Background/Objectives:Clostridioides difficile colonization is common among hospitalized onco-hematological patients, yet its clinical significance and risk factors in this population remain incompletely characterized. This study aimed to determine the prevalence, risk factors, and genomic characteristics of C. difficile colonization among oncology and hematology inpatients, and to assess its relationship with progression to symptomatic infection. Methods: We conducted a prospective cohort study of patients admitted to the oncology and hematology departments of a tertiary-care hospital in the Canary Islands, Spain, between March and October 2025. Weekly active screening for C. difficile colonization was performed on stool samples throughout hospitalization. Risk factors were assessed using multivariable logistic regression, and whole-genome sequencing was performed on 16 of the 23 recovered isolates (after excluding 3 non-recoverable and 4 contaminated isolates) to characterize sequence types, ribotypes, and antimicrobial resistance determinants. Results: Among 215 patients (262 admission episodes), colonization was detected in 23 episodes (8.8%), with higher rates in oncology (10.9%) than hematology (7.2%; adjusted OR 0.37, 95% CI 0.14-0.96, p = 0.042). Chemotherapy administered during hospitalization was the strongest independent risk factor for colonization (adjusted OR 4.16, 95% CI 1.56-11.10, p = 0.004). Only 4.3% of colonizations were classified as truly community-associated, with 95.7% of patients showing documented healthcare contact. Sequencing of 16 isolates identified nine sequence types, including ST11 (ribotype 078, of zoonotic origin) and rare ribotypes (RT010, RT451); four isolates (36%) exhibited moxifloxacin resistance linked to gyrA/gyrB mutations, while all remained susceptible to vancomycin and metronidazole. No colonized patient progressed to symptomatic infection; the single CDI case in the cohort occurred in a non-colonized patient. Conclusions: These findings support current recommendations against isolating or treating asymptomatically colonized patients, while underscoring the need for continued genomic surveillance and reinforced environmental hygiene and antimicrobial stewardship in this high-risk population.

Introduction: Severe periodontitis, corresponding to Stage III and Stage IV disease according to the 2018 World Workshop classification, represents a substantial global health burden. Systemic antibiotics have been investigated as adjuncts to mechanical periodontal therapy; however, their effectiveness and appropriate use in severe periodontitis remain uncertain. This umbrella review aimed to synthesize the available evidence on adjunctive systemic antibiotics in Stage III and Stage IV periodontitis and assess the methodological quality of the available systematic reviews. Methods: This umbrella review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, Embase, and other relevant databases was conducted from June 2018 to June 2026. Systematic reviews evaluating adjunctive systemic antibiotics in patients with Stage III or Stage IV periodontitis, classified according to the 2018 World Workshop, were eligible. Methodological quality was assessed using AMSTAR-2 and overlap among primary studies was evaluated using the Corrected Covered Area (CCA). Results: Two systematic reviews met the inclusion criteria: a network meta-analysis by Lin et al. and a systematic review by Jones and Hoyle focusing on azithromycin. The CCA was approximately 52.9%, indicating substantial overlap between the included reviews. Lin et al. reported moderate-certainty evidence that adjunctive amoxicillin plus metronidazole (AMX + MTZ) resulted in greater clinical attachment level gain and probing pocket depth reduction compared with mechanical debridement alone. Jones and Hoyle found insufficient evidence to support routine adjunctive azithromycin, owing to low certainty and heterogeneity among studies. Discussion and Conclusions: Adjunctive systemic antibiotics, particularly AMX + MTZ, may provide additional clinical benefits in severe periodontitis. However, the limited number of systematic reviews, substantial overlaps, and uncertainty surrounding some antibiotic protocols limit the strength of the evidence. Current findings support selective rather than routine antibiotic use, guided by individual patient and disease characteristics and antimicrobial stewardship. Future studies should emphasize long-term outcomes and consistently distinguish Stage III from Stage IV periodontitis.

Background/Objectives: Antibiotic-associated encephalopathy (AAE) is a serious adverse reaction whose presentation is thought to differ between antibiotics; whether these agent-specific profiles are consistently reflected in spontaneous reports across independent data sources is unknown. Methods: Using the Japanese Adverse Drug Event Report (JADER) database and the US FDA Adverse Event Reporting System (FAERS, 2004-2026), we studied metronidazole, cefepime, ceftriaxone, ceftazidime, and levofloxacin. Encephalopathy was defined by the MedDRA terms Encephalopathy or Toxic encephalopathy, and reporting odds ratios (RORs) were calculated in each database; co-reported neurological manifestations, time to onset, patient age, and renal-associated terms were then characterized. Results: All five antibiotics showed significant reporting disproportionality in both databases, with metronidazole and cefepime showing the largest RORs in each (JADER: metronidazole ROR 186.70, cefepime 55.33; FAERS: cefepime 69.29, metronidazole 29.11), consistent with established adverse reactions. In FAERS, metronidazole showed a cerebellar profile (ataxia OR 12.48, dysarthria OR 11.11) and cefepime a renal-associated altered-mental-status/myoclonus profile (depressed level of consciousness OR 12.88, myoclonus OR 11.76; renal-associated terms OR 2.88; median age 71 years); event-specific JADER dates indicated a delayed course for metronidazole (median 28 days). The symptom-level contrast was FAERS-based and was not reproduced when the same analysis was repeated in JADER, a discrepancy that may reflect differences in coding practice. Conclusions: AAE is reported not as a single uniform event but with profiles specific to the causative antibiotic. Awareness of these agent-specific patterns may support earlier recognition, although confirmation in analytic studies with exposure denominators is warranted.

Background: Community-acquired intra-abdominal infections (CA-IAIs) exhibit significant clinical heterogeneity. However, most studies focusing on CA-IAIs do not stratify comparisons by infection site. Methods: This post hoc analysis of the prospective multicenter PERICOM cohort (13 French university hospitals, April 2018 to February 2019) included adult patients with CA-IAIs requiring surgical management. We compared clinical characteristics, microbiology, and outcomes between appendicular and non-appendicular sites. Secondary analyses assessed the impact of Enterococcus spp., Pseudomonas aeruginosa, or fungal documentation, and the theoretical coverage of empirical antibiotic regimens. Results: Of the 205 patients, 86 (42%) had appendicular and 119 (58%) had non-appendicular CA-IAIs. Appendicular CA-IAIs involved younger patients with fewer comorbidities and were followed by fewer major postoperative complications (Clavien-Dindo score ≥ 3: 10% versus 43%, p < 0.001) and no deaths (0% versus 12%, p < 0.001). Among 118 culture-positive patients, appendicular CA-IAIs showed higher rates of non-fermenting Gram-negative bacilli (25% versus 10%, p = 0.046) and anaerobes (53% versus 28%, p = 0.008) and were more often polymicrobial (76% versus 55%, p = 0.020). Conversely, Staphylococcus spp. (0% versus 9%, p = 0.036) and fungal co-infection (0% versus 12%, p = 0.010) were confined to non-appendicular CA-IAIs. Furthermore, Enterococcus spp. documentation (24/118, 20%) identified patients with greater admission severity and higher 28-day mortality (33% versus 2%, p < 0.001). Amoxicillin-clavulanic acid plus gentamicin covered the isolates of 92% of patients versus 61% for third-generation cephalosporin plus metronidazole (p < 0.001), a difference identical in both appendicular and non-appendicular sites. Conclusions: Appendicular and non-appendicular CA-IAIs appear to be distinct entities, supporting stratified management. Future guidelines should consider site-specific strategies, therapeutic individualization, and the integration of CA-IAI ecology.

Background: Monitoring antibiotic consumption represents an important objective for antimicrobial stewardship programs in hospitals. The aim of this study was to analyze antibiotic consumption patterns in three Romanian hospitals. Methods: A five-year retrospective study was conducted using monthly pharmacy consumption data from three Romanian hospitals for the years 2018, 2019, 2023, 2024, and 2025. Antibiotic consumption was quantified using defined daily doses (DDD) per 100 bed-days. Antibiotics were grouped using the World Health Organization AWaRe (Access, Watch, Reserve) classification. Results: The analysis revealed statistically significant differences in overall antibiotic consumption among the three hospitals (p < 0.001). A significant annual correlation between hospitalization days and antibiotic consumption was observed for some years in two of the facilities. Post hoc analysis confirmed statistically significant differences across all AWaRe category pairwise comparisons. Watch antibiotics had the highest consumption rates (over 60%). By therapeutic classes, the highest overall consumption was for cephalosporins, fluoroquinolones, penicillins, and carbapenems. Cefuroxime accounted for the highest cumulative consumption, followed by ceftriaxone, meropenem, vancomycin, ciprofloxacin, and metronidazole. Conclusions: Antibiotic consumption differed among the participating hospitals and study years. Monitoring antibiotic consumption provides valuable information on hospital antibiotic utilization patterns and can support evidence-based antimicrobial stewardship in hospitals.

Preclinical and clinical infectious disease research introducing intravaginal devices containing active agents and probiotic bacteria need to rely on materials that meet appropriate microbiologic standards. However, research methods for quality control of intravaginal devices are poorly described. Here, we develop a practical workflow that specifies media types, culture techniques, and modifications to commonly used assays to suit vaginal applications. A set of quality control assays were developed to test electrospun fibers intended for use in an experimental (mouse) model. The fibers carried probiotics, antibiotics, or no cargo (i.e., "blank"). To validate anti-bacterial action for metronidazole-containing fibers against a relevant target bacterium associated with bacterial vaginosis (BV), a modified Kirby Bauer disc diffusion assay confirmed a zone of Gardnerella clearance on NYCIII agar plates. For "blank" fibers containing no cargo, simple turbidity assays using TSB were effective in highlighting batches of electrospun fibers that were contaminated with culturable bacteria. CHROMagar™ Orientation agar was also a useful tool, particularly if fibers contained vaginal probiotic bacteria (Lactobacillus crispatus) as the intended cargo. For example, CHROMagar™ identified a probiotic strain other than L. crispatus SmR incorporated into fibers in one experiment (L. rhamnosus SmR). The limulus amebocyte lysate assay was also used to measure endotoxin levels in specimens from mice and humans, establishing what may be considered "normal" in these settings. Women with an abnormal BV-like microbiota (Nugent score > 4) had ∼250-fold higher levels of endotoxin compared to those without BV (median 134.2 vs. 0.528 EU/ml in vaginal swab elutions). Vaginal washes from uninfected female mice likewise had low concentrations of endotoxin (∼0.6900 EU/ml). Process improvements during the fabrication of electrospinning fibers identified contributing sources of endotoxin and resulted in a 10-fold improvement in median concentrations from 14.21 to 1.143 EU/device. Together, these studies demonstrate a feasible workflow that can quickly identify culturable contaminants or high levels of endotoxin in electrospun fibers intended for vaginal application.

The core challenge in contact-electro-catalysis (CEC) for antibiotic degradation is its reliance on exogenous oxidants and low efficiency under additive-free conditions. To address this, a catalytic strategy without external oxidants was developed based on ultrasound-driven contact electrification (CE) at the polytetrafluoroethylene (PTFE) interface. The degradation and mineralization of metronidazole (MNZ) were investigated without any chemical oxidants. Near-complete MNZ removal (>97%) and deep mineralization (85% TOC removal) were achieved within 180 min. Singlet oxygen ([1]O2) was identified as the dominant reactive oxygen species (ROS), contributing nearly 50% with a generation rate of 0.118 μmol/L/min-significantly higher than other ROS. Dissolved oxygen was revealed as the key oxygen source, and an optimal concentration window was identified. Three MNZ degradation pathways were elucidated, with [1]O2-mediated selective oxidation as the predominant route, characterized by high efficiency, minimal byproduct formation, and significantly reduced ecotoxicity. Additionally, excellent catalytic stability and environmental resistance were demonstrated. After five consecutive cycles, the catalytic activity was retained above 90%. Furthermore, good tolerance was exhibited toward common inorganic anions and natural organic matter. This work eliminates the dependence on exogenous oxidants in conventional CEC and offers theoretical insights for efficient removal of recalcitrant antibiotics in water.

Although Arctium lappa L. polysaccharides (ALPs) possess recognized pharmacological potential, their green extraction using deep eutectic solvents (DESs) combined with ultrasound has not been previously explored. This study reports, for the first time, an optimized DES-based ultrasound-assisted extraction (DES-UAE) protocol for ALPs. Response surface optimization identified the following conditions: choline chloride/oxalic acid molar ratio of 2:1, water content of 18.508%, liquid-to-solid ratio of 37.425 mL/g, extraction time of 97.262 min, and ultrasonic power of 275.787 W, yielding 16.581% polysaccharides. Sequential chromatographic purification afforded a homogeneous fraction, ALPs-1, with a weight-average molecular weight of 8827 Da. Monosaccharide analysis revealed that ALPs-1 is composed of rhamnose, glucuronic acid, glucose, and galactose at a molar ratio of 2.18:1.00:6.62:7.17. Functionally, ALPs-1 exhibited moderate α-glucosidase inhibition, weak DPPH• scavenging, and notable ABTS•[+] scavenging (IC50 = 0.87 mg/mL). Importantly, ALPs-1 significantly suppressed NO, TNF-α, and IL-1β production in LPS-stimulated BV2 microglia and protected zebrafish keratinocytes from metronidazole-induced oxidative injury. These results demonstrate that ALPs-1 possesses promising antioxidant, hypoglycemic, and anti-neuroinflammatory activities. This work provides the first evidence for the effective application of DES-UAE in extracting bioactive ALPs, supporting their potential use in functional foods and pharmaceuticals.