Microbiology Spectrum

Recessive dystrophic epidermolysis bullosa (RDEB) is an inherited disorder characterized by recurrent wounds and frequent bacterial colonization. Clinically applicable methods that provide information on bacterial composition, viable burden, and spatial distribution are needed to support wound assessment and therapeutic evaluation. In this exploratory four-week longitudinal study, standard-of-care-treated wounds from five patients with RDEB were examined using autofluorescence imaging, quantitative and chromogenic culture, MALDI-TOF MS, 16S rRNA and staphylococcal tuf2 amplicon sequencing, and spatial Bactogram analysis. Sequencing showed that staphylococci dominated 22/23 communities, with Staphylococcus aureus being the most abundant staphylococcal species (21/23). Culture likewise identified S. aureus as the most frequent species in all 14 swab samples. Aerobic bacterial burden showed no association with open wound area and remained high in several contracting wounds. The Bactogram provided a spatial representation of viable bacterial growth and, when combined with chromogenic agar, reflected the predominance of S. aureus identified by sequencing, MALDI-TOF MS, and quantitative culture. Together, these complementary methods captured the dynamic nature of RDEB wounds through heterogeneous healing trajectories and longitudinal variation in bacterial burden, while consistently identifying a low-diversity, S. aureus-dominated microbiota. Bactogram spatial imprinting and autofluorescence imaging warrant further evaluation as minimally invasive tools for longitudinal EB assessment.

Background: Anal squamous cell carcinoma (ASCC) develops from high-grade squamous intraepithelial lesions (HSIL), but only a subset of patients with HSIL progress to invasive cancer, suggesting that factors beyond persistent human papillomavirus (HPV) infection contribute to disease progression. The anal microbiome may be a contributing factor; however, direct comparisons between HSIL and treatment-naive ASCC remain limited. Methods: Anal canal swabs were collected from adults with histologically confirmed HSIL or nonmetastatic ASCC prospectively enrolled at Montefiore Medical Center from September 2022 through October 2024. Shotgun metagenomic sequencing was performed after human-read removal. Microbial diversity and community composition were compared between disease groups. Differentially abundant species were identified using ANCOM-BC2 and validated using adjusted centered log-ratio regression. Longitudinal changes and MetaCyc pathways associated with persistent ASCC-enriched species were also evaluated. Multivariable analyses adjusted for age, sex, tobacco use, HIV status, and HPV status. Results: Among 121 participants, 102 had HSIL and 19 had ASCC. Observed richness was lower in ASCC (adjusted beta = -21.28; p = 0.035), while Shannon and inverse Simpson diversity did not differ. Microbial community composition differed by disease group using Bray-Curtis (R2 = 0.100; p = 0.001), Jaccard (R2 = 0.133; p = 0.002), and Aitchison distances (R2 = 0.172; p = 0.001). Of 60 species identified by ANCOM-BC2, 58 were validated, including six enriched in ASCC: Fusobacterium nucleatum, Parvimonas micra, Peptococcus niger, Porphyromonas asaccharolytica, Porphyromonas levii, and Porphyromonas sp. CAG:1061. All six remained associated with ASCC longitudinally, and five demonstrated greater baseline-to-month-6 decreases in ASCC than HSIL. Twenty-six MetaCyc pathways were linked to the persistent ASCC-enriched species and were also enriched in ASCC, highlighting shared functions in amino acid metabolism, anaerobic degradation, and carbohydrate and energy metabolism. Conclusion: ASCC was characterized by lower observed richness and enrichment of a distinct anaerobic microbial signature that persisted across longitudinal sampling and declined following treatment initiation. These taxa were linked to a shared functional profile dominated by amino acid metabolism and anaerobic metabolic pathways. These findings identify microbial features associated with invasive anal cancer and provide a foundation for evaluating their relationship with disease progression, tumor burden, and treatment response.

Background: Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridioides difficile infections, yet the diversity of FMT formulations and delivery routes hampers comparisons across studies. Oral frozen capsules are widely used and current guidelines recommend storage at -80C for up to two years. Despite extensive use of FMT, data on the long-term persistence and maintenance of their microbial composition remains limited. Method: In this prospective study, we assessed the temporal stability of bacterial profiles in frozen FMT capsules derived from 48 donations of 10 healthy donors. Using metabarcoding, we longitudinally profiled one capsule per donation thawed within a month of production and after 3, 6, 12, and 24 months of storage. We used linear mixed effect models to evaluate changes in alpha diversity and community composition over time. Results: Species richness remained stable across all timepoints, whilst species evenness decreased slightly. Although changes in community composition were detectable, they were small and mostly affected low-abundance genera. Clinical efficacy, assessed in a subset of recipients, was not associated with storage duration. Conclusion: Our findings demonstrate that frozen FMT capsules preserve their bacterial community structure for at least two years of storage at -80C, supporting their suitability for long-term biobanking and standardised clinical or research use.

The recent invasion of the two-spot cotton leaf hopper (TSCL) (Amrasca biguttula) into the U.S. now threatens row and vegetable crops as well as ornamentals. TSCL ecology and biology, including microbial diversity, are understudied. Insect-specific microbes could influence host biology and ecology including insect-plant interactions. Here, microbiota (bacteria and viruses) within TSCL along with its feeding behavior were characterized using high throughput sequencing, microscopy, and Electrical penetration graph (EPG). Results revealed low diversity of bacteria dominated by Wolbachia and confirm the absence of obligate (primary) symbionts. Two distinct and differentially abundant Wolbachia strains (B-supergroup) were found co-infecting midgut tissues of 60% of TSCL tested, and the remaining 40% were free of symbionts. Virome analysis uncovered a diverse complex of at least eight dsDNA genomes (12-17 kb) of Adintoviruses (Eupolintoviridae), but no RNA viruses commonly found in other leafhoppers were identified in TSCL. The mesophyll feeding nature of TSCL was identified by observing chlorophyll derived autofluorescence in midguts and higher abundance of chloroplast transcripts (photosystem I, II, Rubisco, cytochrome b6 and ATP synthase complex) in TSCL (whole insects) compared with thrips and aphids. EPG recordings show a cell-rupture style of feeding with differences between adults and nymphs. Lastly, consistent with its cell-rupturing feeding style, no evidence for the presence of plant-pathogenic bacteria or viruses that could induce hopperburn was found. These results overall provide insights into the microbial diversity and feeding pattern of TSCL and lay a foundation for future research. Key messageThis work characterizes the TSCL microbiome and its mesophyll feeding pattern. Symbionts within insects often complement the nutritional deficiencies of its host and can aid insect spread by boosting immunity. The findings of this study lay the foundation for future research on the biology, ecology, and management of this invasive pest.

Corynebacterium bovis is an important opportunistic pathogen of immunodeficient mice and the etiologic agent of Corynebacterium-associated hyperkeratosis (CAH). Although disease severity varies, specific vendor-derived microbiomes have been shown to protect against CAH. Preinoculation with nonpathogenic Corynebacterium amycolatum prior to C. bovis infection has been demonstrated to limit disease severity. To define community features associated with protection, axenic outbred athymic nude mice stocks (A, B, and C) were reassociated with donor microbiomes from four vendor sources (A1, A2, B, and C) and topically challenged with C. bovis. C. amycolatum was added to the A1 microbiome in a separate group. Skin (Stock A) and fecal (Stocks A, B, and C) microbiomes were evaluated at 21 days post-inoculation via shotgun metagenomic sequencing. The A2 microbiome, previously associated with resistance to clinical disease and minimal skin pathology, exhibited greater cutaneous microbial evenness after challenge and significantly lower relative abundance of C. bovis than all other microbiome groups. Addition of C. amycolatum to the A1 microbiome did not fully confer disease protection and relative abundance was low, suggesting that sustained colonization by this organism was insufficient to explain the protective phenotype seen with the A2 microbiome. C. kroppenstedtii was detected in all A2 skin samples and was absent from all other groups. Several anaerobic taxa, including Duncaniella dubosii, D. muris, Bacteroides caecimuris, and Muribaculum gordoncarteri, were uniquely detected or enriched in the A2-associated microbiome, whereas Mammaliicoccus lentus and Staphylococcus nepalensis were absent from A2 but present in all nonprotective groups. Gut alpha diversity did not differ significantly among microbiomes, although several taxa, including segmented filamentous bacteria, were enriched in A2 feces. These findings associate resistance to CAH with preservation of cutaneous community structure, suppression of C. bovis prominence, and distinct microbial taxa. The identified organisms represent candidates for future mechanistic studies of microbiome-mediated colonization resistance.

Background Metagenomic next-generation sequencing (mNGS) is increasingly adopted as a rapid and unbiased alternative to culture-based pathogen detection. However, standardized approaches for analytical validation of mNGS workflows are lacking. Validation strategies based solely on comparison with culture are inherently limited due to low diagnostic yield of culture, and the inability to derive analytical parameters such as limit of detection (LoD) from clinical samples with unknown microbial loads. Systematic analytical approaches are therefore required to define mNGS workflow performance independently of clinical comparators. In addition to diagnostics, mNGS is widely applied to microbiome profiling, where preservation of microbial diversity at low DNA inputs is a key performance criterion. Materials and Methods The analytical performance of the PaRTI-Seq mNGS workflow (Micronbrane, Taiwan), comprising host depletion, DNA extraction, library preparation, and bioinformatics analysis, was evaluated. Library-level analytical sensitivity was assessed using quantified genomic DNA (gDNA) from Enterobacter hormaechei, Candida albicans, and Mycobacterium smegmatis. Workflow-level sensitivity was evaluated using enumerated suspensions of E. hormaechei, Staphylococcus aureus, M. smegmatis, C. albicans and Aspergillus brasiliensis. Microbiome performance at low DNA input was evaluated using stool, saliva and gut mock community samples at 50ng, 5ng, and 0.5ng gDNA input and compared with an alternative low-input library preparation workflow. Results The library preparation module demonstrated analytical sensitivity down to 0.1 pg of E. hormaechei and C. albicans gDNA, and 1pg for M. smegmatis gDNA. Workflow-level LoDs were determined to be 1 CFU for E. hormaechei, 272 CFUs for S. aureus, 39 CFUs for A. brasiliensis, 36 CFUs for C. albicans and 3,702 CFUs for M. smegmatis. Differences in extraction efficiencies and extracted gDNA qualities appeared to be important determinants of workflow-level LoDs. For microbiome applications, Micronbrane Unison Ultra-low DNA input library preparation kit maintained more consistent bacterial diversity indices down to 5ng DNA input for stool and saliva samples, and the gut mock community than the comparator workflow. Conclusion This study outlines practical and generalizable analytical validation approaches for mNGS library preparation and complete workflows using defined spike-in models, providing a foundation for informed clinical interpretation and implementation of mNGS in diagnostic and microbiome applications.

Delafloxacin (DLX) is a novel fluoroquinolone with enhanced antibacterial activity in acidic environments, a property that may be advantageous for treating Pseudomonas aeruginosa infections in cystic fibrosis (CF), where airway surface liquid pH is typically reduced (pH 5.5-6.7). However, the propensity for resistance development and the underlying mechanisms in P. aeruginosa remain incompletely defined. We conducted serial passage experiments on six clinical P. aeruginosa isolates (three CF-derived and three non-CF-derived) exposed to sub-inhibitory concentrations of DLX or ciprofloxacin (CIP) at pH 6.0 and 7.3 over nine days. Susceptibility was assessed by broth microdilution (BMD), and resistance mechanisms were characterized by whole-genome sequencing (WGS), efflux pump expression analysis (qRT-PCR), and functional validation using CRISPR/Cas9-mediated genome editing and complementation assays. DLX minimal inhibitory concentrations (MICs) rose only 10.1- to 28.5-fold over 9 days, compared with 77.6- to 97.8-fold for CIP, indicating a substantially higher genetic barrier to resistance. This barrier was most pronounced under acidic conditions: only 38.9% of DLX-passaged samples crossed the resistance breakpoint, compared with 94.4% at neutral pH, whereas CIP resistance reached 100% regardless of pH. Cross-resistance was asymmetric: exposure to DLX consistently selected for CIP cross-resistance (97.2% of samples), whereas exposure to CIP induced DLX cross-resistance efficiently at neutral pH but only partially under acidic conditions. A previously undescribed gyrA mutation (p.Ala51Val) conferred a 4-fold increase in DLX MIC when introduced by CRISPR/Cas9, and upregulation of the MexEF-OprN efflux pump, reversible by mexS complementation, emerged as a prominent resistance mechanism. Overall, DLX exhibited a markedly higher genetic barrier to resistance than CIP in P. aeruginosa, particularly under the acidic conditions characteristic of the CF airway. However, its use may co-select for CIP cross-resistance through efflux upregulation, underscoring the need for careful stewardship in CF.

Pseudomonas aeruginosa is a major opportunistic pathogen, responsible for healthcare-associated urinary tract infections. Its metabolic flexibility and genomic plasticity promote its survival and adaptation in complex environments. Here, we conducted an in-depth analysis of three pairs of sequential P. aeruginosa urinary isolates, named "early" and "late", from three patients to investigate metabolic and phenotypic changes during urinary tract adaptation. An integrated multi-omics approach combining RNA sequencing and metabolomics was performed on isolates grown in human urine (HU) and trypticase soy (TS) medium, and compared with previously published proteomics data. Late isolates showed down-regulation of genes encoding type VI secretion system in both media, while oxidative phosphorylation associated-genes were up-regulated in HU. These late isolates also displayed significant down-regulation of amino-acid metabolism suggesting an increased use of carbon sources available in urine. As previously observed in proteomics, siderophore- and iron-related genes were significantly down-regulated for all late isolates in HU but not in TS, supporting convergent adaptation to the low-iron urinary environment. Metabolomic profiles of HU supernatants from late isolates clustered together, showing common metabolite production in HU. The differential metabolic profile between early and late isolates included phosphatidylcholines, acylcarnitines, biogenic amines and amino-acids, highlighting their importance in urinary adaptation. While long-term survival in HU and TS was similar between isolates, biofilm formation was reduced or lost in late isolates in line with the down-regulation of biofilm-related genes. These findings highlight the transcriptomic and metabolic reprogramming as well as the phenotypic changes occurring during P. aeruginosa adaptation to the urinary tract. ImportancePseudomonas aeruginosa is a major opportunistic bacterial pathogen responsible for healthcare difficult-to-treat urinary tract infections. Understanding how this bacterium adapts and persists in the human urinary tract is essential for improving the management of persistent infections. Through an integrated analysis of six sequential clinical isolates from three patients, this study shows that P. aeruginosa undergoes coordinated metabolic and phenotypic changes that promote survival in the urinary environment. During adaptation, the bacterium reduces traits involved in bacterial competition and biofilm formation while reprogramming its metabolism to the nutrients available in urine. These changes emerged independently in different patients, revealing convergent adaptation to this challenging environment. By identifying biological processes consistently associated with urinary tract persistence, this work provides new insight into the mechanisms that support long-term colonization and highlights adaptive metabolic pathways that may represent future targets for therapeutic intervention.

Total laryngectomy is performed for advanced laryngeal and hypopharyngeal cancers. Following the surgery, the insertion of indwelling silicone-based voice prosthesis (VP) implants is considered the gold standard for speech rehabilitation. However, early VP failure due to biofilm formation and invasion of the VP surface can lead to routine use of nystatin and the need for frequent valve changes. Despite these burdens, the composition and impact of colonising pathogens on VP integrity are poorly understood. We have developed a rapid pipeline which permitted the transfer, fixation, staining, and imaging of explanted VPs from patients within 90 minutes of sample collection. Using this pipeline, we demonstrate a multimodal reflection contrast and fluorescence confocal laser scanning microscopy technique to simultaneously map the VP surface and visualise the biofilms in situ, providing new insights into the role of pathogens on VP failure. Our results reveal that complex fungal and bacterial biofilms form polymicrobial biofilms on the VP surface. We demonstrate that biofilms not only reside on the VP surface but can invade the device, releasing silicone particles that are visible within the volume of the biofilms and are separate from the VP surface. Our findings highlight the complexity of the biofilms that form on speech valves; complex polymicrobial biofilms require more advanced treatment than what is conventionally used. Work should focus both on the patient factors that may influence this and the material properties of the valve.

L-Serine is an important metabolic and immunomodulatory biomolecule with promising role in managing infections, and autoimmune diseases. L-Serine provides the energy requirements and triggers the toll-like receptor signalling collaterally. However, the role of L-Serine in host antimicrobial response against Mycobacterium tuberculosis (Mtb) remains unexplored. In this study, we investigated whether this metabolite could modulate the antibiotics efficacy against Mtb. Although L-Serine exhibits limited intrinsic anti-mycobacterial activity, but L-Serine demonstrates a synergistic effect when combined with rifampicin and moxifloxacin against both drug-sensitive and multidrug-resistant Mtb. Moreover, L-Serine particularly in combination with palmitic acid showed the enhanced intracellular bacterial clearance in a dose- and time-dependent manner in murine and human macrophages. This synergistic effect was accompanied by increased nitric oxide production and modulation of the host immune response. We identified elevated levels of pro-inflammatory cytokines and reduced IL-10 expression. Furthermore, the metabolic supplementation demonstrated enhanced antimicrobial activity in isolated primary CD14+ monocytes from TB patients. Similarly, the metabolic supplementation of L-Serine in combination with isoniazid and rifampicin significantly reduced bacterial burdens in the lungs and spleen, while improving tissue architecture in murine infection model. Our observations suggest that L-Serine contributes to the observed therapeutic effects. Collectively, this study concludes that L-Serine acts as a promising host-directed therapeutic adjunct, which enhances antimicrobial immunity and potentiating antibiotic efficacy, providing a potential strategy for improving tuberculosis treatment outcomes.

Objective Heme-dependent metronidazole (MTZ) resistance has emerged in Clostridioides difficile and is primarily mediated by a T-to-G single-nucleotide polymorphism (SNP) in the promoter of nimB (PnimBG). We aimed to develop a CRISPR-Cas12a-based assay for rapid detection of the PnimBG mutation associated with MTZ resistance. Methods A series of primers and CRISPR RNAs (crRNAs) were designed and optimized to identify the most effective combination for discriminating between PnimBG (MTZ-resistant) and PnimBT (MTZ-susceptible) alleles. Detection was evaluated by visual fluorescence using blue-light and UV imaging systems, as well as by quantitative fluorescence measurements. Results The CRISPR-Cas12a assay accurately differentiated PnimBG and PnimBT alleles in C. difficile. In a collection of clinical isolates, the assay correctly identified all 11 MTZ-susceptible isolates carrying the PnimBT allele and all 10 MTZ-resistant isolates carrying the PnimBG allele. Fluorescence signals were readily detected both visually and quantitatively. Furthermore, colony PCR using crude colony lysates yielded results comparable to those obtained with purified genomic DNA, enabling rapid colony-based detection without conventional DNA extraction. Conclusions The CRISPR-Cas12a assay enables rapid molecular detection of the PnimBG mutation associated with heme-dependent MTZ resistance in C. difficile. This approach could complement conventional susceptibility testing for MTZ resistance detection.

Pseudomonas aeruginosa (P. aeruginosa) is the primary pathogen responsible for morbidity and mortality in patients with cystic fibrosis (CF). Its genomic plasticity and constant selective pressure from antimicrobial treatments have favored the emergence of multidrug-resistant clones. This study conducted a comparative genomic analysis of 41 P. aeruginosa isolated from pediatric patients with CF in Mexico from 2015 to 2024, with the aim of characterizing their evolutionary dynamics, resistome, and virulome. Whole-genome sequencing (MGI, Illumina, and PacBio platforms) was used, with de novo assemblies performed using Unicycler v0.4.8 on the BV-BRC platform. The databases used for the resistome were CARD and NDARO, and for the virulome, VFDB. Phylogenetic reconstruction was based on core-genome alignments generated with Roary v3.13.0, with maximum likelihood reconstruction performed in IQ-TREE v2.1.2. The statistical significance of the segregation of resistance and virulence patterns was evaluated using PERMANOVA analysis. The results revealed a significant clonal prevalence of sequence types (ST) 307 and ST 167. Phylogenomic analysis grouped the isolates into three main clades; Clade 1 stood out for having the highest resistance gene load (mean of 75 genes/genome), establishing itself as the main reservoir of multidrug-resistant profiles. Genotype-phenotype concordance reached 65.5% overall, with high accuracy for aminoglycosides (87.8%) and fluoroquinolones (82.9%). Furthermore, virulome analysis identified 67 distinct patterns that were significantly segregated among the clades (PERMANOVA: R2=0.31, p=0.001). These findings demonstrate that the evolution of P. aeruginosa lineages in the pediatric clinical setting involves parallel and coordinated adaptations in both their resistance potential and their virulence arsenal. This study underscores the need to adopt a multidisciplinary approach to the clinical management of chronic P. aeruginosa infections in pediatric patients. The persistence of extensively drug-resistant (XDR) strains calls for the integration of genomic surveillance and functional diagnostics, as well as the search for therapeutic alternatives for the clinical management of patients with cystic fibrosis.

Trachoma programs are increasingly using serological tools to complement clinical indicators and to measure current and historical transmission of Chlamydia trachomatis (Ct). In January 2024, the Amhara Trachoma Program in Ethiopia implemented the Pgp3 lateral flow assay (LFA) for trachoma serosurveillance through the regional public health laboratory system. Three Amhara Public Health Institute Trachoma Molecular Laboratory scientists were trained and passed competency testing on the assay. The scientists then conducted LFA testing on dried blood spot (DBS) samples collected during a December 2023 trachoma impact survey in Tach Gaynt, Amhara. During testing, 2,542 DBS samples were processed over 12 days. Age-specific seroprevalence and seroconversion rates (SCRs) were estimated. Among children ages 1-5 years, seroprevalence was 20.8% (95% confidence interval [CI]): 17.4-24.7%), and the SCR was 7.9 per 100 child-years (95% CI: 4.6-13.5). Among children ages 1-9 years, seroprevalence was 26.0% (95% CI: 22.9-29.3%), and the SCR was 7.0 per 100 child-years (95% CI: 4.6-10.6). Seroprevalence among individuals ages 15 years and older was 85.8% (95% CI: 83.9-87.4%). Trachomatous inflammation-follicular prevalence among children ages 1-9 years (TF1-9) was 28.6% (95% CI: 22.1-35.4%), and Ct infection among children ages 1-5 years was 5.7%, suggesting ongoing transmission. The concordance between LFA results, TF1-9 prevalence, and Ct infection prevalence supports the utility of the LFA for trachoma surveillance in Ethiopia, with Pgp3 LFA testing performed in a regional public health laboratory. Integrating LFA-based serology into the Ethiopia national trachoma surveillance systems offers a scalable approach to guide programmatic decisions and support trachoma elimination as a public health problem.

The global prevalence of Extended-spectrum {beta}-lactamase-producing Enterobacterales (ESBL-E) colonization is increasing. However, it is unclear whether ESBL-E persist and if that is associated with an altered gut microbial ecology especially in early life where the developing microbiome may not provide the same colonization resistance as in adults. In this study, we collected longitudinal infant gut microbiome samples at delivery and in the nonclinical home setting in Chicago, Illinois, U.S.A, aiming to disentangle how genetic factors pertaining to the ESBL-E, as well as the surrounding gut ecology, influences persistence in the infant gut microbiome. We observed not only a higher-than-expected prevalence of ESBL-E in healthy infant gut microbiomes, but also a trend of ESBL-E persistence once colonized. Microbial communities showed higher dissimilarity between ESBL-E positive and negative infant gut microbiome at earlier time points. Although dissimilarity decreased over time, we present evidence that ESBL-E persist even when traditional detection methods are negative.

Metformin is one of the most widely prescribed drugs with a proven safety profile, making it an excellent candidate for drug repurposing strategies. Its anti-Candida effect and its synergistic potential with azoles have already been described against C. albicans and C. glabrata, alongside AMPK involvement and its divergent consequences on autophagy. However, metformin has additional effects on C. albicans biology that remain to be explored using differential proteomics. In the present study, C. albicans SC5314 was treated with metformin to identify the proteins involved in its anti-Candida activity. First, we demonstrated that metformin inhibits C. albicans SC5314 growth in a dose-dependent manner, an effect that intensifies under low glucose (0.2%) and filament-inducing conditions. It also reduces virulence traits such as filamentation, biofilm formation, and invasive growth. Furthermore, it induces significant oxidative stress, which is neutralized by antioxidant agents such as N-acetylcysteine and glutathione. Additionally, 50 mM metformin substantially increased fluconazole efficacy under 0.2% glucose. Our label-free proteomic study of C. albicans SC5314 exposed to 50 mM metformin allowed the identification and quantification of 1,899 proteins, with 95 and 47 proteins showing increased and decreased abundance, respectively. Notably, 26 of the down-regulated proteins were encoded by essential genes, demonstrating the drastic effect of metformin on C. albicans viability. GO Term analysis revealed that the most relevant functions affected were ATP binding, inhibition of ATPase activity (with reduced ATP levels), translation inhibition, mitochondrial function, filamentation, and responses to oxidative stress and antifungals. In conclusion, metformin significantly compromises the viability and virulence of C. albicans at high concentrations. Given that high concentrations of metformin have recently been reported in the intestinal tract, and that intestinal Candida is a known source of invasive infections in immunocompromised, under chemotherapy, and post-surgery patients, understanding metformin anti-Candida action becomes increasingly relevant.

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.

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.

BackgroundOutbreaks of fluconazole-resistant Candida parapsilosis have recently emerged worldwide. In Spain, this phenomenon has been reported since 2020, mainly involving isolates from different clones harbouring the Y132F mutation at Erg11. MethodsWe analysed the expansion of fluconazole resistant C. parapsilosis strains within the national antifungal resistance surveillance program. Genetic clustering and relationships were assessed using microsatellite typing and whole genome sequencing. FindingsWe identified the expansion of three distinct clones carrying the Y132F mutation. Additionally, there was an increase in strains harbouring the G458S mutation, most of which belonged to a clonal complex, although other less prevalent clones were also detected. G458S isolates showed higher resistance to azoles than Y132F strains, particularly to voriconazole and isavuconazole. This increased resistance was associated with mutations in the Tac1 transcriptional regulator and duplication of a chromosomal region containing Tac1 and Erg11. One G458S isolate without mutation at Tac1 exhibited lower MIC values. Furthermore, two isolates carried the K143R mutation, and a distinct group of resistant strains without detectable ERG11 mutations was also identified. Resistant cases were detected across 31 hospitals in 12 autonomous regions. InterpretationOur findings indicate a concerning nationwide expansion of antifungal-resistant C. parapsilosis in Spain, involving multiple resistance mechanisms and clonal lineages, with implications for antifungal treatment and infection control strategies.

Objective: To evaluate the specimen-level performance of a multichannel electronic nose (e-nose) sensor array in classifying stool specimens into relevant Clostridioides difficile categories. Design: Retrospective single-center validation study with reference to polymerase chain reaction (PCR) and C. difficile toxin testing. Participants: A convenience sample of 31 discarded stool specimens with PCR and confirmatory toxin testing. Categorized into PCR-positive (+)/toxin+, PCR+/toxin-negative (-), and PCR-. Methods: Specimens were sampled in controlled headspace by two e-nose sensor arrays in 10-minute sessions with 5-second sampling intervals. The primary endpoint was one-versus rest classification performance (sensitivity, specificity, positive predictive value, and accuracy) into three classes: PCR+/toxin+, PCR+/toxin-, and PCR-. Data were normalized and the region of interest was extracted for training and testing. Random forests were utilized for classification of normalized data with a test-train split at the specimen-level. Results: There were 457 unique 10-minute sampling events (147 PCR+/toxin+, 183 PCR+/toxin-, 127 PCR-). Sensors 1 and 2 captured 20,331 and 23,538 unique 5-second exposures within the region of interest, respectively. Testing data classification accuracy was 0.79 [0.78, 0.81] and 0.84 [0.83, 0.85] for Sensors 1 and 2. Sensitivity for PCR+/toxin+ exposures was 0.82 [0.79, 0.84] and 0.94 [0.92, 0.95], and specificity was 0.91[0.90, 0.93] and 0.93 [0.92, 0.94] for Sensors 1 and 2. Conclusion: An e-nose sensor array partially differentiated PCR-classified C. difficile specimen classes at the exposure level under headspace-controlled conditions. Performance was strongest for PCR+/toxin+ exposures. Findings support further prospective validation in the hospital room setting.

Background: Blood culture-negative infective endocarditis (BCNIE) poses a significant diagnostic challenge. This study evaluated a multimodal diagnostic algorithm combining serological and molecular methods at the Argentine National Reference Laboratory. Methods: A prospective analysis was conducted on 53 consecutive patients with suspected BCNIE referred between January 2019 and December 2024. The diagnostic workflow included indirect immunofluorescence for Bartonella spp. and Coxiella burnetii, species-specific PCR for Bartonella spp. and Tropheryma whipplei, and broad-range 16S rRNA PCR with Sanger sequencing on available blood and valvular tissue specimens. Results: An etiological diagnosis was established in 17 of 53 patients (32.1%). Bartonella spp. was the predominant pathogen (47.1%; 8/17), followed by T. whipplei (35.3%; 6/17) and Streptococcus spp. (17.6%; 3/17). All Bartonella cases were initially detected via serology, with molecular confirmation achieved exclusively through valvular tissue analysis. Conclusions: Implementing a standardized multimodal diagnostic algorithm significantly enhances etiological yields in BCNIE. The findings emphasize the complementary value of frontline serology and targeted molecular testing, highlighting that simultaneous submission of serum, blood, and valvular tissue is essential for optimal diagnosis.