We evaluated food-associated differences in clindamycin hydrochloride capsule exposure by pooling publicly available regulatory bioequivalence (BE) summaries from the Center for Drug Evaluation of the National Medical Products Administration in China. Fourteen candidate regulatory identifiers were reviewed; one 0.15-g BE-exempt record without analyzable pharmacokinetic (PK) data was excluded, leaving 13 records (ten 150 mg and three 300 mg). CYHB1901758 and CYHB2140526 were treated as independent 300-mg BE records under the authors' prespecified working assumption. For each record and endpoint, test and reference formulation fed/fasted ratios were combined on the log scale, and regulatory records were pooled with equal weight. For the 150-mg strength, pooled fed/fasted geometric mean ratios (GMRs) [95% descriptive interval] were 1.31 [1.24, 1.38] for AUC0-t, 1.30 [1.23, 1.38] for AUC0-inf, and 0.85 [0.80, 0.90] for Cmax. For the 300-mg strength, the corresponding GMRs were 1.17 [0.92, 1.50], 1.19 [0.93, 1.52], and 0.93 [0.88, 0.97]. Thus, the available aggregate summaries showed higher total exposure and lower peak concentration under fed conditions, particularly for the 150-mg strength. These findings describe a food-associated PK pattern but do not constitute a formal regulatory food-effect assessment or support a change in meal-timing recommendations.

The emergence and dissemination of antimicrobial resistance through the food chain pose a significant threat to food safety and public health. Our nationwide surveillance of retail foods in China revealed alarmingly high resistance rates among foodborne Staphylococcus isolates, particularly to antibiotics targeting the 50S ribosomal subunit. Among these, Mammaliicoccus lentus (formerly Staphylococcus lentus) is a coagulase-negative species commonly found in food-producing animals and retail foods, increasingly recognized as a reservoir of antimicrobial resistance genes. To elucidate the genetic basis of this severe phenotype, we identified M. lentus strain M177 from retail potato flour exhibiting exceptionally high resistance to tiamulin, clindamycin, and lincomycin, a profile unexplained by known resistance genes. Targeted BLASTp analysis identified a putative ARE ABC-F gene sharing 98.71% amino acid identity with Sal(B), which we designated sal(B). Functional validation confirmed that Sal(B) confers specific resistance to PLSA (pleuromutilins-lincosamides-streptogramin A) antibiotics, with tiamulin MIC increased by 128-fold, and clindamycin and lincomycin by 8-fold. Systematic alanine-scanning mutagenesis identified the Loop region as the primary effector of resistance, with Tyr251 playing a predominant role, while Ser262, Pro263, Gly266, Arg275, and Phe276 contributed to varying degrees. Structural analysis revealed an allosteric protection mechanism in which resistance-altering mutations disrupt specific interactions with 23S rRNA nucleotides within the peptidyl transferase center, rather than directly displacing antibiotics. ATP hydrolysis was strictly required for Sal(B) function. Genetic environment analysis indicated that sal(B) is chromosomal and likely intrinsic to M. lentus, with limited horizontal transfer potential. Notably, sal(B) or highly similar homologs were detected in geographically distinct food sources, suggesting a potential distribution that warrants further systematic surveillance. To the best of our knowledge, this is the first report of sal(B) in a foodborne M. lentus isolate, establishing Sal(B) as a mechanochemical allosteric regulator of PLSA resistance. These findings highlight the need for enhanced surveillance of ARE ABC-F genes in foodborne coagulase-negative staphylococci beyond the traditional focus on S. aureus, due to the potential threat these resistance determinants pose to food safety and public health.

Lemierre syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein with metastatic septic emboli, most commonly affecting the lungs. We report a case of Lemierre syndrome temporally associated with influenza A infection in a previously healthy 21-year-old male. The patient initially presented to the emergency department with severe headache and tested positive for influenza A. Over the following seven days, his symptoms progressed to neck pain with decreased range of motion, hemoptysis, cough, and persistent myalgias. Despite four additional emergency department visits, his evolving neck symptoms were attributed to influenza-related myalgias and cervical strain. On the day of admission, examination demonstrated neck swelling, tenderness, restricted jaw opening, and pink foamy sputum. Laboratory studies were significant for severe thrombocytopenia, lactic acidosis, and sepsis. Imaging revealed right mastoid effusion, paranasal sinusitis, multifocal pneumonia, and a near-occlusive thrombus of the right internal jugular vein. Blood cultures grew beta-hemolytic group C Streptococcus and Peptoniphilus asaccharolyticus. The patient was treated with vancomycin, ceftriaxone, clindamycin, and metronidazole. Anticoagulation was initially deferred because of profound thrombocytopenia. Additional therapies included nebulized tranexamic acid, platelet transfusion, corticosteroids, and intravenous immunoglobulin for suspected immune-mediated thrombocytopenia. His hospital course was complicated by metabolic encephalopathy requiring intubation. The patient improved with treatment and was discharged after 17 days on oral antibiotics and rivaroxaban. He was subsequently readmitted 20 days later with a right empyema requiring bronchoscopy, chemical pleurodesis, and decortication. He has remained free of further hospitalization for one year. This case highlights the diagnostic challenges of Lemierre syndrome and the potential for diagnostic anchoring following an initially confirmed viral diagnosis. Although a causal relationship between influenza A infection and Lemierre syndrome cannot be established, clinicians should reassess the diagnosis when patients with confirmed influenza develop persistent or progressive focal symptoms, particularly neck pain or swelling, restricted jaw opening, respiratory symptoms, or systemic deterioration. Early recognition of Lemierre syndrome and prompt treatment are critical to reducing severe complications and morbidity.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of skin and soft tissue infections in otherwise healthy pediatric populations. Empirical beta-lactam therapy failure may delay appropriate management, particularly in community-exposed individuals. An 11-year-old competitive swimmer presented with progressive lower lip swelling and purulent discharge unresponsive to amoxicillin therapy. Clinical examination revealed a solitary pustular lesion with significant edema on the lower vermilion border. Microbiological culture confirmed MRSA resistant to beta-lactams but susceptible to clindamycin and gentamicin. The patient was treated with local debridement, antisepsis, systemic clindamycin, and topical gentamicin, resulting in complete resolution within 10 days. This case emphasizes the importance of microbiological evaluation in persistent labial abscesses in pediatric patients, particularly in the context of rising antimicrobial resistance.

Odontogenic infections may progress to deep space infection with systemic complications and require prompt surgical drainage and, when indicated, systemic antibiotics. In patients with a documented penicillin allergy label, empiric therapy is often shifted toward clindamycin, although resistance is increasingly reported. This multicenter retrospective cohort study included 88 hospitalized patients with surgically treated odontogenic infections and a documented penicillin allergy label at two German tertiary oral and maxillofacial surgery centers (Center A, n = 59; Center B, n = 29). Empiric antibiotic therapy was predominantly clindamycin-based (90.9%). Microbiological diagnostics were performed in 58.0% of patients and infections were mostly polymicrobial. Antimicrobial susceptibility testing was available in 43.2%; among cases with clindamycin testing, resistance was 76.7%. Antibiotic regimen changes occurred in 25.0%, most frequently to ampicillin/sulbactam. Median length of stay was 5 days; ICU-level care was required in 5.7%, revision surgery in 15.9%, one intracranial complication and one in-hospital death occurred. These findings suggest a clinically relevant mismatch between label-driven empiric clindamycin use and observed susceptibility patterns. Early structured allergy assessment and delabeling strategies may strengthen antibiotic stewardship and support safe first-line β-lactam use.

Amivantamab is an epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET) antibody. Lazertinib is an EGFR tyrosine kinase inhibitor with central nervous system penetration. Used in combination, this targeted therapy is effective in treating non-small cell lung cancer (NSCLC). However, it has been associated with severe dermatologic adverse reactions. A 61-year-old woman with a history of EGFR-mutated NSCLC with brain metastases on amivantamab-lazertinib therapy presented for follow-up with drainage from her scalp incision after undergoing a right parietal craniotomy and mass excision five months prior. The patient denied constitutional and neurologic symptoms, but reported yellow staining on her pillow. Examination initially demonstrated yellow fibrinous exudate and hair matting along the surgical incision. Computed tomography (CT) of the head revealed overlying scalp swelling and minimal extra-axial dural thickening over the prior right parietal craniotomy site with stable intracranial metastatic lesions. Due to concern for dehiscence, her biologic therapy was paused, and she was taken to the operating suite where no evidence of infection, delayed healing, or wound dehiscence was noted. A 10 × 5 cm area of patchy granulation tissue and ulceration was observed along the right parietal scalp. Biopsy revealed granulation tissue and multinucleated giant cells and was negative for tumor. Given the risk of malignant progression with all targeted therapy paused, the patient was restarted on amivantamab monotherapy. Following disease progression two months later, she was transitioned to carboplatin and etoposide. EGFR is widely expressed in skin keratinocytes and intimately involved in epithelial differentiation. Therapies targeting EGFR, such as amivantamab plus lazertinib, are associated with adverse dermatologic reactions, ranging from dry skin to severe scalp ulceration, which can interrupt treatment, contribute to poorer clinical outcomes, and reduce quality of life. Standard of care includes limiting sun exposure and avoiding alcohol-based topical agents. The use of daily prophylactic antibiotics, such as oral doxycycline, topical clindamycin, chlorhexidine wash, and ceramide moisturizer, may significantly reduce the risk of adverse skin reactions. Implementation of this multicomponent regimen reduced the rate of severe scalp reactions from 26% to 10% relative to the standard of care, with sustained benefit observed for at least six months.

OKC is an odontogenic developmental cyst with a significant risk of recurrence. Secondary infections of the lesion with Actinomyces organisms are rare and may pose a dilemma in managing the recurrent lesion. A 20-year-old male patient reported to the outpatient department with a radiolucent multilocular lesion of the posterior right side of the mandible. A diagnosis of OKC was made based on histopathology, and a conservative approach involving decompression and marsupialisation with subsequent enucleation of the cyst and peripheral ostectomy was planned. The lesion healed without any complications. After one year, swelling occurred along with a radiolucent lesion in the same area. Re-examination revealed a case of recurrent OKC with cortical expansion and sequestration. Resurgery revealed a lesion with basophilic filamentous bacterial colonies, eosinophilic peripheral clubs with a sulfur granule, and marked inflammation, indicating secondary actinomycotic infection rather than colonization. Aerobic and anaerobic cultures were done. Postoperatively, the patient received antimicrobial therapy consisting of intravenous clindamycin for 7 days, followed by oral amoxicillin-clavulanate for 4 weeks and metronidazole for 7 days. followup was performed clinically and radiographically, with gradual improvement and healing of the disease without recurrence for 4 years after treatment of the recurrent lesion, constituting 5 years of followup from the first diagnosis. This case highlights the importance of re-evaluation through repeated histopathological examination of the recurrent OKC, especially when inflammatory or destructive changes are present.

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.

We evaluated changes in population attributable risk of "4C" antibiotics for community-associated Clostridioides difficile infection in Ontario (2017-2024). Contributions from clindamycin, cephalosporins, and fluoroquinolones declined, whereas amoxicillin-clavulanate increased and became the leading contributor by 2022, highlighting a potential emerging target for outpatient antimicrobial stewardship.