This study demonstrates the application of low-cost laser-induced graphene (LIG) electrodes for the determination of azithromycin using a batch injection analysis (BIA) system. The LIG/BIA platform provided a sensitive and rapid electroanalytical response, with excellent linearity (R2 = 0.999), low detection limit (LOD = 0.024 µmol L-1) and linear range of 1.0 to 80.0 µmol L-1, together with satisfactory precision and accuracy across different matrices. The method was successfully applied to pharmaceutical formulations, synthetic urine, and environmental water samples, providing satisfactory recovery results under the investigated sample conditions. In addition to its analytical performance, the proposed approach offers key practical advantages, including simple electrode fabrication, low sample consumption, minimal sample manipulation, and rapid successive measurements. These results highlight the potential of LIG-based sensors as a versatile and accessible alternative for routine monitoring of azithromycin in complex samples.

Foreign body aspiration (FBA) in adults is rare, and tooth aspiration represents an exceptionally uncommon subset. Even rarer is the prolonged retention of a tooth in the left main bronchus, which is anatomically less favorable for aspiration than the right. However, individual airway variations may predispose to such occurrences. We report the case of a 56-year-old woman with an 11-year history of recurrent "pneumonia-like" episodes characterized by chronic productive cough, intermittent fever, hemoptysis, and pleuritic chest pain. She had been repeatedly treated with empirical antibiotic regimens - including azithromycin, amoxicillin-clavulanate, and levofloxacin - and intermittent corticosteroids, resulting in only transient symptomatic relief. Subsequently, she developed recurrent profuse watery diarrhea following prolonged antibiotic exposure, initially managed with oral metronidazole but complicated by recurrence and eventual toxic megacolon secondary to severe Clostridioides difficile colitis. She was referred to our tertiary care center for possible surgical intervention and was successfully managed conservatively with oral vancomycin and intravenous metronidazole. During hospitalization, further evaluation of her chronic respiratory symptoms with CT and bronchoscopy revealed a retained incisor lodged in the left main bronchus. Flexible bronchoscopy was unsuccessful because of dense impaction and bleeding; however, definitive extraction was achieved using rigid bronchoscopy under general anesthesia. Post-procedure recovery was uneventful, and six-month follow-up demonstrated complete clinical and radiologic resolution. This case highlights the importance of considering FBA in adults with chronic, unexplained pulmonary symptoms, the potential consequences of repeated empirical antibiotic therapy - particularly in resource-limited settings - and the critical role of rigid bronchoscopy in definitive management.

Background and objectives The Salmonella strains causing bloodstream infection show wide genetic diversity together with different antibiotic resistance profiles worldwide. The response of typhoidal Salmonella to standard antimicrobial treatments has become increasingly concerning during the past few decades. This study was conducted to evaluate the occurrence rate, antibiotic susceptibility patterns, and clinical characteristics of patients with Salmonella bacteraemia in a tertiary care hospital in Pune, Maharashtra, India. Methods A cross-sectional study was conducted from March 2024 to March 2025, analysing blood culture-confirmed cases of enteric fever. All patients with Salmonella-positive cultures were included, and data were gathered from clinical and microbiology records. Results Out of 6,862 blood cultures processed, 42 (0.6%) tested positive for Salmonella species. Of these, 50% were Salmonella Typhi, 36% were Salmonella Paratyphi A, and the remaining 14% included S. Cholerasuis, S. Typhimurium, and S. Gallinarum. All S. Typhi and S. Paratyphi A isolates were fully susceptible to first-line antibiotics, including chloramphenicol, amoxicillin, and co-trimoxazole, as well as to ceftriaxone and cefixime. However, 78.5% of isolates showed reduced susceptibility to ciprofloxacin. Initial disc diffusion testing suggested potential azithromycin resistance in 11 isolates, but confirmatory E-strip testing found none to be resistant based on MIC values. One S. Paratyphi A isolate exhibited a notably high MIC of 24 µg/mL, which is not classified as resistant according to U.S. NARMS guidelines. Interpretation and conclusions The increasing azithromycin MIC values among typhoidal Salmonella indicate potential resistance development, so additional research should assess azithromycin susceptibility patterns in detail.

Antibiotic prioritization in wastewater treatment plants (WWTPs) commonly relies on influent-effluent changes. Such assessments may mask differences among configurations, treatment contexts, and endpoint media. Here, we established a process-resolved antibiotic Environmental Health Prioritization index (PA-EHPi). At the configuration × antibiotic scale, PA-EHPi integrates effluent occurrence, apparent removal, ecological risk, and antimicrobial resistance selection pressure. Across anaerobic-anoxic-oxic (AAO), sequencing batch reactor (SBR), and membrane bioreactor (MBR) treatment configurations with broadly comparable influent antibiotic profiles and conventional pollutant removals, PA-EHPi revealed distinct priority profiles. PA-EHPi identified 2 of 22 antibiotics as priorities in AAO, 9 of 26 in SBR, and 9 of 24 in MBR. Azithromycin and clarithromycin remained priorities across all three configurations. Treatment-train diagnosis further revealed stable apparent removal in the sampled AAO plants, fluctuating removal in SBR plants, and significant terminal rebound in MBR plants. Linking PA-EHPi with sludge partitioning and antibiotic resistance gene profiles translated effluent priorities into endpoint-specific management pathways, identifying quinolones as dual effluent-sludge concerns, macrolides as effluent residual targets, tetracyclines as sludge-associated concerns, and chloramphenicols as resistance-background monitoring targets. Overall, the established PA-EHPi extends static effluent ranking into a process- and endpoint-resolved diagnostic framework, helping identify priority targets for antibiotic control and multimedia management in WWTPs.

In the article "Suárez-Casillas P, Mejías-Trueba M, Peñalva G, Fontán-Díaz F, Villanueva-Bueno C, Herrera-Hidalgo L, Varela-Rubio E, Jiménez-Parrilla F, Cisneros JM, Gil-Navarro MV, Guisado-Gil AB. Antimicrobial Use Monitoring in Neonatal Population Using a Defined Daily Doses Method. Neonatology. 2026;123(1):64-73. https://doi.org/10.1159/000548869" the authors identified a mathematical error in the calculation of antimicrobial consumption data reported in the Results section ("Evaluation of Antimicrobial Consumption"). Specifically, the conversion factors used to transform adult defined daily doses (DDD) into neonatal defined daily doses (DDDn) were incorrectly applied as multiplication instead of division.This error occurred during the data processing stage when applying the conversion methodology, resulting in systematically incorrect numerical values in the manuscript, Table 1 and 2, and Figures 1 and 2. The corrected values are now highlighted in yellow in the revised manuscript.Table 1.DDDn values assessment based on the established criteriaAntimicrobialsTheoretical DDDn1DDDn actual prescriptions2Individual differences between DDDn values3DDDn selection criteria4DDDn value, g/dayvalue, g/daydegree of consensusNmedian, g/day95% CImedian, g/day95% CIpower >80%relative difference value5 (>10%)statistical significance (p < 0.01)degree of agreement (>75%)Azithromycin IV60.0310010.06---NA-NAYes0.03Cefepime IV60.2762.5580.270.20 to 0.340-0.07 to 0.08NoNoNoNo0.27(76%)(0%)(0.858)Ceftriaxone IV60.1310020.13---NA-NAYes0.13Piperacillin- tazobactam IV0.5466.71300.300.27 to 0.450.240.14 to 0.27Yes (98%)Yes (44%)Yes (<0.001)No0.30Tobramycin IV60.0188.910.01---NA-NAYes0.01Amoxicillin-clavulanic acid VO60.0855.6440.080.04 to 0.200-0.04 to 0.03NoNoNoNo0.08(64%)(0%)(0.054)Azithromycin VO60.0310010.04---NA-NAYes0.03Cefixime VO60.0210050.03---NA-NAYes0.02Fluconazole VO60.0288.920.03---NA-NAYes0.02Linezolid VO60.0810010.02---NA-NAYes0.08DDDn, Defined Daily Doses for neonatal population; CI, confidence intervals; IV, intravenous; VO, oral.1Theoretical DDDn: DDDs agreed upon by a panel of expert. The results of the expert panel are published in Villanueva-Bueno et al. [11, 12].2DDDn actual prescriptions: DDDs obtained from actual prescriptions. N: number of actual prescriptions obtained in the present study combined with the data from Villanueva-Bueno et al. [11]3Individual differences between DDDn values: difference between the theoretical DDDn and the DDDn obtained from actual prescriptions.4DDDn Selection Criteria: established criteria to select DDDn values (online suppl. Table S2).5Relative difference (%): difference between the theoretical DDDn and the DDDn obtained from actual prescriptions, expressed as the absolute value of the percentage.6Antimicrobials with insufficient potency; the DDDn values were estimated based on expert consensus due to a lack of empirical data. They should therefore be approached with caution.Table 2.Antimicrobial consumption during the study period (2016-2023)Antimicrobials20162017201820192020202120222023Mean±SDAmikacin3.20714.07210.9970.9390.0111.2240.0001.6364.011±5.420Amoxicillin13.0507.76216.2926.6760.0006.84813.31315.7539.962±5.592Amoxicillin-clavulanic acid24.9483.3208.96812.4499.51115.6209.2049.57311.699±6.377Ampicillin77.96410.50517.39543.12520.48228.21124.04528.01431.218±21.156Azithromycin0.4496.3532.4091.0010.2830.0001.8241.0001.665±2.057Cefazolin6.5347.1090.9326.3921.8342.3470.1152.2863.444±2.783Cefepime0.0080.3290.4180.9820.5600.8710.4270.2930.486±0.316Cefixime0.808------1.6360.306±0.607Cefotaxime39.71535.92930.97823.60620.31626.79118.15520.74027.029±7.845Ceftriaxona1.4302.5230.3032.3113.2600.8780.6860.6291.503±1.072Cloxacillin7.5844.3813.1843.9006.6503.4205.8005.6635.073±1.596Fluconazole31.114110.71653.55572.85659.75184.42823.10772.79663.540±28.372Gentamicin29.50445.92420.33917.58532.62324.18024.03326.06327.532±8.819Linezolid0.0000.0000.0000.0000.0630.0740.4180.0070.070±0.144Meropenem19.62733.56514.5888.9015.3409.3708.0819.85213.666±9.169Piperacillin-tazobactam13.03810.23610.1787.4694.2449.6695.2356.9408.376±2.926Tobramycin4.1582.5312.77117.3246.1132.0232.0110.1624.637±5.412Vancomycin18.00435.22018.2910.0080.0070.01416.13115.79012.933±12.367 291.140330.475211.600225.524171.047215.966152.586218.833227.146±58.453Data are presented as defined daily doses (DDDn) per 1,000 occupied bed days (OBDs). SD, standard deviation.Fig. 1.Consumption of the five most frequently prescribed antibiotics during the study period (2016-2023). Date are presented as defined daily dose for neonatal population (DDDn) and DDD related to adult doses per 1,000 patients occupied bed days (OBDs).Fig. 2.Consumption comparisons between 2016 and 2023. Data are presented as defined daily doses for neonatal population (DDDn) per 1000 patients occupied bed days (OBDs).The error was identified during the preparation of a subsequent multicenter study in Spain, in which the same conversion approach was being applied. During internal validation, the unexpectedly low consumption values prompted a re-examination of the calculation procedure, at which point the incorrect application of the conversion factor was detected. After correction, all results were recalculated and independently verified by the study team to ensure accuracy and consistency with the original raw data.Importantly, this correction does not affect the study methodology, nor does it change the overall interpretation or conclusions of the article.The article has been updated to reflect these changes and the original publication has been archived by the journal.

Complete responses in metastatic pancreatic adenosquamous carcinoma (ASCP) are extremely rare and carbohydrate antigen 19-9 (CA 19-9) interpretation is difficult during cholestasis. A 65-year-old man underwent Whipple procedure on 29 May 2025; pathology confirmed ASCP (pT3 pN2, R0). Contrast-enhanced magnetic resonance imaging (MRI) on 26 June 2025 showed 11 liver lesions interpreted as metastases. Treatment with folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) began on 7 July 2025. From cycle 2, high-dose intravenous vitamin C, doxycycline and later azithromycin were added by the patient and author as off-label home measures, without efficacy claims. After three cycles, follow-up MRI showed complete radiological regression of the hepatic lesions; MRI around the sixth cycle confirmed complete radiological response. Chemotherapy stopped after six cycles. In late September 2025, cholestasis and CA 19-9 rise were initially suspected as recurrence; after ursodeoxycholic acid, CA 19-9 decreased and normalized by 10 January 2026. Follow-up MRI on 20 February 2026 showed no visible hepatic lesions.

Salmonella Typhi is an invasive pathogen with sustained bacteraemia and intracellular persistence, requiring therapy that achieves systemic exposure and intracellular penetration. Clinical efficacy should remain central to therapeutic decision-making, while pharmacokinetic/pharmacodynamic (PK/PD) analyses provide complementary insights into dose optimization and the pharmacological limitations of candidate therapies. Oral therapy remains central to typhoid fever management, particularly in South and Southeast Asia, where most patients are managed in the outpatient setting. However, the emergence of MDR and extensively drug-resistant (XDR) S. Typhi has substantially narrowed the available oral treatment options. Azithromycin remains the only widely available oral agent with established clinical efficacy, but emerging resistance threatens its continued utility. Several alternative oral agents, including mecillinam, faropenem, tebipenem, fosfomycin and β-lactam/β-lactamase inhibitor combinations, demonstrate favourable in vitro activity against S. Typhi. However, robust clinical efficacy and contemporary PK/PD data are lacking to support their use against MDR and XDR S. Typhi. Addressing these evidence gaps through integrated PK/PD investigations and prospective clinical trials will be essential to expand the oral therapeutic armamentarium for typhoid fever.

There is an urgent need for novel antimicrobials to treat multidrug-resistant strains of Neisseria gonorrhoeae. In a phase III trial (EAGLE-1), gepotidacin, a first-in-class triazaacenaphthylene antibacterial, demonstrated non-inferiority to ceftriaxone plus azithromycin as measured by microbiological success for the treatment of uncomplicated urogenital gonorrhea. Here, we assessed the in vitro activity of gepotidacin against key N. gonorrhoeae drug-resistant phenotypes and genotypes from EAGLE-1. There were 408 baseline urogenital isolates recovered from 406 patients during the EAGLE-1 study. Agar dilution minimum inhibitory concentration (MIC) susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines, and all isolates were molecularly characterized. All of the isolates were susceptible to ceftriaxone. All isolates had gepotidacin MICs of ≤2 µg/mL, with values ranging from ≤0.06 to 2 µg/mL; MIC50, 0.25 µg/mL, and MIC90, 0.5 µg/mL. As defined by the Food and Drug Administration (FDA) breakpoints and interpretive criteria (MIC breakpoints of ≤1 µg/mL [susceptible]; 2 µg/mL [intermediate]; and ≥4 µg/mL [resistant]), 99% of the study isolates were susceptible to gepotidacin, 1% were intermediate, and no isolates were resistant. Susceptibility percentages remained high across resistance phenotypes and genotypes. These findings support the in vitro activity of gepotidacin against the N. gonorrhoeae isolates, including drug-resistant phenotypes and genotypes, recovered in the EAGLE-1 clinical study.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT04010539.