The Journal of Infection in Developing Countries
A peer-reviewed open access medical journal, focusing on global health.
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Antimicrobial resistance: a critical public health challenge in Albania
Antimicrobial resistance (AMR): AMR represents a critical challenge for healthcare systems globally and in Albania. The increasing ability of microorganisms to withstand standard therapies complicates infection management, elevates morbidity and mortality, and drives up healthcare costs. Overprescribing and incomplete antibiotic courses are principal contributors, underscoring the necessity for robust stewardship and ongoing education. Continued research and the development of novel antimicrobials are essential. Growing concern: AMR is exacerbated by inappropriate antimicrobial use, suboptimal infection control, and global mobility. Both human and veterinary medicine are affected, with resistance spreading via direct contact and the food chain. The “One Health” approach-integrating human, animal, and environmental health-is essential for effective AMR management; and without intervention, AMR could result in millions of deaths annually. The major drivers of AMR include (i) unnecessary prescriptions and incomplete treatment courses; (ii) poor hygiene and infection control in clinical settings; (iii) international movement of people and goods; and (iv) limited development of new antimicrobial agents. Albania is experiencing rising rates of antibiotic resistance, particularly in urinary tract infections (UTIs) and community-acquired pathogens. Excessive antibiotic prescribing among certain healthcare professionals highlights the need for improved stewardship and adherence to clinical guidelines. The National Action Plan on AMR exists, but its implementation requires further evaluation. Conclusions: Albania has established a functioning AMR surveillance system and continues to implement awareness campaigns. Ongoing research and targeted interventions are needed to address resistance trends. Strengthening stewardship and surveillance is critical to mitigating the impact of AMR on patient outcomes and public health.
Copyright (c) 2026 Laidon Shapo, Blerta Brati (Kika) https://creativecommons.org/licenses/by/4.0
The role of SARS-CoV-2 infection in patients with bronchial asthma and allergic rhinitis at tertiary St. George Hospital Plovdiv, Bulgaria
Introduction: The COVID-19 pandemic has generated uncertainty about epidemiology, clinical course, and the influence of comorbidities. Evidence is conflicting on whether bronchial asthma and allergic rhinitis alter susceptibility to SARS‑CoV‑2 or the severity of COVID‑19. This study describes occurrence and clinical course of SARS‑CoV‑2 infection in a small cohort of patients with allergic respiratory comorbidities. Methodology: Nineteen patients with PCR‑confirmed COVID‑19 were observed from 11 to 30 November 2020 at the Department of Occupational Diseases with Clinical Allergy Activity, University Hospital “St. George”, Plovdiv. Viral RNA was extracted from respiratory specimens using automated systems and amplified by real‑time PCR; cycle threshold (Ct) values were recorded as an indirect viral load measure. The department was temporarily reorganized as a dedicated COVID‑19 unit and care followed institutional protocols based on international evidence. Data were obtained retrospectively from official medical records; informed consent was included. Results: Clinical histories, examinations, and laboratory data were reviewed for all 19 patients. Six had bronchial asthma and three had allergic rhinitis. Although the sample is small and not statistically representative, allergic respiratory diseases were observed to coexist with SARS‑CoV‑2 infection in this hospitalized series. Conclusions: Given the lung’s central role in both allergic airway disease and COVID‑19, clinicians should evaluate infection risk and clinical implications in patients with asthma and allergic rhinitis to inform prevention and management strategies.
Copyright (c) 2026 Svetlan Dermendzhiev, Atanaska Petrova, Gergana Lengerova, Nikoleta Dimitrova, Petya Deleva https://creativecommons.org/licenses/by/4.0
Analysis of in-hospital mortality and associated risk factors in hospitalized elderly patients with an Omicron infection
Introduction: The aim of this study was to evaluate the in-hospital mortality rate and associated risk factors in elderly patients hospitalized with an Omicron coronavirus disease 2019 (COVID-19) infection. Methodology: This retrospective cohort study included 137 elderly patients with Omicron infection. The cases were divided into survival and mortality groups based on the discharge outcomes. The basic data were collected. A logistic regression model was used to analyze the risk factors for mortality. Results: The in-hospital mortality rate was 25.54% (102 survivors, 35 non-survivors). The mean age was higher in the mortality group. Shock and dyspnea were more common in the mortality group (p = 0.041). Multivariable logistic regression analysis concluded that advanced age (odds ratio, (OR) = 2.158, 95% confidence interval (CI): 1.183–3.368), shock (OR = 2.876, 95% CI: 1.538–8.304), high neutrophil-to-lymphocyte ratio (NLR; OR = 1.872, 95% CI: 1.060–2.424), radiographic pleural effusion (OR = 1.756, 95% CI: 1.592–3.662), and elevated fasting glucose (OR = 1.785, 95% CI: 1.263–3.821) were independent predictors of in-hospital mortality. The Hosmer–Lemeshow test showed that the proposed model had a good fit with observed values (χ2 = 4.681, p = 0.341). The receiver operating characteristic curve indicated that the proposed model had an area under the curve of 0.791 for predicting mortality, with a sensitivity of 83.9% and specificity of 61.5%. Conclusions: The in-hospital mortality rates were high in elderly patients with Omicron infection. Advanced age, glucose level, shock, NLR, and pleural effusion were identified as risk factors.
Copyright (c) 2026 Yan Liu, Jiao Liu, Ya-Nan Wang, Yu-Tong Zhao, Jie Zhang, Jing Cao https://creativecommons.org/licenses/by/4.0
Red cell distribution width and mean platelet volume as mortality markers in patients with COVID-19: a retrospective cohort study
Introduction: This study investigates RDW and MPV as simple, cost-effective markers linked to increased mortality in COVID-19, highlighting their potential prognostic value in viral infections. Methods: This retrospective observational study examined hospitalized COVID-19 patients from 2020 to 2022, assessing clinical outcomes such as ICU admission, hospital stay duration, and mortality. It focused on the prognostic value of Red Cell Distribution Width (RDW) and Mean Platelet Volume (MPV), investigating whether elevated levels of these markers could serve as accessible indicators of mortality risk. Results: The mean age at diagnosis among patients was 48.07 ± 17.33 years. The mean hospital stay was 5.82 ± 5.44 days. Among 1,810 patients, elevated Red Cell Distribution Width (RDW > 15%) and Mean Platelet Volume (MPV > 11.5 fL) were associated with significantly higher mortality rates (p < 0.01 and p = 0.014, respectively). Logistic regression analysis identified age, male sex, length of hospital stay, WBC count, RDW-CV, glucose, ferritin, and low albumin as independent predictors of mortality. Conversely, MPV, D-dimer, creatinine, calcium, and ALT were not significant mortality predictors. These findings suggest that routine markers, particularly RDW and WBC, may serve as accessible and cost-effective tools for early risk stratification in COVID-19 patients, while others, like MPV, may have limited independent prognostic value in this context. Conclusions: RDW and MPV, routinely available from blood tests, may help identify early clinical deterioration, supporting timely interventions to improve outcomes.
Copyright (c) 2026 Jehat KILIÇ, İhsan Solmaz, Ömer Faruk ALAKUŞ https://creativecommons.org/licenses/by/4.0
Prognostic performance of ferritin in combination with CT-SS and NEWS, to predict ICU admission and mortality in COVID-19
Introduction: The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created significant challenges in predicting severe disease outcomes. This study evaluates the combined prognostic performance of serum ferritin, national early warning score (NEWS), and computed tomography severity score (CT-SS) in predicting intensive care unit (ICU) admission and 30-day mortality. Methodology: This retrospective study included 693 COVID-19 patients with confirmed RT-PCR results and complete medical records. Demographic, clinical, and laboratory data, including ferritin levels, NEWS, and CT-SS, were analyzed. Statistical analyses were conducted to evaluate their individual and combined predictive capabilities. Results: Elevated ferritin levels, higher NEWS, and greater CT-SS were significantly associated with increased ICU admission and mortality risks. Receiver operating characteristic (ROC) analysis revealed excellent predictive accuracy for mortality: ferritin (area under the receiver operating characteristic curve [AUROC]: 0.916), NEWS (AUROC: 0.927), and CT-SS (AUROC: 0.881). Integrating ferritin into NEWS and CT-SS models enhanced predictive precision, with combined scoring systems yielding the highest odds ratios for adverse outcomes. Patients with a NEWS ≥ 5 and ferritin level ≥ 275.8 had a 151-fold increased risk of mortality, while those with a CT-SS ≥ 9 and ferritin level ≥ 275.8 had a 72-fold increased risk. Conclusions: Combining ferritin with NEWS and CT-SS improves the prognostic accuracy for predicting severe outcomes in COVID-19 patients. This study emphasizes the value of integrating laboratory markers with established scoring systems to optimize clinical decision-making. The findings can guide early interventions, reduce mortality, and improve resource utilization during pandemics.
Copyright (c) 2026 Murat Daş, Fatma Beyazıt, Okan Bardakcı, Ece Ünal Çetin, Gökhan Akdur, Canan Akman, Okhan Akdur, Yavuz Beyazıt https://creativecommons.org/licenses/by/4.0
Successful rapid intravenous desensitization to rifampicin in a patient with tuberculosis
Copyright (c) 2026 Federico Spataro, Roberto Ria, Mattia Cristallo, Lucia Indrio, Vanessa Desantis, Angelo Vacca, Antonio Giovanni Solimando, Attilio Di Girolamo https://creativecommons.org/licenses/by/4.0
Parvovirus B19-induced aplastic crisis in a kidney transplant recipient
Introduction: Parvovirus B19 infection is a rare, but important cause of severe anemia in kidney transplant recipients. Case presentation: We present the case of a 32-year-old male with end-stage kidney disease undergoing living-donor kidney transplantation and subsequently developing profound anemia. Our case emphasizes the heightened risks of developing infectious complications among kidney transplant recipients due to their intense immunosuppressed state and the diagnostic challenges parvovirus B19 presents in this population. In this context, maintaining a high index of clinical suspicion in recipients presenting with severe, erythropoietin-resistant anemia and reticulocytopenia is essential in ensuring a timely diagnosis. Conclusions: Adopting a tailored, multidisciplinary approach that balances the risks of acute rejection with the need to reduce immunosuppression to promote viral clearance, is paramount to improving hematological and allograft outcomes.
Copyright (c) 2026 Ariana Strakosha, Elvana Rista, Amantia Imeraj, Nevi Pasko, Vilma Çadri, Teuta Dedej https://creativecommons.org/licenses/by/4.0
Pancytopenia associated with Weissella confusa septicemia
Introduction: Weissella spp. are facultative gram-positive bacteria. They are also part of the human microbiota and can cause opportunistic infections. There are very few case reports in the literature describing bacteremia caused by W. confusa. Case presentation: A 74-year-old male patient presented to the Internal Medicine Department of Ankara Etlik City Hospital with complaints of fever, chills, nausea, and vomiting. Laboratory tests revealed pancytopenia. Etiological investigation identified W. confusa in blood cultures using MALDI-TOF MS, and other potential causes of pancytopenia were excluded. The patient had chronic kidney disease and was undergoing hemodialysis three times a week. Conclusions: W. confusa should be considered among opportunistic pathogens, especially in patients with end-stage renal disease. This case is presented as a rare clinical report due to the association of pancytopenia with W. confusa septicemia.
Copyright (c) 2026 Canan Akkus, Abdulhamid Arslan https://creativecommons.org/licenses/by/4.0
Nocardia farcinica infection after facial lipolysis injection in an immunocompetent patient
Introduction: Injection lipolysis is a widely used technique for the rapid reduction of localized fat deposits. Although complications such as non-tuberculous mycobacterial infections have been reported, Nocardia infections following this procedure remain rare. Case presentation: This report details a case of Nocardia infection in an immunocompetent patient after facial lipolytic agent administration. The patient exhibited amelioration of facial edema and resolution of chest rash following a course of amoxicillin-clavulanate treatment, ultimately achieving recovery and discharge. Conclusions: This case highlights the importance of considering Nocardia infection as a potential complication of lipolytic injections and provides valuable insights into its diagnosis and management.
Copyright (c) 2026 Wei Xu, Fang Su, Youqi Ji, Mengyuan Chen, Xin Hong, Bingqian Zhuo, Yumei Ge https://creativecommons.org/licenses/by/4.0
Determinants of sputum smear non-conversion after intensive phase treatment among pulmonary TB patients in southern Thailand
Background: Tuberculosis remains a global health challenge, with sputum conversion serving as a critical indicator of treatment success during the intensive phase. This study aimed to identify factors associated with sputum smear non-conversion at the end of intensive phase treatment among patients with pulmonary tuberculosis. Methodology: This case-control study utilized data from the National Tuberculosis Information Program (NTIP) Registry database between 2014 and 2019. Newly diagnosed pulmonary tuberculosis patients were included. The study comprised 322 cases of sputum smear non-conversion and 644 controls who achieved sputum smear conversion. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: Factors significantly associated with sputum smear non-conversion included male sex (Adjusted Odds Ratio [AOR] = 1.57, 95% CI: 1.10-2.25), age 35-59 years (AOR = 1.75, 95% CI: 1.19-2.59), age ≥ 60 years (AOR = 1.72, 95% CI: 1.09-2.71), sputum AFB smear grading of 2+ (AOR = 2.74, 95% CI: 1.20-6.28) and 3+ (AOR = 4.72, 95% CI: 2.14-10.43), and receiving treatment at a private hospital (AOR = 4.94, 95% CI: 2.34-10.44). In contrast, patients weighing ≥ 50 kg at baseline treatment were less likely to experience non-conversion (AOR = 0.72, 95% CI: 0.54-0.96). Conclusions: Patients’ sex, age, sputum acid-fast bacilli [AFB] smear grading, and private hospital access were significant risk factors for sputum smear non-conversion, while higher baseline weight appeared protective. Enhanced monitoring of high-risk groups could improve treatment outcomes.
Copyright (c) 2026 Wilaiwan Buatong, Bhunyabhadh Chaimay, Somkiattiyos Woradet https://creativecommons.org/licenses/by/4.0
Temperature influences the development-related phenotypes of Philippine Aedes albopictus: implications for vector control
Introduction: This study investigated the development-related phenotypes (percent pharate larvae, PPL; hatch rates, HRs; and reproductive outputs, ROs) of Aedes albopictus F1 eggs; with parental eggs collected from selected highland and lowland sites of the major islands in the Philippines (Luzon, Visayas, and Mindanao) in 2018–2020. Methodology: Field-trapped parental Aedes eggs were reared and coupled. Ae. albopictus F1 eggs were separately placed inside environmental chambers (18 °C, 25 °C, and 38 °C) for 6 weeks. PPL, HRs, and ROs were determined. Results: Temperature had significant effects on PPL and ROs of F1 eggs of wet season-collected Ae. albopictus; and on PPL, HRs, and ROs of F1 eggs of dry season-collected samples. Temperature had significant effects on PPL, HRs, and ROs across all sites. No seasonal differences were found for PPL, HRs, and ROs. The means of PPL (14.01%) and HR (10.18%) were the highest at 25 °C and lowest at 38 °C (0.64% and 0.00%, respectively); mean RO (2.5) was highest at 18 °C. Pharate larvae of Ae. albopictus at 38 °C were first reported. PPL, HRs, and ROs were similar between highlands and lowlands in Visayas and Mindanao. Conclusions: Temperature influences the development-related phenotypes of Ae. albopictus. F1 eggs can withstand extreme temperatures, hence are public health threats amidst global warming. Both Ae. albopictus and Ae. aegypti should be included in all-year round vector control strategies against Aedes-borne diseases in the tropics. It is recommended to install water pipelines in the rural mountains to prevent mosquito breeding sites.
Copyright (c) 2026 Frances Edillo, Rhoniel Ryan Ymbong, Alyssa Angel Bolneo, Ric Jacob Hernandez, Mark Windy Suycano, Anavaj Sakuntabhai https://creativecommons.org/licenses/by/4.0
Antibiogram and molecular insights into quinolone resistance in Salmonella spp. from food-producing animals in the Philippines
Introduction: The increasing quinolone resistance in food animals in the Philippines has been documented in previous studies. This study aims to investigate the prevalence and underlying molecular mechanisms responsible for quinolone non-susceptibility in Salmonella isolated from food-producing animals. Methodology: A total of 227 Salmonella isolates were obtained from food-producing animals and their derived food products in the Philippines. These isolates were subjected to antimicrobial susceptibility testing against 17 different agents. Quinolone non-susceptible isolates were screened for mutations in the quinolone resistance-determining region (QRDR) and plasmid-mediated quinolone resistance (PMQR) genes. QRDR- and PMQR-positive isolates were also screened for virulence genes and genotyped using the multilocus sequence typing (MLST) method. Results: Most isolates showed high resistance to tetracycline, ampicillin, streptomycin, sulfamethoxazole-trimethoprim, and nalidixic acid. About 68.3% of the isolates showed resistance to at least one antimicrobial agent, and 44.9% exhibited multidrug resistance. Out of the 74 quinolone non-susceptible isolates, 74.3% carried amino-acid substitutions in the QRDR of GyrA and ParC, 4.1% harbored PMQR genes, and 14.9% had both. High-level resistance was associated with double amino-acid substitutions in GyrA (Ser83Phe + Asp87Tyr) and ParC (Thr57Ser + Ser80Ile), while PMQR-positive isolates displayed variable low resistance. Moreover, 17 unique sequence types (STs) were identified, predominantly S. London ST155, S. Infantis ST32, and S. Anatum ST64. All Salmonella isolates exhibit QRDR mutations and/or PMQR genes that possess virulence factors invA and agfA. Conclusions: The findings highlight the widespread fluoroquinolone-resistant Salmonella in food-producing animals and their products, posing a significant threat to the effective treatment of Salmonella-related food-borne diseases.
Copyright (c) 2026 Lawrence Belotindos, Angel Mae Magalong, Marvin Bryan Salinas, Joel Miguel Jr., Marvin Villanueva, Claro Mingala, Chie Nakajima, Yasuhiko Suzuki https://creativecommons.org/licenses/by/4.0
Prevalence and drug resistance patterns of ESKAPE pathogens in Nigde, Türkiye
Introduction: The escalating burden of antimicrobial resistance (AMR) presents a significant global health challenge. ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), frequently exhibiting multidrug resistance (MDR), are especially alarming. This study evaluated the prevalence and antibiotic susceptibility profiles of ESKAPE infections in patients from Nigde, Türkiye. Methodology: This descriptive cross-sectional study was performed at Nigde Ömer Halisdemir University Training and Research Hospital from September 2022 to June 2024. Clinical specimens were collected and evaluated for antimicrobial susceptibility with the VITEK®2 compact system. Results: A total of 13,387 bacterial isolates were obtained from 7,438 patients. The majority of isolates were Gram-negative (9,671; 72.2%), of which 3,928 (39.6%) were ESKAPE. Gram-positive isolates accounted for 3,716 (27.8%), with 1,123 (30.2%) categorized as ESKAPE. Klebsiella pneumoniae (K. pneumoniae) was the most common Gram-negative ESKAPE pathogen (1,921; 19.9%), while Escherichia coli (E. coli) was the most frequent non-ESKAPE pathogen (4,747; 49.1%). Of the 5,051 ESKAPE isolates, 29.7% (1,501) were categorized as MDR and 30.9% (1,562) as extensively drug-resistant (XDR). MDR was widespread, with the highest prevalence observed in Enterococcus faecium (76.9%). Acinetobacter baumannii exhibited the highest prevalence of XDR isolates at 72.4%. Conclusions: This study emphasizes the substantial AMR burden linked to ESKAPE infections in Nigde, Türkiye, highlighting the necessity for effective infection management, antibiotic stewardship, and continuous research to track resistance patterns.
Copyright (c) 2026 Mohammed A Salim, Songül Budak Diler, Ramazan Köklü, Ali Öztrük, Fikriye Polat, Nooh Mohamed Hajhamed, Nouh Saad Mohamed https://creativecommons.org/licenses/by/4.0
Disinfectant/antiseptic resistance genes of Staphylococci and serotyping of clinical Staphylococcus aureus isolates
Introduction: Staphylococci are commonly isolated from healthcare settings worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important causes of nosocomial infections. Objectives: This study aims to evaluate the resistance of Staphylococci to the most commonly used disinfectants and antiseptics in healthcare settings and the detection of the dominant serotype of Staphylococcus aureus in Hatay province. Methodology: The frequency of disinfectant/antiseptic resistance genes was detected by the polymerase chain reaction (PCR) technique in identified staphylococcal strains, and antibiotic susceptibility of strains was evaluated phenotypically. Staphylococcus aureus strains were classified in terms of clonal and phylogenetic relationships with Pulse Field Electrophoresis and spa sequence typing methods. Results: The identification rate of coagulase-negative staphylococci was 43.2% and the others (56.8%) were Staphylococcus aureus. Among these isolates, 103 methicillin-resistant S. aureus were identified. It was determined that 81 (78.64%) of these isolates harbored qacA/B and/or smr genes. The dominant spa serotype was found to be t223. Conclusions: According to spa serotyping results, it was detected the serotype t223 was the dominant clone in our region, unlike the t030 was dominant in Turkey. Since there are many Syrian immigrants living in the Hatay region due to its geographical location, being the dominant clone of a different serotype has an epidemiologically significant importance.
Copyright (c) 2026 Hamdullah Suphi Bayraktar, Fatih Köksal, Nizami Duran, Tülay Kandemir, Başak Baykara, Tülin Güven Gökmen, Melda Meral Öcal https://creativecommons.org/licenses/by/4.0
Occurrence of virulence genes and carbapenemase genes in multidrug resistant clinical isolates of Pseudomonas aeruginosa
Introduction: Multi-drug resistant (MDR) Pseudomonas aeruginosa strains with virulence characteristics have high morbidity and mortality rates. This study aimed to examine the prevalence of antibiotic resistance, virulence factors, and carbapenemase genes in clinical samples. Methodology: 400 clinical samples (200 UTI+200 wound samples) were collected from hospitalized patients, targeting P. aeruginosa. Results: Out of 400 samples, 162 (40%) were found positive for P. aeruginosa, and they revealed significant resistance, with 55% classified as multidrug-resistant. Ceftazidime and Imipenem showed the highest resistance rate. Notably, 90% isolates were resistant to Tobramycin and Amikacin, while only 15-25% of isolates were sensitive to several antibiotics. The samples showed that 101 isolates (62% of the total) had the algD gene. Of these, 78% were found to be resistant to multiple drugs. Carbapenemase gene prevalence varied, with IMP (77.27%) being the most common, followed by TEM (63.63%) and NDM (43.18%). The detected exo enzyme genes in 67.9%-88.88% of isolates, with toxA being the most prevalent at 88.88%. Wound isolates showed higher virulence gene frequencies compared to urine isolates. Conclusions: The misuse/overuse of antibiotics, poor hygiene, and errors of health care personnel were the main factors that significantly increased the prevalence of MDR P. aeruginosa. Hospitals should craft and implement a specific control strategy to reduce the distribution of MDR P. aeruginosa. The MDR isolates expressed exoenzymes-encoding genes as compared to the drug-susceptible isolates. The prevalence of these virulence genes was higher in wound isolates as compared to UTIs. This study indicates that exoenzymes-encoding genes are associated with drug resistance in P. aeruginosa.
Copyright (c) 2026 Hira Ahsan, Bilal Aslam, Zeeshan Nawaz, Muhammad Zishan Ahmad, Riaz Hussain, Rasheeha Naveed, Asma Baig, Farid Shokry Ataya, Dalia Fouad, Abu Baker Siddique https://creativecommons.org/licenses/by/4.0
Susceptibility of carbapenem-resistant Klebsiella pneumoniae in urinary tract infections: clinical efficacy of fosfomycin
Introduction: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) limits effective treatment options. The aim of this study was to evaluate the susceptibility patterns of CR-Kp strains isolated from urine cultures to oral treatment options recommended by the Infectious Diseases Society of America guidelines, and ceftazidime-avibactam. Additionally, clinical data and outcomes of patients diagnosed with CR-Kp urinary tract infections (UTI) who were treated with fosfomycin sodium-including therapy regimens (FSITR) were analyzed. Methodology: This retrospective cohort study included adult patients with urine culture-proven CR-Kp between March 2016 and October 2022. Demographic and clinical data, antibiotic susceptibility, treatment outcomes, and one-month mortality (OMM) were evaluated. Results: A total of 179 patients were included. The susceptibility to fosfomycin tromethamol, nitrofurantoin, and co-trimoxazole (TMP-SMX) were (33.7%; 55/163), (7.7%; 13/167), and (11.1%; 20/179), respectively. All strains were resistant to ciprofloxacin. The susceptibility data compared until 2020 (pre-COVID-19) and afterwards, revealed TMP-SMX susceptibility (4.9% vs 24.1%, p = 0.0001) increased significantly. Susceptibility data for ceftazidime-avibactam were available for 22 isolates and 59% of the isolates were sensitive. OMM of the 179 patients with CR-Kp in urine cultures was 37.4% (67/179). There were 9 FSITR cases. Among those, microbiological eradication was achieved in 87.5% (7/8) and OMM was 44.4% (4/9). Conclusions: Clinical experience may be feasible and needed to assess the efficacy of nitrofurantoin and TMP-SMX. Fosfomycin-including regimens may serve as a salvage treatment option for CR-Kp UTI in selected patients. However, the retrospective and single-center design of the study should be considered as a limitation.
Copyright (c) 2026 Arda Kaya, Deniz Akyol Seyhan, Seichan Chousein Memetali, Melike Yaşar, Merve Mert Vahabi, Dilşah Başkol Elik, Şükrü Dirik, Gamze Şanlıdağ, Cansu Bulut Avşar, Melike Görür Demir, Gunel Guliyeva, Ayşe Uyan Önal, Uğur Önal, Nazlıhan Yalçın, Buse Kenanoğlu, Şevket Yeniyol, Deniz Dağ, Pervin Korkmaz, Erkin Özgiray, Devrim Bozkurt, Hadiye Şirin, Ece Çınar, Kubilay Demirağ, Hilal Sipahi, Feriha Çilli, Şöhret Aydemir, Meltem Taşbakan, Hüseyin Aytaç Erdem, Hüsnü Pullukçu, Tansu Yamazhan, Sercan Ulusoy, Bilgin Arda, Oğuz Reşat Sipahi https://creativecommons.org/licenses/by/4.0
Rapid detection of carbapenem resistance genes using multiplex LAMP and melt curve analysis in clinical specimens
Introduction: Carbapenem-resistant Enterobacteriaceae have become a major clinical and public health challenge due to the need for rapid administration of effective antimicrobials and implementation of supplemental infection control practices. Identifying genes associated with carbapenem resistance is crucial for managing these cases. The timely initiation of effective antimicrobial therapy and infection control interventions to prevent spreading are critical. Therefore, rapid diagnostic tests for detecting carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are necessary. Methodology: This study aimed to evaluate the use of LAMP and melting curve analysis in real-time polymerase chain reaction (RT-PCR) to identify carbapenem resistance genes New Delhi metallo-β-lactamase (NDM) and oxacillinase (OXA) in clinical specimens. Results: This study emphasized the benefits of the LAMP strategy in comparison to traditional methods, demonstrating its effectiveness and practicality. LAMP was proven to be more sensitive than RT-PCR and conventional multiplex PCR, with a detection rate of 96.7% and 91.6% respectively. While LAMP had a slightly lower specificity rate of 88.7%, it remains a promising method for rapid and accurate identification. Furthermore, the study found that LAMP could detect bacterial DNA even in low quantities, with a limit of detection of 102 CFU/mL for both K. pneumoniae and E. coli. This capability is crucial for early diagnosis and treatment in settings where multidrug-resistant (MDR) bacteria are prevalent. Conclusions: RT-PCR systems that combine melting curve analysis with LAMP offer promise for quick and precise identification of carbapenem resistance genes in clinical specimens. This approach can enhance the diagnosis and management of multidrug-resistant bacterial infections.
Copyright (c) 2026 Vaishnavi Vishram Naik, Sumit kumar, Tejal Thrimurthy, Vani Channareddy, Tushar Shaw https://creativecommons.org/licenses/by/4.0
Climate and health in Asia: a scoping review of vulnerability and community adaptation
Introduction: Climate change intensifies environmental risks across Asia, disproportionately affecting vulnerable populations and exacerbating health disparities. However, evidence on community adaptation strategies and the integration of health dimensions into adaptation policies remains fragmented. This scoping review aimed to map climate-sensitive health risks, evaluate the equity and effectiveness of community adaptation measures, and examine theoretical frameworks for vulnerability assessments across Asia. Methodology: Guided by the PRISMA-ScR checklist, this scoping review analyzed 21 peer-reviewed studies on climate-health interactions and adaptation strategies in Asia published between 2008 and 2024. Data were systematically charted and synthesized thematically. Results: Five cross-cutting themes emerged: physical and socioeconomic exposure, gender-related vulnerability, community-based and informal adaptation, climate-related health impacts, and institutional and policy gaps. Adaptation strategies rely heavily on community-led practices with limited attention to gender and health in national plans. The review also highlights challenges to equity in community adaptation and critiques existing vulnerability frameworks. This review underscores the need for justice-oriented, integrated approaches to climate and health. Conclusions: This review underscores the importance of integrating community knowledge and gender-sensitive approaches into climate–health frameworks. Strengthening health systems and formalizing local adaptation practices are essential for reducing inequities. Future research should adopt longitudinal and interdisciplinary perspectives to capture long-term health outcomes and policy implementation barriers in rapidly urbanizing environments.
Copyright (c) 2026 Ika Dharmayanti, Khadijah Azhar, Rachmadi Purwana, Dwi Hapsari, Tri Edhi Budhi Soesilo https://creativecommons.org/licenses/by/4.0
Utilizing metagenomic next-generation sequencing to diagnose central nervous system infections after craniotomy
Introduction: Postoperative central nervous system (CNS) infections in craniotomy patients diagnosed through clinical signs and cerebrospinal fluid (CSF) bacterial culture, pose a challenge due to the morbidity and mortality of bacterial meningitis. The objective of this study was to evaluate the clinical value of metagenomic next-generation sequencing (mNGS) in diagnosing CNS infections post craniotomy. Methodology: A prospective study compared mNGS with traditional diagnostics from January 2021 to October 2023. Patients with suspected post-craniotomy intracranial infections were enrolled, following guidelines and regulations. Results: mNGS and traditional culture diagnosed 111 patients with suspected intracranial infections. mNGS showed higher sensitivity (62.5% vs. 25%). Traditional culture excelled in specificity and positive predictive value. Of the 18 mNGS-positive samples, 12 were culture-negative. mNGS detected pathogens such as Candida albicans (2 cases), Enterobacter cloacae (1 case), Enterococcus faecalis (1 case), Klebsiella pneumoniae (2 cases), Pseudomonas aeruginosa (1 case), Staphylococcus aureus (2 cases), Staphylococcus epidermidis (2 cases), and Streptococcus haemolyticus (1 case). Some pathogens were likely missed due to prior antibiotic use and fastidious growth requirements. Physicians adjusted treatments based on mNGS pathogen detection for culture-negative patients. Empirical therapy continued for patients with negative results until more diagnostic information was available. Conclusions: mNGS detects post-neurosurgery CNS infections, especially hard-to-cultivate microorganisms. While mNGS has advantages, traditional culture's higher positive predictive value confirms infections and remains indispensable. Combining mNGS with traditional methods provides a comprehensive diagnostic strategy, aiding physicians in accurately identifying infections, reducing misdiagnosis, and offering personalized treatment plans to improve outcomes and quality of life.
Copyright (c) 2026 Jin Wang, Bingjie Jiang https://creativecommons.org/licenses/by/4.0
Procalcitonin: the bacterial and non-bacterial sepsis marker
Introduction: The aim of this study was to evaluate the role of procalcitonin (PCT) in differentiating causative agents of bacterial sepsis, and sepsis from non-bacterial causes (viral, fungal, and parasitic). Methodology: This study was conducted in the Department of Microbiology (April 2023 to March 2024) and included 1,346 clinically suspected cases of bacterial, fungal, viral, and parasitic infections confirmed through various diagnostic methods. Serum/plasma samples were collected from the participants and healthy controls, and PCT levels were measured. PCT concentration of < 2 ng/mL was classified as low, while levels ≥ 2 ng/mL were considered high, serving as threshold for sepsis diagnosis. Results: PCT levels were significantly higher in sepsis caused by Gram-negative bacteria compared to Gram-positive bacteria, and showed a notable increase in Plasmodium infections (p < 0.0001). No significant association was observed between PCT levels and Candida albicans infections; however, cases involving non-albicans Candida species showed significantly elevated PCT levels (p = 0.0265). Infections with Cryptococcal species, hepatitis B, and hepatitis C showed a marked decrease in PCT levels. PCT levels were low in all cases involving skin commensals, with a more pronounced reduction in the case of coagulase-negative Staphylococcus compared to diphtheroids. Conclusions: PCT levels showed a significant elevation in infections caused by non-bacterial agents, including Plasmodium and non-albicans Candida. A notable decline in PCT levels was observed in systemic infections caused by viruses and Cryptococcus. PCT is emerging as a universal biomarker for both bacterial and non-bacterial sepsis, making it a potential universal marker for sepsis.
Copyright (c) 2026 Anu Aravindh, Akanksha Gupta, Professor Jaya Garg, Professor Anupam Das, Professor Manodeep Sen, Professor Jyotsna Agarwal https://creativecommons.org/licenses/by/4.0
Prevalence and molecular identification of protozoan parasites in cancer patients in Jordan
Introduction: Parasitic infections are prevalent in developing countries, and cancer patients with weakened immune systems are particularly vulnerable. This study examined the prevalence of protozoan parasites among cancer patients. Methodology: A total of 300 stool and heparinized plasma samples were collected from cancer patients at the King Hussien Cancer Center (KHCC). Cryptosporidium, Giardia duodenalis, and Blastocystis were detected by microscopy. Immunodiagnostic tests included electrochemiluminescence immunoassay (ECLIA) for Toxoplasma gondii IgG and IgM antibodies in plasma samples, and the ImmunoCard STAT Cryptosporidium/Giardia Kit for G. duodenalis and Cryptosporidium detection in stool. DNA extraction from stool samples was followed by nested polymerase chain reaction (PCR) to confirm the presence of intestinal parasites. Results: Toxoplasma gondii, Cryptosporidium, G. duodenalis, and Blastocystis were detected. T. gondii was found in 22% of patients via IgG antibodies and in 2.7% via IgM, with the highest IgG seropositivity in multiple myeloma and uterine cancer patients (50%), and the highest IgM seropositivity in multiple myeloma patients (12.5%). The prevalence of Cryptosporidium varied depending on the detection method: 8.3% by microscopy, 11% by immunodiagnostic tests, and 12.3% by PCR. The highest infection rate was among colorectal cancer (CRC) patients. Giardia duodenalis was detected at rates of 1.7% by microscopy, 2.0% by immunodiagnostic testing, and 0.7% by PCR. Blastocystis was most prevalent in CRC patients, with detection rates of 31.0% by microscopy and 48.3% by PCR. Conclusions: This study highlights the significance of protozoan parasitic infections among cancer patients, emphasizing the need for screening and management to improve patient outcomes.
Copyright (c) 2026 Rashed Almashakbeh, Nawal Hijjawi, Haya Abu Suilike, Maher Sughayer, Ali Al-Radaideh https://creativecommons.org/licenses/by/4.0