Pharmaceuticals are widely detected in surface waters, posing significant ecological and human-health risks. China is a major producer and consumer of pharmaceuticals, and widespread contamination has been reported in its surface waters. Regional differences in topography, hydrology, land use, and socioeconomic conditions can shape patterns of pharmaceutical exposure and risk, calling for priority lists tailored to individual river basins. However, previous studies mainly focused on national-scale assessments, selected river basins, or specific pharmaceutical classes. In this study, we systematically reviewed 226 peer-reviewed articles and compiled 8628 occurrence records for 158 pharmaceutical compounds. A multi-criteria prioritization framework that integrated both hazard and exposure potential was used to identify priority pharmaceuticals across nine river basins. Antibiotics were the most frequently detected class of pharmaceuticals, although most had low or moderate priority scores. Erythromycin, roxithromycin, and azithromycin were notable exceptions and ranked highly. Among nonantibiotic pharmaceuticals, estrone and ibuprofen ranked highly in all nine basins. Beyond these shared priorities, several pharmaceuticals showed distinct basin-specific priority pattern. Psychotropic medicines, including diazepam, fluoxetine, sertraline, and citalopram, were identified as priorities in highly urbanized basins, particularly the Haihe and Yangtze River basins. In the Yellow River Basin, the lipid modulator gemfibrozil was prioritized, while in the Pearl River Basin, the veterinary antibiotic salinomycin was prioritized. Combining the rankings with uncertainty estimates showed that high-priority compounds with low uncertainty should be considered for stringent monitoring and control, whereas compounds with high uncertainty require additional occurrence and toxicity data. These findings underscore the importance of basin-scale prioritization in capturing regional differences and provide a basis for tiered monitoring and management in China.

Chronic lung allograft dysfunction (CLAD) is the primary cause of late graft loss after lung transplantation, affecting up to half of lung transplant recipients within 5 years and presenting with heterogeneous phenotypes, most commonly bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome. Prevention and treatment of CLAD are challenging. This European Society for Organ Transplantation (ESOT) clinical practice guideline was developed by a multidisciplinary Task Force, including patient and allied healthcare representation, using systematic reviews and GRADE methodology. Eight key PICO questions addressing prevention and treatment of CLAD were evaluated. In terms of prevention, recommendations are in favor of using tacrolimus over cyclosporine, either mycophenolate or azathioprine, and azithromycin to reduce the risk of CLAD. Regarding treatment, montelukast could be considered in early-stage BOS. Current data are inconclusive in demonstrating benefits of anti-thymocyte globulin, alemtuzumab or extracorporeal photopheresis compared with standard of care, and do not support the use of antifibrotics in BOS. The Task Force emphasizes the urgent need for high-quality clinical trials and standardized care pathways in CLAD management.

We present a case of disseminated Nocardia otitidiscaviarum infection in a 72-year-old male with a history of renal transplantation on chronic immunosuppressive therapy with prednisone, cyclosporine, and mycophenolate mofetil. He presented with pneumonia and was initially treated with ceftriaxone and azithromycin. Bronchoalveolar lavage (BAL) and cultures from a biopsied thigh lesion both grew N. otitidiscaviarum. His hospital course was complicated by visual hallucinations, and brain magnetic resonance imaging (MRI) revealed multiple intracranial abscesses. He initially received meropenem, trimethoprim-sulfamethoxazole (TMP-SMX), and linezolid. His antimicrobial regimen was subsequently modified during the treatment course. Linezolid was discontinued after hematologic abnormalities developed, TMP-SMX was temporarily held because of worsening renal function and later reintroduced, and meropenem was also discontinued. He was discharged on TMP-SMX and minocycline and completed an initial six-week antimicrobial treatment course from the time of diagnosis. He was subsequently maintained on minocycline and moxifloxacin; moxifloxacin was later discontinued because of QT-interval prolongation, while minocycline was continued for slightly longer than one year, with clinical and radiologic resolution.

The high rate of entry of microplastics (MPs) and pharmaceuticals into the agroecosystem leads to progressive accumulation within the soil year after year, raising concerns about both soil ecological health and crop productivity. The combined contamination of macrolide antibiotics and nanoplastics in the rhizosphere remains poorly understood. In this work, microbial shifts in the rhizosphere and bulk soil under wheat growth as affected by the polystyrene (PS) and azithromycin antibiotics (AZM) co-contamination were investigated. In this study, the toxicity effects of different sizes and concentrations of PS (i.e., 100 nm; 300 nm; 50 and 500 mg/kg, respectively) and AZM (i.e., 5 and 20 mg/kg) were combined under wheat growth in the greenhouse for 110 days. A total of 15 treatments with three replicates each were prepared and arranged in a completely random design. Findings revealed that combined contamination (i.e., PS+AZM) negatively affected microbial richness and diversity compared to individual contamination, and it was more prominent in the rhizosphere than in bulk soil. This, in turn, affected the composition of the bacterial community, abundances, functions, and interactions. It also influenced functions involved in biogeochemical cycles within the system. The co-occurrence network showed that PS+AZM inhibited wheat growth in general and reduced bacterial interactions (nodes: 770, edges: 6184, positive interactions: 4656, negative interactions: 1528) compared to individual PS (nodes: 1301, edges: 18,190, positive interactions: 11,597, negative interactions: 6593) and AZM application (nodes: 866, edges: 7464, positive interactions: 5192, negative interactions: 2272). The same trend occurred in the rhizosphere vs bulk soil. PS+AZM drove distinct microbial community shifts, where the rhizosphere was enriched with mostly bacteria involved in nitrogen biogeochemical cycling (Microvirga; Pseudorhodoplanes; Polaromonas; Hydrogenophaga; and Bauldia) and bulk soil was enriched with bacteria adapted to low nutrients and stress resistance (i.e., Opitutus; Adhaeribacter; Blastococcus; Ilumatobacter; IS-44; Bryobacter; Subgroup_10; Gemmatimonas). These results shed light on the co-occurrence of MPs and antibiotics in agroecosystems. They may help in developing mitigation measures against the effects of MPs and antibiotics in agroecosystems.

This study reports the genomic insights into a Streptococcus pneumoniae serotype 17F isolate in Malaysia (IMRCC/SS430/25), collected from an adult patient with aspiration pneumonia in 2025. Phenotypic identification revealed characteristic alpha-haemolytic colonies and optochin susceptibility. Species identity as S. pneumoniae was further verified by bile solubility testing and the 17F serotype was confirmed using the Quellung reaction. The isolate was subjected to whole-genome sequencing using the Oxford Nanopore platform. The assembly yielded a highly accurate, single circular contig of 2,065,967 bp with 100% completeness and 48× coverage. In silico typing assigned the genome to ST2355 within the globally disseminated GPSC10 cluster. Antimicrobial susceptibility testing demonstrated resistance to erythromycin, azithromycin, clindamycin, and tetracycline. This phenotypic profile was concordant with genomic screening which identified the ermB and tetM_8 genes responsible for macrolide-lincosamide-streptogramin B (MLSB) and tetracycline resistance respectively. The penicillin-binding protein allelic profile (pbp1a: 79, pbp2b: 26, pbp2x: 194) predicted uniform susceptibility to beta-lactam antibiotics shown by phenotypic testing of amoxicillin-clavulanate and penicillin. Phylogenomic characterization identified the Malaysian isolate within the predominant global ST2355 clade of GPSC10, clustering alongside isolates from Nepal, the United Kingdom, Bangladesh, and the United States. This study demonstrates the utility of combining routine clinical microbiology with high-resolution genomic surveillance to resolve lineage relationship, reveal underlying resistance mechanisms, and confirm genotype-phenotype concordance.

The intrapulmonary pharmacokinetics of antimicrobial agents used to treat nontuberculous mycobacterial (NTM) pulmonary disease remains poorly characterized, limiting the optimization of dosing regimens. This study characterized the plasma and intrapulmonary pharmacokinetics of azithromycin, ethambutol, rifampicin, clofazimine, and amikacin, as well as their penetration into pulmonary lesion sites. We prospectively enrolled patients undergoing guideline-based treatment for NTM pulmonary disease who were indicated for surgical resection at a single center in Japan. Drug concentrations were measured in the plasma and lung samples and analyzed using a population pharmacokinetic model. The lung lesion site, cavity, or nodule/bronchiectatic lesion was evaluated as covariates of the lung-to-plasma partition ratios. Twenty-four patients were enrolled in the study. The estimated lung-to-plasma partition coefficients and intrapulmonary half-lives were 535-fold and 6.3 months for azithromycin, 40-fold and 2.0 months for ethambutol, 5.2-fold and 6.3 min for rifampicin, 18,800-fold and 22 years for clofazimine, 1.3-fold and 2.3 h for intravenous amikacin, and 1.3-fold and 5.0 h for inhaled amikacin, respectively. Evaluation of drug penetration into cavities and nodular/bronchiectatic lesions showed no clearly reduced concentration compared to a normal lung tissue. The intrapulmonary pharmacokinetic characteristics identified in this study provide valuable information for optimizing antimicrobial dosing regimens in the treatment of NTM pulmonary disease. Furthermore, the absence of clearly reduced drug penetration into lesion sites suggests that lesion phenotype alone may have limited value in guiding antimicrobial selection.

Pasteurella multocida is an important bacterial respiratory pathogen of buffaloes and may cause major economic losses in the livestock sector. But there is a lack of data on its prevalence, risk factors, and antimicrobial resistance patterns in Bangladesh. The study was cross-sectional, and a total of 400 buffaloes from seven locations in Bangladesh were included in the nasal swab collection. Isolation was done using culture methods and confirmed by polymerase chain reaction (PCR). Associations between infection and risk factors were explored using logistic regression analysis; antibiotic susceptibility was determined by the disc diffusion method. The co-resistance patterns were assessed by Pearson's correlation analysis. The culture-based prevalence of P. multocida was 12.25%, compared with a PCR-confirmed prevalence of 7.25%; all PCR-positive isolates were capsular type B, with notable regional variation in prevalence. Buffaloes with respiratory symptoms had significantly greater odds of being infected (OR = 8.88, p < 0.001), and the younger group of animals aged 1-3 years had a greater predisposition to infection than the younger ones, but sex was not significantly associated with infection. The isolates exhibited high antibiotic resistance, as demonstrated by antimicrobial susceptibility testing, particularly against ampicillin (96.55%), oxytetracycline (93.10%), and penicillin-G (89.65%). Cefixime (93.10%) and azithromycin (68.96%) remained largely effective by contrast. Positive correlations were identified between resistance to β-lactams, tetracyclines, and aminoglycosides. These findings suggest that multidrug-resistant P. multocida type B is circulating in buffaloes in Bangladesh and highlight the need for increased surveillance, rational use of antimicrobials, and integrated control strategies.

Reactive infectious mucocutaneous eruption (RIME) is a recently defined mucocutaneous manifestation associated with respiratory infections, most commonly reported secondary to Mycoplasma pneumoniae. The core diagnostic criteria of RIME involve greater than or equal to two mucosal areas with erosive mucositis, minimal cutaneous lesions, a recent infectious prodrome, and exclusion of drug-induced etiologies. RIME presents with acute mucositis involving the oral, ocular, and genital mucosa, with presentations similar to other mucocutaneous disorders such as Stevens-Johnson syndrome (SJS), erythema multiforme (EM), and multisystem inflammatory syndrome in children (MIS-C) secondary to SARS-CoV-2 infection. This case report describes a unique presentation of RIME secondary to a Mycoplasma infection, highlighting diagnostic challenges and therapeutic approaches. A 16-year-old male, previously healthy with no significant past medical history, was accepted for transfer to our hospital for evaluation of persistent fever, worsening left lower lobe pneumonia, oral mucositis, and conjunctivitis. On examination, extensive erythema and inflammation throughout the oral cavity, exudative pharyngitis, clear ocular discharge with conjunctival injection, and sloughing of the scrotal skin were noted. The patient's medical history and clinical examination raised initial suspicion of Kawasaki disease or possible MIS-C. Lab studies showed elevated CRP, ESR, and B-type natriuretic peptide (BNP), indicating extensive systemic inflammation; however, the PCR was negative for respiratory syncytial virus (RSV), influenza A and B, and SARS-CoV-2. Further investigations revealed a positive Group A Streptococcus PCR on throat swab, felt to be colonization, and elevated Mycoplasma pneumoniae IgG titers suggested previous or recent exposure; however, acute infection could not be confirmed due to negative PCR and IgM. The patient improved over the following several days after initiation of azithromycin, continuation of clindamycin, and wound care for scrotal and oral mucosal lesions. Differentiating RIME from other mucocutaneous disorders is vital to prescribing proper treatment and preventing further systemic effects. This case underscores the importance of considering Mycoplasma as a potential etiology in patients presenting with mucocutaneous lesions and conjunctivitis following a previous respiratory infection.

Azithromycin (AZM) is a second generation macrolide, a semi-synthetic derivative of erythromycin. AZM accumulates extensively in cells and tissues, making the evaluation of potential off-target effects relevant when cellular exposure is prolonged or elevated. This study characterized the in vitro genotoxic, cytostatic, metabolic, and apoptotic effects of AZM in primary human peripheral blood lymphocytes (PBLs) and HepG2 cells. PBL cultures from four healthy donors were exposed to 1.25-5.0 μg/mL AZM for 48 h and assessed using chromosome aberration (CA), micronucleus (MN), mitotic index (MI), and cytokinesis-block proliferation index (CBPI) analyses. HepG2 cells were evaluated using the MTT reduction assay after exposure to 0.312-40 μg/mL AZM for 24-72 h and by Annexin V-APC/7-AAD flow cytometry after 48 h. AZM increased chromosomal aberration and micronucleus frequencies and reduced MI and CBPI in PBLs. In HepG2 cells, AZM reduced MTT-derived metabolic activity in a concentration- and time-dependent manner (48-h IC50: 13.64 μg/mL) and increased apoptotic cell populations, while necrosis remained limited. These findings demonstrate concentration-dependent in vitro toxicological effects in both models.