Antibiotics

Background: Acute respiratory infections (ARIs) are among the most common reasons for primary healthcare consultations. Although most ARIs are viral, antibiotics are frequently prescribed, contributing to antimicrobial resistance. In Mozambique, evidence on factors associated with antibiotic prescribing for ARIs remains limited. Objective: To identify clinical factors associated with antibiotic prescribing among patients with ARIs attending the Eduardo Mondlane University Health Center (CS-UEM) between April and August 2024. Methods: We conducted a retrospective, observational, cross-sectional study using a convenience sample of 196 clinical records of patients with ARIs. Demographic, clinical, and prescriber-related variables were extracted from medical records. Associations with antibiotic prescribing were assessed using chi-square tests and Cramer's V. Multivariable logistic regression was used to identify factors independently associated with antibiotic prescribing, and model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Antibiotics were prescribed in 69.4% (136/196) of consultations. Amoxicillin was the most frequently prescribed antibiotic (45.4%), followed by azithromycin (26.0%), while 43.4% of prescriptions belonged to the WHO AWaRe "Watch" category. In the multivariable model, clinical category and presenting signs and symptoms were independently associated with antibiotic prescribing (chi-square(8) = 36.58; p < 0.001; McFadden's pseudo-R2 = 0.151). Diagnosis, age, sex, and prescriber nationality were not significantly associated with prescribing. The model showed acceptable discriminative performance (AUC = 0.760). Conclusion: Antibiotic prescribing among patients with ARIs at CS-UEM was primarily associated with clinical presentation rather than demographic characteristics or formal diagnosis. These findings support the implementation of locally adapted antimicrobial stewardship interventions to promote more rational antibiotic prescribing in primary healthcare settings. Keywords: Acute respiratory infections; antibiotic prescribing; antimicrobial resistance; antimicrobial stewardship; primary health care; Mozambique.

Antimicrobial resistance in Pseudomonas aeruginosa has emerged as a major clinical concern. Ciprofloxacin has potent intrinsic activity against P. aeruginosa, but resistance to this antibiotic is increasingly reported in clinical settings. In this study, P. aeruginosa ATCC 27853 strain was exposed to gradually increasing ciprofloxacin concentrations for 50 passages ([~]100 days). The final selected resistant strain (CIP-R) with 256-fold of minimum inhibitory concentration was studied further. Whole-genome sequencing revealed 12 genomic alterations, including known mutations in the quinolone resistance-determining genes gyrA (Thr83Ile), parC (Thr177Asn), parE (Glu459Lys). A duplication mutation in nfxB (Tyr153_Gly154dup) was also observed. In addition to these genes, we observed mutations in pilA, tadB, psdR, NP446_RS32055 (TRAP transporter permease), multiple dppA3 variants, and a prophage-associated hypothetical gene (NP446_RS24255), which have not been reported previously. The gyrA Thr83Ile substitution was conserved in 86.38% of ciprofloxacin-resistant clinical isolates retrieved from the NCBI database. Resistance acquisition was accompanied by slower growth, impaired swimming and swarming motility, diminished surface attachment, reduced biofilm formation. The resistant strain has enhanced {beta}-lactamase activity, and resistance to levofloxacin, cefepime, and meropenem together with sensitivity to piperacillin-tazobactam and aztreonam. This study highlights the gyrA Thr83Ile mutation as a key genomic marker for molecular screening of ciprofloxacin resistance and reveals secondary adaptive trade-offs that can be targeted for clinical diagnostic and therapeutic decision-making. In conclusion, achieving high-level ciprofloxacin resistance in P. aeruginosa involves non-target-site genomic adaptations and physiological trade-offs beyond classical target mutations.

The minimum inhibitory concentration (MIC) assay is the gold standard for evaluating antimicrobial activity1. However, conventional agar-based MIC methods often underestimate the potency of physicochemically complex compounds[1, 2]. Hydrophobic and adhesive molecules, such as lipoglycopeptide antibiotics, exhibit poor diffusion and non-specific binding to agar, leading to artificially elevated MIC values compared to broth-based methods[3]. This issue complicates accurate potency assessment and is particularly an issue when attempting resistance frequency (FOR) studies, which must be conducted on solid media. Here, we developed a modified miniaturised agar MIC assay using 1% agarose, 0.002% Tween 80-supplemented tryptic soy broth (TSB), and a 24-well plate format[4]. These modifications improved compound dispersion, reduced matrix interactions, and lowered compound requirements. The optimised assay was validated with vancomycin, oritavancin, and dalbavancin against Staphylococcus aureus ATCC 43300 (MRSA) and Streptococcus pneumoniae ATCC 700677. This efficient, cost-effective, high-throughput platform overcomes the limitations of traditional agar methods, enhancing reliability in evaluating challenging antimicrobials and supporting next-generation antibiotic development.

The global spread of antimicrobial-resistant (AMR) bacteria represents one of the greatest threats to modern medicine, making the development of novel therapeutic strategies increasingly urgent. Phage therapy, which exploits bacteriophages (phages, viruses that specifically infect and kill bacteria) has regained attention as a therapeutic approach for multidrug-resistant infections. One critical determinant of treatment outcome is the capacity of phages to sustain bacterial growth suppression; however, no metric has previously existed to directly quantify the duration of effective lytic activity. Here, we propose the Sustainability Index (SusI), a novel metric that quantifies both the duration and extent of phage-mediated bacterial growth suppression, which is restricted to the primary lysis period from lysis initiation to resistance emergence. Evaluation of individual phages and two-phage cocktails against both laboratory and clinical isolates of Escherichia coli demonstrated that SusI provides information independent of the Virulence Index, which primarily reflects bactericidal activity during the initial phase of infection, and serves as a complementary metric to the Suppression Index, which may incorporate behavior beyond primary lysis. Cocktails composed of phages targeting different receptors specificities consistently exhibited higher SusI values, consistent with the notion that multifaceted selective pressure delays resistance emergence. Furthermore, in a mouse model of systemic infection established by intraperitoneal administration, cocktails with higher SusI values demonstrated superior therapeutic efficacy. These results confirm SusI as a practical metric for rational phage cocktail design. As phage therapy advances toward clinical implementation, standardized quantitative metrics such as SusI are expected to facilitate evidence-based selection of therapeutic phages across diverse pathogens and infection conditions. ImportanceThe global spread of antimicrobial-resistant bacteria is making bacterial infections increasingly difficult to treat. Phage therapy, which uses bacteriophages (viruses that specifically infect bacteria), has re-emerged as a therapeutic alternative; however, reliable methods to determine in advance which phages will be therapeutically effective remain limited. Current evaluation metrics are well-suited for quantifying how rapidly phages kill bacteria but were not designed to directly measure how long lytic activity is sustained before resistant bacteria emerge. Here, we developed the Sustainability Index (SusI), a novel metric that specifically quantifies the duration of effective bacterial growth suppression. Evaluation of multiple phages and their combinations (cocktails) against both laboratory and clinical bacterial isolates demonstrated that SusI can distinguish phage combinations that existing metrics fail to differentiate. Moreover, in a mouse model of lethal bacterial infection, higher SusI values correlated with improved therapeutic outcomes. SusI has potential as a practical tool for selecting phages with greater likelihood of therapeutic success.

Co-administration of phages and antibiotics has been proposed as a therapeutic approach against antibiotic-resistant bacteria. The relationship, however, between antibiotic resistance and phage resistance in clinical isolates is unclear. Here, we examine associations between phage and antibiotic resistance profiles across a panel of Pseudomonas aeruginosa clinical isolates from the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) Antimicrobial Resistance Isolate (ARI) Bank comprising 55 clinical strains with full genome sequences and antibiotic susceptibility testing (AST) data for 11 clinically relevant antibiotics. As phages in this study, we use three well-characterized, morphologically distinct phages, OMKO1, Luz19, and PAML31-1. We screen for phage resistance using a growth suppression assay, then conduct statistical analysis against antibiotic MIC (Minimum Inhibitory Concentration) data provided by the CDC to define association patterns across this dataset. We find multiple significant susceptibility correlations between pairs of antibiotics and phages, and a positive overall association between average phage resistance and antibiotic resistance across the 55 strains, even controlling for phylogenetic associations (=0.358, p<0.005). We conclude that phage and antibiotic resistance are positively associated across this clinical isolate collection, suggesting that the two resistance phenotypes are not independent in P. aeruginosa. These findings have implications for the development of phage-antibiotic cocktails.

Klebsiella aerogenes, a member of the Enterobacteriaceae, is a causative agent of healthcare-associated infections, and outbreaks caused by drug-resistant K. aerogenes have been reported worldwide. The range of antimicrobial agents available for treating infections caused by carbapenem-resistant K. aerogenes is limited. While in vivo animal experiments using clinical K. aerogenes isolates to evaluate antimicrobial therapy could facilitate selection of the most effective treatment, conducting infection experiments involving large numbers of mammals such as mice is challenging due to ethical concerns related to animal welfare. Silkworms are invertebrates increasingly used as experimental models for infectious disease research to evaluate antimicrobial efficacy. In this study, we aimed to establish a silkworm infection model using a clinical K. aerogenes isolate to evaluate its utility for determining effective antimicrobial doses. K. aerogenes strains were isolated from a patient at a Japanese hospital, and a silkworm infection model was established using the clinical isolate. The non-metallo-beta-lactamase-producing strain K. aerogenes TUM25562, isolated from a patient with a complicated urinary tract infection, was susceptible to meropenem (MEPM) and gentamicin (GM) in vitro. During treatment, additional isolates with increased resistance to MEPM and subsequently to both MEPM and GM emerged. K. aerogenes TUM25562 caused dose-dependent mortality in silkworms. Treatment with clinically equivalent weight-based doses of MEPM or GM did not cure the infected silkworms. The median effective (ED50) doses of MEPM and GM were therefore investigated using the silkworm infection model. Administration of higher doses corresponding to four times the ED50 significantly prolonged the survival of infected silkworms. These results suggest that a silkworm infection model using clinical K. aerogenes isolates may provide a practical approach for evaluating antimicrobial efficacy and determining effective antimicrobial doses.

SynopsisO_ST_ABSBackgroundC_ST_ABSThe complexity of diagnosing and treating biofilm-associated infections necessitates a comprehensive strategy to mitigate the rising rates of antimicrobial resistance (AMR). Microtiter plate methods are used globally for determination of biofilm eradication concentrations (MBEC) but few have been adapted to observe pharmacodynamic observations. Here, we describe a method which allows for both static and pharmacodynamic assays of biofilm evaluation. MethodsA total of 150 clinical isolates from Southmead Hospital were assessed, representing five bacterial species (N=30 per bacterial species): Pseudomonas aeruginosa, Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. MBECs were determined using a developed method using 96 well plates and glass beads. MBECs of seven different antibiotics were compared to those determined using the established Calgary biofilm device (CBD). Dynamic pharmacodynamic evaluations to produce Biofilm Time Kill curve (BTKC) based on published planktonic time kill curve (TKC) data and ISO recommendations were carried out using the glass bead model for K. pneumoniae and ciprofloxacin, S. aureus and levofloxacin and S. pneumoniae and vancomycin. Quantification of biofilm biomass was assessed at 0, 2, 4, 8 and 24 hours and compared to planktonic culture survival under comparable challenge conditions. ResultsComparing MBEC results for all bacterial strains and antibiotic challenges showed no statistical difference between the glass bead and CBD methods (P <0.05). Biofilm BTKC AUBKC were inferior to planktonic equivalents but demonstrated specific pharmacodynamic patterns of biofilm reduction efficacy. MBEC correlated with biofilm BTKC penetration in line with clinical observations for S. aureus vs vancomycin and S. pneumoniae vs levofloxacin. ConclusionsThe glass bead biofilm models provide robust, reproducible alternatives to the traditional methods of determining MBEC and bridge the gap with biofilm pharmacodynamic evaluations. These methods also provide a low-cost option to current methods as only standard laboratory equipment is required, allowing for the generation of comprehensive data sets. This ensures greater translatability to complex in vitro models and clinical scenarios.

The vancomycin-resistant Enterococcus faecium (VREfm) has been declared as a high priority pathogen by World Health Organisation (WHO). It presents a major therapeutic challenge to healthcare, remaining with limited antibiotic options. Bacteriophage therapy has emerged as a promising alternative for combating antimicrobial-resistant pathogens. This study reports the isolation and characterization of bacteriophages active against VREfm and MDR E. faecium clinical isolates from India. Two bacteriophages, NIMS_EF375_N69_P9 ({Phi}1) and NIMS_EF375_N74_P12 ({Phi}2), were isolated from sewage by enrichment using MDR E. faecium strain EF375 as the propagation host. Lytic activity was confirmed by spot assay and double-layer soft agar plaque assay; both phages produced clear plaques of 1.5-2.0 mm. Transmission electron microscopy showed icosahedral heads with long non-contractile tails, presenting siphovirus-like morphotype within the class Caudoviricetes. Host range was assessed against 10 MDR E. faecium isolates (including the propagation host), 2 of which were VREfm. {Phi}1 lysed 5 of 10 isolates, including the VanA-type VREfm, whereas {Phi}2 lysed 7 of 10, including both VanA- and VanB-type VREfm. In time-kill assays against EF375 at an MOI of 1, {Phi}1 produced effective decline in optical density sustained through 24 h (~80% reduction relative to the untreated control), whereas {Phi}2 suppressed bacterial growth with only ~50% reduction. To the best of our knowledge, this study represents the first report from India on the isolation and characterization of bacteriophages active against clinical VREfm isolates. The broader host range of {Phi}2 and the stronger killing kinetics of {Phi}1 suggest complementary roles in a phage cocktail, warranting genomic characterization and in vivo evaluation.

Shigella flexneri is an enteric pathogen responsible for causing shigellosis, a type of bacillary dysentery of significant global health concern. The increasing prevalence of antibiotic resistance has driven the search for alternative treatments, including bacteriophage (phage) therapy. However, the effectiveness of orally administered phages for enteric pathogens depends on their ability to survive passage through the gastrointestinal tract. In this study, the ability of bacteriophage Sf14 to maintain infectivity was evaluated under simulated gastrointestinal conditions using a modified INFOGEST 2.0 in vitro digestion model. This model includes salivary, gastric, and intestinal fluids with physiologically relevant compositions of electrolytes, bile salts, and enzymes. Phages were incubated in each simulated phase at standard physiological temperature, then tested for infectivity using quantitative plaque assays. Results show that Sf14 remained stable during the short duration of the oral phase and for the duration of the intestinal phase. By contrast, survival in simulated gastric fluid required a pH of 2.75 or higher, with rapid and substantial loss of infectivity at pH 2.5 and below. These findings demonstrate that while Sf14 is stable in oral and intestinal environments, the gastric phase poses a critical barrier to phage survival. With in vivo fasting gastric pH ranging from 1.5 to 3, encapsulation would enable the most flexible oral phage therapy against enteric pathogens, but ingestion after eating or alongside antacids may be sufficient.

Background: Pseudomonas aeruginosa is a major opportunistic Gram-negative pathogen responsible for healthcare-associated infections, while increasing antimicrobial resistance has narrowed therapeutic options. Vaccine development therefore represents an important complementary strategy for prevention. This study compared the immunogenicity and protective efficacy of a formaldehyde-inactivated whole-cell vaccine with a sonicated whole cell extract preparation against multidrug-resistant (MDR) P. aeruginosa in mouse model. Methods: Clinical P. aeruginosa isolates were obtained from specimens collected at Dhaka Medical College Hospital between July 2022 and February 2026. Formaldehyde-inactivated whole-cell and sonicated whole cell extract preparations were produced from P. aeruginosa. A total of 144 female Swiss albino mice aged 6-8 weeks were used: 120 mice were allocated to two independent immunization experiments and 24 mice were used for LD50 determination. Mice received three intramuscular immunizations on days 0, 14, and 28. Antigen-specific serum IgG was assessed by enzyme-linked immunosorbent assay (ELISA), functional antibody activity was evaluated by serum bactericidal assay (SBA), and protective efficacy was assessed following lethal intraperitoneal challenge. Results: Ten isolates from MDR P. aeruginosa were selected by simple random sampling from the clinical isolates for vaccine preparation. The estimated protein concentration of the sonicated preparation was 1.872 mg/mL. Both vaccine groups developed significantly higher anti-P. aeruginosa IgG responses than the control group after immunization (p<0.001). Following lethal challenge, survival was 100% in mice receiving the formaldehyde-inactivated vaccine and 91.7% among mice receiving the sonicated preparation; no control mice survived. Between-vaccine differences in survival were not statistically significant. SBA demonstrated complement-dependent bactericidal activity in sera from both vaccinated groups, with activity detectable to a dilution of 1:32 for the whole-cell vaccine and 1:64 for the sonicated preparation. Conclusions: Both vaccine preparations elicited strong humoral responses and substantial protection against lethal MDR P. aeruginosa challenge in mice. The findings support further investigation of multicomponent P. aeruginosa vaccine strategies, although additional studies using multiple challenge strains and broader immunological endpoints are required before conclusions regarding translational efficacy can be drawn.

IntroductionIn sub-Saharan Africa, and more specifically in Cameroon, antimicrobial resistance (AMR) represents a major public health threat. This is underlined by the increasing appearance of multidrug-resistant bacteria. Extended-spectrum {beta}-lactamase producing Escherichia coli (ESBL-Ec), a critical priority bacterium, is increasingly implicated in life-threatening infections in hospital and community settings in Cameroon. Data on the genetic composition of ciprofloxacin-resistant Escherichia coli are limited in Cameroon. This study aimed to investigate the prevalence, genetic diversity, resistance mechanisms in multidrug-resistant Escherichia coli organisms isolated from clinical samples in two hospitals in Yaounde, Cameroon. MethodA cross-sectional study was conducted from February to June 2025 in two healthcare facilities in Yaounde, Cameroon. All clinical samples from in- and out-patients were analysed. After culturing, identification was performed using API20E as per the manufacturers instructions and ESBL production was screened in CHROMagarTM ESBL. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Polymerase chain reaction (PCR) was used to detect ESBL and plasmid mediated quinolone resistance (PMQR)genes, as well as mutations in quinolone resistance-determining region (QRDR) (gyrA/parC) Horizontal. plasmid transfer was also investigated. Finally, phylogroup analysis was assessed. ResultThe prevalence of MDR E. coli was 50.7% (n=33/65), all of which (100%) were ESBL producers and 91% were ciprofloxacin-resistant. Highest resistance rates were observed for cefotaxime (100%), ceftriaxone (100%), and ciprofloxacin (91%). The most frequent ESBL genes were blaTEM (36.3%; n=12/33). Among PMQR genes, qnrB was detected in 16.6% (n=5/30) of isolates. Only the ESBL genes were carried by plasmids; the most prevalent plasmid-borne gene was blaTEM (40%), followed by blaCTX-M (26.7%). Mutations within the topoisomerase QRDR (parC gene) were identified in 36.6% (n=11/30) of ciprofloxacin-resistant strains. Phylogroup analysis revealed a predominance of phylogroup A, followed by group B. ConclusionThis study reveals a high prevalence of multidrug-resistance, ESBL (blaTEM dominant) and fluoroquinolone resistance in E. coli in Yaounde, with plasmid dissemination of ESBL genes and chromosomal stabilization of PMQR determinants. The predominance of commensal phylogroups in clinical samples underlines the role of the community reservoir. It is urgent to reinforce " real-time One Health" genomic surveillance in Cameroon.

Urinary tract infections (UTIs) are frequently caused by Escherichia coli and are increasingly associated with antimicrobial resistance, highlighting the need for alternative therapies. Although phage therapy is a promising approach, the rational selection of phages and phage cocktails remains challenging, particularly when detailed genomic information on the infecting strain is unavailable. In this study, we isolated 18 phages from environmental samples collected in Sherbrooke, Quebec, Canada. Genome sequencing identified 15 pure lytic phages representing diverse taxonomic groups and revealed prophage-derived contaminants in three isolates, underscoring the importance of genomic validation during phage discovery. Host range was determined using efficiency-of-plating (EOP) assays against UTI-associated E. coli isolates. Based on host-range overlap and cumulative EOP values, we developed a phenotype-based framework for phage cocktail design and classified combinations as redundant or complementary. Complementary cocktails composed of phages with distinct host ranges and high infection effectiveness consistently outperformed redundant combinations in time-kill assays, demonstrating that host-range diversity and lytic effectiveness are independent properties that should be considered separately during cocktail design. To evaluate cocktail performance under physiologically relevant conditions, the most effective combinations were tested in artificial urine. Both cocktails exhibited reduced activity compared with standard laboratory media, indicating that environmental conditions strongly influence phage-host interactions. Together, our results demonstrate that host-range overlap and cumulative infection effectiveness provide a practical framework for identifying effective phage combinations in the absence of detailed bacterial genomic information and may facilitate the rational development of phage therapies for UTIs.

Enterococcus faecalis is a leading cause of infective endocarditis, particularly in older and hospitalized patients. Treatment is challenging due to the intrinsic resistance of E. faecalis to many clinically important antibiotics and the increasing prevalence of multidrug-resistant strains. Bacteriophage (phage)-based therapies, including phage cocktails and phage-antibiotic combinations, offer a promising approach for treating resistant bacterial infections. In this study, we isolated ten novel phages from wastewater by screening on E. faecalis clinical isolates and tested phage activity both individually and in phage-phage and phage-antibiotic combinations against 18 E. faecalis clinical isolates collected from patients with infective endocarditis. We found that 15/18 (83%) isolates were susceptible to at least one phage tested, and that the same proportion of isolates were susceptible to a cocktail of three phages with complementary activities. We also observed improved bacterial growth inhibition and increased killing when phages were combined with ampicillin or daptomycin, two antibiotics commonly used to treat E. faecalis infections. Finally, we found that treatment with the three-phage cocktail improved the survival of Galleria mellonella infected with a pathogenic E. faecalis endocarditis isolate. Overall, these findings suggest that phages could be a helpful addition to the therapeutic repertoire for treating E. faecalis infective endocarditis. ImportanceNew approaches are needed for treating infective endocarditis, a life-threatening heart infection. Here we focus on Enterococcus faecalis, a resilient bacterium that is increasingly resistant to standard-of care antibiotic regimens, and explore the use of phage therapy for treating E. faecalis endocarditis. We found that combining phages together in a cocktail or pairing them with existing antibiotics can effectively kill E. faecalis clinical isolates from patients with infective endocarditis, and that treatment of infected waxworm moth larvae with a phage cocktail improved their survival. The results of this study contribute to the development of phage-based therapeutic approaches for E. faecalis endocarditis, which could ultimately lead to improved outcomes for patients facing this severe infection.

Background: Retail red meat may act as a source of foodborne pathogens, antimicrobial resistant bacteria, and antibiotic residues, posing a significant public health concern in Bangladesh. Objectives: This study aimed to isolate and identify major bacterial pathogens from retail red meat, determine their antimicrobial susceptibility patterns, assess the prevalence of antibiotic resistant bacteria, and detect antibiotic residues in meat samples. Methods: A cross-sectional study was conducted from January to June 2019 using 60 retail red meat samples (20 cattle, 20 goat, and 20 buffalo) collected from Rajshahi and Naogaon districts. Bacterial isolates were identified using standard cultural, morphological, staining, and biochemical techniques. Antimicrobial susceptibility was evaluated by the Kirby Bauer disc diffusion method according to CLSI guidelines. Antibiotic residues were screened in 15 representative samples using thin layer chromatography (TLC). Results: Overall prevalence of Escherichia coli, Salmonella spp., and Staphylococcus aureus was 10.0%, 13.3%, and 28.3%, respectively. E. coli showed complete resistance to penicillin (100%) and high resistance to amoxicillin (83.3%), while remaining highly susceptible to ciprofloxacin (83.3%) and gentamicin (66.7%). Salmonella spp. exhibited highest resistance to penicillin (87.5%) and tetracycline (75.0%), whereas gentamicin (87.5%) and ciprofloxacin (75.0%) remained the most effective agents. S. aureus demonstrated marked resistance to penicillin (94.1%), ampicillin (58.8%), tetracycline (47.1%), and amoxicillin (47.1%), but high susceptibility to gentamicin (88.2%) and ceftriaxone (70.6%). TLC detected ciprofloxacin and oxytetracycline residues in one cattle meat sample each (6.7%). Conclusions: Retail red meat marketed in the study areas harbored multidrug-resistant bacterial pathogens and detectable antibiotic residues, highlighting potential risks to food safety and public health. Continuous surveillance, prudent antimicrobial use, improved slaughterhouse hygiene, and strict compliance with antibiotic withdrawal periods are essential to minimize antimicrobial resistance and residue contamination.

To prevent antimicrobial resistance (AMR), antibiotic courses are traditionally prescribed to completion, overlooking their collateral impact on the commensal microbiota. We developed a deterministic within-host model linking pathogen growth, immune responses, antibiotic action, and commensal dynamics to explore how treatment duration influences resistance development. Simulations across community-acquired infection parameters showed that 71% of cases successfully treated with a standard 7-day regimen could also be cured with shorter "Stop When Better" (SWB) courses, where treatment cessation was triggered by a predefined threshold in pathogen abundance, and 97% by SWB plus 1 day. Compared with standard treatment, SWB+1 approaches reduced overall antibiotic exposure and resistance emergence in commensal niches while preserving efficacy. While this threshold-based definition of "feeling better" offers a clear theoretical framework, it would require translation into clinical cues. Therefore, although these findings suggest that response-based antibiotic stopping rules could inform future adaptive prescribing strategies, further empirical validation is essential.

Pseudomonas aeruginosa remains one of the most important clinical pathogens for which new drugs are needed, due to its resistance machinery. Consequently, there is an increasing effort to develop new and effective treatments against this pathogen. We recently showed that tetrasodium ethylenediaminetetraacetic acid (tEDTA) exhibits promising antibacterial and antibiofilm activity against P. aeruginosa in advanced biofilm models. tEDTA is known to chelate divalent cations, with predicted effects on the outer membrane; however, a full understanding of how this kills P. aeruginosa is lacking. Also, it is currently not clear how slowly or rapidly P. aeruginosa will evolve resistance to this treatment. Using membrane disruption assays and RNA-seq, we showed that tEDTA disrupts bacterial membrane potential and permeabilises P. aeruginosa membranes. RNA-seq revealed the significant upregulation of genes involved in the transport of iron, phosphate, potassium, and magnesium ion. The arnABCD operon which is involved in lipid A biosynthesis was also upregulated. Using a 7-day evolutionary ramp approach, we showed that P. aeruginosa could not evolve resistance to tEDTA under strong selection. Lastly, we carried out a cytotoxicity assay with Human Epithelial type 2 (HEp-2) cells and showed that there was reduced cytotoxicity of tEDTA compared to meropenem. This study provides good insight into the mechanism of action of tEDTA and further evidence of its potential as an alternative to antibiotics for P. aeruginosa infections.

Pharmacodynamic curves describe how changes in drug concentration affect pathogen growth. They are essential for designing treatments that promote pathogen eradication and minimize the evolution of antibiotic resistance. The classical function for modelling pharmacodynamics is a phenomenological, S-shaped curve with stable growth and death rates separated by a single drop. In this study, we characterized the pharmacodynamic curve of the {beta}-lactam antibiotic cefotaxime (CTX) acting against Escherichia coli. We found that the relationship between CTX concentration and net growth rate diverged from classical model predictions, instead yielding a two-step curve defined by distinct phases of growth, population maintenance, and killing. We hypothesized that the intermediate phase arose from antibiotic tolerance conferred by bacterial filaments. Microscopic assessment of treated cells indeed showed a difference in degree of filamentation with concentration. We further sought to explain this with a semi-mechanistic pharmacodynamic function, modelling the binding of CTX to its cellular targets, penicillin binding proteins (PBP) 1 and 3. By incorporating the preferential concentration-dependent binding of CTX to PBP3 and then PBP1, yielding filaments or lysed cells respectively, we replicated the two-step curve in silico. We also assessed the pharmacodynamics of CTX against mutants conferring resistance; these displayed further altered curves, in line with their fitness costs. Altogether, our results show that CTX has a two-step pharmacodynamic curve against E. coli arising from multiple targets separated in their affinity for the antibiotic. We present a model offering a mechanistically grounded framework for capturing such dynamics. These pharmacodynamic curves deserve careful consideration when defining optimal dosing.

The rapid rise of multidrug-resistant (MDR) bacterial infections has severely limited treatment options, particularly for Gram-negative pathogens such as Klebsiella pneumoniae, a leading contributor to pneumonia, bloodstream, urinary tract, and surgical-site infections. One strategy to restore antibiotic efficacy is the use of resistance-mitigating agents (RMAs), compounds that re-sensitize bacteria to existing antibiotics without displaying independent antibacterial activity. Herein, we report the results of a high-throughput screen of a 3,200-compound fragment-based library against an MDR K. pneumoniae isolate in the presence of subinhibitory ciprofloxacin. This screen identified a tetrahydrocarbazole-containing compound, 1, as a ciprofloxacin potentiator. Subsequent structure-activity relationship studies yielded a difluorinated analog, compound 5, which potentiated multiple antibiotic classes in MDR K. pneumoniae, reducing MICs up to [&ge;]16 fold. Further testing demonstrated synergistic interactions between compound 5 and ciprofloxacin, ceftriaxone, cefoxitin, and tetracycline across four genetically diverse MDR K. pneumoniae strains. These findings suggest that tetrahydrocarbazole-containing compounds constitute a promising new class of RMAs with potential for future development as therapies against MDR K. pneumoniae infections.

BackgroundEscherichia coli contamination of chicken eggs is an important food-safety concern, while antimicrobial-resistant E. coli may contribute to the dissemination of antimicrobial resistance through the food chain. However, information on egg-associated E. coli and its antimicrobial susceptibility in Natore District, Bangladesh, is limited. ObjectivesThis study aimed to determine the prevalence of E. coli in chicken eggs collected from commercial farms, markets and indigenous/backyard flocks in Natore District, identify the isolates based on cultural, morphological and biochemical characteristics, and assess their antimicrobial susceptibility. Materials and MethodsA total of 84 egg-shell swab samples, comprising 28 samples each from commercial farms, markets and indigenous chicken flocks, were collected from seven upazillas of Natore District between January and June 2023. Samples were cultured on selective and differential media, and presumptive isolates were confirmed by Gram staining, motility and biochemical tests. Antimicrobial susceptibility was determined using the Kirby-Bauer disc-diffusion method against seven antimicrobial agents. ResultsE. coli was detected in 56/84 (66.67%) egg samples. Prevalence was highest in indigenous eggs (22/28, 78.57%), followed by farm eggs (18/28, 64.28%) and market eggs (16/28, 57.14%). Among 22 confirmed isolates tested for antimicrobial susceptibility, resistance was highest to neomycin (90.91%) and erythromycin (86.36%), followed by oxytetracycline (77.27%), amoxicillin (68.18%), ciprofloxacin (63.63%), levofloxacin (59.09%) and doxycycline (36.36%). No isolate was sensitive to neomycin or erythromycin. ConclusionThe high prevalence of E. coli and substantial antimicrobial resistance among egg-associated isolates indicate an important food-safety and public-health concern. Improved hygienic egg handling, prudent antimicrobial use and continued antimicrobial-resistance surveillance are warranted throughout the poultry production and marketing chain.

Resistance to the polymyxin antimicrobial colistin in Gram-negative bacteria is associated with a modification of the immunogenic lipid A moiety of the lipopolysaccharide (LPS). Chromosomal and plasmid-borne colistin resistance results in the addition of L-Ara4N and pEtN groups to lipopolysaccharide (LPS), respectively. Here, using THP-1 cells, we studied the impact of different LPS modifications of Klebsiella pneumoniae in stimulating host immune response. K. pneumoniae clinical isolates were screened for colistin resistance using broth microdilution (BMD) and the MALDIxin test. LPS was extracted from colistin-resistant isolates and used to stimulate differentiated THP-1 cells. Luminex cytokine assay measured the immune induction via a panel of proinflammatory cytokines. Out of a collection of 72 clinical K. pneumoniae, eight (11.1%) exhibited phenotypic colistin resistance with a minimum inhibitory concentration (MIC) of 8 to 64 mg/L. In total, five isolates possessed genes associated with polymyxin resistance; three isolates had a mutation in the pmrB gene, and two were mcr-8.1 positive. MALDIxin demonstrated that all eight phenotypic colistin-resistant isolates elaborated peaks at m/z 1,955 and m/z 2,193, indicating an L-Ara4N group of LPS modification. For two mcr-8.1 positive isolates, LPS had a pEtN group. The LPS modification positively correlated with colistin MIC (correlation coefficient, r= 0.6 and R2= 0.4). Compared to the native structure, LPS modification was associated with greater production of IL-1{beta}, IL-6, and CXCL-8 (p<0.001). The pEtN-conjugated LPS triggered a significantly greater production of TNF-, IL-6, and CXCL-8 compared to L-Ara4N (p<0.05). This study reveals that the colistin MIC value can significantly predict lipid A modification in clinical K. pneumoniae, and differences in resistance-mediated lipid A modification result in variation in the immunological response. This study highlights the potential of dynamic host-pathogen interaction in the context of colistin resistance.