International Journal of Antimicrobial Agents

BackgroundHospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP), particularly those caused by multi-drug resistant organisms (MDROs), often require newer antibiotic treatment. The efficacy and safety of newer antibiotics compared to generic antibiotics in randomized controlled trials (RCTs) have not been evaluated before. MethodsIn this systematic review, we searched RCTs in the United States National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Ovid MEDLINE, Clinical Trials.gov and Google Scholar databases published between 2013 and 2025. The primary efficacy endpoint was 28-day all-cause mortality. Secondary efficacy endpoints were clinical and microbiological response. Safety endpoint was nephrotoxicity. ResultsWe identified eight eligible RCTs involving 2,881 patients (1,450 patients treated with newer antibiotics and 1,431 patients treated with generic antibiotics) with HABP/VABP. The meta-analysis did not reveal any significant differences between newer and generic antibiotics for all-cause mortality at day 28 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.72-1.30), clinical response (RR 1.04, 95%CI 0.93-1.17), and microbiological response (RR 1.05, 95%CI 0.89-1.24). However, newer antibiotics showed significant lower occurrences of nephrotoxicity compared to colistin component (RR 0.30, 95%CI 0.11-0.79). In subgroup analysis, newer antibiotic regimens demonstrated significant improvement in microbiological eradication of carbapenem-resistant Gram-negative bacilli (RR 1.50, 95%CI 1.18-1.90). ConclusionsNewer antibiotics showed similar efficacy and safety in treating HABP/VABP compared to generic drugs. The superiority in microbiological eradication of carbapenem-resistant Gram-negative bacilli of newer antibiotics could suggest that future trials should be targeted for those patients to improve understanding of their therapeutic use and pathophysiology of these conditions. Key pointsNewer antibiotics, despite broader antimicrobial coverage, have not significantly outperformed generic comparators in terms of 28-day all-cause mortality, clinical, or microbiological response in patients with Gram-negative HABP/VABP. This may reflect limitations in current trial designs focused primarily on regulatory approval.

Infectious diseases remain a persistent global health burden, with bacterial infections predominating. The growing global burden of drug-resistant infections has led to greater emphasis on the discovery and development of novel antibacterial compounds. In an attempt to discover new potent antibacterials, the antibacterial activity of novel 2-substituted benzimidazole derivatives (NR-1 to NR-9) was evaluated in this study against three bacteria, viz. M. smegmatis, B. subtilis and E. coli in vitro using Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). Among the nine derivatives assessed, two (NR-4 and NR-5) exhibited inhibitory activity against M. smegmatis, while two (NR-5 and NR-7) were active against B. subtilis, with MICs between 62.5 and 250 g/ml. Notably, NR-5 demonstrated antibacterial activity against both M. smegmatis and B. subtilis, with more efficacy against M. smegmatis (MIC: 62.5 g/ml), which was considerably closer to rifampicin (MIC: 31.25 g/ml). Cytotoxicity analysis of these derivatives in Vero cells indicated minimal toxicity for NR-4 and NR-5, and SwissADME evaluation suggested favourable physicochemical properties and drug-likeness, supporting good oral bioavailability. Moreover, the growth kinetics profiling of the NR-5 Benzimidazole derivative demonstrated that it inhibited the growth of M. smegmatis effectively, even after prolonged exposure. These findings highlighted the promise of the active benzimidazole derivative, NR-5, as a potential candidate for developing a more effective and less toxic antimycobacterial drug. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=76 SRC="FIGDIR/small/710429v1_ufig1.gif" ALT="Figure 1"> View larger version (28K): org.highwire.dtl.DTLVardef@126a0fcorg.highwire.dtl.DTLVardef@1131372org.highwire.dtl.DTLVardef@161a70corg.highwire.dtl.DTLVardef@1e0dbe_HPS_FORMAT_FIGEXP M_FIG C_FIG

APC148 is a novel metallo-beta-lactamase inhibitor with broad activity against Ambler class B enzymes including NDM, VIM and IMP. It is being developed for patients with serious infections caused by multidrug-resistant Gram-negative bacteria. APC148 is combined with the broad-spectrum beta-lactam antibiotic meropenem and the serine-beta-lactamase inhibitor avibactam, which targets Ambler class A, C, and some class D (OXA-48-like) enzymes. In combination with meropenem and avibactam, APC148 demonstrated superior in vitro activity against a global, multidrug resistant collection of Enterobacterales, showing its promising activity against beta-lactamase producing pathogens. In this randomized, placebo-controlled, first-in-human study, the safety, tolerability and pharmacokinetics of APC148 were evaluated in healthy adults. Single doses ranging from 50 mg to 760 mg APC148 were administered intravenously over 3 h to 46 participants across six dose groups. APC148 was well tolerated at all dose levels. All adverse events were of mild intensity, and no serious adverse events or adverse events leading to study- or treatment discontinuation occurred. The pharmacokinetics of APC148 were dose-proportional with low plasma clearance, low to moderate volume of distribution and a mean plasma half-life of 2.6 h. APC148 is well tolerated in humans at therapeutically relevant doses and represents a promising candidate in the fight against antibiotic-resistant bacteria. (This study has been registered at ClinicalTrials.gov under registration number NCT06360640).

The increasing cases of resistance among UTI pathogens pose a significant threat to the continued clinical use of nitrofurantoin. In this study, we explored the molecular mechanisms underlying nitrofurantoin resistance and investigated the potential of synergistic activity of salicylates in enhancing the antibacterial activity of nitrofurantoin. In our initial observation, deletion of lon ({Delta}lon) conferred enhanced susceptibility to nitrofurantoin. We identified the critical role of Lon protease in regulating the sensitivity to nitrofurantoin. Investigation into the mechanisms revealed that the lon deletion strains show a higher level of marA and nfsA, which is likely to facilitate the conversion of nitrofurantoin from its pro form to its active form. The {Delta}lon strains displayed an elevated level of ROS, membrane alteration and filamentation upon treatment with nitrofurantoin. Higher ROS levels and membrane alteration were reversed upon treatment with glutathione, further confirming the role of oxidative stress in mediating the sensitivity to nitrofurantoin. Building on these mechanistic insights, we tested salicylates to synergistically enhance the efficacy of nitrofurantoin by indirectly inducing marA through the repression of the mar operon, thereby enhancing nfsA transcription. Both sodium salicylate and acetyl salicylate enhanced the efficacy of nitrofurantoin and lowered the dose of nitrofurantoin required to inhibit the growth of the WT strain. Importantly, this synergistic effect with acetyl salicylate was also observed in nitrofurantoin-resistant clinical isolates, where the combination reduced the effective nitrofurantoin concentration required for growth inhibition. This work provides novel insights into the roles of transcriptional regulators and proteolysis in antibiotic susceptibility, advancing the notion that antibiotic adjuvants are a reliable means of reviving the efficacy of antibiotics. ImportanceThis study unravels the uncharacterised role of Lon protease in nitrofurantoin susceptibility and illustrates the enhanced efficacy of nitrofurantoin-salicylate combinations as a promising therapeutic strategy to overcome emerging resistance in UTI pathogens. This study highlights the importance of investigating the repurposing of other FDA-approved molecules to combat resistance.

Many commonly prescribed non-antibiotic medicines have off-target antimicrobial activity, yet their impact on antibiotic efficacy remains poorly understood. In this study, we investigated eight widely used UK prescription medicines and identified simvastatin, amlodipine, and fluoxetine as growth inhibitory towards methicillin-resistant Staphylococcus aureus (MRSA). These drugs disrupt bacterial membranes, with amlodipine and fluoxetine also triggering stress responses linked to cell wall and membrane damage. Further mechanistic analysis using transposon mutant screening revealed that simvastatin impairs cell wall synthesis by inhibiting the mevalonate pathway. Notably, checkerboard assays demonstrated antagonistic interactions: simvastatin reduced the efficacy of {beta}-lactams and vancomycin, amlodipine with vancomycin and daptomycin, and fluoxetine with vancomycin activity. Prolonged exposure to these drugs also accelerated resistance development to vancomycin and daptomycin. Together, these findings underscore the potential for commonly prescribed non-antibiotic medicines to undermine antibiotic therapy, warranting further study given the rising S. aureus treatment failures.

The rise of multidrug-resistant (MDR) bacteria, particularly carbapenem-resistant Enterobacterales (CRE), poses a significant threat to public health. Infections caused by CRE, such as Escherichia coli and Klebsiella pneumoniae, are associated with high rates of antibiotic treatment failure. {beta}-lactam antibiotics, like meropenem, remain crucial in treating these infections, but their efficacy is undermined by {beta}-lactamase production. This study investigates the potential of APC24-7, a novel broad-spectrum {beta}-lactamase inhibitor (BLi) with dual activity, to restore antimicrobial activity of meropenem against CRE clinical isolates. The in-vitro analysis of a diverse panel of clinically relevant E. coli and K. pneumoniae isolates expressing both serine- and metallo-{beta}-lactamases demonstrated that APC24-7 effectively restored meropenem activity by reducing the minimum inhibitory concentrations (MICs) to below breakpoint. Time-kill assays confirmed that the combination therapy showed dose-dependent bacterial killing, with significant potentiation of meropenem activity against isolates expressing both serine- and metallo-{beta}-lactamases. In-vivo efficacy evaluation in a murine thigh infection model further confirmed APC24-7s potential to restore meropenem efficacy against meropenem resistant strains. These findings suggest that APC24-7offers a promising strategy to combat infections caused by {beta}-lactamase-producing Enterobacterales.

Background: Metronidazole (MTZ) is a first-line antibiotic for several enteric infections. Its use is common in low-income countries, where most primary-care consultations are conducted by nurses. However, increasing resistance among some enteric pathogens is a growing concern. Using WHO guidelines, we conducted a register-based cross-sectional study to assess MTZ prescribing practices and their determinants in public and private primary healthcare facilities in South Benin. Methods: We performed a register-based cross-sectional study covering the year 2020 in 11 primary healthcare facilities (5 public and 6 private) in Abomey-Calavi, South Benin, following WHO recommendations. In total, 200 visits per facility were selected using systematic random sampling. The primary outcome was the prevalence of MTZ prescription. Determinants of MTZ prescription were identified using multivariable logistic regression analysis. Results: In total, 2,200 medical visits were analyzed. The median age of patients was 19 years, and 57% were female. Antimalarials were prescribed in 52% of visits. Antibacterial agents were prescribed in the majority of visits, with MTZ being the second most frequently prescribed antibiotic (18%), after aminopenicillins (27%). In multivariable analysis, digestive symptoms (adjusted odds ratio [aOR], 8.65; 95% confidence interval [CI], 6.49-11.6), genitourinary symptoms (aOR, 6.84; 95% CI, 3.18-15.0), and skin lesions (aOR, 2.39; 95% CI, 1.58-3.60) were independently associated with increased odds of MTZ prescription. In contrast, fever (aOR, 0.66; 95% CI, 0.49-0.87), respiratory symptoms (aOR, 0.44; 95% CI, 0.26-0.71), and malaria (aOR, 0.21; 95% CI, 0.15-0.28) were associated with decreased odds. Visits in the private sector were also associated with higher odds of MTZ prescription compared with the public sector (aOR, 2.31; 95% CI, 1.78-3.02). Conclusion: MTZ is the second most commonly prescribed antibiotic in primary care in the study area, with its use largely driven by digestive symptoms. Further studies are needed to assess the appropriateness of this prescription. Additionally, research is warranted to understand better the determinants of higher antimicrobial prescribing in the private healthcare sector.

BackgroundPatients undergoing hematopoietic stem cell transplantation (HSCT) often receive multiple antibiotics and antifungal agents concurrently, making it crucial to understand potential pharmacokinetic interactions. We report here an interaction between the glycopeptide antibiotic teicoplanin (TEIC) and sulfo-butyl ether-{beta}-cyclodextrin (SBECD), a solubilizing excipient in the intravenous formulation of posaconazole (PSCZ). MethodsWe performed a single-center retrospective analysis of HSCT patients who received oral and intravenous PSCZ during TEIC therapy. Associations between PSCZ administration and TEIC concentration-to-dose (C/D) ratios were evaluated using linear mixed-effects models. In rats, we examined the effects of intravenous PSCZ and SBECD on TEIC pharmacokinetics by assessing the area under the concentration-time curve (AUC) and urinary excretion of total TEIC and its components. Molecular docking and in vitro protein-binding assays were also conducted to investigate the interaction between TEIC and SBECD. ResultsIn HSCT patients, TEIC C/D ratios were significantly lower during intravenous PSCZ administration but not during oral PSCZ use. In rats, both intravenous PSCZ and SBECD decreased TEIC AUC and increased urinary excretion, particularly for the A2 group. Docking simulations indicated that the hydrophobic side chain of TEIC A2-2 fit within the SBECD cavity, and in vitro assays confirmed SBECD concentration-dependent increases in TEIC unbound fractions. ConclusionCo-administration of intravenous PSCZ containing SBECD may reduce TEIC protein binding, thereby enhancing renal elimination.

The global dissemination of Enterobacterales producing both metallo-{beta}-lactamases (MBLs) and serine {beta}-lactamases (SBLs) represents a critical threat to modern medicine, as no currently marketed antibiotics effectively target MBL-mediated resistance. APC148 is a novel, selective zinc-chelating MBL inhibitor designed to restore {beta}-lactam activity in MBL positive isolates, when used in combination with a broad-spectrum carbapenem. In this study, we evaluated the in vitro efficacy of APC148 in triple combinations with either meropenem-avibactam (APC301) or cefepime-avibactam (APC302) against a diverse global collection (JMI collection) of 176 MBL- and SBL-producing Enterobacterales isolates (including NDM, VIM, and IMP variants). Using broth microdilution, the triple combinations were compared against several newly approved and late-stage pipeline antibiotic products. Both APC301 and APC302 demonstrated superior potency, achieving a MIC90 of 0.12 {micro}g/mL. When applying CLSI breakpoint interpretive criteria for the parent {beta}-lactams, 99.4% of the MBL and SBL-containing isolates were susceptible to APC301, while 97.2% were susceptible to APC302. These results indicate that the addition of a selective MBL inhibitor to an SBL-inhibitor/{beta}-lactam antibiotic effectively bypasses complex co-existing {beta}-lactam resistance mechanisms in multidrug-resistant (MDR) pathogens. Given that MDR Enterobacterales frequently harbor multiple {beta}-lactamase classes simultaneously, these triple combinations constitute a highly promising clinical strategy to address the therapeutic void in MBL-mediated resistance

Background Antibiotic use is prevalent in hospitals, driving the emergence of drug-resistant pathogens. We investigated the contextual influences on antibiotic prescribing behaviour across hospitals in high, middle, and low-income countries in Asia with an aim to provide actionable insights to improve prescribing behaviour. Methods We conducted a large qualitative study across ten institutions in Singapore, Nepal, and Thailand. Semi-structured interviews and ethnographic observations involving physicians, nurses, pharmacists, and management staff were conducted. Data were analysed thematically using QSR NVivo 14. Findings A total of 194 interviews were conducted amongst physicians (54{middle dot}1%), nurses (19{middle dot}6%), pharmacists (12{middle dot}4%), and management staff (13{middle dot}9%). Structural factors such as limited microbiology laboratory capabilities, concerns about antibiotic quality, weak infection prevention and control policies, and the lack of relevant, updated guidelines were prominent drivers for prolonged and broad-spectrum antibiotics prescriptions. Where these system supports were in place, prescribing decisions were less defensive and more targeted, although prescriber responsibility and concerns about immediate patient deterioration continued to influence practice. Across settings, clinicians tended to prioritise short-term perceived benefits of antibiotic treatment over the longer-term risks of antimicrobial resistance.

BackgroundCefiderocol is a siderophore-conjugated cephalosporin antibiotic used to treat multi drug resistant Gram negative infections, including metallo-beta-lactamase producing Enterobacterales. Antimicrobial useage is guided by antimicrobial susceptibility testing (AST) which is hampered by differences between EUCAST and CLSI breakpoints, methodological challenges of AST, and lack of information on clinical outcome related to AST. ObjectivesThis study assessed the agreement between AST methods under EUCAST and CLSI breakpoints in a collection of 57 blaNDM producing Enterobacterales isolated from a UK hospital network. MethodsAll isolates, including Klebsiella pneumoniae, Enterobacter hormaechei, Escherichia coli and Citrobacter freundii, were whole-genome sequenced and tested with disk diffusion and MIC gradient test strip, and broth microdilution MICs were determined for a subset. Categorical agreement between methods was calculated using both EUCAST and CLSI breakpoints. Mutations and acquired resistance genes associated with cefiderocol resistance were identified and compared with AST results. ResultsThe disk diffusion method, based on EUCAST interpretation, classified 94.7% of isolates as cefiderocol resistant and 5.3% as susceptible, with 22.8% within the Area of Technical Uncertainty. The CLSI breakpoint classified one isolate as resistant (1.8%) and 5.26% intermediate. Category agreement of broth microdilution and disk diffusion for E. coli using EUCAST guidelines was 38.5%. Mutations associated with cefiderocol resistance were highly prevalent and varied between species. ConclusionsThe discordant EUCAST and CLSI breakpoint values provided have large impacts on the classification of isolates susceptibility to cefiderocol, which will impact global cefiderocol usage and surveillance of resistance, further complicated by poor agreement between AST methods.

BackgroundSepsis-induced mortality is frequently driven by the systemic dissemination of pore-forming toxins (PFTs), such as Staphylococcus aureus alpha-hemolysin. Biomimetic "nanosponges" which are nanoparticles coated in red blood cell (RBC) membranes have emerged as a promising detoxification strategy. However, current methods rely largely on empirical iteration, often failing to optimize the competitive binding kinetics required to outcompete native RBCs in a high-flow hemodynamic environment. MethodsWe developed a deterministic ordinary differential equation (ODE) kinetic model based on the law of mass action to simulate the competitive inhibition of alpha-toxin by decoy nanoparticles. Unlike prior geometric models, this study explicitly tracked molar receptor concentrations to enforce saturation kinetics and mass conservation. We performed a multi-parametric sweep of nanoparticle radius (r_{NP}: 50-200 nm) and receptor surface density (d_{rec: 200-10,000 sites {micro}m{square}2) to identify the design window that maximizes toxin sequestration efficiency within a clinically relevant timeframe (60 minutes). ResultsBaseline simulations established a native RBC receptor concentration of 3.34 x 10^{-7} M. The optimization landscape revealed a non-linear dependence on receptor density rather than particle size. The optimal design window was identified at a receptor density of >8,000 sites {micro}m{square}2 on an 80 nm vector, achieving a theoretical toxin neutralization efficiency of 91.79%. Notably, complete (100%) neutralization was not observed even under optimized conditions, suggesting a theoretical upper bound imposed by physiological competition. In contrast, standard biomimetic formulations (low-density, 100 nm) achieved suboptimal capture, failing to prevent significant toxin-RBC interaction. ConclusionWe demonstrate that "decoy" efficacy is governed primarily by receptor surface density rather than geometric surface area. Our model suggests that current manufacturing protocols, which prioritize particle stability over receptor enrichment, may be kinetically insufficient for human application. These findings provide a rational design framework for next-generation nanotoxoid therapeutics.

Objectives: Optimising parenteral antimicrobial use is central to antimicrobial resistance (AMR) control, yet its appropriateness is difficult to assess. We aimed to develop a quantitative indicator to evaluate the appropriateness of parenteral antimicrobial therapy in hospitalised patients with bloodstream infections. Methods: We developed the Susceptibility-Spectrum Discrepancy Index (S2DI), reflecting the discrepancy between antimicrobial susceptibility of blood culture isolates and the spectrum width of prescribed agents. Using a database from 67 National Hospital Organization hospitals in Japan, we identified patients with Staphylococcus aureus or Escherichia coli bacteraemia from 2017 to 2023. An expert panel of 10 infectious disease physicians independently ranked antimicrobial susceptibility (A) and spectrum width of commonly used agents (B). S2DI was defined as B minus A on day 7 after treatment initiation, with values closer to zero indicating more appropriate therapy. S2DI was calculated for individual cases, aggregated at the hospital level, and analysed using linear mixed-effects models with hospital-level random effects. Results: A total of 4,505 S. aureus and 9,563 E. coli bacteraemia cases were included. Median S2DI was 1 (IQR 0-1) for S. aureus and 2 (IQR 0-3) for E. coli. For both pathogens, later calendar years were significantly associated with more favourable S2DI, suggesting gradual improvement in antimicrobial use. In E. coli bacteraemia, female sex and younger age were also associated with more appropriate therapy. Conclusions: Although variation across hospitals persists, appropriateness of parenteral antimicrobial use has improved over time. S2DI is a simple metric that may support optimisation of antimicrobial use.

Multidrug-resistant (MDR) Klebsiella pneumoniae, classified by the World Health Organization (WHO) as a critical priority pathogen, represents a global health thereat requiring novel antimicrobials urgently. Here we evaluated the in vitro antimicrobial activity of a novel iridium-based compound (OMKP-3), against MDR K. pneumoniae. OMKP-3 exhibited robust antimicrobial activity in M9 minimal media (MIC=6.25{micro}g/mL) and rapid bactericidal effect (MBC=12.5{micro}g/mL) against the tested MDR K. pneumoniae strains. OMKP-3 showed antibiofilm ability and was active against multiple MDR Gram-negative pathogens, including Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginosa and Serratia marcescens (MIC range:6.25-25{micro}g/mL). Importantly, OMKP-3 showed no cytotoxicity against mammalian cells after 24 hours of exposure. When combined with polymyxin B, OMKP-3 acted as an adjuvant, enhancing polymyxin B activity (FIC[≤]0.5). OMKP-3 was less prone to induce high-level resistance in MDR K. pneumoniae compared to ciprofloxacin, and supressed the growth of resistant bacteria at a low and non-cytotoxic concentration (4xMIC). K. pneumoniae strains harboring truncated Ompk35/36 porin genes exhibited higher OMKP-3 MICs, indicating that these porins may serve as an important entry pathway. Spectrometry analysis revealed that OMKP-3 was able to accumulate intracellularly (1.57{micro}g/mL), with minimal Resistance-Nodulation-Division (RND) efflux pump extrusion involvement. Furthermore, analysis of the resistant mutant, harboring a mutation in the outer membrane protein DegS, together with fluorescence microscopy, suggests that OMKP-3 induces membrane-associated damage. No cross-resistance between OMKP-3 and commonly used antibiotics was observed. Collectively, these findings identify OMKP-3 as a promising novel antimicrobial agent against MDR K. pneumoniae, likely acting through an unexplored bacterial target. ImportanceMultidrug-resistant (MDR) Klebsiella pneumoniae is a critical global health threat and is among the leading causes of hospital0hyphenorendash;associated mortality, largely due to the scarcity of effective therapeutic options. Alarmingly, the current antimicrobial pipeline fails to address this issue, relying largely on derivatives of existing scaffolds that offer only short-term clinical benefit due to rapid resistance emergence. Developing antibiotics against Gram-negative pathogens is particularly challenging because of their highly impermeable outer membrane and efficient efflux systems, limiting intracellular drug accumulation. Metal-based antimicrobials emerge as a promising alternative. Our findings showed that OMKP-3, an iridium complex, exhibits potent bactericidal activity against MDR K. pneumoniae without selecting for high-level resistance, suggesting the potential for sustained therapeutic efficacy. Additionally, it demonstrated to accumulate intracellularly with minimal efflux involvement. Together, these features position OMKP-3 as a valuable and underexplored novel antimicrobial strategy for addressing the escalating threat of MDR K. pneumoniae infections.

The emergence of antimicrobial resistance (AMR) has driven the search for alternative therapeutic strategies, including antivirulence approaches targeting bacterial quorum sensing (QS). Azelaic acid (AzA), a naturally occurring dicarboxylic acid with known antimicrobial properties, has not previously been characterized as a QS inhibitor in Gram-negative pathogens. This study evaluated the dual antimicrobial and antivirulence activity of AzA against reference strains and clinical isolates of Pseudomonas aeruginosa, Enterobacteriaceae, and Staphylococcus aureus through in vitro assays and molecular docking analyses. Minimum inhibitory concentration (MIC) values ranged from 250 to 1000 {micro}g/mL, with lower MICs observed in clinical isolates of E. coli and S. aureus. Subinhibitory concentrations (250, 500 and 750 {micro}g/mL) were used to assess QS-regulated virulence factors in P. aeruginosa, including pyocyanin, elastase, alginate, and protease production. AzA exhibited a significant, dose-dependent inhibition of all evaluated virulence factors across both reference and multidrug-resistant (MDR) and pan-drug-resistant (PDR) clinical strains (p < 0.001), achieving inhibition levels exceeding 90% in several cases, particularly for protease activity. Molecular docking analyses revealed that AzA interacts with key QS-related proteins (LasI, LasR, PqsD, and PqsR), showing moderate binding affinities (-5.3 to -6.5 kcal/mol) and stable interactions within conserved ligand-binding domains. These findings suggest a multitarget modulatory mechanism affecting interconnected QS pathways. Overall, this study demonstrates, for the first time, that AzA acts as a quorum sensing inhibitor in P. aeruginosa, attenuating virulence without directly affecting bacterial growth, highlighting its potential as a promising antivirulence therapeutic strategy.

IntroductionAcinetobacter is a highly diverse genus which includes a range of common pathogenic species such as A. baumannii, A. lwoffii etc. Acinetobacter species causes bacteremia, pneumonia, wound infections, Urinary tract infections in community as well as hospital settings. A. baumannii is one of the ESKAPE pathogen which makes it even more lethal as antibiotics cannot action on this. AimTo isolate Acinetobacter species from various clinical samples and to check their antimicrobial susceptibility pattern by VITEK {square} Compact in SGT Hospital, Gururam, Haryana. ResultsOut of total 6673 samples 595 were the positive isolates from which 35 were Acinetobacter isolates which were received from various wards of the hospital. Occurrence of Acinetobacter was seen more in males(57.14%) as compare to females (46.8%). A total of 31 strains were A. baumannii, 3 were A. lwoffi and 1 strain was of A. haemolyticus. Prominent presence of Acinetobacter was seen in Blood (48.57%) specimen along with pus(22.85%), endotracheal (22.85%), tracheal (2.85%) and eye swabs (2.85%). All the isolates were resistant to piperacillin/tazobactam (100%), ceftriazone (100%), amikacin (100%), gentamicin (100%) ciprofloxacin (91.42%), ceftazidime (91.42%), cefepime (88.57%), levofloxacin (88.57%) and trimethoprim/sulfamethoxazole (80%). Colistin susceptibility was observed in 88.57% of the isolates. ConclusionAcinetobacter is a common pathogen in hospital acquired as well as in community acquired infections as it is a opportunistic pathogen hence to identify the Acinetobacter species and to understand their antimicrobial resistance pattern this study was conducted.

BackgroundThere is currently no approved antiviral therapy against measles virus (MeV). Repurposing available compounds with broad antiviral activity may rapidly identify candidate drugs for clinical evaluation. Here we evaluated the antiviral activity of the clinically approved drugs azelastine hydrochloride and zafirlukast as well as the flavonoids quercetin and isoquercetin against MeV in preventative and therapeutic in vitro studies. MethodsCompounds were tested for antiviral activity against MeV in preventative (prophylactic and virucidal) and therapeutic (steady-state and persistent) assays in Vero/hSLAM cells. Viral loads and cell viability were measured 48h post-infection, and dose-response curves were used to calculate EC50 values. Flavonoids were also tested in the presence of 1 mM ascorbic acid. ResultsAzelastine hydrochloride did not show evidence of antiviral activity against MeV under these conditions, whereas zafirlukast, quercetin, and isoquercetin showed therapeutic activity against MeV. The addition of ascorbic acid enhanced the therapeutic potency of quercetin to 4.2-4.8 {micro}M and of isoquercetin to 10.7-10.9 {micro}M. Antiviral activity was dose-dependent when administered post-infection. ConclusionAmong the four compounds tested, quercetin showed the most potent therapeutic antiviral activity against MeV in vitro. Isoquercetin and zafirkulast also showed therapeutic activity. These findings support further evaluation of quercetin, isoquercetin, and zafirlukast as candidate antiviral drugs for MeV and highlight the utility of in vitro platforms for rapid antiviral drug screening.

WHO recommends bedaquiline-pretomanid-linezolid- (BPaL) and BPaL-moxifloxacin (BPaLM) for treatment of rifampicin-resistant tuberculosis, informed by the TB-PRACTECAL results. However, clinical explanatory data of these drugs exposure and Mycobacterium tuberculosis clearance rates and toxicity relationships remain understudied. We therefore investigated the relationship between the patients exposure to anti-TB drugs in TB-PRACTECAL trial investigational regimens and their treatment outcomes. PRACTECAL-PKPD was a prospective pharmacokinetics and pharmacodynamics study nested in TB-PRACTECAL. Patients with rifampicin-resistant pulmonary tuberculosis were enrolled from Belarus and South Africa. The first objective was to develop drug exposure metrics for bedaquiline, pretomanid, linezolid, moxifloxacin and clofazimine. The efficacy objectives were to establish an exposure-response model for each drug and regimen to both bactericidal activity and long-term treatment outcomes. The safety objective was to investigate the exposure-toxicity relationship of each drug. Antimicrobial exposure did not correlate with the speed of sputum bacterial clearance, however there was a 20% increased bacillary killing rate with BPaLM compared to the standard of care arm whilst BPaL and BPaL-clofazimine (BPaLC) displayed a 15% decreased bacillary killing rate compared to the standard of care arm. Linezolid plasma exposure was higher amongst patients with anaemia or neutropenia compared to those without. No other exposure-toxicity relationships were identified for all other drugs. Absence of correlation between drug exposure and bacillary clearance suggest that the dosages used achieve saturation of bacillary killing, while remaining safe.

BackgroundBiofilms are central to Salmonella pathogenesis, and targeting their formation is believed to produce less evolutionary pressure of growth inhibition than traditional antibacterials. In this study, we screened the Medicines for Malaria Venture (MMV) Pathogen Box library to identify anti-biofilm agents against S. enterica that possess drug-like properties. Methodology/ Principal FindingsA crystal-violet-based medium-throughput antibiofilm screen of Salmonella enterica serovar Typhimurium ATCC 14028 and a clinical Salmonella enterica serovar Elisabethville isolate was performed on polystyrene surfaces using the 400-compound Pathogen Box library. Compounds that inhibited biofilm formation by >30% and growth by <10% were identified as hits. Salmonella red-dry-rough and motility phenotypes were explored in mechanism of action studies on one hit compound. The Salmonella antibiofilm hit rate was 0.75% for this library. MMV688371 (benzamide) inhibited biofilm formation of S. Typhimurium ATCC 14028 by 33% without inhibiting growth. An ethambutol analogue (MMV687273) and auranofin (MMV688978) met the hit criteria against S. Elisabethville LLD035X. Auranofin showed concentration-dependent, growth-inhibition-independent antibiofilm activity against typhoidal and non-typhoidal Salmonella from Nigeria, and inhibited the motility of S. Elisabethville LLD035X at 5 {micro}M. At 5 {micro}M aurothioglucose, an auranofin gold (I) analogue, and non-gold analogue 1-Thio-beta-D-glucose tetraacetate, inhibited biofilm formation by 61.30% and 11.39%, respectively, pointing to essentiality of the gold (I) moiety for activity. Conclusions/ SignificanceStructurally diverse small molecules can inhibit biofilm formation by Salmonella, and motility inhibition is an important mechanism for this activity. Auranofin inhibits typhoidal and non-typhoidal Salmonella biofilm formation, with its gold content being required for these activities.

The spread and rise of antimicrobial resistance poses a risk to public health due to limited effective treatment options. Alternative antimicrobials that are effective against gram-negative multi-drug resistant pathogens. The increasing rate of carbapenem resistance observed in Klebsiella pneumoniae, indicates the need for alternative antimicrobial options. Bacteriophages that target Klebsiella pneumoniae are promising alternative antimicrobial option, with successful treatments being reported. Here we characterized 30 lytic bacteriophages from various environmental sources and tested their effectiveness against nine clinically relevant carbapenem-resistant K. pneumoniae isolates. These phages were characterized through genomic sequencing, bioinformatic analysis, virulence in liquid medium, and host range on different mediums. Bioinformatic analysis revealed a diverse collection of phages that span 9 ICTV recognized families and 13 genera with genome sizes ranging from 39-349 kbp. The phages were able to inhibit bacterial growth, and no virulence or antibiotic resistance genes were detected within the phage genomes. Host range testing demonstrated phages with broad host range have varying infectivity when plated on different common growth mediums. This study includes candidate phages for further potential development as potential antimicrobial agents against CR-KP, and the complexity in understanding phage-host dynamics of non-capsule phages that target against K. pneumoniae.