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Background: Tuberculosis remains an infectious disease of global concern, with potential impacts on respiratory and intestinal microbiota owing to prolonged broad-spectrum antibiotic therapy. Despite its potential to cause infertility, the vaginal microbiota of women with genital tuberculosis remains poorly understood. We comprehensively analyzed the vaginal microbiota in Chinese women with genital tuberculosis. Results: We recruited women with pelvic (n = 28), endometrial (n = 16), and pulmonary (n = 12) tuberculosis as the research group, and healthy women (n = 11) as the control group. Vaginal discharges were collected for metagenomic analysis of its microbiota. The alpha diversity of the vaginal microbiota in women with genital tuberculosis was slightly higher than that in healthy women, though the difference was not statistically significant (P = 0.23). Similarly, no significant differences in alpha diversity were observed between women with genital and pulmonary tuberculosis (P = 0.82) or between those with pelvic and endometrial tuberculosis (P = 0.82). Notably, the lowest alpha diversity was recorded six months to one year after initiating anti-tuberculosis treatment, with this decline being statistically significant (P = 0.023). The dominance of Lactobacillus iners in the vaginal microbiota was more common in women with genital tuberculosis than that of Lactobacillus crispatus. Furthermore, the abundance of short-chain fatty acid -producing anaerobes, such as Actinomycetes, Streptococcus, and Finegoldia, were significantly increased. Short-chain fatty acid precursor pathways, including the ko03010 ribosome pathway, ko00970 aminoacyl-tRNA synthesis, ko00230 purine metabolism, ko00240 pyrimidine metabolism, and ko00010 glycolysis gluconeogenesis pathway, were significantly upregulated in women with endometrial tuberculosis. Conclusions: Extrapulmonary tuberculosis, particularly genital tuberculosis and its associated vaginal dysbiosis impacts female fecundity. Vaginal dysbiosis is more pronounced when M. tuberculosis invades the endometrium. Given the effect of antibiotics on vaginal flora, probiotic combined interventions could be used as a future research direction. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Introduction: Antibiotic overuse is driving a global rise in antibiotic resistance, highlighting the need for robust antimicrobial stewardship (AMS) initiatives to improve prescription practices. While antimicrobials are essential for treating sepsis and preventing surgical site infections (SSIs), they can inadvertently disrupt the gut microbiota, leading to postoperative complications. Treatment methods vary widely across nations due to differences in drug choice, dosage, and therapy duration, affecting antibiotic resistance rates, which can reach up to 51% in some countries. In Romania and the Republic of Moldova, healthcare practices for surgical antibiotic prophylaxis differ significantly despite similarities in genetics, culture, and diet. Romania's stricter healthcare regulations result in more standardized antibiotic protocols, whereas Moldova's limited healthcare funding leads to less consistent practices and greater variability in treatment outcomes. Methods: This study presents the results of a prospective cross-border investigation involving 86 colorectal cancer patients from major oncological hospitals in Romania and Moldova. We analyzed fecal samples collected from patients before and 7 days post-antibiotic treatment, focusing on the V3–V4 region of the 16S rRNA gene. Results: Our findings indicate that inconsistent antibiotic prophylaxis policies—varying in type, dosage, or therapy duration—significantly impacted the gut microbiota and led to more frequent dysbiosis compared to stricter prophylactic antibiotic practices (single dose, single product, limited time). Discussion: We emphasize the need for standardized antibiotic prophylaxis protocols to minimize dysbiosis and its associated risks, promoting more effective antimicrobial use, particularly in low- and middle-income countries (LMICs). [ABSTRACT FROM AUTHOR]

Anaerobe-targeted antibiotic (ATA) therapy may adversely impact the developing neonatal microbiome. We describe utilization patterns, potential indications, and related outcomes of ATA therapy in neonatal intensive care units across the United States over 13 years. While overall antibiotic use decreased, ATA use was unchanged. Potentially associated indications were inconsistent. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course. [ABSTRACT FROM AUTHOR]

Objectives To establish a formal diagnosis in infectious disease is not an easy task. Our aim was to characterize diagnostic uncertainty (DU) in patients for whom blood cultures were positive (PBC) and to determine its impact on both the antibiotic therapy and the outcome. Methods This was a prospective multicentre study including PBC for 6 months. The laboratory gave the PBC result to the infectious disease (ID) specialists in real time (24/7). The latter analysed all data from electronic patient charts and gave therapeutic advice to the physicians in charge of the patient to either initiate an antibiotic therapy, or to modify or to pursue continuing antimicrobial treatment. A DU was defined as no diagnosis of ID after thorough reading of the patient's chart, or more than two diagnoses despite two medical opinions obtained before PBC. An unfavourable outcome was defined by the occurrence of death during hospitalization. Results One hundred and nighty-nine PBCs were communicated to ID specialists, including 93 DUs (47%). In multivariate analysis, DU was associated with hospitalization in medical wards: [adjusted odds ratio (AOR) (95% CI): 6.94 (3.41–14.28)], the advice to initiate an antibiotic treatment: [3.89 (1.56–9.70)] and piperacillin-tazobactam use [3.75 (1.56–9.00)]; ICU requirement at initiation of care was a protective factor [0.38 (0.17–0.84)]. An unfavourable outcome was observed in 22 cases, and in a second logistic regression showed that DU was associated with the latter [AOR (95% CI): 5.07 (1.60–16.12)]. Conclusion DUs were frequent during infections proved by PBC, and were associated with admission in medical wards, broad-spectrum antibiotic use and a high rate of unfavourable outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI. Methods: We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision. Duration of antibiotic administration were classified to three groups: short-term IV therapy (≤ two weeks), short-term IV therapy plus oral therapy, and long-term IV therapy (minimum six weeks). Results: We identified 963 studies, of which 21 were included in the systematic review. Coagulase-negative Staphylococcal species were the most frequently isolated pathogens. The mean eradication rate for all the studies analyzed was 88.4% (range, 62.5–100%). Short-term IV + long-term oral antibiotic therapy demonstrated significantly higher eradication rate compared to the other two regimens following one-stage revision TKA (p = 0.023) (Table 4). In the ten studies with great than five years of follow-up, this difference was no longer statistically significant. Subgroup analysis of antibiotic-loaded cement (ABLC) usage demonstrated higher eradication rates with short-term IV + long-term oral (92.8%) and long-term IV antibiotics (89.7%) compared to short-term IV antibiotics alone (p = 0.006). Conclusion: We demonstrated that short-term IV antibiotics followed by oral antibiotics had similar eradication rates to long-term IV antibiotics in long-term studies, which were both superior to short-term IV antibiotics alone. Nevertheless, there remains a need for prospective and randomized studies to further elucidate a patient-based protocol for the type and duration of antibiotic use following one-stage PJI treatment of the knee. [ABSTRACT FROM AUTHOR]

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS. [ABSTRACT FROM AUTHOR]

Introduction: The shaping of the human intestinal microbiota starts during the intrauterine period and continues through the subsequent stages of extrauterine life. The microbiota plays a significant role in the predisposition and development of immune diseases, as well as various inflammatory processes. Importantly, the proper colonization of the fetal digestive system is influenced by maternal microbiota, the method of pregnancy completion and the further formation of the microbiota. In the subsequent stages of a child's life, breastfeeding, diet and the use of antibiotics influence the state of eubiosis, which determines proper growth and development from the neonatal period to adulthood. The literature data suggest that there is evidence to confirm that the intestinal microbiota of the infant plays an important role in regulating the immune response associated with the development of allergic diseases. However, the identification of specific bacterial species in relation to specific types of reactions in allergic diseases is the basic problem. Background: The main aim of the review was to demonstrate the influence of the microbiota of the mother, fetus and newborn on the functioning of the immune system in the context of allergies and asthma. Methods: We reviewed and thoroughly analyzed the content of over 1000 articles and abstracts between the beginning of June and the end of August 2024. Over 150 articles were selected for the detailed study. Results: The selection was based on the PubMed National Library of Medicine search engine, using selected keywords: "the impact of intestinal microbiota on the development of immune diseases and asthma", "intestinal microbiota and allergic diseases", "the impact of intrauterine microbiota on the development of asthma", "intrauterine microbiota and immune diseases", "intrauterine microbiota and atopic dermatitis", "intrauterine microbiota and food allergies", "maternal microbiota", "fetal microbiota" and "neonatal microbiota". The above relationships constituted the main criteria for including articles in the analysis. Conclusions: In the present review, we showed a relationship between the proper maternal microbiota and the normal functioning of the fetal and neonatal immune system. The state of eubiosis with an adequate amount and diversity of microbiota is essential in preventing the development of immune and allergic diseases. The way the microbiota is shaped, resulting from the health-promoting behavior of pregnant women, the rational conduct of the medical staff and the proper performance of the diagnostic and therapeutic process, is necessary to maintain the health of the mother and the child. Therefore, an appropriate lifestyle, rational antibiotic therapy as well as the way of completing the pregnancy are indispensable in the prevention of the above conditions. At the same time, considering the intestinal microbiota of the newborn in relation to the genera and phyla of bacteria that have a potentially protective effect, it is worth noting that the use of suitable probiotics and prebiotics seems to contribute to the protective effect. [ABSTRACT FROM AUTHOR]

Background: Specialized outpatient palliative care (SAPV) is a component of palliative care in Germany, which assists approximately 10% of palliative patients. The majority of these patients have a malignant disease and are at increased risk of complications or severe infection. Antibiotic stewardship (ABS) measures are implemented to optimize antibiotic administration; however, there is little data available in this area, particularly for SAPV. Therefore, we examined the extent to which ABS measures can be meaningfully used or implemented in SAPV. Methods: After establishing a corresponding interview guide, 15 experts from specialized areas were interviewed on this subject by the Institute for Market Research in Healthcare Munich (IMIG) through audio-registered individual interviews. The interviews were analyzed using the qualitative content analysis method according to Mayring. Results: All 15 experts participated. The primary benefits cited were greater safety in the prescription and decision-making process for antibiotics in the areas of SAPV and improved quality of life. The implementation of continuous ABS measures for SAPV was considered difficult in some cases and linked to certain prerequisites, such as supportive advice from existing systems. The possibility of further training for SAPV members in the area of ABS was considered particularly advantageous. Conclusions: The implementation of ABS measures in SAPV is feasible in principle; however, it is difficult to implement under the current conditions. Close cooperation with an existing external ABS expert/team will be helpful. This will provide more security for a small, but relevant proportion of SAPV patients, and for the SAPV team treating them. [ABSTRACT FROM AUTHOR]

Therapeutic considerations for aspiration pneumonia prioritize the risk of multidrug-resistant organisms. This involves integrating microbiological insights with each patient's unique risk profile, including the location at the time of aspiration, and whether it occurred in or out of the hospital. Our understanding of the microbiology of aspiration pneumonia has also evolved, leading to a reassessment of anaerobic bacteria as the primary pathogens. Emerging research shows a predominance of aerobic pathogens, in both community and hospital-acquired cases. This shift challenges the routine use of broad-spectrum antibiotics targeting anaerobes, which can contribute to antibiotic resistance and complications such as Clostridium difficile infections—concerns that are especially relevant given the growing issue of antimicrobial resistance. Adopting a comprehensive, patient-specific approach that incorporates these insights can optimize antibiotic selection, improve treatment outcomes, and reduce the risk of resistance and adverse effects. [ABSTRACT FROM AUTHOR]

In Switzerland and other high-income countries, one out of 3000 to 5000 term and late preterm neonates develops early onset sepsis (EOS) associated with a mortality of around 3%, while incidence and mortality of EOS in very preterm infants are substantially higher. Exposure to antibiotics for suspected EOS is disproportionally high compared to the incidence of EOS with consequences for future health and antimicrobial resistance (AMR). A safe reduction of unnecessary antibiotic treatment has to be a major goal of new management strategies and guidelines. Antibiotics should be administered immediately in situations with clinical signs of septic shock. Group B streptococcus (GBS) and Escherichia coli (E. coli) are the leading pathogens of EOS. Amoxicillin combined with an aminoglycoside remains the first choice for empirical treatment. Serial physical examinations are recommended for all neonates with risk factors for EOS. Neonates without any clinical signs suggestive of EOS should not be treated with antibiotics. In Switzerland, we do not recommend the use of the EOS calculator, a risk stratification tool, due to its unclear impact in a population with an observed antibiotic exposure below 3%. Not all neonates with respiratory distress should be empirically treated with antibiotics. Isolated tachypnea or respiratory distress starting immediately after delivery by elective caesarean section or a clearly assessed alternative explanation than EOS for clinical signs may point towards a low probability of sepsis. On the other hand, unexplained prematurity with risk factors has an inherent higher risk of EOS. Before the start of antibiotic therapy, blood cultures should be drawn with a minimum volume of 1 ml in a single aerobic blood culture bottle. This standard procedure allows antibiotics to be stopped after 24 to 36 h if no pathogen is detected in blood cultures. Current data do not support the use of PCR-based pathogen detection in blood as a standard method. Lumbar puncture is recommended in blood culture–proven EOS, critical illness, or in the presence of neurological symptoms such as seizures or altered consciousness. The accuracy of a single biomarker measurement to distinguish inflammation from infection is low in neonates. Therefore, biomarker guidance is not a standard part of decision-making regarding the start or stop of antibiotic therapy but may be used as part of an algorithm and after appropriate education of health care teams. Every newborn started on antibiotics should be assessed for organ dysfunction with prompt initiation of respiratory and hemodynamic support if needed. An elevated lactate may be a sign of poor perfusion and requires a comprehensive assessment of the clinical condition. Interventions to restore perfusion include fluid boli with crystalloids and catecholamines. Neonates in critical condition should be cared for in a specialized unit. In situations with a low probability of EOS, antibiotics should be stopped as early as possible within the first 24 h after the start of therapy. In cases with microbiologically proven EOS, reassessment and streamlining of antibiotic therapy in neonates is an important step to minimize AMR. Conclusion: This guideline, developed through a critical review of the literature, facilitates a probability-based approach to the management of neonates at risk of early onset sepsis. What is Known: • Neonatal exposure to antibiotics is disproportionally high compared with the incidence of early onset sepsis with implications for future health and antimicrobial resistance. What is New: • A probability-based approach may facilitate a more balanced management of neonatal sepsis and antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Background: Biofilm-associated infections frequently span multiple body sites and represent a significant clinical challenge, often requiring a multidisciplinary approach involving surgery and antimicrobial therapy. These infections are commonly healthcare-associated and frequently related to internal or external medical devices. The formation of biofilms complicates treatment, as they create environments that are difficult for most antimicrobial agents to penetrate. Fluoroquinolones play a critical role in the eradication of biofilm-related infections. Numerous studies have investigated the synergistic potential of combining fluoroquinolones with other chemical agents to augment their efficacy while minimizing potential toxicity. Comparative research suggests that the antibiofilm activity of fluoroquinolones is superior to that of beta-lactams and glycopeptides. However, their activity remains less effective than that of minocycline and fosfomycin. Noteworthy combinations include fluoroquinolones with fosfomycin and aminoglycosides for enhanced activity against Gram-negative organisms and fluoroquinolones with minocycline and rifampin for more effective treatment of Gram-positive infections. Despite the limitations of fluoroquinolones due to the intrinsic characteristics of this antibiotic, they remain fundamental in this setting thanks to their bioavailability and synergisms with other drugs. Methods: A comprehensive literature search was conducted using online databases (PubMed/MEDLINE/Google Scholar) and books written by experts in microbiology and infectious diseases to identify relevant studies on fluoroquinolones and biofilm. Results: This review critically assesses the role of fluoroquinolones in managing biofilm-associated infections in various clinical settings while also exploring the potential benefits of combination therapy with these antibiotics. Conclusions: The literature predominantly consists of in vitro studies, with limited in vivo investigations. Although real world data are scarce, they are in accordance with fluoroquinolones' effectiveness in managing early biofilm-associated infections. Also, future perspectives of newer treatment options to be placed alongside fluoroquinolones are discussed. This review underscores the role of fluoroquinolones in the setting of biofilm-associated infections, providing a comprehensive guide for physicians regarding the best use of this class of antibiotics while highlighting the existing critical issues. [ABSTRACT FROM AUTHOR]

Introduction: Patients with cirrhosis are known to be prone to infections. Infections can trigger organ failures and decompensations in cirrhosis. Septic shock can increase mortality by fourfold and cause hemodynamic imbalances, adding to the already hyperdynamic circulation. Management of septic shock in cirrhosis can be tricky due to this complex interplay of altered hemodynamics, immune function, and coagulation. Areas covered: In this review, we explore the pathophysiological basis, screening, monitoring and management of septic shock in cirrhosis. We also explore novel biomarkers, the growing challenge of multidrug-resistant pathogens and novel and adjunctive therapies. Finally, we propose an algorithm for the management of septic shock in cirrhosis. We conducted a comprehensive search of electronic databases such as PubMed, Web of Science, and Cochrane Library using the keywords and MeSH terms like 'septic shock,' 'cirrhosis,' 'liver disease,' 'sepsis' among others. The search was restricted to peer-reviewed articles in English. Expert opinion: The difficulties in managing septic shock in cirrhosis are discussed, emphasizing personalized approaches over protocol-driven care. Fluid and vasopressor management, antibiotic timing and selection, the role of adjunctive therapies, the importance of lactate clearance, gut failure, and the need for further research in this population are highlighted. [ABSTRACT FROM AUTHOR]

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Introduction: The emergence of carbapenem-resistant pathogenic bacteria is a growing global public health concern. Carbapenem-resistant uropathogenic strains of Klebsiella pneumoniae can cause uncomplicated or complicated urinary tract infections, leading to a high risk of treatment failure and the spread of resistance determinants. The objectives of this 24-month study were to identify the prognostic characteristics of patients who were infected with carbapenem-resistant Klebsiella pneumoniae (CRKpn) and to create a tool to estimate the probability of a CRKpn infection before having the complete results of a patient's antibiogram. Results: We found that 41.6% of all urinary infections with Kpn were caused by CRKpn. Factors such as male gender, the presence of upper urinary tract infections, invasive urinary maneuvers, recent infection with or carriage of the germ, and the nosocomial occurrence of UTIs with Kpn were predictive for CRKpn infection. Based on these factors, we proposed a model to estimate the presence of CRKpn. Methods: A retrospective case–control study including all hospitalized patients with urinary tract infections (UTIs) caused by Klebsiella pneumoniae was carried out. We reported data as percentages, identified independent predictors of the presence of CRKpn, and proposed a tool to evaluate the probability through multivariate analysis. Conclusions: Through this study, we aim to provide clinicians with a tool to support decision making regarding first-line antibiotic treatment. [ABSTRACT FROM AUTHOR]

Dandan Weng,1,* Hongyuan Zhou,1,* Guancheng Huang,1 Qingren Cao,2 Huafeng Wang,3 Zhujun Cao,2 Qing Xie2 1Department of Infectious Diseases, Yuyao People’s Hospital, Ningbo, Zhejiang, People’s Republic of China; 2Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing Xie; Zhujun Cao, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People’s Republic of China, Email xieqingrjh@163.com; estherlucifer@163.comBackground: Pyogenic thoracic spondylitis is a rare but severe infection, particularly when complicated by sepsis and acute kidney injury (AKI). Early diagnosis and precise management are essential for improving outcomes, given the limitations of traditional microbiology detection methods in identifying the causative pathogens.Case Presentation: A 68-year-old immunocompetent male presented with recurrent fever, fatigue, loss of appetite and initial evidence of sepsis and AKI upon admission. With the prompt computed tomography (CT)-guided percutaneous biopsy of the thoracic vertebrae, Escherichia coli was identified as the causative pathogen using metagenomic next-generation sequencing (mNGS). A diagnosis of pyogenic thoracic spondylitis was then made followed by the treatment of antibiotics optimized by therapeutic drug monitoring (TDM) techniques. With a total effective antibiotic treatment period of 7 weeks, the patient recovered without resorting to surgical interventions.Conclusion: This is a rare case of acute thoracic spondylitis caused by E. coli, successfully treated without surgery. This case highlights the significant challenges in diagnosis and treatment. It underscores the value of mNGS in identifying rare infections and emphasizes the role of TDM in optimizing antibiotic therapy, providing a reference for future cases of rare and critical infections with fever of unknown origin.Keywords: pyogenic thoracic spondylitis, metagenomic next-generation sequencing, mNGS, therapeutic drug monitoring, TDM, antibiotic therapy, fever of unknown origin

This review presents the latest data on preventing and treating otitis media in children. Despite the high prevalence of this inflammatory condition affecting the middle ear and the extensive research focused on finding the most effective strategies, several unresolved issues continue to generate active discussions among specialists. Scientific guidelines for the use of antibiotics in various conditions remain generalized. This generalization is primarily due to limited studies that can reliably identify the most effective antibacterial therapies for short-term and long-term management. Specifically, otitis media, a common condition, still lacks sufficient analysis and response from the scientific community, leaving critical questions about its onset, progression, and effective treatment options unanswered. This situation underscores the need for more detailed scientific research in this area. A literature search was conducted using several databases, including PubMed, Cochrane Library, Scopus, and eLibrary. The search employed keywords such as "acute otitis media", "otitis media with effusion", "chronic suppurative otitis media", "conservative treatment", "antibiotic therapy", "surgical treatment". and "prevention".

Brucella fever also called as Bangs disease or Malta fever is a relatively uncommon Zoonotic illness which is on the rise in many parts of India. The disease often presents in humans with constitutional symptoms such as fever, malaise, weight loss or generalised body weakness, but is not limited to this in all cases. The present case report involves a 47-year-old female who presented to the Orthopaedic Outpatient Department of a tertiary care centre with complaints of fever and low backache and was diagnosed as a case of Brucellar Spondylodiscitis after careful history taking revealing an exposure to cattle in her household. Brucellosis should also be considered as a differential diagnosis to Tuberculosis (TB) and thoroughly investigated through a detailed medical history and radiological imaging. Effective management can be achieved with a multidisciplinary team, including orthopaedic surgeons, infection specialists, radiologists and microbiologists, as was done in the present case to ensure a favourable outcome.

Abstract The use of antibiotics by dentist surgeons faces a lack of consensus among professionals and researchers, whether in relation to prophylaxis, or at least regarding the real need for their use. Recent studies increasingly question the use of prophylactic antibiotic therapy in healthy patients. This study aimed to evaluate the knowledge of dentist surgeons working in offices across Brazil regarding antibiotic use protocols and antibiotic resistance. A questionnaire was made via Google Forms and sent by email. The results showed that most dentists prescribe antibiotics for all surgical procedures performed in their office, regardless of the complexity and the patient. Furthermore, low scientific basis was observed among some of the professionals interviewed regarding the best therapeutic choice and the role of antibiotics in the surgical procedure. The present study highlights the urgent need to improve the knowledge of these professionals in Brazil, to reduce the impact on antibiotic resistance.

Abstract Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, with a date restriction from 2012 to April 2024, but without language limitations. The review included studies conducted in high-income countries on antibiotic therapy in children over 3 months of age diagnosed with mild-moderate CAP. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. Amoxicillin is the first-line treatment if the child is at least immunized against Haemophilus influenzae type b (low/very low quality of evidence, strong recommendations), while amoxicillin-clavulanate or second- or third-generation cephalosporins should be prescribed for those unimmunized or with incomplete immunization coverage for both H. influenzae type b and Streptococcus pneumoniae (low/very low quality of evidence, strong recommendations). Macrolides should be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 h of therapy (low/very low quality of evidence, strong recommendations). The dosage of amoxicillin is 90 mg/kg/day divided in three doses, although two doses could be considered to improve compliance (moderate quality of evidence, weak recommendations). A five-day duration of therapy is recommended, with clinical monitoring and re-assessment approximately 72 h after the start of antibiotic treatment to evaluate symptom resolution (moderate quality of evidence, strong recommendations). To improve the management of CAP in pediatric patients, we have developed this consensus based on a thorough review of the best available evidence and extensive discussions with an expert panel. However, further efforts are needed. Future research should focus on enhancing diagnostic accuracy, optimizing antibiotic utilization, comparing the efficacy of different antibiotic regimens, and determining the optimal dosage and duration of treatment in different setting.

Aims: This study aimed to assess the risk of acute kidney injury (AKI) associated with combined intravenous (IV) and topical antibiotic therapy in patients undergoing treatment for periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA), utilizing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for classification. Methods: We conducted a retrospective analysis of 162 knees (162 patients) that received treatment for PJI post-TKA with combined IV and topical antibiotic infusions at a single academic hospital from 1 January 2010 to 31 December 2022. The incidence of AKI was evaluated using the KDIGO criteria, focussing on the identification of significant predictors and the temporal pattern of AKI development. Results: AKI was identified in 9.26% (15/162) of the cohort, predominantly presenting as stage 1 AKI, which was transient in nature and resolved prior to discharge. The analysis highlighted moderate anaemia and lower baseline serum creatinine levels as significant predictors for the development of AKI. Notably, the study found no instances of severe complications such as wound dehiscence, skin erosion, or the need for haemodialysis following treatment. Conclusion: The findings suggest that the combined use of IV and topical antibiotic therapy in the management of PJIs post-TKA is associated with a low incidence of primarily transient stage 1 AKI. This indicates a potentially favourable renal safety profile, advocating for further research to confirm these outcomes and potentially influence treatment protocols in PJI management. Cite this article: Bone Joint Res 2024;13(10):525–534.

Background. The problem of obtaining certified planting material with biotechnological methods is important for expanding commercial and homestead plantations of hazelnut cultivars in Belarus. Materials and methods. Regenerated plants of cv. ‘Akademyk Yablokov’, representing the genus Corylus L., were a model object for studying in vitro morphogenesis and effectiveness of antibiotics against bacterial contamination, so that a protocol could be developed to obtain healthy planting material of hazelnut cultivars. The plants produced during this study were included in the duplicate ex situ collection of nut crops preserved in vitro in the active growth state. Results. Single exposure to the antibiotic kanamycin monosulfate at a concentration of 100 mg/L during antibiotic therapy in the stage of in vitro micropropagation eliminated bacterial infection in 83.3% of regenerated plants, and twofold exposure in 100%. Further cultivation revealed its phytotoxic aftereffect manifested in the form of necrosis on most of the regenerated plants and a decrease in the activity of gemmogenesis and growth. Neither single nor twofold exposure to cefotaxime sodium salt at a concentration of 90 mg/L caused elimination of bacterial infection, but gemmogenesis and regenerated plant growth retained their activity during subsequent cultivation on antibiotic-free media. The best development parameters were observed on a modified Murashige–Skoog medium with 6 mg/L 6-BA, 0.01 mg/L IBA, and 0.1 mg/L GA3 (average number of shoots: 2.2; number of microcuttings: 2.3), and a modified DKW medium with 6 mg/L 6-BA, 0.01 mg/L IBA, and 0.1 mg/L GA3 (average number of shoots: 2.05; microcuttings: 2.9). The use of zeatin as a cytokinin to stimulate adventitious morphogenesis or activate the growth of axillary meristems at a concentration of 5 or 6 mg/L was not as effective as 6-BA.

The article presents the review and synthesis of mo­dern data of scientific publications from the Scopus, Web of Science databases, and the register of professional scientific publications of Ukraine on the causes, consequences, and methods of correcting secondary lactase deficiency in children. The features of secondary lactase deficiency in antibiotic therapy and other pathological changes in the gastrointestinal tract that develop with the use of antibacterial drugs are described. The authors present their own data on the treatment of secondary lactase deficiency caused by antibiotic therapy in school-age children. It has been found that the use of the lactase enzyme in children with secon­dary lactase deficiency, which has developed on the background of antibiotic therapy, leads to positive dynamics of clinical manifestations already on the third day of taking the drug, and it is a more effective method of correcting these symptoms compared to only dietary recommendations and limited consumption of lactose products. The criteria proposed for prescribing a hydrogen breath test to diagnose secondary lactase deficiency developed on the background of antibiotics are as follows: the presence of clinical manifestations (diarrhea, abdominal pain, excessive gas, bloating, nausea, vomiting) that occurred during antibiotic therapy and are aggravated by the use of lactose-containing products; repeated courses of antibacterial drugs (every 3–4 months) according to the anamnesis; changes in the results of the coprogram (yellow, mushy, foamy feces with an acidic odor, the presence of mucus, fecal pH less than 5.5, a small amount of iodophilic flora); no signs of inflammatory bowel disease according to the results of the coprogram (blood, leukocytes); negative results of rapid tests for the detection of Clostridium difficile toxins A and B in the feces. The use of these criteria to diagnose secondary lactase deficiency associated with antibiotics will improve the frequency of its detection and the reasonable prescription of lactase drugs to reduce the severity of clinical manifestations of lactase deficiency and restore the functional state of the gastrointestinal tract more quickly.

Background.In the outpatient setting, it is important for pediatricians and general practitioners to determine the indications and empirically prescribe an effective antibacterial drug in a timely manner. In the Russian Federation in recent years, clinical guidelines for various diseases have been developed and approved, defining indications for systemic antibacterial therapy, according to which amoxicillin is the starting drug for most bacterial acute respiratory infections, and inhibitor-protected aminopenicillins (amoxicillin/clavulanate) are recommended in case of ineffective therapy or drug-resistant pathogens.Conclusion. The article presents the determining indications for the prescription of antibacterial therapy and the peculiarities of the choice of the starting antibacterial drug in such infectious-inflammatory diseases of the upper respiratory tract in children as acute tonsillitis and/or pharyngitis, acute sinusitis, acute otitis media. It is shown that the most optimal dosage form for the use of antibacterial drugs is dispersible tablets, which increases the safety of treatment and patient adherence to medical recommendations.

Abstract Background One of the greatest and most effective strategies to decrease the likelihood of discovering antibiotic-resistant bacteria in patients receiving critical care is to shorten the duration of antibiotic therapy. Objectives To assess the utility of procalcitonin compared to traditional inflammation markers like C-reactive protein in an antimicrobial stoppage in patients with septic shock. Methods This was a comparative, prospective, randomized, observer-blind clinical experiment conducted on 60 septic patients hospitalized in intensive care units at Benha University hospitals between May 2021 and May 2022. Groups for PCT and CRP patients were separated. The full clinical history, co-morbidities that were related, and patient history were recorded. The baseline PCT and CRP values were determined on days 4, 7, 10, and 14. They were contrasted with sepsis ratings obtained from the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sepsis-related Organ Failure Assessment (SOFA). Days 4, 7, and 10 were used to evaluate the antibiotic's efficacy. Results There was no correlation between CRP levels and APACHE II and SOFA scores on days 1, 4, and 7, but on days 7 and 10, PCT levels were strongly linked with both (P

Abstract Introduction The greater predisposition to infections, as well as the possibility of a worse response to treatment, can lead to the excessive use of antimicrobials among cancer patients. C-reactive protein (CRP) has gained prominence as a tool for monitoring therapeutic responses and reducing the duration of antibiotic therapy; however, few studies have analyzed this protein in cancer patient populations. We hypothesize that cancer patients with a good response to antibiotic therapy show a faster decline in serum CRP levels, which would allow us to identify candidates for short-course treatments. Objective To evaluate the behavior of serum CRP levels among adult cancer patients using antibiotic therapy, and its association with the duration of this treatment, therapeutic response, and clinical recurrence. Methods This work consisted of a retrospective study with cancer patients admitted to a university hospital between September 2018 and December 2019. Adults (age ≥ 18 years) who underwent at least one course of antibiotic therapy were included. CRP behavior over the first 7 days of treatment was classified as: i) good response: when the CRP value on the fifth day of therapy reached 50% or less of the peak value detected in the first 48 h of treatment, and ii) poor response: Maintenance, within the same interval, of a CRP value > 50% of the peak value in the first 48 h. The duration of antibiotic therapy was categorized as up to seven full days or more. Outcomes were assessed by events that occurred during the 30 days of hospitalization or until hospital discharge. Primary outcome: Clinical recurrence of the index infection. Secondary outcomes: i) Death from any cause; ii) microbiological recurrence; iii) therapeutic response; iv) colitis associated with Clostridioides difficile; and v) isolation of multi-resistant bacteria, whether in clinical or surveillance samples. Results The final analysis consisted of 212 patients, with a median age (IQ) of 59.2 (48 – 67) years old and a predominance of females (65%), who were hypertensive (35%), smokers (21%), and diabetics (17.8%). There was no difference in clinical recurrence between the two groups (8.1% vs. 12.2%; p = 0.364), with a lower 30-day mortality in the good CRP response group (32.2% vs. 14.5%; p = 0.002). Despite the tendency towards a lower occurrence of other secondary outcomes in the good response group, these differences were not statistically significant. In the poor CRP response group, outcomes like clinical recurrence, mortality, and therapeutic response were significantly worse, regardless of the duration of antibiotic treatment. Conclusion In this study, cancer patients with a good CRP response during antibiotic therapy presented lower mortality and a higher proportion of satisfactory therapeutic responses. CRP can be a useful tool when combined with other clinical information in optimizing the duration of antimicrobial treatment in a hospitalized cancer population.

The use of antibiotics by dentist surgeons faces a lack of consensus among professionals and researchers, whether in relation to prophylaxis, or at least regarding the real need for their use. Recent studies increasingly question the use of prophylactic antibiotic therapy in healthy patients. This study aimed to evaluate the knowledge of dentist surgeons working in offices across Brazil regarding antibiotic use protocols and antibiotic resistance. A questionnaire was made via Google Forms and sent by email. The results showed that most dentists prescribe antibiotics for all surgical procedures performed in their office, regardless of the complexity and the patient. Furthermore, low scientific basis was observed among some of the professionals interviewed regarding the best therapeutic choice and the role of antibiotics in the surgical procedure. The present study highlights the urgent need to improve the knowledge of these professionals in Brazil, to reduce the impact on antibiotic resistance. [ABSTRACT FROM AUTHOR]

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Background: Brucellosis is a zoonotic disease caused by Brucella infection, which is common in pastoral areas. Neurological involvement in brucellosis is relatively rare. But since 1993, continuous studies have been reporting neurological complications of brucellosis, collectively referred to as neurobrucellosis. A bibliometric analysis of existing literature outlines current research progress and gaps and provides guidance for the clinical treatment of neurobrucellosis, promoting patient health in the process of guiding clinical practice, and improving their quality of life. Methods: CiteSpace and VOSviewer are software tools to visualize research trends and networks. By selecting specific areas of interest and configuring the right parameters, the tools can visualize past research data. The study retrieved the literature from the Web of Science Core Collection Database and downloaded it in plain text file format. Citespace6.1.6, VOSviewer v1.6.20, and Microsoft Excel 16.59 were used for analyzing the following terms: countries, institutions, authors' cooperation, journals, keywords, and co-citation. Results: There are eight key results. (1) The publication volume shows a general upward trend. (2) Turkey is the country with the highest publication volume and contributing institutions. (3) Giambartolomei GH, Gul HC, and Namiduru M are the authors with the highest number of publications. (4) Neurology is the journal that published the highest number of related articles (n = 12). (5) "Diagnosis," "meningitis," and "features" are the top three frequently occurring keywords. (6) Keyword clusters show "antibiotic therapy" and "cerebrospinal fluid" have future study value. (7) The burst analysis of the keywords also indicates that "cerebrospinal fluid" may become a prominent keyword in future research. (8) The co-citation analysis concludes three categories of the cited articles, which are diagnosis, therapy, and complications, indicating the past research direction. Conclusion: This study highlights the complexity of neurobrucellosis, presenting the need for advanced diagnostic techniques and multifaceted treatment approaches. While antibiotics remain the cornerstone of therapy, the use of corticosteroids to mitigate inflammatory responses shows promise, albeit with concerns about potential sequelae and relapse. Future research should focus on refining therapeutic strategies that address both the direct effects of infection and the broader immunological impacts to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

The swift rise of antibiotic resistance, coupled with limited new antibiotic discovery, presents a significant hurdle to global public health, demanding innovative therapeutic solutions. Recently, collateral sensitivity (CS), the phenomenon in which resistance to one antibiotic increases vulnerability to another, has come to light as a potential path forward in this attempt. Targeting either unidirectional or reciprocal CS holds promise for constraining the emergence of drug resistance and notably enhancing treatment outcomes. Typically, the alteration of bacterial physiology, such as bacterial membrane potential, expression of efflux pumps, cell wall structures, and endogenous enzymatic actions, are involved in evolved collateral sensitivity. In this review, we present a thorough overview of CS in antibiotic therapy, including its definition, importance, and underlying mechanisms. We describe how CS can be exploited to prevent the emergence of resistance and enhance the results of treatment, but we also discuss the challenges and restrictions that come with implementing this practice. Our review underscores the importance of continued exploration of CS mechanisms in the broad spectrum and clinical validation of therapeutic approaches, offering insights into its role as a valuable tool in combating antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background Although a significant number of cases of Staphylococcus aureus bacteraemia (SAB) are managed at non-referral community hospitals, the impact of a bundle-of-care intervention in this setting has not yet been explored. Methods We performed a quasi-experimental before–after study with the implementation of a bundle of care for the management of SAB at five non-referral community hospitals and a tertiary care university hospital. Structured recommendations for the five indicators selected to assess quality of care were provided to investigators before the implementation of the bundle and monthly thereafter. Primary endpoints were adherence to the bundle intervention and treatment failure, defined as death or relapse at 90 days of follow-up. Results One hundred and seventy patients were included in the pre-intervention period and 103 in the intervention period. Patient characteristics were similar in both periods. Multivariate analysis controlling for potential confounders showed that performance of echocardiography was the only factor associated with improved adherence to the bundle in the intervention period (adjusted OR 2.13; 95% CI 1.13–4.02). Adherence to the bundle, performance of follow-up blood cultures, and adequate duration of antibiotic therapy for complicated SAB presented non-significant improvements. The intervention was not associated with a lower rate of 90 day treatment failure (OR 1.11; 95% CI 0.70–1.77). Conclusions A bundle-of-care intervention for the management of SAB at non-referral community hospitals increased adherence to quality indicators, but did not significantly reduce rates of 90 day mortality or relapse. [ABSTRACT FROM AUTHOR]

Refractory osteomyelitis is typically defined as a chronic infection that persists or recurs despite definitive surgical management and antibiotic therapy. Cases often involve complex wounds or fractures and can be challenging to treat, resulting in multiple courses of broad-spectrum antibiotic therapy and numerous surgeries over periods of months to years. Adjuncts to improve resolution of these complicated infections are sorely needed. Here, we describe the case of a 47-year-old active duty military member who sustained an open right ankle fracture during a skydiving accident that was subsequently complicated by refractory osteomyelitis. The patient failed more than three courses of combined medical and surgical management over a 9-month period before undergoing adjunctive hyperbaric oxygen therapy (HBOT), ultimately resulting in resolution of the infection. Adjunctive HBOT for treatment of conditions such as refractory osteomyelitis may be an underutilized resource in part because of a general paucity of high-quality data in the literature supporting its use, as well as a relative lack of availability of this resource. Nonetheless, the overall accumulating body of evidence indicates that the use of adjunctive HBOT in select patients with refractory osteomyelitis is safe and effective and further research may be warranted given its relevance and potential impact to military populations. [ABSTRACT FROM AUTHOR]

Background: Puerperal infection is one of the four main causes of maternal mortality. A giant intrauterine mass caused by puerperal infection is a rare form of infection. The delay in treatment may result in the removal of the uterus. Case Presentation: We report a case of a large intrauterine mass resulting from puerperal infection, in which the uterus was salvaged through antibiotic treatment and curettage. The patient was a 27-year-old female, who presented with a large intrauterine mass, accompanied by fever and abdominal pain 35 days after vaginal delivery. The large intrauterine mass was ultimately pathologically confirmed to be necrotic smooth muscle tissue instead of residual pregnancy tissue. Conclusion: In most cases, the intrauterine mass after pregnancy is residual pregnancy tissue. Early identification and management are critical to ensure a good prognosis for patients. Obstetricians and pregnant women should be fully aware of the hazards of puerperal infections. [ABSTRACT FROM AUTHOR]

The present article presents a case report and literature review concerning the Streptococcus equi subspecies zooepidemicus (SEZ), a rare zoonotic pathogen in humans. The case involves a 62-year-old man with no prior heart disease, presenting with endocarditis, pneumonia, and meningitis following close contact with a horse. The patient underwent urgent aortic valve replacement due to severe valvular damage caused by the infection. Blood and cerebrospinal fluid cultures confirmed the presence of SEZ, and the patient was treated with a combination of antibiotics, followed by a successful step-down to oral therapy using linezolid. A review of 25 additional Streptococcus equi endocarditis cases highlights the rarity of the condition, its association with animal contact, and its tendency to cause multi-site infections, such as pneumonia and meningitis. Early diagnosis, appropriate antibiotic therapy, and, in severe cases, surgical intervention are critical for a favorable outcome. This report emphasizes the importance of recognizing zoonotic infections in at-risk populations and the potential need for public health surveillance in these scenarios. [ABSTRACT FROM AUTHOR]

Background: Dalbavancin is a long-acting lipoglycopeptide, approved for treatment of skin and skin structure infections. Its PK/PD profile and safety allow for short hospital stays even in the case of difficult-to-treat infections requiring long courses of therapy, e.g., osteomyelitis, cardiovascular, and prosthetic infections. Objectives: We aimed to evaluate the safety and efficacy of dalbavancin in real life settings for both in-label and off-label indications. Methods: retrospective evaluation of all consecutive patients treated with dalbavancin at our site between May 2017 and September 2021. Results: A total of 100 patients treated with dalbavancin and followed up for 6 months after treatment (58% male; median age 63.5 years, median Charlson Comorbidity Index CCI = 2.7, 28% inpatients) were included with the following indications: acute bacterial skin and skin structure infections (22%), bone and prosthetic infections (57%), and cardiovascular infections (19%). Infections were caused by MSSA (30%), MRSA (5%), MR-CoNS (20%), and Streptococcus spp. (8%). In 32 cases, no isolate was obtained. The average number of infusions was 5 (s.d. = 3). Neither ensuing alteration of renal function nor neutropenia or thrombocytopenia were observed during treatment and follow-up. Two self-limiting skin rashes occurred. The overall clinical success rate was 84%—91% for registered and 82% for unregistered indications. The prescription of higher loading doses was the only predictor independently associated with better outcomes in multivariate models (OR: 5.2, 95%CI: 1.5–17.9, p < 0.01). Conclusions: Dalbavancin proved to be effective for skin and skin structure infections, as well as for difficult-to-treat infections in highly comorbid patients. Regarding tolerability, our results support the use of dalbavancin for long-lasting treatments of deep-seated infections. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, with a date restriction from 2012 to April 2024, but without language limitations. The review included studies conducted in high-income countries on antibiotic therapy in children over 3 months of age diagnosed with mild-moderate CAP. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. Amoxicillin is the first-line treatment if the child is at least immunized against Haemophilus influenzae type b (low/very low quality of evidence, strong recommendations), while amoxicillin-clavulanate or second- or third-generation cephalosporins should be prescribed for those unimmunized or with incomplete immunization coverage for both H. influenzae type b and Streptococcus pneumoniae (low/very low quality of evidence, strong recommendations). Macrolides should be considered in addition to amoxicillin in children over 5 years old, if symptoms persist and the clinical condition remains good after 48 h of therapy (low/very low quality of evidence, strong recommendations). The dosage of amoxicillin is 90 mg/kg/day divided in three doses, although two doses could be considered to improve compliance (moderate quality of evidence, weak recommendations). A five-day duration of therapy is recommended, with clinical monitoring and re-assessment approximately 72 h after the start of antibiotic treatment to evaluate symptom resolution (moderate quality of evidence, strong recommendations). To improve the management of CAP in pediatric patients, we have developed this consensus based on a thorough review of the best available evidence and extensive discussions with an expert panel. However, further efforts are needed. Future research should focus on enhancing diagnostic accuracy, optimizing antibiotic utilization, comparing the efficacy of different antibiotic regimens, and determining the optimal dosage and duration of treatment in different setting. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a zoonotic disease caused by Brucella infection, which is common in pastoral areas. Neurological involvement in brucellosis is relatively rare. But since 1993, continuous studies have been reporting neurological complications of brucellosis, collectively referred to as neurobrucellosis. A bibliometric analysis of existing literature outlines current research progress and gaps and provides guidance for the clinical treatment of neurobrucellosis, promoting patient health in the process of guiding clinical practice, and improving their quality of life. Methods: CiteSpace and VOSviewer are software tools to visualize research trends and networks. By selecting specific areas of interest and configuring the right parameters, the tools can visualize past research data. The study retrieved the literature from the Web of Science Core Collection Database and downloaded it in plain text file format. Citespace6.1.6, VOSviewer v1.6.20, and Microsoft Excel 16.59 were used for analyzing the following terms: countries, institutions, authors' cooperation, journals, keywords, and co-citation. Results: There are eight key results. (1) The publication volume shows a general upward trend. (2) Turkey is the country with the highest publication volume and contributing institutions. (3) Giambartolomei GH, Gul HC, and Namiduru M are the authors with the highest number of publications. (4) Neurology is the journal that published the highest number of related articles (n = 12). (5) "Diagnosis," "meningitis," and "features" are the top three frequently occurring keywords. (6) Keyword clusters show "antibiotic therapy" and "cerebrospinal fluid" have future study value. (7) The burst analysis of the keywords also indicates that "cerebrospinal fluid" may become a prominent keyword in future research. (8) The co-citation analysis concludes three categories of the cited articles, which are diagnosis, therapy, and complications, indicating the past research direction. Conclusion: This study highlights the complexity of neurobrucellosis, presenting the need for advanced diagnostic techniques and multifaceted treatment approaches. While antibiotics remain the cornerstone of therapy, the use of corticosteroids to mitigate inflammatory responses shows promise, albeit with concerns about potential sequelae and relapse. Future research should focus on refining therapeutic strategies that address both the direct effects of infection and the broader immunological impacts to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

In the current era of antibiotic resistance, researchers are exploring alternative ways to treat bacterial infections that are resistant to multiple drugs. Acinetobacter baumannii (A. baumannii) is a bacterium that is commonly encountered in clinical settings and is known to be resistant to several drugs. Due to the increase in drug-resistant infections caused by this bacteria, there is an urgent need to investigate alternative treatment options such as phage therapy and combination therapy. Despite the success of phages in some cases, there are some limitations in their clinical application that can be overcome by combining phages with other substrates such as nanoparticles to improve their function. The integration of nanotechnology with phage therapy against A. baumannii promises to overcome antibiotic resistance. By exploiting the targeted delivery and controlled release capabilities of nanoparticles, we can enhance the therapeutic potential of phages while minimizing their limitations. Continued research in this field will undoubtedly pave the way for more effective and precise treatments against A. baumannii infections and provide hope in the fight against antibiotic-resistant bacteria. [ABSTRACT FROM AUTHOR]