The Journal of Infection in Developing Countries
A peer-reviewed open access medical journal, focusing on global health.
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Comparison of lymphocyte populations, cytokine, and autoantibody profile in patients with rheumatoid arthritis: a study of cases with COVID-19 and controls without COVID-19
Introduction: The SARS-CoV-2 pandemic is associated with the development of acute respiratory distress syndrome (ARDS) and post-COVID syndrome (PCS). PSC has been linked to autoimmune diseases, including rheumatoid arthritis (RA), a condition characterized by chronic joint pain driven by dysregulated immune response. This study aims to evaluate the impact of SARS-CoV-2 infection on patients with RA. Methods: A total of 300 RA patients were included in the study, categorized into two groups: patients with a history of SARS-CoV-2 infection (n = 148) and without prior COVID-19 infection (control group; n = 152). Demographic information, comorbidities, treatments, autoantibodies, cell populations, and cytokines were assessed. Results: A majority of the patients included in this study were female. A high percentage of patients completed the COVID-19 vaccination schedule. The mean age at RA diagnosis was 44.71 years, with most patients presenting with low disease activity. Patients with a history of SARS-CoV-2 infection reported headache, cough, and fatigue more often. A proportion of these symptoms persisted beyond 12 weeks, consistent with PCS. Autoantibody analysis revealed a high seropositivity rate in both groups, with no statistically significant differences related to SARS-CoV-2 infection. Similarly, the evaluation of immune system cell populations showed no significant variations between groups. Cytokine level analysis also demonstrated no statistically significant differences between cases and controls. However, IL-6 data were unavailable for 37% of participants. Conclusions: Long-term follow-up did not demonstrate statistically significant alterations in the immunological profile of RA patients with SARS-CoV-2 infection. Nevertheless, further prospective studies are required to elucidate potential long-term immunological effects in this population.
Copyright (c) 2026 Julian Arias-Aponte, Gabriel E. Acelas-Gonzalez, Rafael Parra-Medina, María Lorcy Monsalve-Córdoba, Adriana Rojas-Villarraga , Paula Daniela Nieto-Zambrano, Hector Fabio Restrepo-Guerrero, Pedro Santos-Moreno, Arley Gómez-López, Maria Camila Cortés-Osma, Laura Villarreal https://creativecommons.org/licenses/by/4.0
Clinical and laboratory characteristics of critically ill COVID-19 patients with chronic lung disease
Introduction: Chronic lung diseases (CLD) are associated with increased susceptibility to respiratory infections and may influence COVID-19 outcomes. This research aims to assess the clinical, laboratory findings, and prognostic outcomes in critically ill COVID-19 patients with and without CLD, and to explore differences between various CLD types. Methodology: A retrospective analysis was conducted on 406 critically ill COVID-19 patients, comparing those with CLD and those without. Clinical characteristics, laboratory markers, and mortality rates were assessed. Subgroup analyses evaluated differences between COPD, asthma, and other CLD types. Results: Patients with CLD were older and had significantly lower lymphocyte and platelet levels than those without CLD (p values were 0.034, 0.021, and 0.013, respectively). The mean age, urea level, and platelet count in the COPD group showed significant differences compared to the other groups. Among critically ill COVID-19 patients, mortality rates were observed to be higher in the CLD group compared to those without CLD, and in the COPD group compared to other CLD types; however, these differences did not reach statistical significance. Systemic steroid use was associated with reduced 3-month (OR: 0.403, 95% CI: 0.226-0.719, p = 0.002) and 1-year mortality (OR: 0.513, 95% CI: 0.288-0.914, p = 0.023). Inhaled corticosteroid use did not increase mortality and was predominantly utilized for symptom management. Laboratory markers such as lymphopenia and thrombocytopenia were significantly associated with worse outcomes. Conclusions: CLD and its subtypes were not independently linked to mortality in critically ill COVID-19 patients; however, their association with older age and worse laboratory profiles highlights their clinical significance.
Copyright (c) 2026 Tunzala Yavuz, Omurhan Sarac, Ozcan Alpdogan, Hicret Yeniay, Didem Celik https://creativecommons.org/licenses/by/4.0
Impact of COVID-19 on the treatment outcomes of secretory otitis media
Introduction: The World Health Organization (WHO) officially lifted the global emergency designation for coronavirus disease 2019 (COVID-19) in May 2023. Nonetheless, the long-term repercussions of the pandemic—referred to as ‘long COVID’—have persisted. It is also highly likely for the disease to be complicated by secretory otitis media (SOM). This study aimed to determine if there is anything particularly distinctive about SOM associated with long-COVID, and could it affect the therapeutic outcomes of the latter. Methodology: A total of 102 patients diagnosed with COVID-19-associated SOM between December 2022 and May 2023 were retrospectively analyzed. Pre- and post-treatment pure-tone audiometry thresholds were assessed to evaluate therapeutic efficacy. Follow-up assessments were performed at 1, 3, 6, and 12 months’ post treatment, and the findings were compared with those of a control group of 98 patients who had SOM but not COVID-19 infection during the same time frame. Results: All patients showed normal hearing thresholds post treatment. A comparative analysis using a two-sample t-test revealed no statistically significant difference in the average speech-hearing thresholds between the two groups post-treatment (t = 0.099, p = 0.92). No recurrence was observed in either group during the year-long follow-up period. Conclusions: Although COVID-19 is commonly associated with SOM, patients can expect satisfactory recovery of their hearing function with proactive treatment strategies.
Copyright (c) 2026 Jishuai, Weihao, Ting, Qiying, Jing, Professor Mao https://creativecommons.org/licenses/by/4.0
Comparative efficacy of Lianhua Qingwen capsules combined with standard care versus standard care alone in patients with mild to moderate COVID-19
Introduction: The COVID-19 pandemic has prompted a search for effective treatments. This study evaluated the efficacy and safety of Lianhua Qingwen capsules combined with standard care for treating patients with mild to moderate COVID-19. Methodology: A retrospective cohort study was conducted in a tertiary hospital in China between 1 March 2023 and 31 December 2023. The medical records of 284 patients with mild to moderate COVID-19 were analyzed; 142 patients who received Lianhua Qingwen capsules plus standard care were compared with 142 matched controls who received standard care alone. Propensity score matching was used to minimize selection bias. The primary outcomes included time to symptom improvement, time to viral clearance, 14-day clinical recovery rate, improvement in chest computed tomography (CT) findings, and quality of life scores. Secondary outcomes included changes in inflammatory markers, immune function improvement, and adverse event rates. Results: The Lianhua Qingwen group showed a significantly shorter time to symptom improvement (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.21–1.69, p < 0.001), faster viral clearance (HR 1.52, 95% CI: 1.28–1.80, p < 0.001), higher 14-day clinical recovery rate (91.5% vs 82.4%, p = 0.024) and more pronounced chest CT improvements (78.9% vs 64.8%, p = 0.009). Quality of life scores, inflammatory markers, and immune function improved more in the treatment group. Adverse event rates were similar (12.7% vs 13.4%, p = 0.856). Conclusions: Lianhua Qingwen capsules, when combined with standard care, demonstrated superior efficacy compared with standard care alone in treating mild to moderate COVID-19, with a favorable safety profile. These findings suggest that Lianhua Qingwen capsules could be a valuable adjunct therapy for COVID-19 management.
Copyright (c) 2026 Yan-Mo Zhang, Mi Zhou https://creativecommons.org/licenses/by/4.0
Long-term follow-up of hospitalized COVID-19 patients with interstitial lung involvement
Introduction: Data regarding the residual lung findings persisting beyond 12 months from acute infection in patients with COVID-19 with pulmonary involvement are scarce. This study investigates the long-term radiological and functional findings of previously hospitalized COVID-19 patients who had residual pulmonary involvement at 3–6-month follow-up. Methodology: This retrospective cohort study was an extended analysis of a previously published study, including patients with COVID-19 pneumonia hospitalized between June 2020 and March 2021. Residual lung involvement due to COVID-19 pneumonia was classified according to the presence of ground glass opacities, honeycombing, traction bronchiectasis, reticulations, and parenchymal bands. Results: 51 out of the 157 patients with abnormal chest findings in high-resolution computed tomography (HRCT) scans at 3–6-month follow-up were included. Mean age of the study population was 60.5 ± 10.5 years; 35 subjects were male (68.6%). HRCT controls were obtained 25.7 ± 6.36 months after the diagnosis. There was regression of predefined radiological involvement in 39 patients (76.5%), whereas 11 patients (21.6%) exhibited stable findings, and one patient had progressive lung involvement with a usual interstitial pneumonia pattern. Persistent residual parenchymal bands were found mostly in ICU-admitted patients (p = 0.04), and reticulations were seen in patients with a CT severity score > 18 (p = 0.04). Conclusions: In most patients with pulmonary sequelae, lesions showed improvement after 18 months, with complete resolution in about one third of patients after a 6-month follow-up. There was a correlation between initial severity and persistence of lung abnormalities.
Copyright (c) 2026 Özer Özdemir, Gülru Polat, Mine Gayaf, Filiz Güldaval, Damla Serçe Unat, Tarık Şimşek https://creativecommons.org/licenses/by/4.0
Nasopharyngeal pneumococcal carriage among unvaccinated healthy Sri Lankan children during the COVID-19 pandemic
Introduction: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide, especially in children. This study focused on the prevalence, serotypes, antibiotic resistance, and biofilm formation of pneumococci colonising an unvaccinated Sri Lankan children cohort aged ≤ 2 years during the COVID-19 pandemic. Methodology: This descriptive, cross-sectional study was carried out between April to August 2021 among healthy children visiting routine immunisation clinics in the Colombo district, Sri Lanka. Nasopharyngeal swabs (NPS) from healthy children were collected and cultured on sheep blood agar to isolate S. pneumoniae and confirmed by lytA gene-specific PCR. All confirmed S. pneumoniae isolates underwent capsular sequence typing to detect serotypes. Antibiotic susceptibility was determined. In-vitro biofilm-forming ability was assessed using the crystal violet assay, tetrazolium reduction assay, and scanning electron microscopy. Results: The S. pneumoniae colonization rate of healthy children was 5.7% (20/350). Serotype 19F was the commonest, and 80% (16/20) of isolates were covered by the 13-valent pneumococcal conjugate vaccine (PCV13). All isolates were sensitive to levofloxacin, vancomycin, and linezolid but showed significant non-susceptibility to penicillin (70%, 14/20) and cefotaxime (15%, 3/20) at non-meningitis break points. All isolates formed biofilms. Conclusions: A comparatively lower rate of pneumococcal colonisation was observed among this cohort compared to the current literature. The most prevalent serotype identified was 19F. Serotype pattern was similar to the pre-vaccine era pattern reported globally. Antibiotic non-susceptibility rates were high for penicillin and erythromycin. Almost all isolates showed evidence of in vitro biofilm formation.
Copyright (c) 2026 Madhusha Gonapaladeniya, Guwani Liyanage, Manjula Weerasekera, Roshan Perera, Thushari Dissanayake https://creativecommons.org/licenses/by/4.0
Risk factors linked to surgical site infections: a prospective survey on an Albanian population following abdominal surgery
Introduction: Despite global improvements in perioperative care, surgical site infections (SSIs) continue to pose a significant burden, and data from Albania remain limited. This study aimed to determine the incidence of SSIs following abdominal surgery in an Albanian tertiary hospital and identify associated risk factors, microbiological profiles, and antimicrobial resistance patterns. Methodology: A prospective observational study was conducted at the University Hospital Centre “Mother Theresa” in Tirana. A univariate and multivariate logistic regression adjusted for confounders was performed to identify factors associated with the development of SSIs. Results: 1179 patients were enrolled in the study, with a mean age of 57.80 ± 16.16 years (range, 19-92 years), and 51.23% were male. 64 patients (5.43%) developed surgical site infections following abdominal surgery. The most frequently isolated microorganisms from infected surgical wounds were Escherichia coli and Enterococcus faecalis, identified in 39.0% and 22.0% of cases, respectively. The rate of SSIs was higher in patients undergoing lower gastrointestinal surgery compared to those having upper gastrointestinal procedures. As risk factors for developing SSIs in univariate regression analysis, age ≥ 50 years (OR: 2.69, 95% CI: 1.25–5.78), comorbidities (OR: 2.71, 95% CI: 1.53–4.83), and type 2 diabetes mellitus (OR: 2.98, 95% CI: 1.59-5.56) were identified. Conclusions: Although the rate of SSIs after abdominal surgery has decreased, it remains a significant concern in Albania. Age, comorbidities, and lower gastrointestinal surgery are important risk factors. The findings emphasise the need for improved infection control and antimicrobial stewardship to reduce postoperative complications.
Copyright (c) 2026 Ardit Kaçani, Krenar Lilaj, Vjollca Shpata, Fjoralba Mulgeci, Sara Ferizaj, Irisi Xure, Emigleo Sulku, Vjollca Durro https://creativecommons.org/licenses/by/4.0
Prevalence of silent plasmid-mediated fosfomycin-resistance genes among clinical isolates of fosfomycin-susceptible Escherichia coli
Introduction: Infections caused by Escherichia coli place a considerable burden on both patients and healthcare facilities. This study aims to investigate the prevalence and molecular detection of silent plasmid-mediated fosfomycin-resistance (PMFR) genes among fosfomycin-sensitive, extended-spectrum β-lactamase (ESβL)- producing E. coli isolates. Methodology: Clinical samples of E. coli were collected from various sources and hospitals in Duhok‚ Iraq‚ from December 2020 to April 2021. Standard microbiological techniques and the Vitek II system were used to identify E. coli, which was further confirmed through species-specific genes. The Kirby-Bauer method was employed for antimicrobial sensitivity testing, followed by the detection of targeted PMFR and genes using conventional polymerase chain reaction (PCR). Results: High resistance levels were observed against ampicillin, ceftriaxone, tetracycline, and ciprofloxacin, whereas a lower resistance rate was detected for carbapenems. Notably, all the isolates were susceptible to fosfomycin. Four isolates tested positive for fosA3, four were positive for fosA, and 16 were positive for the blaCTX-M9 gene. Within the isolates, three co-harbored fosA3, fosA, and blaCTX-M9 genes, while one isolate co-expressed fosA3 and blaCTX-M9 genes. The distribution of these genes, both individually and co-harbored, was observed across all clinical samples analyzed, except those derived from blood and sputum. Conclusions: The dissemination of silent PMFR genes could pose a future risk for public health under the selective pressure of antibiotics, especially extended-spectrum beta-lactams, for a long time, or transfer to other bacteria, potentially leading to the activation of these genes.
Copyright (c) 2026 Rojan Albazaz, Haliz Saddeq Hasan, Najim A. Yassin https://creativecommons.org/licenses/by/4.0
Serotyping, drug resistance, virulence, and antibiotic resistance genes of Salmonella isolated from contaminated food
Introduction: Antibiotic resistance (AMR) is a serious problem for veterinary and human health. Its progression is leading to therapeutic failures and risks taking humanity back to the era before the discovery of antimicrobials. The impact of AMR on the economy is considerable. This study was carried out to assess the extent of AMR in Salmonella isolated from food products. Methodology: The European Committee on Antimicrobial Susceptibility Testing (EUCAST) standard method and the recommendations of the Antibiotic Susceptibility Committee of the French Society of Microbiology (CA-SFM) version 2023 V.1.0. 19 were used to test antibiotic susceptibility. A total of 41 antimicrobials were tested on the isolates. Virulence genes fimA and stn, and the antibiotic resistance gene CMY-2 were tested by real-time polymerase chain reaction (PCR) on bacterial DNA extracted using the MacheryNagel RNA viral nucleospin extraction kit. The integrated search engine on the National Center for Biotechnology Information (NCBI) website was used to search for the primer sequence of interest for the predefined genes. Results: All the isolates were resistant to at least one antibiotic, while 90% of isolates were multiresistant (resistant to at least 3 antimicrobial agents). All strains tested positive for the presence of the stn and fimA virulence genes, with the exception of one isolate. Similarly, with the exception of one strain, all strains tested positive for CMY-2. Conclusions: These results point to the progression of AMR, which is increasingly gaining ground, and to the danger of Salmonella virulence as a major agent of food-borne illness in Morocco.
Copyright (c) 2026 El Hanafi Motassim, Safae Skenndri, Pr. Mouahid, Pr. Bouchrif, Pr. Dahani, Pr. Bouchriti, Dr. Sami, Pr. Karib, Pr. AAbdellaoui Maane, Pr. Nassik https://creativecommons.org/licenses/by/4.0
Microbiology and antibiotic resistance of diabetes-related foot infections in Brazil: a systematic review
Introduction: Diabetic foot infections are the main cause of lower limb amputations. Knowing the microbiology of these infections is important because the most effective empirical antibiotic therapy varies by region due to differences in the prevalence of causative pathogens. This study aimed to identify the microbiological profile and antimicrobial resistance patterns of diabetes-related foot infections in Brazil. Methodology: The study followed a systematic literature review methodology. Manuscripts in the electronic databases PubMed, SciELO and VHL were searched through November 2022. Eligible studies were retrieved using the MeSH terms “diabetic foot” AND “Brazil”. Two independent evaluators selected the articles. Of the 466 titles identified, 10 observational studies met the eligibility criteria. Results: All 10 studies had observational design and covered 7 Federative Units of Brazil. The sample size varied between 17 and 320 cases, and hospital inpatients predominated (9 studies). Two studies performed anaerobic cultures. Among the 1,506 isolates, more than half were Gram-negative (836/55.5%) followed by Gram-positive (624/41.4%) and anaerobic bacteria (46/3.1%). The 3 most common species were Staphylococcus aureus (251), Enterococcus faecalis (112), and Pseudomonas aeruginosa (97). Forty percent (40%) of Staphylococcus aureus isolates were methicillin-resistant (MRSA). A fifth (20%) of the Pseudomonas spp isolates were resistant to carbapenems. The prevalence of extended-spectrum beta-lactamase-producing (ESBL-producing) was 43%, 33%, and 26% for K. pneumoniae, Proteus spp, and E. coli respectively. Conclusions: In Brazil, the microbiology of foot infections in persons with diabetes showed Gram-negative predominance. Staphylococcus aureus was the most frequently isolated species with a high prevalence of MRSA.
Copyright (c) 2026 Vanessa Pardo dos Santos, Catarina França dos Santos, Valter Castelli Júnior, Neima Prado, Roberto Augusto Caffaro, Carlos Alberto Silveira Alves https://creativecommons.org/licenses/by/4.0
Evaluation of β-lactam monotherapy and conventional anti-staphylococcal combination therapy for polymicrobial MSSA infections
Introduction: Staphylococcus aureus (SA) remains a major pathogen in both community-acquired and healthcare-associated infections, necessitating effective treatment strategies. Management of infections involving methicillin-susceptible S. aureus (MSSA) has traditionally included the use of targeted anti-staphylococcal antibiotics in combination with broad-spectrum agents. Recent evidence suggests that beta-lactam antibiotics may provide equivalent or superior outcomes in MSSA infections, challenging conventional treatment paradigms. Methodology: This retrospective cohort study evaluated adult patients with polymicrobial infections involving MSSA across multiple healthcare facilities from January 2019 to December 2023. Patients receiving beta-lactam monotherapy were compared with those receiving beta-lactam therapy plus a traditional anti-staphylococcal agent. Primary outcomes included treatment failure, defined as recurrence or escalation of infection within 90 days. Secondary outcomes were 90-day hospital readmission rates and all-cause mortality. Results: Of 1,000 patient records reviewed, 108 met the inclusion criteria. Beta-lactam monotherapy was associated with a significantly lower treatment failure rate compared with combination therapy (1.6% vs. 17.0%, p = 0.035). Hospital readmission rates (24.6% vs. 51.1%, p = 0.093) and all-cause mortality (11.5% vs. 19.1%, p = 0.784) were lower in the beta-lactam group, though the differences were not statistically significant. Conclusions: Beta-lactam monotherapy demonstrated comparable or superior efficacy to traditional anti-staphylococcal combination regimens for polymicrobial infections with MSSA. These findings support the potential for simplifying treatment regimens, reducing unnecessary antibiotic exposure, and enhancing antibiotic stewardship. Further prospective studies are needed to confirm these results and inform clinical practice guidelines.
Copyright (c) 2026 Dr. Gulnihal Akbulut, Dr. Kathy Tin, Julia Sapozhnikov, PharmD, BCIDP, Dr. Abdullah Chahin https://creativecommons.org/licenses/by/4.0
Stenotrophomonas maltophilia infections in intensive care units: a prospective and international ID-IRI study
Introduction: Stenotrophomonas maltophilia (S. Maltophilia) is a multidrug-resistant pathogen causing severe infections in intensive care units (ICUs). This study aimed to identify the risk factors influencing 30-day mortality and evaluate antimicrobial susceptibility patterns in ICU patients with S. maltophilia infections. Methodology: A prospective, multicenter, international observational study was conducted between 15 October 2023 and 15 April 2024, in 36 ICUs across 12 countries. Adult patients (≥ 18 years) with S. maltophilia isolated from blood, urine, or respiratory cultures were included if isolates were considered clinically consistent with infection. Colonized or coinfected patients were excluded. Clinical, laboratory data were collected prospectively. Thirty-day outcome was defined as survival or death after the first positive culture. Results: A total of 207 patients were included; 109 (52.7%) died within 30 days. The primary infection sites were pneumonia (28.5%) and bloodstream infections (38.0%). Resistance rates were 7.2% for trimethoprim-sulfamethoxazole (TMP-SMX), 10.4% for levofloxacin, and 27% for ceftazidime. None of the patients received effective empiric therapy. Older age (p = 0.030), acute renal failure (p = 0.016), chronic obstructive pulmonary disease (COPD; p = 0.008), malignancy (p = 0.001), and sequential organ failure assessment (qSOFA) ≥ 2 (p = 0.001) were independently associated with higher mortality. Repeat culturing and antimicrobial modification according to susceptibility testing reduced mortality (p = 0.017). Conclusions: S. maltophilia remains a lethal ICU pathogen. Early risk assessment, cultures, susceptibility testing, and therapy changes are vital. TMP-SMX and levofloxacin stay effective; but surveillance, infection control, and prudent antibiotic use remain essential.
Copyright (c) 2026 Hülya Çaşkurlu, Yasemin Çağ, Handan Ankaralı, Alper Tahmaz, Gökhan Vatansever, Yeşim Aybar Bilir, Pınar Yürük Atasoy, Meltem Taşbakan, Gülden Eser Karlıdağ, Arzu Şenol, Özlem Aldemir, Gergena Lengerova, Fatma Amer, Ahmed Almessabi, Bülent Durdu, Hakan Evren, Yurdagül Albayrak, Ramesh Shankar Ganeshan, Esra Gürbüz, Rositsa Tanova, Mehmet Özdemir, Abdullah Umut Pekok, Fatma Çölkesen, Meltem Karslıoğlu, Mustafa Serhat Şahitoğlu, Ayşe Sağmak Tartar, Serkan Öncü, Özlem Alıcı, Şafak Özer Balin, Irina Magdelena Dumitru, Maha Ali Gad, Sevil Alkan, Maya Belitova, Chavdar Stefanov, İlknur Erdem, Amani El-Kholy, Nirav Pandya, Bilal Ahmad Rahimi, Fahad Almajid, Rusmir Baljic, Luca Catalina, Anna Liskova, İlknur Şenel, Tarsila Vieceli, Merve Sarı, Halenur Vural Akbal, Ferda Yılmaz İnal, Gulmira Alkenovna Utepbergenova, Hakan Erdem https://creativecommons.org/licenses/by/4.0
Exogenous colonization of carbapenem-resistant Klebsiella pneumoniae and vancomycin-resistant Enterococcus in preterm infants: a PFGE-based molecular epidemiology study
Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) and vancomycin-resistant Enterococcus (VRE) pose significant threats in neonatal intensive care units (NICUs) due to their high transmission potential and limited treatment options. Identifying the source of colonization and detection of predominant antibiotic-resistant genes are crucial for effective infection control measures. Methodology: In this study, we analyzed 20 carbapenem-susceptible Klebsiella pneumoniae (CSKP) and 20 Vancomycin-susceptible Enterococcus (VSE) of meconium versus 20 CRKP and 20 VRE of rectal swabs isolates, respectively, from 20 preterm infants hospitalized in the NICU. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed PCR (AP-PCR) were used for molecular epidemiological analysis. The presence of carbapenemase (blaOXA-48, blaNDM, blaKPC) and Vancomycin-resistance (vanA, vanB, vanC) genes was investigated by multiplex PCR. Results: No predominant outbreak strain was detected, and isolates exhibited high genetic diversity, indicating an exogenous source of colonization of both CRKP and VRE. PFGE analysis revealed 24 distinct genotypes among CRKP and 25 among VRE isolates, with a clustering rate of 57.5%. The most commonly detected resistance gene in CRKP isolates was blaOXA-48 (50%), followed by blaNDM (35%) and blaKPC (10%). Among VRE isolates, only the vanA gene was present (85%). Conclusions: The absence of a clonal outbreak and the detection of resistance genes primarily on plasmids indicate healthcare-associated transmission rather than endogenous selection. This highlights the critical role of hand hygiene and strict infection control measures in preventing multidrug-resistant pathogen colonization in vulnerable preterm infants.
Copyright (c) 2026 Ahmet Aktaş, Elif Seren Tanrıverdi, Tuba Demirkalp, Barış Otlu, Yaşar Nakipoğlu https://creativecommons.org/licenses/by/4.0
Biofilm-associated genes and their role in antibiotic resistance among clinical Staphylococcus aureus isolates
Introduction: Staphylococcus aureus is a significant pathogen known for its ability to form biofilms, which enhances survival under adverse conditions. This study investigated the molecular mechanisms underlying biofilm formation in clinical S. aureus isolates, focusing on key biofilm-associated genes and their correlation with antibiotic resistance (ABR). Methodology: A total of 40 clinical S. aureus isolates were collected from Medical City Teaching Hospital, Baghdad. Biofilm production was assessed using the microtiter plate assay. Biofilm-related genes (icaB, icaC, crtM, crtN) were examined by polymerase chain reaction (PCR). Antimicrobial susceptibility was evaluated using the Kirby-Bauer disk diffusion method, and genes was correlated with resistance profiles. Results: A significant variation in biofilm production was observed, with 80% of isolates classified as non-biofilm formers, 12.5% as weak, 5% as moderate, and 2.5% as strong biofilm producers. Genetic testing revealed that all investigated isolates had a high percentage of icaB and icaC, with 95 % possessing crtM. A significant prevalence of mecA (97.5 %) was observed; however, an increased prevalence of mecA did not correlate significantly with enhanced biofilm formation. Conclusions: This is the first report from Baghdad demonstrating the prevalence of these biofilm-associated genes and their link to ABR, offering potential targets for future therapeutic interventions. These results highlight the importance of biofilm-associated genes in the persistence and reinfection potential of S. aureus within clinical settings. Additionally, the common occurrence of icaB with icaC suggests that both genes could serve as new targets for developing treatments aimed at preventing biofilm formation and enhancing therapy effectiveness.
Copyright (c) 2026 Dr. Asmaa S. Mohsin, Dr. Munim R. Ali, Dr. Ali Haider Alsakini https://creativecommons.org/licenses/by/4.0
Knowledge and practice regarding antibiotic usage in dogs among pet owners in a district in South India
Introduction: Antimicrobials are vital for human and animal health; however, their improper use leads to antimicrobial resistance. Shared living spaces and close bonds between humans and pets raise concerns about transferring resistant pathogens from pets to humans. This study assessed antibiotic usage among dog owners in a South Indian district to understand their knowledge and practices. Methodology: A quantitative cross-sectional study was conducted among 427 dog owners in a district in South India using snowball sampling. A semi-structured questionnaire was administered using telephonic interviews. The responses were expressed in frequencies and percentages, and Chi-square analyses were performed to establish significant associations between variables. Results: Most of the respondents were aware of antibiotics, less than half were aware of antibiotic resistance, and 4% were aware of antibiotic stewardship. More than half of the respondents followed correct practices in accessing, using, and storing antibiotics. The majority said that the use of antibiotics in dogs would not affect them indirectly, but scientific evidence shows a causal effect between antibiotic use and the development of antibiotic resistance. A significant association was found between awareness about antibiotics and socio-demographic factors such as education, area of residence, and years of experience as a pet owner. Conclusions: This study emphasizes the urgency of educating dog owners about antibiotic usage and resistance. It warns against the risks of inappropriate antimicrobial use in pets, stressing its impact on public health and promoting responsible antibiotic stewardship to curb antimicrobial resistance in both veterinary and human medicine.
Copyright (c) 2026 Sneha Elsa Sam, Rinila Das, Navya Vyas https://creativecommons.org/licenses/by/4.0
Distribution of non-tuberculous Mycobacteria strains and analysis of drug resistance in Lishui City, China
Introduction: This study aimed to investigate the distribution and drug resistance of clinically isolated Non-tuberculous Mycobacteria (NTM) strains in Lishui City, and to provide a basis for the development of NTM disease prevention and control strategies in the region. Methodology: This retrospective cross-sectional study was performed using NTM-positive clinical specimens collected from patients at a sentinel tuberculosis hospital in Lishui City, Zhejiang Province, China, between January 2023 and December 2024. The isolated NTM strains were identified using a gene chip–based method. Antimicrobial susceptibility testing was conducted using the microbroth dilution method. Statistical analyses were applied to evaluate the isolation rate, species distribution, and drug-resistance patterns of the strains. Results: The isolation rate of NTM among clinical patients at the sentinel hospital was 18.09% (157/868); The rate was significantly higher in women (26.97%, 72/267) than in men (14.14%, 85/601) (χ2 trend = 20.518, p < 0.001); Nine common NTM species were identified, with Mycobacterium intracellulare being the most prevalent (68.79%, 108/157), followed by Mycobacterium avium (11.46%, 18/157) and Mycobacterium chelonae/abscessus (8.28%, 13/157). Antimicrobial susceptibility testing revealed high resistance rates to several drugs, including imipenem (94.27%, 148/157), doxycycline (94.27%, 148/157), rifampicin (91.72%, 144/157), amoxicillin/clavulanic acid (91.08%, 143/157), meropenem (89.81%, 141/157), cefoxitin (87.90%, 138/157), minocycline (85.99%, 135/157), and ciprofloxacin (85.99%, 135/157). Species-specific differences in resistance patterns were observed. Conclusions: The distribution of clinically isolated NTM strains in Lishui City was dominated by Mycobacterium intracellular, Mycobacterium avium, and Mycobacterium chelonae/abscessus. These isolates demonstrated high levels of resistance to commonly used antimicrobial agents, highlighting the need for improved treatment and control strategies.
Copyright (c) 2026 Henan Xu, Zhongda Liu, Congjuan Lai, Li Lin, Jing Guo, Yutong Zhang, Ying Zhang, Zunjing Zhang https://creativecommons.org/licenses/by/4.0
Bioinformatics analysis identifies IL-23A and JAK2 as regulatory factors in sepsis immune response via the JAK/STAT3 pathway
Introduction: Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection. Identifying key genes associated with sepsis and exploring their interactions with immune cells are crucial for advancing diagnostic and therapeutic strategies. Methodology: In order to explore the genetic underpinnings, five datasets—GSE28750, GSE57065, GSE64457, GSE65682, and GSE95233—were analyzed using the \"Limma\" package in R to identify differentially expressed genes (DEGs). Functional enrichment analysis was conducted using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Protein-protein interaction (PPI) networks and key modules were analyzed using STRING and Cytoscape. The core genes were selected using the least absolute shrinkage and selection operator (LASSO) regression, and their diagnostic value was validated through receiver operating characteristic (ROC) curve analysis. Immune cell infiltration was assessed using the CIBERSORT algorithm. Results: A total of 230 DEGs were identified, including 183 upregulated and 47 downregulated genes. GO and KEGG analysis revealed significant enrichment in immune-related pathways. Two core genes, IL-23A and JAK2, emerged as key players. ROC curve analysis demonstrated high diagnostic value with area under the curve (AUC) values of 0.82 and 0.90 for IL-23A and JAK2, respectively. IL-23A showed a strong positive correlation with CD8+ T cells and activated natural killer (NK) cells, while also activating the JAK/STAT3 signaling pathway and mitigating JAK2-mediated immune cell infiltration. Conclusions: This study highlights the potential role of IL-23A and JAK2 in the immune regulation of sepsis and provides new insights into immune therapeutic strategies via the JAK/STAT3 signaling pathway.
Copyright (c) 2026 Zhiying Liin, Wu Fang, Chunli Yang https://creativecommons.org/licenses/by/4.0
Comparison of the cleaning effectiveness of pulsed vacuum cleaning and disinfection machine versus spraying cleaning and disinfection machine for rigid endoscope instruments
Background: This study aims to compare the cleaning effectiveness of the pulsed vacuum cleaning and disinfection machine (PVD) and the spraying cleaning and disinfection machine (SCD) in cleaning rigid endoscope instruments. Methodology: A total of 900 postoperative rigid endoscope instruments from the sterilization supply room of our hospital, collected between July and December 2024, were included in the study. Instruments were randomly divided into two groups using a computer-generated random number sequence, ensuring a 1:1 allocation ratio: the research group (450 items) and the control group (450 items). The research group used the PVD machine, while the control group used the SCD machine. The sterilization effectiveness, cleaning quality, ATP bioluminescence assay, and protein residue measurement were compared between the two groups. Results: The sterilization time in the research group was longer than that in the control group. The instrument damage rate and endotoxin positive rate were significantly lower in the research group (p < 0.05). The research group showed significantly higher results in the paper test method compared to the control group (p < 0.05). No significant difference was found between the two groups in visual inspection and blood residue comparison (p > 0.05). The ATP bioluminescence detection and protein residue pass rates were higher in the research group than in the control group, with a statistically significant difference (p < 0.05). Conclusions: The pulsed vacuum cleaning and disinfection machine performs better than the spraying cleaning and disinfection machine in cleaning rigid endoscope instruments, offering potential benefits for patient safety and instrument longevity.
Copyright (c) 2026 Jian Li, Yue Hu, Licong Bo, Xue Wang, Wenjing Hu https://creativecommons.org/licenses/by/4.0
Fungal colonization and ASCA/p-ANCA positivity in inflammatory bowel disease: a cross-sectional study from Turkey
Introduction: Recent research indicates that individuals with inflammatory bowel disease (IBD) exhibit distinct intestinal fungal communities compared with healthy individuals. This study examined the relationship among anti-Saccharomyces cerevisiae antibodies (ASCA), perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), and Candida spp. colonization to assess their utility in diagnosing IBD, differentiating subtypes, and predicting disease localization. Methodology: Serum samples from 240 patients with IBD and 61 healthy controls were tested for ASCA and p-ANCA using indirect immunofluorescence assay (IIFA). Fecal samples were cultured to identify Candida species. Results: ASCA positivity was significantly higher in Crohn’s disease (CD) (61.7%), whereas p-ANCA positivity was more frequent in ulcerative colitis (UC) (51.6%) (p = 0.005 and p = 0.002, respectively). Fluorescence intensity showed stronger ASCA reactivity in CD and higher p-ANCA intensity in UC. Candida colonization (≥ 5 CFU) was detected in 64.2% of IBD patients, with Candida albicans the most common species. Saccharomyces cerevisiae was detected exclusively in IBD patients (3.7%, p = 0.038). Higher colonization rates were observed in UC with pancolitis (78.9%) and in CD with colonic involvement (80%). ASCA intensity inversely correlated with Candida load in CD (p = 0.021), whereas p-ANCA intensity positively correlated with Candida load in UC (p = 0.038). No significant differences in Candida species diversity were observed between subtypes. Conclusions: These findings support the diagnostic value of ASCA and p-ANCA in distinguishing IBD subtypes and highlight their association with Candida colonization. Further studies are warranted to elucidate fungal antigen–antibody interactions and to refine subtype-specific diagnostic and therapeutic strategies.
Copyright (c) 2026 Zulal Asci Toraman, PINAR ÖNER, MERYEM ERDOĞAN, BERÇEM AFŞAR KARATEPE, ABDURRAHMAN SAHIN, YASEMİN ÜSTÜNDAĞ, HANDAN AKBULUT https://creativecommons.org/licenses/by/4.0