently no antiviral treatments that have been shown to be safe and effective for the treatment of mpox. AREAS COVERED: Brincidofovir is a lipid-modified acyclic nucleotide with in vitro and in vivo activity against multiple DNA viruses, including MPXV. It is licensed in the US and Canada for the treatment of human smallpox disease in adults and children, including neonates. It has been used under FDA-authorized emergency use for patients in the US with severe mpox. The authors review the antiviral activity, clinical development, pharmacokinetics, safety and efficacy of brincidofovir and its potential as an mpox treatment. A comprehensive review was conducted in PubMed, Science Direct, Embase and Google Scholar. EXPERT OPINION: Research is needed to better understand mpox epidemiology, natural history, antiviral therapy and vaccines. Brincidofovir is being evaluated in a randomized, double-blind, placebo-controlled trial under the Mpox Study in Africa (MOSA) protocol. Additional studies will assist in clarification of single vs. combination therapy, safety and populations most likely to benefit, as well as the management of treatment complications such as immune reconstitution inflammatory syndrome (IRIS).
INTRODUCTION: clinical isolates commonly have high antimicrobial resistance levels. We evaluated the risk factors associated with colistin-resistant, extensively drug-resistant (XDR), and pan-drug-resistant (PDR) . AREA...INTRODUCTION: clinical isolates commonly have high antimicrobial resistance levels. We evaluated the risk factors associated with colistin-resistant, extensively drug-resistant (XDR), and pan-drug-resistant (PDR) . AREAS COVERED: A literature review was done using three electronic resources, encompassing 18 observational studies with 2,462 participants. Our study examined the association between risk factors and infections caused by colistin-resistant (6 studies, 847 participants), XDR (10 studies, 1413 participants), and PDR (3 studies, 202 participants). The most common independent risk factor identified for all three resistance phenotypes was prior use of antibiotics, with adjusted odds ratios (aORs) ranging from 1.3 to 155.9. Additional contributing factors included mechanical ventilation, prolonged stays in the intensive care unit (ICU), and use of invasive devices, such as urinary catheters, central line catheters, and hemodialysis catheters. The severity of illness was also linked to these infections, as indicated by high scores on the APACHE II, SOFA, or SAPS II scales. EXPERT OPINION: Certain risk factors, particularly prior use of antibiotics, have been consistently associated with the development of three resistant phenotypes. Future research should focus on multicenter studies with well-defined criteria for resistance, identifying risk factors, and guiding intervention strategies more effectively.
INTRODUCTION: HIV late presentation, defined as a CD4+ cell count below 350 cells/μL or the presence of an AIDS-defining condition at diagnosis, represents a significant global challenge, accounting for approximately 50%...INTRODUCTION: HIV late presentation, defined as a CD4+ cell count below 350 cells/μL or the presence of an AIDS-defining condition at diagnosis, represents a significant global challenge, accounting for approximately 50% new HIV diagnoses worldwide. This phenomenon is associated with suboptimal clinical outcomes, increased morbidity and mortality, and elevated transmission risks due to prolonged undiagnosed infection. AREAS COVERED: This review examines the definitions, risk factors, epidemiology, and clinical implications of late presentation in HIV. It highlights evidence supporting the timely initiation of antiretroviral therapy (ART), discusses the choice of optimal therapeutic regimens, and addresses the management of opportunistic infections in late presenters. Special attention is given to challenges posed by advanced disease, including immune reconstitution inflammatory syndrome, and drug-drug interactions in the context of opportunistic infections. EXPERT OPINION: Late HIV presenters face unique clinical and therapeutic challenges. High-risk groups, including older individuals, women, people who inject drugs, and migrants, require tailored prevention efforts to improve early diagnosis and care access. While INSTI-based ART regimens are preferred due to their efficacy and tolerability, evidence gaps persist regarding optimal ART strategies and timing in severe opportunistic conditions, such as cryptococcal and tuberculous meningitis. Further studies are needed to address these gaps.
INTRODUCTION: HIV remains a major global health concern. Unexpected disruptions in antiretroviral drug supply chains carry increased mortality and transmission risks. The integrase strand transfer inhibitor dolutegravir...INTRODUCTION: HIV remains a major global health concern. Unexpected disruptions in antiretroviral drug supply chains carry increased mortality and transmission risks. The integrase strand transfer inhibitor dolutegravir plays an increasingly critical role in the global fight against the epidemic. Its high barrier to resistance has been extensively documented in rich countries. Recent reports of resistance cases after dolutegravir failure in resource-limited cohorts raise concerns about whether its high barrier to resistance will hold in low-income countries. AREAS COVERED: For this review, we performed a search on the recent published literature and conference communications focused on acquired drug resistance against dolutegravir in low- and middle-income countries. EXPERT OPINION: Overall, the data unsurprisingly showed that resistance against dolutegravir emerged mainly from unsuppressed individuals with treatment adherence issues. This emergence happened at a population rate below 1% despite structural challenges. Almost half of the resistance cases involved the R263K substitution, which did not always preclude re-suppression with dolutegravir. Minor adjustments in the programmatic large-scale rollout of dolutegravir could further improve these outcomes. Continued treatment adherence support and the preservation of antiretroviral drug supply chains remain crucial for the success of HIV treatment.
Goff DA, Amir A, Ashiru-Oredope D
… +11 more, Balasa E, Carter V, Dramowski A, Flayhart D, Kanj S, Rossi F, Schellack N, Shader Smith D, Thursky K, van den Bergh D, Villegas MV
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 40616819
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INTRODUCTION: Human babesiosis is an emerging tick-borne disease caused by intraerythrocytic protozoa. Most cases are due to which is endemic in the northeastern and upper Midwestern United States. Other spp. cases ar...INTRODUCTION: Human babesiosis is an emerging tick-borne disease caused by intraerythrocytic protozoa. Most cases are due to which is endemic in the northeastern and upper Midwestern United States. Other spp. cases are endemic in China and/or sporadically reported in the United States, Europe, Asia, and elsewhere in the Northern Hemisphere. Cases in immunocompetent hosts are typically mild to moderate, while disease in immunocompromised hosts is often severe. AREAS COVERED: A historical perspective of compounds that are effective against spp. is provided. The current management of mild, moderate, and severe babesiosis is discussed, as is the genetic basis of antimicrobial resistance associated with relapsing babesiosis. The use of red blood cell exchange transfusion is reviewed. EXPERT OPINION/COMMENTARY: Most cases of human babesiosis are successfully treated with atovaquone plus azithromycin or clindamycin plus quinine. A major research topic is the management of immunocompromised hosts, especially those experiencing severe or relapsing babesiosis. Two immediate goals are, (i) to develop new antimicrobial agents that target spp. through novel mechanisms and can overcome resistance to currently recommended antimicrobial agents and, (ii) to gain a better understanding of the efficacy of red blood cell exchange transfusion and indications for its use.
Nakagaki M, Hajkowicz K, Roberts JA
… +1 more, Henden AS
Expert Rev Anti Infect Ther
· 2025 Oct · PMID 40591953
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INTRODUCTION: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of infection due to immunosuppression, prompting routine use of prophylactic and broad-spectrum antibiotic...INTRODUCTION: Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of infection due to immunosuppression, prompting routine use of prophylactic and broad-spectrum antibiotics for treatment. However, emerging evidence suggests that gut microbiome disruption (dysbiosis), partly caused by antibiotic use, is associated with poorer transplant outcomes, including graft-versus-host disease (GVHD), infection, and mortality. AREAS COVERED: This narrative review discusses antibiotic use to prevent and treat febrile neutropenia in allo-HSCT recipients, including effectiveness, impacts on microbiome and GVHD, antimicrobial resistance and infection (CDI). It also reviews available strategies to reduce unnecessary antibiotic use and proposes potential future interventions. A comprehensive PubMed search was conducted through 2024 using terms related to HSCT, antimicrobials, microbiome, resistance, and CDI. EXPERT OPINION: Improving outcomes while minimizing emergence of antibiotic resistance and CDI requires personalized, risk-adaptive antimicrobial stewardship (AMS). Tailored AMS approaches, including patient risk stratification and early de-escalation, could limit unnecessary antibiotic use and mitigate adverse effects. In the future, microbiome preservation and restoration may reduce transplant complications by maintaining colonization resistance and immune balance. Integrating these strategies into allo-HSCT care is essential for optimizing both clinical and microbiological outcomes.
Expert Rev Anti Infect Ther
· 2025 Aug · PMID 40591517
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INTRODUCTION: Pertussis is a severe and potentially life-threatening disease, particularly for young children. Pertussis can have severe complications, including pneumonia, apnea, encephalopathy, rib fractures, and death...INTRODUCTION: Pertussis is a severe and potentially life-threatening disease, particularly for young children. Pertussis can have severe complications, including pneumonia, apnea, encephalopathy, rib fractures, and death, and globally, it is not well controlled. In 2019, there were 19.5 million cases of pertussis worldwide. Countries that transitioned from whole cell to acellular pertussis vaccine programs have reported increasing incidence of pertussis in adolescents and adults. Older adults and adults with chronic health conditions are more likely to experience severe pertussis-related illness. AREAS COVERED: This review presents a summary of the evidence documenting diagnostic, surveillance, and vaccination challenges to controlling pertussis in adults. Searches of PubMed/Medline and clinicaltrials.gov were used to inform this review. EXPERT OPINION: Based on the limited data available to document the burden of pertussis in adults, the true burden of disease in this population remains unknown. There is therefore a need for (1) stronger surveillance and increased awareness of pertussis in adults in high-income and low- and middle-income countries; (2) improved pertussis vaccines that can provide longer-lasting immunity and/or block transmission; and (3) enhanced efforts to increase pertussis vaccination in adults.
INTRODUCTION: Treatment failure is a critical outcome in community-acquired pneumonia (CAP), especially in severe cases, where it increases the risk of complications, prolonged hospital stays and mortality. Treatment fai...INTRODUCTION: Treatment failure is a critical outcome in community-acquired pneumonia (CAP), especially in severe cases, where it increases the risk of complications, prolonged hospital stays and mortality. Treatment failure was reported between 4% and 32% in severe CAP cases. Identifying causes and risk factors for treatment failure is crucial as it enables timely modifications to antibiotic treatment, accurate identification of patients who may require admission to the intensive care unit, and implementation of appropriate management strategies. Understanding the underlying mechanisms and host responses leading to treatment failure is essential for improving patient outcomes. AREAS COVERED: The authors discuss the latest scientific evidence on treatment failure focusing on definition, risk factors, causes, etiology, and the role of biomarkers. This article is based on the available literature from PubMed. EXPERT OPINION: Early detection and timely initiation of proper antimicrobial therapy are key elements to prevent treatment failure and complications, ultimately reducing CAP-associated mortality. However, treatment failure requires a more nuanced approach: identifying and categorizing complications, understanding its timing (early vs. late), and recognizing main risk factors and biomarkers that could help predict, diagnose and monitor treatment failure as early as possible. A multidisciplinary approach is essential in the prevention of treatment failure.
Rai M, Golińska P, Sionkowska A
… +5 more, Shirsat S, Gade AK, Ingle AP, de Matos JME, Prokisch J
Expert Rev Anti Infect Ther
· 2025 Aug · PMID 40579795
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INTRODUCTION: Fungal infections of the scalp and hair are usually caused by fungi like spp. spp. and . These are major global health concerns but are often overlooked and misdiagnosed. Moreover, antimicrobial resistanc...INTRODUCTION: Fungal infections of the scalp and hair are usually caused by fungi like spp. spp. and . These are major global health concerns but are often overlooked and misdiagnosed. Moreover, antimicrobial resistance and other challenges, like early detection methods, inefficient delivery of the antifungal agents, and their side effects, are important challenges in the treatment of such infections. These challenges can be overcome by using nanomaterials, which have been emerging as promising solutions. AREA COVERED: Nanomaterials are reported to play a key role in combating scalp and hair infections caused by different fungi. This review highlights the major fungal infections of the scalp, conventionally used antifungal agents, nanomaterials used in diagnosis, nanocarriers for the delivery of drugs, the toxicity of nanomaterials, and safety. EXPERT OPINION: Nanomaterials can inhibit the growth of emerging and existing pathogens, especially those resistant to conventional fungicides used to treat scalp and hair infections. The lower efficacy of current antifungal drugs has created a need for alternative antifungal strategies to treat these infections. In this context, nanomaterials offer promising potential as fungicidal agents that could be used alone or in combination with existing antifungals to combat scalp and hair infections more effectively.