BACKGROUND: to describe the utilization patterns and therapeutic indications of antivirals used for herpesvirus infections in a Colombian patient population. RESEARCH DESIGN/METHODS: a cross-sectional study on the use of...BACKGROUND: to describe the utilization patterns and therapeutic indications of antivirals used for herpesvirus infections in a Colombian patient population. RESEARCH DESIGN/METHODS: a cross-sectional study on the use of antivirals for treating outpatients with herpesviruses between November 2023 and January 2024 in a Colombian population database. The Micromedex® database was used to identify Food and Drug Administration (FDA)-approved indications, off-label uses, and potentially inappropriate indications. Descriptive, bivariate, and multivariable analyses were performed. RESULTS: a total of 14,816 individuals were included (median age: 53.0 years [IQR: 35.0-65.0]; 60.5% women). Acyclovir was the most frequently prescribed antiviral (oral: 77.3%; topical: 43.4%). Overall, 56.1% received oral therapy only, 25.2% combined oral and topical therapy, and 18.7% topical therapy only. FDA-approved indications accounted for 29.1% of use (mainly treatment of herpes zoster), off-label use for 26.9% (mainly prophylaxis in immunocompromised patients), and potentially inappropriate use for 25.3% (primarily topical treatment of herpes zoster). Acyclovir use (OR: 5.93; 95% CI: 4.60-7.64) and specialist care (OR: 2.17; 95% CI: 1.73-2.71) were associated with off-label use. CONCLUSIONS: Antiviral prescribing for herpesvirus infections in a group of patients in Colombia is largely driven by acyclovir, with a substantial proportion of off-label and potentially inappropriate use, particularly involving topical therapies for herpes zoster. These findings highlight significant gaps in adherence to evidence-based recommendations and underscore the need for targeted interventions to optimize prescribing practices. One study limitation was that medications purchased out of pocket were not captured, as these purchases are not recorded in the dispensing database.
INTRODUCTION: , particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. T...INTRODUCTION: , particularly multidrug-resistant strains, is a high-burden nosocomial pathogen with limited therapeutic options. Eravacycline is increasingly used off-label despite limited supporting clinical evidence. This meta-analysis aimed to evaluate the effectiveness and safety of eravacycline versus non-eravacycline-based regimens in adults with resistant infections. METHODS: MEDLINE, Embase, and Cochrane Central were searched for studies evaluating eravacycline regimens in hospitalized adults with infection. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Data were analyzed using R statistical software. RESULTS: Fifteen studies encompassing 462 patients were included. Populations consisted predominantly of older adults, with respiratory tract infections representing the most common source of infection (77.6%). Carbapenem-resistant accounted for 84.4% of evaluable cases. No statistically significant differences were observed between eravacycline and non-eravacycline-based regimens in all-cause mortality (RR 1.06; 95% CI 0.46-2.47), clinical cure (RR 0.90; 95% CI 0.77-1.07), or microbiological eradication (RR 0.88; 95% CI 0.56-1.37). Complementary single-arm pooled estimates among eravacycline-treated cohorts were favorable. CONCLUSION: This meta-analysis strengthens the evidence base for eravacycline effectiveness in resistant infections and supports its consideration when preferred regimens are not feasible; adequately powered randomized trials are needed to define optimal positioning.
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42372294
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INTRODUCTION: pneumonia (PJP) remains a life-threatening lower respiratory tract infection associated with respiratory failure in patients with impaired T-cell immunity. Its incidence is increasing in non-HIV patients,...INTRODUCTION: pneumonia (PJP) remains a life-threatening lower respiratory tract infection associated with respiratory failure in patients with impaired T-cell immunity. Its incidence is increasing in non-HIV patients, who typically experience a more severe disease course and poorer outcomes than HIV patients. Keeping a high level of suspicion for PJP when confronted to an immunocompromised patient presenting with an acute respiratory failure (ARF) is essential to start promptly the treatment and thereby reduce associated morbidity and mortality. AREAS COVERED: The mechanism of infestation and the immune cells implicated in the host response are discussed. The clinical and patterns on imaging are reported. The need for prompt treatment initiation, even before diagnostic confirmation is emphasized. The prophylactic and therapeutic arsenal is listed and discussed, as well as adverse events and additional measures. EXPERT OPINION: The research field for PJP in non-HIV patients in the next years should focus on: individualize the risk prediction of PJP, define an international quantitative PCR threshold, improve diagnostic criterion, optimize the treatment.
de Oliveira ACP, Assone T, Haziot ME
… +8 more, Smid J, Marcusso RMN, Folgosi V, Gascon MRP, Pacheco F, Rosadas C, Taylor GP, Casseb J
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42348426
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BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) infection is classically categorized as either asymptomatic or associated with HTLV-1-associated myelopathy (HAM). However, accumulating clinical evidence suggests t...BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) infection is classically categorized as either asymptomatic or associated with HTLV-1-associated myelopathy (HAM). However, accumulating clinical evidence suggests that a substantial proportion of individuals labeled as asymptomatic present early inflammatory and neurological manifestations that do not fulfill established HAM diagnostic criteria. RESEARCH DESIGN AND METHODS: We conducted an observational study within a large, long-standing Brazilian HTLV-1 cohort. Between January 2015 and December 2025, adults previously classified as asymptomatic were systematically evaluated during routine follow-up at a specialized outpatient clinic. Standardized clinical and neurological examinations were newly performed by clinicians not previously involved in their care and assessment. These findings were then integrated with neuropsychological, radiological and laboratory assessments. RESULTS: Among individuals previously considered asymptomatic, 24% fulfilled predefined criteria for an intermediate condition termed HTLV-1-associated multiple inflammatory disease (HAMID). HAMID was associated with older age, female sex, higher proviral load, markers of chronic immune activation, subtle spinal cord abnormalities, and measurable cognitive impairment, particularly affecting episodic memory. CONCLUSIONS: HTLV-1 infection encompasses an early, biologically active inflammatory disease stage distinct from both asymptomatic infection and overt HAM. Recognition of HAMID refines the clinical spectrum of HTLV-1 infection and provides a framework for earlier diagnosis, improved risk stratification, and closer clinical surveillance.
Maher A, Baddour LM, El Dalati S
… +5 more, Miro JM, DeSimone DC, Marti-Carvajal AJ, Thornhill MH, Dayer MJ
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42345234
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INTRODUCTION: Infective endocarditis (IE) is a complex infection of the endocardium, associated with significant morbidity and mortality. Diagnosing IE can be challenging, as shown by the evolution of original diagnostic...INTRODUCTION: Infective endocarditis (IE) is a complex infection of the endocardium, associated with significant morbidity and mortality. Diagnosing IE can be challenging, as shown by the evolution of original diagnostic criteria. Managing IE is difficult, involving decisions about diagnosis, antibiotic therapy, and surgery. Given these challenges, the 2015 European Society of Cardiology (ESC) IE Guidelines recommended establishing an endocarditis team (ET) in centers managing IE. This review evaluates the evidence supporting ETs. AREAS COVERED: We identified 19 before-and-after studies including 5,327 patients (3,069 before and 2,258 after ET introduction) that examined the impact of implementing an ET on the quality of care for patients with IE. No RCTs were found. The studies were reviewed and revealed a significant reduction in in-hospital mortality (20.9-16.3% [RR 0.71, CI 0.54 to 0.93], = 0.0154)) and the proportion of endocarditis cases in which an organism was not identified (23.8-9.8%; [RR 0.50, 0.39 to 0.64, < 0.0001]) following ET introduction. EXPERT OPINION: This review provides consistent observational evidence that ETs are effective in saving lives. Despite limitations, the consistency of effect across multiple studies, biological plausibility, and alignment with successful multidisciplinary models in other diseases support the widespread implementation of ETs.
Duan X, Tan D, Deng Q
… +4 more, Hou X, Liu L, Zhai K, Li X
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42334844
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BACKGROUND: is the leading pathogen of life-threatening invasive candidiasis, with mortality exceeding 40% in immunocompromised patients. Global azole resistance and limited approved antifungal classes severely restrict...BACKGROUND: is the leading pathogen of life-threatening invasive candidiasis, with mortality exceeding 40% in immunocompromised patients. Global azole resistance and limited approved antifungal classes severely restrict clinical treatment, making repurposing FDA-approved drugs a promising low-barrier strategy. RESEARCH DESIGN AND METHODS: The synergistic antifungal activity of crisaborole (CRB) combined with azoles was validated via checkerboard microdilution assay. efficacy of CRB plus ketoconazole (KCZ) was evaluated in a Galleria mellonella infection model, with mechanisms explored via phenotypic assays and qPCR. RESULTS: CRB combined with azoles exerted potent synergism against drug-resistant (FICI 0.023-0.500). CRB+KCZ significantly improved larval survival, reduced fungal burden, inhibited fungal efflux pump activity, and impaired hyphal growth and host cell adhesion of . CONCLUSIONS: CRB specifically enhances azoles' antifungal activity, offering a clinically translatable therapeutic strategy for drug-resistant infections.
Kuo AP, Hamdan S, Donnelley MA
… +1 more, Thompson GR
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42328766
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INTRODUCTION: Coccidioidomycosis infections can pose severe clinical complications with high morbidity and mortality. There exist numerous treatment options with emerging evidence accumulating for each. AREAS COVERED: Th...INTRODUCTION: Coccidioidomycosis infections can pose severe clinical complications with high morbidity and mortality. There exist numerous treatment options with emerging evidence accumulating for each. AREAS COVERED: This review summarizes evidence regarding current and novel agents for the treatment of coccidioidomycosis. Key topics include a review of therapeutic agents, current guidelines, and evidence regarding selection of the most optimal treatment regimen. EXPERT OPINION: There exist multiple antifungal regimens that have been demonstrated to be efficacious in treating systemic coccidioidomycosis infections; however, determining the most optimal therapy as new therapeutic agents emerge should be weighed upon a variety of factors including efficacy, tolerability, penetration into areas of infection such as the central nervous system (CNS), and susceptibility of the pathogen. Novel agents in preclinical and clinical development may assist in addressing patients with refractory, resistant or intolerance to currently available treatment regimens.
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42312997
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BACKGROUND: Prolonged β-lactam infusion and therapeutic drug monitoring (TDM) are recommended to optimize target attainment in critically ill patients, but implementation varies, and Middle Eastern data are scarce. This...BACKGROUND: Prolonged β-lactam infusion and therapeutic drug monitoring (TDM) are recommended to optimize target attainment in critically ill patients, but implementation varies, and Middle Eastern data are scarce. This study assessed intensivists' practices, beliefs, and perceptions regarding β-lactam administration and TDM in intensive care units (ICUs) in Kuwait. METHODS: A cross-sectional study was conducted among intensivists in adult, pediatric, and neonatal ICUs across public hospitals using a validated questionnaire. Descriptive and multivariable regression analyses were performed. RESULTS: Of 348 intensivists invited, 212 responded (61%). Intermittent infusion predominated for cephalosporins (91%), cloxacillin (84%), and piperacillin-tazobactam/meropenem (81%). Piperacillin-tazobactam/meropenem extended infusion was reported by 60%, while continuous infusion was rare (<10%). Loading doses for severe infections were more frequent with intermittent infusion (68%) than extended (39%) or continuous (9%). Experience >10 years predicted greater use of intermittent infusion and loading doses; neonatal ICU respondents were less likely to use prolonged infusions or loading doses. Beliefs toward prolonged infusion were neutral or uncertain (median 3.0), whereas perceptions of TDM were generally positive (median 4.0), both lower in pediatric ICUs. CONCLUSIONS: Intermittent infusion remains dominant. Practices vary by experience and ICU type, underscoring the need for national protocols, targeted education, and TDM implementation to strengthen stewardship.
BACKGROUND: Antimicrobial resistance (AMR) is a major threat in oncology, where immunosuppression and repeated healthcare exposure increase susceptibility to severe infections. Multicenter data on antibiotic resistance p...BACKGROUND: Antimicrobial resistance (AMR) is a major threat in oncology, where immunosuppression and repeated healthcare exposure increase susceptibility to severe infections. Multicenter data on antibiotic resistance patterns among cancer patients in Iraq remain limited. RESEARCH DESIGN AND METHODS: A multicenter observational study was conducted across three oncology centers in Iraq between January 2024 and March 2025. A total of 125 non-duplicate blood culture isolates from patients with hematological and solid malignancies were analyzed, including 100 resistant and 25 susceptible isolates. Antibiotic susceptibility testing followed Clinical and Laboratory Standards Institute criteria, and categorical variables were analyzed using chi-square tests. RESULTS: Multidrug-resistant and carbapenem-resistant phenotypes were frequent among Klebsiella pneumoniae (35/100, 35%), Escherichia coli (36/100, 36%), and Pseudomonas aeruginosa (29/100, 29%). P. aeruginosa showed the highest burden of advanced resistance phenotypes, including difficult-to-treat resistance. Resistant isolates were more common in patients with hematological malignancies (77/100, 77%) than in those with solid tumors (23/100, 23%). Resistance was prominent for third-generation cephalosporins, fluoroquinolones, and β-lactam/β-lactamase inhibitor combinations, whereas tigecycline and colistin retained greater activity against several resistant isolates. CONCLUSIONS: This study identified substantial antibiotic resistance among bloodstream isolates from cancer patients in Iraq, supporting oncology-specific surveillance and antimicrobial stewardship.
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42298392
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INTRODUCTION: Chronic hepatitis B infection affects an estimated 258 million people globally. Mother-to-child transmission (MTCT) accounts for over one-third of new cases in endemic regions and almost invariably results...INTRODUCTION: Chronic hepatitis B infection affects an estimated 258 million people globally. Mother-to-child transmission (MTCT) accounts for over one-third of new cases in endemic regions and almost invariably results in lifelong infection if acquired at birth. Over the past four decades, universal vaccination, hepatitis B immunoglobulin (HBIG), and maternal antiviral prophylaxis have substantially reduced MTCT. However, limited access to antiviral therapy and HBIG in resource-constrained settings continues to hinder elimination efforts. AREAS COVERED: This review focuses on HBV in pregnancy and breastfeeding, with emphasis on maternal antiviral prophylaxis. It outlines epidemiology, maternal risk factors, and the limitations of vaccination and HBIG. Evidence supporting tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) is evaluated, alongside HBIG-free strategies and novel vaccine delivery platforms. Postpartum management, including hepatitis flares and the safety of breastfeeding during antiviral therapy, is also addressed. EXPERT OPINION: Maternal antiviral prophylaxis with TDF, and increasingly TAF, is central to preventing mother-to-child transmission of hepatitis B. HBIG-free strategies, earlier treatment initiation, and improved vaccines may further reduce transmission, particularly in resource-limited settings. Achieving WHO 2030 elimination goals will require policy commitment, affordable access, and integration of HBV prevention into routine maternal - child health care.
BACKGROUND: Antimicrobial resistance is a major public health issue. Little is known about patients' understanding of the risks associated with antibiotic use or antimicrobial resistance. We conducted a survey in Houston...BACKGROUND: Antimicrobial resistance is a major public health issue. Little is known about patients' understanding of the risks associated with antibiotic use or antimicrobial resistance. We conducted a survey in Houston, Texas among ethnically and racially diverse patients to identify factors associated with knowledge of antibiotic risks and to determine whether knowledge of antibiotic risks impacts patients' intention to use antibiotics without a prescription. METHODS: A survey was conducted between January 2020 and June 2021 among adult patients in waiting rooms at six public clinics and two private emergency rooms in Houston, Texas. Univariate and multivariate analyses were performed to identify independent risk factors associated with the intention to use non-prescription antibiotics. RESULTS: Surveys were collected among 564 individuals, of which 62% knew about any risks (individual or public health) associated with antibiotics, 19% had some knowledge of antibiotic resistance, and 6% had knowledge about microbiome effects. Knowledge gaps, younger age, receiving care in public rather than private healthcare setting were independent predictors of intention to use non-prescription antibiotics in the future. CONCLUSIONS: Improving knowledge regarding antibiotic risks may reduce the use of antibiotics without a prescription.
INTRODUCTION: Antimicrobial resistance (AMR) has shifted from a projected threat to a measurable global crisis, with recent surveillance showing rising resistance across major pathogen-drug combinations. This perspective...INTRODUCTION: Antimicrobial resistance (AMR) has shifted from a projected threat to a measurable global crisis, with recent surveillance showing rising resistance across major pathogen-drug combinations. This perspective examines why resistance is accelerating despite years of global action. AREAS COVERED: Drawing on an exploratory search of PubMed, Scopus, Google Scholar, and key WHO and CDC reports, we synthesized peer-reviewed studies and surveillance reports published up to October 2025. We focus on five interlinked failures: fragmented surveillance, inappropriate antibiotic use in human and animal sectors, environmental amplification of resistance, stagnation in antibiotic innovation, and inequities in diagnostic and treatment capacity. Available estimates indicate that around 90% of AMR deaths occur in low- and middle-income countries, while livestock consume most antibiotics used globally. Headline surveillance figures are largely based on laboratory-confirmed infections and uneven country reporting, and therefore should not be interpreted as true population incidence. EXPERT OPINION: AMR control will require enforceable stewardship and agricultural reforms, stronger laboratory and sanitation systems, rapid diagnostics, and new economic incentives for antibiotic development. Progress will depend on shared accountability across health systems, regulators, industry, and governments.
INTRODUCTION: Urinary tract infection (UTI) is among the most common infections in long-term care facilities worldwide and is a leading driver of antimicrobial use. Increasing antimicrobial resistance (AMR), particularly...INTRODUCTION: Urinary tract infection (UTI) is among the most common infections in long-term care facilities worldwide and is a leading driver of antimicrobial use. Increasing antimicrobial resistance (AMR), particularly among multidrug-resistant gram-negative organisms, presents major clinical and public health challenges in this vulnerable population. AREAS COVERED: A comprehensive literature search and narrative review of studies published between 2010 and March 2026 were conducted using PubMed and international surveillance databases. Current knowledge regarding AMR in UTIs in long-term care residents is summarized. EXPERT OPINION: UTIs account for 15-30% of infections and 25-50% of antibiotic prescriptions in long-term care facilities globally. Resistance rates among isolates are high worldwide: trimethoprim-sulfamethoxazole (30-70%), fluoroquinolones (25-60%), and third-generation cephalosporins (15-40%). Extended-spectrum β-lactamase prevalence ranges from 10-50%, depending on the region. Carbapenem-resistant Enterobacterales are increasingly reported in long-term care settings. Risk factors include prior antibiotic exposure, indwelling catheter use, functional impairment, recent hospitalization, and polypharmacy. Inappropriate treatment of asymptomatic bacteriuria significantly contributes to AMR. Implementation of antimicrobial stewardship programs, catheter minimization strategies, infection and prevention control, and improved diagnostic criteria is critical to mitigating resistance and improving resident outcomes.
INTRODUCTION: With recent reports of the emergence of parasites resistant to artemisinin-based combination therapies (ACTs) in Africa, health-care providers are pivotal in the optimal effectiveness of these drugs. This...INTRODUCTION: With recent reports of the emergence of parasites resistant to artemisinin-based combination therapies (ACTs) in Africa, health-care providers are pivotal in the optimal effectiveness of these drugs. This systematic review was designed to analyze knowledge, attitudes, and practices of health-care providers toward antimalarial drug prescriptions in Cameroon. METHODS: The study was registered with PROSPERO (CRD42024596768). Reference databases were queried to identify relevant studies as per PRISMA guidelines. The methodological quality of the studies was assessed using the JBI tools. RESULTS: Twelve studies were included. The analysis indicates that health-care providers are knowledgeable about ACTs and national treatment guidelines. However, their attitudes and practices toward adherence to guidelines remain inconsistent and often suboptimal. Drug prescription without laboratory confirmation of malaria, non-prescription drug administration, and incorrect prescriptions (incorrect drugs and/or posology) are the main malpractices. Key gaps include a lack of studies in underrepresented regions, non- malaria treatment, and therapeutic management of special populations. CONCLUSIONS: Collectively, the findings outline the need to reinforce awareness strategies in health-care providers and address the identified gaps to achieve successful malaria control in Cameroon.
Touati A, Boufahja F, Touaitia R
… +3 more, Khezami L, Idres T, Grenni P
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42217234
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INTRODUCTION: Antimicrobial resistance (AMR) is propelled by horizontal gene transfer (HGT), with conjugative plasmids enabling rapid, cross-species spread and stable carriage of resistance. Interventions that reduce pla...INTRODUCTION: Antimicrobial resistance (AMR) is propelled by horizontal gene transfer (HGT), with conjugative plasmids enabling rapid, cross-species spread and stable carriage of resistance. Interventions that reduce plasmid transmission or persistence can complement bactericidal therapies and infection-control programs. AREAS COVERED: We review druggable vulnerabilities in conjugation (mating-pair formation, type IV secretion/ATPase motors, coupling proteins, and relaxosome functions) and in plasmid maintenance (replication, partition, and toxin-antitoxin enforcement). The review is grounded in a narrative search of recent mechanistic, ecological, and literature. We cover biological antagonists (exclusion, fertility inhibition, and host defenses), chemical and metabolic inhibitors, and genetic strategies that repress transfer functions or selectively eliminate resistance elements. EXPERT OPINION: HGT inhibition is moving from proof-of-concept to actionable containment, but progress depends on mechanism-confirmed leads, standardized transfer metrics, plasmid confirmation, and safety evaluation in complex microbiomes and environments. Near-term impact is most likely an adjunct to stewardship and infection prevention, aiming to reduce new acquisition and shorten carriage of high-risk resistance plasmids.
Gok A, Kavakli AS, Sugur T
… +2 more, Karaveli A, Ozturk N
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42212500
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BACKGROUND: This study aimed to assess culture positivity rates and the microbiological profile of intensive care unit (ICU)-acquired superinfections in patients with severe COVID-19 pneumonia treated with pulse-dose met...BACKGROUND: This study aimed to assess culture positivity rates and the microbiological profile of intensive care unit (ICU)-acquired superinfections in patients with severe COVID-19 pneumonia treated with pulse-dose methylprednisolone, with or without adjunctive tocilizumab. RESEARCH DESIGN AND METHODS: A total of 443 adult patients with confirmed COVID-19 pneumonia who received pulse-dose methylprednisolone were included. Patients were divided into two groups: those who received pulse steroids alone (PS group, = 328) and those who received steroids plus tocilizumab (PS+TCZ group, = 115). Superinfections were defined as new bacterial or fungal infections occurring ≥48 hours after ICU admission. RESULTS: Culture positivity rates did not significantly differ between the PS and PS+TCZ groups in blood (48.6% vs. 57.4%; = 0.219), tracheal aspirate (60.2% vs. 66.2%; = 0.413), or urine (21.6% vs. 19.7%; = 0.752) samples. The most frequently isolated organisms were coagulase-negative staphylococci (blood), Acinetobacter spp. (tracheal aspirates), and Candida albicans (urine). The PS+TCZ group had significantly longer ICU stays (18.5 ± 16.9 vs. 14.8 ± 13.1 days; = 0.017) but a lower mortality rate (56.8% vs. 67.4%; = 0.049) compared to the PS group. CONCLUSION: The addition of tocilizumab to pulse-dose methylprednisolone did not increase the risk of ICU-acquired superinfection.
INTRODUCTION: Antimicrobial resistance is escalating globally, while the development of new antibiotic classes has stagnated. This trend is reminiscent of the late-stage dynamics of S-curve innovation, where incremental...INTRODUCTION: Antimicrobial resistance is escalating globally, while the development of new antibiotic classes has stagnated. This trend is reminiscent of the late-stage dynamics of S-curve innovation, where incremental advances no longer meet clinical needs. To overcome this impasse, disruptive innovation is required. As protein-based antibacterials, lysins represent a fundamentally different modality from traditional small-molecule antibiotics and offer new opportunities for disruptive innovation in terms of resistance development and microbiome preservation. AREAS COVERED: Sourced from a vast natural reservoir, lysins exhibit rapid, targeted bactericidal activity with low resistance potential and high specificity. Their narrow-spectrum nature supports a potential for microbiome preservation and the conceptual development of theranostic platforms for precision infectious disease management, combining ultra-fast pathogen detection with targeted therapeutic activity. EXPERT OPINION: To initiate new innovation cycles, disruptive modalities such as protein-based lysins will be needed, offering a paradigm shift in antimicrobial therapy. Their modular architecture and amenability to protein engineering enable a hit-to-lead development strategy akin to small-molecule pipelines. Their synergistic interactions with standard-of-care antibiotics and booster-like activity could facilitate incremental clinical integration into existing treatment protocols. This positioning supports regulatory acceptance and paves the way for lysins to become transformational components of precision antimicrobial therapy.
Marcatto-Abreu MF, de Magalhães Tenório PH, Etchebehere M
Expert Rev Anti Infect Ther
· 2026 May · PMID 42139662
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Routine surgical antibiotic prophylaxis (SAP) is frequently used to prevent surgical site infections, although its benefit in clean elective upper limb soft-tissue surgery remains questionable due to the low baseline ris...Routine surgical antibiotic prophylaxis (SAP) is frequently used to prevent surgical site infections, although its benefit in clean elective upper limb soft-tissue surgery remains questionable due to the low baseline risk of infection. This issue is particularly relevant in resource-limited settings, where concerns about infection and limited locally generated evidence often sustain routine antibiotic use. This study evaluated whether SAP provides clinical benefit in this context using a randomized, double-blind, placebo-controlled design. A total of 110 adult patients undergoing clean outpatient upper limb surgery were allocated to receive either a single preoperative dose of antibiotics or placebo. Surgical site infection rates were low and equivalent in both groups (1.8%), with no meaningful differences in postoperative wound complications. These findings suggest that routine SAP does not improve outcomes in this setting and support more judicious, evidence-based antibiotic use in low-risk surgical procedures, even in environments where perceived infection risk remains a concern. ClinicalTrials.gov NCT05990842.