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Issue: Newsletter 17 | April 1, 2026

Randomised Controlled Trials

Citation of Articles PICO Main Results Risk of Bias
Neyra JA, Legrand M, Tidswell MA, Al-Khafaji A, Galphin C, Rains R, et al. Polymyxin B haemoadsorption in endotoxic septic shock (Tigris): a multicentre, open-label, Bayesian, randomised, controlled, phase 3 trial. Lancet Respir Med. 2026 Mar 23; doi:10.1016/S2213-2600(26)00047-0

• Editorial Commentary:
Schupp T, Behnes M, Akin I. Implementing endotoxin adsorption for septic shock into clinical practice. Lancet Respir Med. 2026 Mar 23; doi:10.1016/S2213-2600(26)00055-X 		P: 157 adults with endotoxic septic shock requiring vasopressors, multiorgan failure, and endotoxin activity between 0.60 and 0.89 units.
I: Two 90-120 minute sessions of polymyxin B haemoadsorption, administered 22 hours apart, in addition to standard of care.
C: Standard of care alone.
O: The primary outcome was 28-day mortality. The key secondary outcome was 90-day mortality. 		Polymyxin B haemoadsorption was associated with a high probability of benefit for mortality. At 28 days, mortality was 39% in the polymyxin B group versus 45% in the control group (adjusted odds ratio 0.67, 95% credible interval 0.39–1.08), yielding a 95.3% posterior probability of benefit. The benefit was more pronounced at 90 days, with a 99.4% posterior probability of a lower mortality rate (adjusted odds ratio 0.54, 95% credible interval 0.32–0.87). Serious adverse events were more common in the treatment group (30% vs. 22%), but only two events were deemed related to the treatment. Moderate risk: The open-label design is a significant limitation, creating a high risk of performance and detection bias, as clinicians and patients were aware of the treatment allocation. The study's credibility is strengthened by its randomized design, use of an intention-to-treat analysis, and hard mortality endpoints. However, the use of a Bayesian framework that borrowed from a prior trial (EUPHRATES) and the relatively small sample size are potential limitations that could influence the results.
Lotz C, Heckelmann J, Lendzian C, Herrmann J, Haack B, Gieselmann M, et al. Clinical and Immunologic Effects of Extracorporeal Cytokine Removal in Patients with Septic Shock: A Randomized Controlled Trial. Shock. 2026 Apr;65(4):637-47. doi:10.1097/SHK.0000000000002802 P: 31 adult patients with septic shock, an existing extracorporeal circuit (CVVHD or ECMO), and hyperinflammation (interleukin-6 >500 pg/mL).
I: Standard care plus CytoSorb hemoadsorption, initiated within 24 hours of septic shock onset.
C: Standard care alone, according to international sepsis guidelines.
O: Primary: Cumulative norepinephrine dose over 72 hours. Secondary: Survival at 48/72 hours, ICU mortality, length of stay, duration of septic shock, and various immunological endpoints. 		Early hemoadsorption with CytoSorb did not improve outcomes and was associated with worse results on some measures. The primary outcome, cumulative norepinephrine dose at 72 hours, was not significantly different between the intervention and control groups (100.7 mg vs 78 mg, P=0.09). However, the control group had a significantly lower total vasopressor dose per hour alive (1.2 mg vs. 2.5 mg, P=0.0053) and significantly higher survival rates at both 48 hours (100% vs. 64%, P=0.01) and 72 hours (94% vs. 57%, P=0.03). No significant differences were observed in ICU mortality, length of stay, or humoral immune responses. High risk: The open-label design, where patients, care providers, and the study team were all unblinded, creates a significant potential for performance and detection bias. The very small sample size (n=31) and single-center design severely limit the statistical power and the generalizability of the findings. Furthermore, the duration of hemoadsorption and the timing of adsorber changes were left to the discretion of the attending ICU team, introducing potential variability and inconsistency in the application of the intervention.
Chen WH, Beckett CG, Al-Ibrahim M, Datar R, Sikorski MJ, Liang Y, et al. Safety and Immunogenicity of a Trivalent Salmonella Conjugate Vaccine to S. Typhi, S. Typhimurium, and S. Enteritidis. J Infect Dis. 2026 Mar 26; doi:10.1093/infdis/jiag156 P: 80 healthy adults aged 20–47 years.
I: A single dose of one of three formulations of a trivalent Salmonella conjugate vaccine (TSCV): full-strength (FS), half-strength (HS), or dilutional half-strength (dilHS).
C: Placebo.
O: Safety (local and systemic adverse events) and immunogenicity (serum antibody and antibody-secreting cell responses). 		All three vaccine formulations were well tolerated, with mild injection site pain and fatigue being the most common adverse events. The vaccines produced robust immune responses to all three Salmonella antigens, with response rates ranging from 85% to 100%. There was no statistically significant difference in the immune response observed between the three different vaccine strengths. As expected, participants who received the placebo did not show any significant antibody or cellular responses. Low to Moderate risk: As a Phase 1/2a trial, the study has a small sample size (n=80), which limits statistical power and the generalizability of the findings to the target population of young children. The abstract does not specify if the trial was blinded, which could introduce performance or detection bias if it was an open-label study. The use of healthy adults as a surrogate for the pediatric target population is a standard practice for initial safety trials but means the immunogenicity results may not be directly transferable.
Todd S, Euden J, Condie J, Aston S, Barlow G, Brookes-Howell L, et al. Procalcitonin testing combined with NEWS2 evaluation compared with usual care based on NEWS2 for identification of sepsis and antibiotic initiation in the emergency department in England and Wales (PRONTO): a multicentre, randomised, controlled, open-label, phase 3 trial. Lancet Respir Med. 2026 Mar 22; doi:10.1016/S2213-2600(25)00433-3

• Editorial Commentary:
Cabral S, Rhee C. Rethinking the role of procalcitonin in suspected sepsis. Lancet Respir Med. 2026 Mar 22; doi:10.1016/S2213-2600(25)00471-0 		P: 5453 adults (from an initial 7667 randomized) with suspected sepsis presenting to 20 UK emergency departments.
I: Procalcitonin-guided care, using rapid procalcitonin testing in combination with standard NEWS2 assessment and a guidance algorithm.
C: Usual care, based on standard clinical management with NEWS2 assessment.
O: Co-primary endpoints were intravenous antibiotic initiation at 3 hours (for superiority) and 28-day mortality (for non-inferiority). 		The availability of a procalcitonin-guided algorithm did not reduce early antibiotic use; there was no significant difference in intravenous antibiotic initiation at 3 hours between the groups (48.4% in the procalcitonin group vs. 48.2% in the usual care group). However, the study found an unexpected reduction in 28-day mortality in the procalcitonin group (13.6%) compared to the usual care group (16.6%), a result that met the criteria for both non-inferiority and superiority. The reason for this mortality benefit was not explained by the study's analyses. High risk: The open-label design, where participants, clinicians, and research staff were all unmasked to the treatment allocation, creates a significant risk of performance and detection bias. This knowledge could have influenced clinical behaviors in ways other than just following the algorithm, potentially confounding the results. Adherence to the intervention was also suboptimal, as clinicians only considered the procalcitonin result in about 65% of cases, which complicates the interpretation of the findings.
Wrønding T, Vomstein K, Lundgaard AT, DeLong K, Mollerup S, Mortensen B, et al. Vaginal microbiota transplantation for treatment of vaginal dysbiosis without the use of antibiotics: a double-blind, randomised controlled trial in women with vaginal dysbiosis. Lancet Microbe. 2026 Mar 26; doi:10.1016/j.lanmic.2025.101294 P: 49 premenopausal women (aged 18–40) with asymptomatic or symptomatic molecular vaginal dysbiosis (defined as <10% Lactobacillus spp and >20% combined Gardnerella spp, Fannyhessea vaginae, and Prevotella spp).
I: Up to three administrations of vaginal microbiota transplant (VMT) across three menstrual cycles, without antibiotic pretreatment.
C: Placebo administration.
O: The primary outcome was the resolution of dysbiosis (defined as ≥70% Lactobacillus spp and <10% combined dysbiotic bacteria) at any timepoint during a six-cycle follow-up. 		The study found no significant difference in the resolution of dysbiosis between the VMT and placebo groups (Hazard Ratio 0.65, 95% CI 0.20–2.16; p=0.49). Adverse events were equally common in both groups (42%), with no serious events reported. However, in a small, un-randomized extension study involving 10 participants who had not responded to the initial treatment, 50% achieved microbiome conversion after receiving an antiseptic pretreatment followed by another VMT. Moderate risk: The study's main strength is its double-blind, randomized, placebo-controlled design, which minimizes performance and detection bias. However, the very small sample size (n=49) is a significant limitation, as it provides low statistical power to detect a true difference between the groups, increasing the risk of a false-negative result (Type II error). The single-center design may also limit the generalizability of the findings.
Lee JL, Kim HJ, Kim KM, Yi JM, Oh J, Lee EK, et al. Target-controlled infusion vs standard dosing of cefoxitin for surgical prophylaxis in colorectal surgery: A randomized clinical trial. Clin Microbiol Infect. 2026 Mar 17; doi:10.1016/j.cmi.2026.03.019 P: 2,494 adults undergoing elective colorectal surgery.
I: Cefoxitin administered via a target-controlled infusion (TCI) pump targeting a specific plasma concentration (80 μg/mL).
C: Standard dosing of cefoxitin (2 g every 2 hours).
O: Primary: Incidence of surgical site infection (SSI) within 30 days. Secondary: Intraoperative cumulative cefoxitin dose and incidence of acute kidney injury (AKI). 		The study found no difference in the primary outcome, with the incidence of surgical site infection being identical in both groups (5.6%). However, the target-controlled infusion (TCI) method resulted in a significantly lower intraoperative antibiotic exposure, with the median cumulative dose being approximately 30% less than in the standard dosing group (1.38 g vs. 2.00 g). There was no significant difference in the rates of acute kidney injury between the two groups. Low to Moderate risk: The study's major strength is its large sample size (n=2,494) and randomized controlled design, which provides high statistical power for the primary outcome. The endpoints are objective, reducing the risk of detection bias. However, the abstract does not specify whether surgeons or outcome assessors were blinded to the treatment allocation, which could introduce bias. Additionally, as a single-center trial, the findings may have limited generalizability to other institutions with different patient populations or surgical protocols.
Bijukchhe SM, Marchevsky NG, Kibengo F, Sharma AK, Basi R, Cantrell L, et al. Optimising DTwP-containing vaccine infant immunisation schedules in Uganda and Nepal (OptImms): two open-label, non-inferiority, randomised controlled trials. Lancet Infect Dis. 2026 Mar 19; doi:10.1016/S1473-3099(26)00053-8 P: 1727 healthy infants (876 in Uganda, 851 in Nepal) aged 42–50 days at enrollment.
I: Four alternative DTwP-Hib-HepB vaccination schedules: two reduced-dose schedules (at 6 & 14 weeks; or 2 & 4 months) and two delayed three-dose schedules (at 2, 3, & 4 months; or 2, 4, & 6 months).
C: The standard three-dose WHO schedule (at 6, 10, and 14 weeks).
O: The primary outcome was the pre-booster IgG antibody response against pertussis antigens to assess if the two-dose schedules were non-inferior to the WHO schedule. Secondary outcomes included antibody responses at other time points. 		The reduced two-dose schedules failed to meet the non-inferiority criteria for pre-booster pertussis antibody levels compared to the standard WHO schedule. While the delayed three-dose schedules produced similar or higher antibody levels just before the booster, the standard WHO schedule was superior in generating higher antibody responses during the first 3 months of life. The authors concluded that the standard WHO schedule is preferable, especially in high-pertussis-burden settings, as it provides the best protection when infants are most vulnerable. Moderate risk: The open-label design, where investigators and participants were not blinded to the vaccine schedule, could introduce performance bias. However, this risk is mitigated because the primary outcome is an objective laboratory measurement (antibody levels), which is not susceptible to subjective interpretation. The study's strengths include its large, multi-country, randomized design and the use of a pre-defined non-inferiority margin, which strengthens the validity of the primary analysis.
Wassil J, Fairman J, Fierro CA, Clark J, Bennett S, Johnson D, et al. Safety, tolerability, and immunogenicity of a 31-valent pneumococcal conjugate vaccine (VAX-31) in healthy adults aged 50 years and older from the USA: a phase 1/2, double-blinded, active-controlled, parallel-group, dose-finding randomised clinical trial. Lancet Infect Dis. 2026 Mar 18; doi:10.1016/S1473-3099(26)00059-9 P: 1015 healthy, pneumococcal-naive adults aged 50 years or older.
I: A single intramuscular dose of VAX-31, a 31-valent pneumococcal conjugate vaccine (PCV), at one of three dose levels (low, mid, or high).
C: A single intramuscular dose of the licensed 20-valent PCV (PCV20).
O: Primary outcomes were safety and tolerability (adverse events). Secondary outcomes were immunogenicity, measured by serotype-specific opsonophagocytic activity (OPA) and IgG concentrations at 1 month. 		VAX-31 was well tolerated at all doses, with a safety profile comparable to the licensed PCV20. Most adverse events were mild to moderate. The mid-dose and high-dose VAX-31 formulations demonstrated immune responses that were non-inferior to PCV20 for all 20 shared serotypes. Furthermore, all three doses of VAX-31 elicited superior immune responses for the 11 additional serotypes not contained in PCV20. Low risk: The study's double-blind, randomized, active-controlled design is a major strength, minimizing the risk of performance and detection bias. The use of a multi-center approach enhances the generalizability of the findings. As a Phase 1/2 trial, its primary focus is on safety and immunogenicity rather than clinical efficacy, which is an inherent limitation of early-phase research but not a flaw in its design for the stated objectives.
Last A, Abdurahman OS, Greenland K, Robinson A, Etu ES, Butcher R, et al. Double-dose azithromycin mass drug administration, facial cleanliness, and fly control measures for trachoma control in Oromia, Ethiopia (Stronger SAFE): a cluster-randomised controlled trial. Lancet Infect Dis. 2026 Mar 24; doi:10.1016/S1473-3099(26)00024-1 P: 68 rural community clusters in Oromia, Ethiopia, with the primary outcome assessed in a cross-section of 3,480 children aged 1–9 years.
I: The "Stronger SAFE" intervention, consisting of enhanced antibiotics (two annual doses of azithromycin 2 weeks apart) plus enhanced facial cleanliness and environmental improvement (fly control and a household behavior change intervention).
C: The "Standard SAFE" intervention (control group), consisting of annual single-dose azithromycin mass drug administration plus standard promotion of latrine use and facial hygiene.
O: The primary outcome was the prevalence of conjunctival Chlamydia trachomatis infection at 3 years. 		After three years of intervention, both groups saw a substantial reduction in the prevalence of C. trachomatis infection. However, the enhanced "Stronger SAFE" strategy provided no additional benefit compared to the standard SAFE strategy. The infection prevalence was 2.2% in the Stronger SAFE group versus 2.7% in the standard care group, a difference that was not statistically significant. The authors concluded that these enhanced measures are unlikely to accelerate trachoma elimination beyond what can be achieved with well-implemented, high-coverage standard SAFE. Moderate risk: The study has a strong cluster-randomized design with an objective primary outcome (PCR test), and key personnel (lab technicians, statistician) were masked, which reduces detection and analysis bias. However, the open-label nature of the trial, where communities and field staff knew the intervention allocation, creates a risk of performance bias. This could have led to a "study effect," where the standard SAFE intervention in the control group was implemented with unusually high fidelity and coverage, potentially masking any true additional benefit from the enhanced interventions.
de Graaf H, Gbesemete DF, Hill AR, Fröberg J, Ibrahim MM, Dale AP, et al. Safety, colonisation kinetics, transmissibility, and immune correlates of protection in healthy adults inoculated with Bordetella pertussis in England: a single-centre, open-label, phase 1, controlled human infection study. Lancet Microbe. 2026 Mar 23; doi:10.1016/j.lanmic.2025.101313 P: 51 healthy volunteers aged 18–55 years who had previously received a whole-cell pertussis vaccine in childhood.
I: Intranasal inoculation with wild-type Bordetella pertussis in an outpatient setting, with a subsequent re-inoculation for a subset of participants.
C: The primary comparison was between volunteers who became colonized with B. pertussis and those who did not, to identify immunological correlates of protection.
O: The primary outcome was safety. Secondary outcomes included the rate of bacterial colonization, identification of immunological biomarkers associated with protection, and assessment of transmission to close contacts. 		The outpatient controlled human infection model was found to be safe, with adverse events being mostly mild to moderate and no serious adverse events related to the inoculation. 40% of volunteers became colonized. Protection from colonization was associated with higher pre-existing antibody levels (including IgG and IgA) and specific T-cell responses. Infection-induced immunity was strong, as only 1 of 13 previously colonized volunteers became re-colonized upon rechallenge. No transmission was detected to 14 enrolled close contacts. Low to Moderate risk: The study's open-label design is inherent to a human challenge model but introduces a risk of performance and detection bias for subjective outcomes like self-reported symptoms. However, the key outcomes of colonization and immunological response were measured by objective laboratory tests, minimizing this bias. The main limitations are the small, single-center sample size and the specific population (healthy adults primed with whole-cell vaccine), which restrict the generalizability of the findings to other populations, such as those primed with acellular vaccines.

Target Trial Emulation

Bartoletti M, Rosselli Del Turco E, Bussini L, Paul M, Fares Sabik E, Castagna A, et al. Monotherapy vs combination therapy for Enterococcus faecalis bacteremia: a target trial emulation. Clin Microbiol Infect. 2026 Mar 16; doi:10.1016/j.cmi.2026.03.018

  • Summary: In a multicenter international cohort of 373 adults with Enterococcus faecalis bloodstream infection without endocarditis, combination antibiotic therapy (e.g., ampicillin plus ceftriaxone or gentamicin) did not improve 90-day clinical outcomes compared to monotherapy, with similar rates of composite failure (death, relapse, or endocarditis), suggesting that simpler monotherapy may be sufficient and support antimicrobial stewardship, while sepsis or septic shock at presentation was the main factor associated with failure.

Trial Protocols / Trial Ideas

Mawson P, Morton M, Walmsley Z, Wafer R, Hancock HC, Mossop H, et al. SHORTER trial: protocol for a pragmatic, multicentre, randomised controlled trial of short-duration antibiotic therapy for critically ill patients with sepsis. BMJ Open. 2026; doi:10.1136/bmjopen-2026-117142

  • Summary: The SHORTER trial is a large multicentre UK randomised controlled study enrolling 2244 critically ill adults with suspected or confirmed sepsis to evaluate whether a fixed 5-day antibiotic course is non-inferior to standard-duration therapy for 28-day mortality while reducing antibiotic use, with additional assessment of longer-term outcomes, readmissions, infection rates and cost-effectiveness to address uncertainty around optimal antibiotic duration in sepsis.

Banerjee R, Komarow L, Li Y, Wu Q, Sanchez-Gonzalez L, Mau D, et al. Study protocol for a multicenter, multinational prospective randomized controlled trial comparing outcomes in subjects with Gram-negative bacteremia who have blood culture evaluation using Fast Antibiotic Susceptibility Testing vs. standard of care testing: the FAST trial. Trials. 2025 Nov 12;26:500. doi:10.1186/s13063-025-09228-4

  • Summary: This multicentre multinational randomised controlled trial of 900 hospitalized patients with Gram-negative bloodstream infections compares rapid phenotypic antibiotic susceptibility testing using VITEK REVEAL™ plus standard care versus standard methods alone to determine whether faster results improve clinical outcomes, including a composite desirability ranking, mortality, length of stay, and timeliness of antibiotic optimisation in high-resistance settings.

Guidelines

Prescott HC, Antonelli M, Alhazzani W, Møller MH, Alshamsi F, Azevedo LCP, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026 Mar 23; doi:10.1097/CCM.0000000000007075

  • Summary: The 2023 Surviving Sepsis Campaign guidelines provide evidence-based recommendations for the identification, management, and post-hospital care of adult patients with sepsis, emphasizing early intervention, antimicrobial stewardship, and patient-centered outcomes; developed by a 69-member international committee with diverse clinical and geographic representation including LMICs, the guidelines used rigorous PICO-based evidence synthesis, consensus voting, and patient/family input to produce actionable guidance across six clinical domains, supporting clinicians and health systems in improving sepsis outcomes globally.

Antibiotic Therapy Reviews

Gatti M, Pea F. Pharmacological approaches to overcome antimicrobial resistance in gram-negative bacterial infections: current practice and future directions. Expert Opin Pharmacother. 2026 Mar 27; doi:10.1080/14656566.2026.2651279

  • Summary: This review highlights the critical need to prevent resistance development among Gram-negative pathogens and emphasizes that optimizing the pharmacokinetic/pharmacodynamic (PK/PD) use of novel beta-lactams and beta-lactam/beta-lactamase inhibitor combinations—through aggressive PK/PD targets, prolonged or continuous infusion, and therapeutic drug monitoring—can help preserve antimicrobial efficacy, supported by both preclinical and clinical evidence.

Lyu S, Luo J, Liu P, Qin X, He W, Jing G, et al. Inhaled antibiotics to treat ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2026 Mar 16; doi:10.1097/CCM.0000000000007072

  • Summary: This systematic review and meta-analysis of 32 RCTs and 41 non-RCTs demonstrates that adjunctive inhaled antibiotics in ventilator-associated pneumonia significantly improve clinical cure, microbiological eradication, and reduce all-cause mortality—particularly in VAP-only populations—while also decreasing emergence of new drug resistance, and exploratory analyses suggest potential benefits over intravenous therapy, including shorter ventilator duration and lower nephrotoxicity, supporting the need for further high-quality trials.

PK/PD and Drug Dosing

Timsit JF, Joannes-Boyau O, Bracht H. The time has come for optimizing beta-lactam therapy in critically ill patients with renal dysfunction. Intensive Care Med. 2026 Mar 23; doi:10.1007/s00134-026-08376-8

  • Summary: Achieving effective antibiotic therapy in critically ill patients requires rapidly attaining optimal β-lactam pharmacokinetic/pharmacodynamic (PK/PD) targets, as subtherapeutic concentrations in the first 24–48 hours increase the risk of treatment failure, resistance, and mortality; strategies such as continuous or prolonged infusion, model-informed precision dosing, nomograms for initial dosing, and therapeutic drug monitoring (TDM) can improve target attainment, particularly in patients with altered pharmacokinetics or on renal replacement therapy, though clinical trials show mixed results on survival benefits and TDM remains primarily a supportive tool for dose adjustment rather than a proven means to improve outcomes.

van den Berg S, Pieren M, Sassen SDT, de Jong WAM, Boonman CSC, Dale GE, et al. The pharmacodynamics of polymyxin B in Acinetobacter baumannii in murine thigh and lung infection models. J Antimicrob Chemother. 2026 Apr;81(4):dkag097. doi:10.1093/jac/dkag097

  • Summary: This preclinical study using murine models shows that while polymyxin B achieves effective bacterial killing in thigh infections caused by Acinetobacter baumannii, its efficacy is limited in lung infections, and standard human dosing regimens are unlikely to reach pharmacodynamic targets without exceeding toxicity thresholds, indicating that polymyxin B monotherapy may be insufficient for treating A. baumannii infections.

Antibiotics - In vitro susceptibility

Kunz Coyne AJ, Gray R, Gonnabathula P, May ES, Tamma PD, Do A, et al. Comparative in vitro activity of aztreonam–avibactam and aztreonam plus ceftazidime–avibactam against Stenotrophomonas maltophilia complex. Antimicrob Agents Chemother. 2026 Mar 24; doi:10.1128/aac.01456-25

  • Summary: This in vitro study demonstrates that aztreonam–avibactam (ATM–AVI) and aztreonam plus ceftazidime–avibactam (ATM–CZA) have comparable bactericidal activity against Stenotrophomonas maltophilia complex isolates, though isolate-specific differences exist, with ATM–AVI showing sustained killing in blaL2-dominant strains and ATM–CZA more effective against blaL1 or smeABC-dominant strains, highlighting the need for further investigation into genotype–phenotype relationships to guide optimal therapy.

Gashaw Y, Sisay A, Getachew E, Asmare Z, Geteneh A, Tamrat E, et al. Colistin-resistance among Acinetobacter baumannii and Pseudomonas aeruginosa from clinical specimens in Africa: a systematic review and meta-analysis. JAC Antimicrob Resist. 2026 Apr;8(2):dlag039. doi:10.1093/jacamr/dlag039

  • Summary: This systematic review and meta-analysis of African clinical isolates shows a rising prevalence of colistin resistance in Acinetobacter baumannii (13.75%) and Pseudomonas aeruginosa (14.42%) with substantial geographic variation and increasing trends over time, highlighting the urgent need for strengthened antimicrobial stewardship, infection control, and molecular surveillance to curb the spread of resistance.

Pham TH, Molina KC, Huang V. Predicting oral cephalosporin susceptibility in Escherichia coli blood isolates using parenteral cephalosporin susceptibility testing. J Antimicrob Chemother. 2026 Apr;81(4):dkag093. doi:10.1093/jac/dkag093

  • Summary: This study evaluated whether parenteral cephalosporin susceptibility testing can predict oral cephalosporin activity in Escherichia coli bloodstream isolates and found that ceftriaxone and cefotaxime reliably predict oral third-generation cephalosporin susceptibility, while cefazolin MIC ≤2 mg/L may serve as a surrogate for oral second-generation agents despite high rates of minor and major errors, indicating the need for further clinical validation.

Beta-Lactamases and Other Resistance Mechanisms

Nguyen HA, Peleg AY, Wisniewski JA, Wang X, Wang Z, Blakeway LV, et al. AMR-GNN: a multi-representation graph neural network framework to enable genomic antimicrobial resistance prediction. Nat Commun. 2026 Mar 6; doi:10.1038/s41467-026-69934-8

  • Summary: AMR-GNN is a graph neural network-based framework that integrates multiple genomic representations to predict antimicrobial resistance phenotypes from whole-genome sequencing data, demonstrated in Pseudomonas aeruginosa, and validated across a large dataset of Gram-negative and Gram-positive pathogens, providing improved performance, mitigation of clonal bias, and identification of informative biomarkers to enhance explainability and applicability in diverse clinically relevant pathogen-drug combinations.

Beh JQ, Howden BP, Webb JR, Connor CH. Global dissemination of optrA-mediated linezolid resistance in enterococci. J Antimicrob Chemother. 2026 Apr;81(4):dkag089. doi:10.1093/jac/dkag089

  • Summary: This genomic analysis of 565 enterococcal genomes reveals that the linezolid-resistance gene optrA is more frequently plasmid-borne in E. faecium than E. faecalis, with diverse genetic contexts including transposons (Tn6674, Tn6261) and multidrug-resistant fexA-optrA-erm(A)/(B) units, often mobilized by IS1216E elements, highlighting the critical role of mobile genetic elements in the global spread of optrA and the associated public health risk of plasmid-mediated drug-resistant enterococci.

Wang J, Zhang X, Zhang Y, Xie Q, Guo Y, Deng Q, et al. Emergence of carbapenem-resistant Escherichia coli coharboring blaCTX-M-199 and penicillin-binding protein 3 insertion conferring increased aztreonam/avibactam resistance in South China. J Infect Dis. 2026 Mar 15;233(Suppl_1):S81–S91. doi:10.1093/infdis/jiag025

  • Summary: This study identifies the emerging blaCTX-M-199 gene in carbapenem-resistant Escherichia coli isolates from South China, predominantly within high-risk clones ST410 and ST167, and demonstrates that blaCTX-M-199, often combined with YRIK/YRIN penicillin-binding protein 3 insertions and coharboring blaNDM-5, substantially reduces susceptibility to aztreonam/avibactam, highlighting the urgent need for surveillance and clinical detection of these multidrug-resistant strains.

González-Díaz A, Pinto M, Cadenas-Jiménez I, Duarte S, Ardanuy C, Ribeiro MM, et al. First identification and molecular characterization of CTX-M-15 extended-spectrum β-lactamase and OXA-9 β-lactamase in Haemophilus influenzae in the Iberian Peninsula. Microb Genet. 2026 Jan 30; doi:10.1128/aac.01649-25

  • Summary: This study reports, for the first time, CTX-M-15 and OXA-9 β-lactamases in Haemophilus influenzae strains from Portugal and Spain, carried on mobile integrative elements (ICEHpaHUB5-like and ICEHinHUB1), revealing multidrug resistance, genomic plasticity, and an expanded resistome, underscoring the need for ongoing genomic surveillance and caution in treatment strategies.

Antibiotic Stewardship

Walker MK, Yek C, Sarzynski S, Warner S, Harris AD, Baghdadi JD, et al. Survival trends in patients with difficult-to-treat, antibiotic-resistant, Gram-negative infections in the era of next-generation antibiotics in the USA: a retrospective cohort study. Lancet Infect Dis. 2026 Mar 25; doi:10.1016/S1473-3099(26)00020-4

Thomas A, Vogrin S, Batrouney A, Devchand M, Khumra S, Narayanasamy S, et al. Sustaining stewardship: longitudinal evaluation of an integrated antimicrobial programme in the ICU. J Antimicrob Chemother. 2026 Apr;81(4):dkag086. doi:10.1093/jac/dkag086

  • Summary: A 7-year prospective study of an ICU electronic medical record–driven antimicrobial stewardship (AMS) ward round at Austin Health showed high acceptance of AMS recommendations, particularly for antibiotic escalation, and sustained reductions in broad-spectrum antimicrobial use (piperacillin/tazobactam, meropenem, ciprofloxacin, vancomycin), with increased amoxicillin/clavulanate suggesting compensatory prescribing, demonstrating the long-term effectiveness and sustainability of the ICU-AMS programme.

Rafiq S, Shi C, Ghosal S, Dark P, Felton T, Kontopantelis E, et al. Clinical effectiveness of procalcitonin- or C-reactive protein-guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta-analysis. Anaesthesia. 2026 Jan 8; doi:10.1111/anae.70109

  • Summary: Moderate-certainty evidence from 19 trials including 6382 critically ill patients with sepsis indicates that procalcitonin-guided protocols probably reduce antibiotic duration by about 2 days without increasing mortality, whereas evidence for C-reactive protein-guided protocols remains limited, highlighting the potential role of procalcitonin in guiding safe and effective antimicrobial stewardship in critical care.

Myatra SN, Boyer KM, Hidalgo JL, Maves RC, Acharya SP, Jacob ST, et al. Gaps and strategies for management of sepsis in low-resource settings: expert consensus statements using a Delphi method. Crit Care Med. 2026 Mar 20; doi:10.1097/CCM.0000000000007102

  • Summary: An international expert panel used a literature review and Delphi process to develop 58 consensus clinical practice statements addressing prevention, early recognition, timely management, and post-sepsis care in low-resource settings, highlighting gaps in evidence while providing actionable guidance to complement existing international sepsis guidelines.

Kortz TB, Hidalgo JL, Akech SO, Myatra SN, Maves RC, Perez-Fernandez J, et al. Ten steps to improve sepsis care in low-resource settings. Crit Care Med. 2026 Mar 20; doi:10.1097/CCM.0000000000007090

  • Summary: A consensus-based process involving literature review, Delphi surveys, stakeholder input, and expert conferences produced ten actionable, nonsequential steps to improve sepsis care in low-resource settings, emphasizing governance, education, prevention, early recognition, timely interventions, post-sepsis care, data systems, quality improvement, culture, and holistic well-being to guide health leaders, clinicians, and policymakers in strengthening the sepsis chain of survival and reducing global inequities in outcomes.

Infection Prevention / Antibiotic Prophylaxis

Rinaldi M, Miani B, Gibertoni D, Di Chiara M, Andrade Lopes C, Cona A, et al. Targeted peri-operative prophylaxis in patients colonized with carbapenem resistant Enterobacterales undergoing liver transplantation: a multinational cohort study. Clin Infect Dis. 2026 Mar 25; doi:10.1093/cid/ciag185

  • Summary: In a multinational cohort of 408 liver transplant recipients colonized with CRE, targeted perioperative prophylaxis using novel β-lactam/β-lactamase inhibitors or cefiderocol (T-PAPnew) significantly reduced CRE infections within the first 15 days post-transplant, whereas standard prophylaxis or older regimens (T-PAPold) showed no protective effect, though the benefit of T-PAPnew diminished by 30 days.

Martelli M, Rosa A, Miranda M, Simone R, Scarpati Cioffari di Castiglione M, De Falco F, et al. Oral hygiene management in critically ill patients: prevention of ventilator-associated pneumonia. Front Dent Med. 2026 Feb 19;7:1748329. doi:10.3389/fdmed.2026.1748329

  • Summary: Maintaining oral hygiene in critically ill, mechanically ventilated patients is essential for preventing ventilator-associated pneumonia (VAP) and other infections; evidence from systematic reviews indicates that combining mechanical plaque removal with chlorhexidine significantly reduces VAP incidence, and implementing standardized, multidisciplinary oral care protocols—including dental specialist involvement—optimizes patient outcomes and overall well-being, though further research is needed to refine techniques and standardize practices.

Bloodstream Infections

Cona A, Curatolo C, Giordani P, D'Andrea F, Bellavia D, Campanella M, et al. Association between unrecognized donor bloodstream infection and outcomes in solid organ transplant recipients: a prospective observational cohort study. Clin Microbiol Infect. 2026 Mar 26; doi:10.1016/j.cmi.2026.03.026

  • Summary: In a prospective study of 968 solid organ transplant recipients, 14% received organs from donors with unrecognized bloodstream infections (BSI); while overall one-year survival was similar to recipients from uninfected donors, those receiving organs from donors with multidrug-resistant (MDR) BSI—particularly carbapenem-resistant Enterobacterales—had significantly lower survival, highlighting that MDR donor infections can adversely impact outcomes despite prompt treatment of donor-derived infections.

Bone and Joint Infections

Piquart L, Goutelle S, Maillard M, Boisset S, Carricajo A, Tristan A, et al. Temocillin: a therapeutic alternative in bone and joint infections due to third generation cephalosporin-resistant Enterobacterales? J Antimicrob Chemother. 2026 Apr;81(4):dkag105. doi:10.1093/jac/dkag105

  • Summary: Temocillin demonstrated high in vitro activity against third-generation cephalosporin-resistant Enterobacterales from bone and joint infections—including ESBL producers and AmpC hyperproducers—with 92.3% susceptibility; however, optimal pharmacokinetic/pharmacodynamic target attainment depends on both the isolate’s MIC and the patient’s renal function, highlighting the need for dosage adjustments to maximize efficacy.

Skin and Soft Tissue Infections

Dulcey M, DeBord KM, Bell ME, Murray MT, Szewc AM, Livingston K, et al. Haematospirillum jordaniae infections after recreational exposure to river water, Pennsylvania, USA, 2020. Emerg Infect Dis. 2025 Nov;31(11):2073-2079. doi: 10.3201/eid3111.241586

  • Summary: Four cases of Haematospirillum jordaniae infection were identified in 2020 in south-central Pennsylvania, USA, linked to leg injuries sustained during recreational river water activities. The bacterium was later detected in river samples collected in 2024 from locations reported by patients. Initial emergency department visits did not identify the causative agent, which was only confirmed months after discharge. Although considered rare, the true incidence of H. jordaniae infections is unknown, and understanding its environmental ecology and seasonality could improve public health guidance and clinician awareness.

Napolitano LM, Biffl WL, Costantini TW, Diaz JJ, Inaba K, Livingston DH, et al. Evidence-based, cost-effective management of necrotizing soft tissue infection: an algorithm of the Journal of Trauma and Acute Care Surgery emergency general surgery algorithms work group. J Trauma Acute Care Surg. 2026 Apr;100(4):542–548. doi:10.1097/TA.0000000000004943

  • Summary: The Journal of Trauma and Acute Care Surgery Emergency General Surgery algorithms work group developed a bedside reference algorithm for the initial evaluation and management of necrotizing soft tissue infection (NSTI) in the emergency setting. NSTI is a rare but rapidly progressive and potentially life- and limb-threatening infection, with mortality rates of 20–25% and high resource utilization, including prolonged ICU and hospital stays. Early recognition and prompt surgical debridement are critical for improving outcomes, though incidence and causative pathogens—such as group A Streptococcus—vary regionally, and readmission rates remain high. The algorithm provides evidence-based guidance but must be adapted to clinical judgment and local protocols.

Sexually Transmitted Infections

Menza TW, Berzkalns A, Cannon CA, Balkus J, Kerani RP, Dombrowski JC, et al. The population-level impact of doxycycline post-exposure prophylaxis on syphilis in King County, WA: an interrupted time series analysis. Clin Infect Dis. 2026 Mar 26; doi:10.1093/cid/ciag209

Barbee LA, Zhang S, Golden MR, Khosropour CM, Soge OO, Manhart LE. The natural history of Mycoplasma genitalium at the pharynx and rectum in a cohort of men who have sex with men: prevalence, incidence, duration and symptomatology. J Infect Dis. 2026 Mar 20; doi:10.1093/infdis/jiag173

  • Summary: In a cohort of men who have sex with men, rectal and pharyngeal Mycoplasma genitalium infections were common, mostly asymptomatic, and persistent—rectal infections often lasting close to a year and pharyngeal infections around three months. The high asymptomatic rates and prolonged duration suggest routine testing at these sites may offer limited individual benefit.

Mukherjee A, Blomqvist SOP, Helekal D, Das AA, Palace SG, Grad YH, et al. Genetic background modulates zoliflodacin and gepotidacin cross-resistance and fitness in Neisseria gonorrhoeae. J Infect Dis. 2026 Mar 19; doi:10.1093/infdis/jiag174

  • Summary: In ciprofloxacin-resistant Neisseria gonorrhoeae, the gyrBD429N mutation conferred cross-resistance to gepotidacin in some strains, with its effects on fitness and resistance influenced by the strain’s genetic background, particularly the presence of parCD86N. These results highlight the need to consider genetic context when introducing and monitoring new topoisomerase inhibitors like zoliflodacin and gepotidacin.

Michalow J, Cori A, Kimani J, Bhattacharjee P, Boily M-C, Imai-Eaton JW, et al. Optimal deployment of gonorrhoea point-of-care tests: modeling the potential impact of diagnostic confirmation testing and screening strategies across five priority populations in Kenya. J Infect Dis. 2026 Mar 17; doi:10.1093/infdis/jiag162

  • Summary: Modeling gonorrhea transmission in Kenya suggests that, under limited POCT availability, prioritizing diagnostic confirmation for symptomatic individuals—particularly pregnant women—prevents the most morbidity and is more efficient than broad screening, supporting WHO guidance to strengthen etiologic diagnosis within syndromic care.

Respiratory Tract Infections

Tam KKG, Suster CJS, Fong W, Golubchik T, Sivalingam V, Jeoffreys N, et al. Genomic surveillance reveals emergence and spread of macrolide-resistant Mycoplasma pneumoniae in Australia during the 2023–2024 epidemic. J Infect Dis. 2026 Mar 21; doi:10.1093/infdis/jiag163

  • Summary: Using targeted metagenomic sequencing, the study revealed a genetically diverse population of Mycoplasma pneumoniae in Australia, with 13% macrolide-resistant strains linked to higher healthcare utilization; while macrolides remain largely effective, ongoing MRMP surveillance is critical to guide treatment and stewardship.

Azoulay E, McEvoy C, Castro P, Ait Hssain A, Taccone FS, Myatra SN, et al. Epidemiology, ventilation, and outcomes of acute respiratory failure in immunocompromised patients from 103 intensive care units in 26 countries: a retrospective observational study. Lancet Respir Med. 2026 Mar 16; doi:10.1016/S2213-2600(26)00046-9

  • Summary: In a large international cohort of 9854 immunocompromised ICU patients with acute hypoxaemic respiratory failure, 30-day mortality was 47.3%, with higher risk associated with older age, comorbidities, coma, invasive fungal infection, unidentified ARF cause, and organ support needs, while solid organ transplantation, connective tissue disease, higher oxygenation, and high-flow nasal oxygen were protective, highlighting factors to guide timely clinical decisions and management.

Zhang X, Z T. Interleukins in community-acquired pneumonia: from biomarkers to precision medicine. Front Immunol. 2026 Feb 24;17:1774731. doi:10.3389/fimmu.2026.1774731

  • Summary: This review highlights the roles of key interleukins in community-acquired pneumonia, categorizing them by pro-inflammatory, anti-inflammatory, dual-action, and emerging functions, and emphasizes integrating cytokine profiles with organ dysfunction, multi-omics, and AI-driven approaches to enable precision medicine and improve severity assessment and management in CAP.

Infections in Children

Weiss SL, Peters MJ, Oczkowski SJW, Belley-Cote E, Buysse C, Choong KLM, et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Intensive Care Med. 2026 Mar 23; doi:10.1007/s00134-026-08360-2

  • Summary: An international panel of experts updated evidence-based guidelines for managing children with sepsis or septic shock, issuing 61 statements—including strong, conditional, and good practice recommendations—highlighting that most recommendations are based on low-quality evidence, with only a few supported by moderate or high-certainty data.

Lieu TA, Alexander JT, Seymour CW. Caring for Pediatric Patients With Sepsis. JAMA. 2026 Mar 26; doi:10.1001/jama.2026.3800

  • Summary: The 2026 Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children update the 2020 recommendations, providing evidence- and expert-informed guidance for children from ≥37 weeks gestational age to <18 years. Key recommendations include routine infectious disease consultation for documented bloodstream infections, blood lactate measurement for tissue perfusion assessment, and use of cardiac and lung POCUS to guide resuscitation. In resource-limited settings, fluid boluses are strongly discouraged except in severe hypotension, and conservative oxygen targets (SpO₂ 88–92%) are suggested for intubated children. The guidelines emphasize early, timely antimicrobial therapy, ongoing hemodynamic assessment, and high-volume hemofiltration when kidney support is required. Of 61 statements, 5 are strong recommendations, 24 conditional, and 10 good practice statements, highlighting that most recommendations remain based on low- to very low-certainty evidence despite updated research and expert consensus.

Founou LL, Founou RC, Charani E, Gwanyama N, Dramowski A, Feasey N. Neonatal sepsis in Africa: what are we missing? Lancet Microbe. 2026 Mar 18; doi:10.1016/j.lanmic.2026.101374

  • Summary: Neonatal sepsis continues to be a critical public health challenge in Africa, posing a major barrier to achieving the UN Sustainable Development Goal target of reducing neonatal mortality to 12 per 1000 livebirths. Progress is hindered not only by diagnostic, treatment, and prevention gaps, but also by sociocultural norms, fragmented health systems, inequities in care, and low political commitment. Antimicrobial-resistant infections exacerbate the crisis, placing neonates at disproportionate risk. Without urgent, context-appropriate interventions, Africa will continue to bear the highest burden of preventable neonatal deaths. A shift toward a community-centred One Health approach, integrating biomedical, environmental, and sociocultural factors, along with coordinated global and local leadership, is essential to accelerate progress and reduce neonatal mortality.

St Peter SD, Ampofo K, Brogan T, Cabana MD, Espinosa C, Florin TA, et al. 2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on the Management of Community-acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of tPa and DNase or tPa Alone for Fibrinolysis. Clin Infect Dis. 2026 Mar 17; doi:10.1093/cid/ciag191

  • Summary: This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children. In this report, the panel provides recommendations for intrapleural fibrinolysis with tissue plasminogen activator (tPA) alone over tPA and dornase alfa (DNase) in children (3 months to 18 years) with complicated parapneumonic effusion and empyema. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

St Peter SD, Ampofo K, Brogan T, Cabana MD, Espinosa C, Florin TA, et al. 2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on the Management of Community-acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Choice of Chest Tube Size. Clin Infect Dis. 2026 Mar 17; doi:10.1093/cid/ciag190

  • Summary: This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children. In this paper, the panel provides recommendations on the appropriate size of thoracostomy tube for drainage. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

St Peter SD, Ampofo K, Brogan T, Cabana MD, Espinosa C, Florin TA, et al. 2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on the Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of Chest Ultrasound in Children with Parapneumonic Effusion. Clin Infect Dis. 2026 Mar 16; doi:10.1093/cid/ciag187

  • Summary: This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children. In this paper, the panel provides recommendations for the role of chest ultrasound to evaluate parapneumonic effusion and empyema. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

St Peter SD, Ampofo K, Brogan T, Cabana MD, Espinosa C, Florin TA, et al. Clinical Practice Guideline by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society: 2026 Guideline Update on The Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Clin Infect Dis. 2026 Mar 16; doi:10.1093/cid/ciag186

  • Summary: As the first part of an update to the clinical practice guideline on the management of community-acquired pneumonia in infants and children older than 3 months of age, we present six updated recommendations. The updated recommendations span the characterization and management of pneumonia with parapneumonic effusion. The panel’s recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Chung CH, Barash JR, Castonguay JL, Penzel-McNamara C, Lee K, Read JS, et al. Multistate Infant Botulism Outbreak Associated with Powdered Infant Formula. N Engl J Med Evid. 2026 Feb 25;5(4): doi:10.1056/EVIDpha2600020

  • Summary: This report details the identification of an outbreak of infant botulism linked to powdered infant formula in the United States. In October 2025, the Infant Botulism Treatment and Prevention Program, California Department of Public Health (IBTPP-CDPH) noted common powdered infant formula exposure among three neonates with suspected infant botulism. Subsequent laboratory analyses at CDPH identified Clostridium botulinum type A from an open container of ByHeart powdered infant formula associated with one infant with infant botulism. As of December 10, 2025, 51 suspected or confirmed infant botulism cases with exposure to ByHeart powdered infant formula had been identified across 19 states. All ByHeart powdered infant formula has been recalled nationwide.

Khan AZ, Khan FZ, Sajid A, Khan ZZ, Murphy KJ, Mazer M. A 9-Year-Old Girl with Persistent Fevers and Lethargy. N Engl J Med Evid. 2026 Mar 24;5(4): doi:10.1056/EVIDmr2400406

  • Summary: This report examines the case of a 9-year-old girl who presented to the emergency department with prolonged fevers and malaise. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.

Caddy SL, van Dorp L, Swadling L, Wang-Koh Y, Houldcroft CJ. Germ factories or immune boot camps? Infection and immunity in childcare settings. Clin Microbiol Rev. 2026 Mar 18; doi:10.1128/cmr.00253-25

  • Summary: Childcare outside the home is common in high-income countries and is associated with higher incidence of infectious diseases for children and their household members. This review examines how the age at which children start childcare interacts with the maturation of cellular and humoral immunity, drawing on maternal antibody dynamics, seroepidemiology, cohort studies, and outbreak reports. It summarizes typical infections in early life, including gastrointestinal, respiratory, and rash-forming illnesses, and considers the additional impact of childcare on pathogen transmission. The economic and personal effects of these infections are discussed, as well as interventions such as vaccination programs. The review also explores a potential trade-off between early-life infections and later school-age illness, concluding that the high burden of infection in young children is biologically normal but its collective impact is often underestimated.

Mycobacterial Infections

Nguyen TM, MacLean ELH, Zhang X, Georghiou SB, Xia H, Beardsley J, et al. Molecular diagnostic tests for isoniazid-resistant tuberculosis: a scoping review. Lancet Microbe. 2026 Mar 20; doi:10.1016/j.lanmic.2026.101362

  • Summary: Molecular diagnostics for isoniazid-resistant tuberculosis have expanded rapidly and generally meet performance targets, but their complexity, cost, and limited accessibility—especially in low-resource settings—continue to hinder widespread implementation despite the critical need for early detection.

Lam WKJ, Chan KKP, Wang G, Lai CKC, Kang G, Chan C, et al. Sequencing of pleural fluid and plasma for tuberculous pleuritis. N Engl J Med Evid. 2026 Mar 24;5(4): doi:10.1056/EVIDoa2500237

Smith JP, O’Connor S, Date A, Moonan PK. Tuberculosis cases and deaths averted by PEPFAR. N Engl J Med. 2026 Mar 24; doi:10.1056/NEJMc2506284

  • Summary: Since 2003, PEPFAR has averted an estimated 11 million tuberculosis cases and 2.1 million deaths among people with HIV, highlighting the major impact of integrated HIV and tuberculosis interventions on global disease control.

Visek C, Dalmat RR, Nalutaaya A, Erisa KC, Biché P, Stein G, et al. Prevalence and predictors of tuberculosis in adults and adolescents with sputum trace Ultra results in 2 high-burden clinical settings. Clin Infect Dis. 2026 Mar 20; doi:10.1093/cid/ciag019

Selva Kumar D S, Somarkutty N, Hariram Prasad D J, Gautam P, Nagaraj V, Karthik R, et al. Role of low-dose infliximab for inflammatory complications of central nervous system tuberculosis: a retrospective cohort study. Clin Infect Dis. 2026 Mar 20; doi:10.1093/cid/ciaf573

van Riet E, Corleis B, Giersing BK, Hatherill M, Burhan E, Jassat W, et al. Accelerating research and development of new vaccines against tuberculosis: 5-year progress on the global roadmap. Lancet Infect Dis. 2026 Mar 18; doi:10.1016/S1473-3099(26)00019-8

  • Summary: Since the 2021 global tuberculosis vaccine R&D roadmap, the pipeline has diversified with several candidates in phase 3 trials, but clinical trial numbers remain small, development challenges persist, and insufficient investment and procurement commitments limit progress, highlighting the need for strategic coordination, diversified funding, and planning for effective vaccine implementation and uptake.

Vuyyuru SK, Singh U, Das P, Basant S, Singh V, Sinha SK, et al. Association of Mycobacterium Avium Paratuberculosis with Crohn's disease: a large multicenter study from a tuberculosis-endemic region. Clin Infect Dis. 2026 Jan 5; doi:10.1093/cid/ciaf738

  • Summary: In a multicenter observational study in India including 889 participants, Mycobacterium avium subspecies paratuberculosis (MAP) was more frequently detected in patients with Crohn's disease (CD) than in controls, intestinal tuberculosis, or ulcerative colitis, particularly by serology, tissue PCR, and solid biopsy culture, suggesting an association between MAP and CD and supporting further research into its potential causal role and therapeutic targeting.

Cerqueira-Silva T, Boaventura VS, Paixão ES, Sanchez M, Leyrat C, Ranzani O, et al. Long-term risk of death after tuberculosis diagnosis and treatment. Nat Med. 2026 Mar 19; doi:10.1038/s41591-026-04294-w

  • Summary: A nationwide Brazilian cohort study found that individuals diagnosed with or treated for tuberculosis had significantly elevated long-term mortality up to 14 years later, including deaths from cancer, cardiovascular, endocrine, respiratory, and external causes, emphasizing the need for prolonged monitoring of TB survivors.

Miranda-Hernandez S, Kumar M, Henderson A, Graham E, Tan X, Taylor J, et al. CD8+ T cells sustain vaccination-induced immunity against dissemination of contained tuberculosis in immunosuppressed hosts. Nat Commun. 2026 Mar 24; doi:10.1038/s41467-026-70911-4

  • Summary: Using a mouse model of lymphatic latent Mycobacterium tuberculosis infection, researchers found that vaccination with BCG or recombinant BCG prevents reactivation and dissemination even without CD4+ T cells, with CD8+ T cells mediating protection, highlighting potential strategies for managing latent TB in immunocompromised individuals.

Chung TK, Yang E, Shin M, Solans BP, Zhou X, Hwang S, et al. Pharmacokinetics and dose optimization of ethambutol in children on first-line antituberculosis therapy: an individual patient data meta-analysis. J Infect Dis. 2026 Mar 30; doi:10.1093/infdis/jiag194

  • Summary: An individual patient data meta-analysis of 220 children with tuberculosis showed that current WHO-recommended ethambutol doses often result in suboptimal drug exposure, particularly in children under 25 kg, and proposed optimized weight-based dosing to improve efficacy while balancing toxicity and formulation considerations.

Zhang S, Qi J, Zheng J, Qin Y, Yang J, Li X, et al. National and subnational burden of XDR-TB in China, 1990-2023: long-term trends, regional disparities, and projections, 2024-2050. J Infect. 2026 Mar 15; doi:10.1016/j.jinf.2026.106728

  • Summary: Analysis of 1990–2023 data in China shows that extensively drug-resistant tuberculosis (XDR-TB) is rising in incidence, prevalence, and mortality, with marked geographic disparities—Xinjiang and Tibet bear the highest burdens—and highlights the need for targeted interventions, especially for high-risk regions and older populations.

Purohit D, van Wijk R, Kafeero P, Kibengo F, Zimmerman M, D'artois V, et al. Impact of high-dose rifampicin on linezolid pharmacokinetics in tuberculous meningitis. Open Forum Infect Dis. 2026 Mar 27; doi:10.1093/ofid/ofag154

  • Summary: High-dose rifampicin significantly increases the clearance of linezolid in adults with tuberculous meningitis, reducing plasma and cerebrospinal fluid concentrations, but twice-daily dosing of linezolid can maintain therapeutic levels, highlighting the need to optimize dosing strategies when these drugs are co-administered to ensure effective treatment.

Funauchi A, Hashimoto K, Fukushima K, Matsumoto Y, Hamada N, Hara R, et al. Gastric aspirate isolate demonstrates strain-level concordance with sputum isolate in nontuberculous mycobacterial pulmonary disease. Open Forum Infect Dis. 2026 Mar 27; doi:10.1093/ofid/ofag175

  • Summary: Nontuberculous mycobacteria isolated from gastric aspirate show over 85% strain concordance with sputum isolates, indicating a pulmonary origin and suggesting that gastric aspirate could serve as a useful supplementary specimen for diagnosing NTM pulmonary disease.

Moyo RC, Okango E, Bolton L, Otto M, Blose N, Sereo T, et al. Effect of the scale-up of dolutegravir on retention in care, risk of developing tuberculosis and viral load suppression among people living with HIV: analysis of routine HIV clinical data in rural KwaZulu-Natal, South Africa (2019–23). Open Forum Infect Dis. 2026 Mar 19; doi:10.1093/ofid/ofag156

  • Summary: In a cohort of 69,919 people living with HIV in rural KwaZulu-Natal, South Africa, approximately 70% transitioned to dolutegravir-containing regimens over four years, and DTG use was associated with higher viral load suppression, better retention in care, and a lower risk of developing tuberculosis, supporting the continued rollout of DTG-based therapy and the need for ongoing programmatic monitoring.

Fungal Infections and Antifungal Agents

Muthu V, Sehgal IS, Agarwal R. Treatment of pulmonary mucormycosis: current concepts. Expert Rev Anti Infect Ther. 2026 Jan 29; doi:10.1080/14787210.2026.2622695

  • Summary: Pulmonary mucormycosis is a rapidly progressive, high-mortality fungal infection, and optimal management involves early recognition, aggressive host factor optimization such as glycemic control and immunosuppression reduction, prompt induction with liposomal amphotericin B followed by oral triazole maintenance, careful consideration of surgery, and multidisciplinary care, while combination antifungal therapy should be reserved for severe or refractory cases, and future research should focus on evaluating treatment strategies, host-directed therapies, emerging antifungals, and adjunctive modalities across special populations.

Gigante V, Alm RA, Rocke T, Melchiorri D, Cameron AM, et al. WHO assessment of the preclinical antifungal pipeline: evaluating innovation and preparedness in the face of emerging fungal threats. Lancet Microbe. 2026 Mar 27; doi:10.1016/j.lanmic.2025.101331

  • Summary: Invasive and mucosal fungal infections are a growing global health threat, particularly among immunocompromised populations, with rising incidence, drug resistance, and climate-related influences, while current antifungal treatments are limited in spectrum and safety, prompting the WHO to identify priority fungal pathogens and stimulate research and development; preclinical and clinical pipelines are emerging with novel agents such as fosmanogepix and olorofim, but sustainability, safety evaluation, and alignment with global health needs remain critical to ensure effective, broad-spectrum, and equitable therapies for these high-burden infections.

Kroustali V, Pournaras S, Meletiadis J. Can fluconazole be used to treat non-resistant Candida (Candidozyma) auris infections? Preclinical PK/PD data from a Galleria mellonella infection model. J Infect Dis. 2026 Mar 20; doi:10.1093/infdis/jiag182

  • Summary: Fluconazole, despite widespread resistance in Candida auris, showed similar in vivo activity to Candida albicans in a Galleria mellonella model, with isolates having MICs ≤8 mg/L potentially treatable at 1,200 mg/day, suggesting that select non-resistant C. auris infections could respond to fluconazole, though clinical studies are needed to confirm efficacy.

Tan M, Guo Z, Wang Y, Xu X, Cao W, Liu Z, et al. Identification of Aspergillus at section and species levels by artificial intelligence-based microscopic morphology image recognition. J Clin Microbiol. 2026 Feb 27; doi:10.1128/jcm.00012-26

  • Summary: FungalNet, a deep learning model based on ResNet-50 and Focal Loss, accurately identified Aspergillus species and sections from 11,689 high-resolution microscopic images with overall accuracies of 98.45% and 97.85%, demonstrating promise for rapid, reliable Aspergillus diagnosis in clinical laboratories and potential integration into routine workflows after further validation.

Godet C, Joste V, Frat J-P, Khalil A, Bunel V, Goletto T, et al. Non-fumigatus Aspergillus-associated pulmonary events: a diagnostic challenge. J Clin Microbiol. 2026 Mar 18; doi:10.1128/jcm.00163-26

  • Summary: In a retrospective study of 497 patients with respiratory samples positive for non-fumigatus Aspergillus species, 10.5% experienced pulmonary events, mostly colonization, while nearly one-third had clinically significant pulmonary disease, with Aspergillus niger, A. flavus, and A. nidulans being most frequent, and low positivity rates across conventional diagnostic tests highlight the need for repeated sampling and the limitations of assays designed primarily for A. fumigatus.

Bitterman R, Kus JV, Verma G, Kopp A, Husain S, Kwong JC, et al. Incidence and outcomes of Candida bloodstream infection in solid organ transplant recipients. JAMA Netw Open. 2026 Mar 17;9(3):e261467. doi:10.1001/jamanetworkopen.2026.1467

  • Summary: In a population-based cohort study of 10,249 solid organ transplant recipients in Ontario, Canada, candidemia occurred in 1.67% of patients, with lung transplant recipients at the highest risk, and was associated with high mortality—39.3% at 30 days and 47.4% at 90 days—with both fluconazole-susceptible and fluconazole-resistant Candida infections significantly increasing the risk of death, highlighting the need for targeted prevention and early intervention strategies in this vulnerable population.

Virulence

Snaith AE, van der Putten B, Bril-Keijzers W, Hall RJ, Dunn SJ, van Schaik W, et al. Lineage dynamics of invasive Escherichia coli isolates in the Netherlands from 1975 to 2021: a retrospective longitudinal genomic analysis. Lancet Microbe. 2026 Mar 18; doi:10.1016/j.lanmic.2025.101300

  • Summary: The SENTINEL study longitudinally analyzed 1,790 invasive Escherichia coli isolates, mainly from neonates in the Netherlands between 1975 and 2021, revealing a highly dynamic population with shifts in dominant lineages and virulence factors, only 58.8% of isolates expressing the K1 capsule, and no clear influence from antimicrobial resistance, highlighting the importance of host-pathogen interactions, immune selection pressures, and the need for ongoing genomic surveillance to guide interventions and cautioning against generalizing findings from a single cohort to other populations.

Microbiome

Baldanzi G, Larsson A, Sayols-Baixeras S, Dekkers KF, Hammar U, Nguyen D, et al. Antibiotic use and gut microbiome composition links from individual-level prescription data of 14,979 individuals. Nat Med. 2026 Mar 11; doi:10.1038/s41591-026-04284-y

  • Summary: This study analyzed fecal metagenomes from 14,979 adults in Sweden and found that oral antibiotic use, even 4–8 years prior, was associated with long-lasting alterations in gut microbiome composition, with the strongest reductions in species diversity observed within one year of use and clindamycin, fluoroquinolones, and flucloxacillin contributing most to changes, highlighting the enduring impact of antibiotics on gut microbial communities.

Spottiswoode N, Neyton LP, Mick E, Kalantar KL, Hao S, Lydon EC, et al. Host–Microbe Multiomic Profiling Predicts Mortality in Sepsis. Am J Respir Crit Care Med. 2026 Jan;212(1):95–104. doi:10.1164/rccm.202410-1996OC

Diagnostics

Gigante V, Murtagh M, Bachmann TT, Rocke T, Trainor BW, Poutanen SM, et al. Diagnostics for priority bacterial pathogens: global gaps and research needs for curbing antimicrobial resistance in low-resource settings. Lancet Microbe. 2026 Mar 20; doi:10.1016/j.lanmic.2026.101385

  • Summary: Antimicrobial resistance (AMR) poses a growing global health threat, particularly in low- and middle-income countries, with an estimated 39.1 million direct deaths projected between 2020 and 2050 if unaddressed, and effective bacterial diagnostics are crucial for pathogen detection, antimicrobial susceptibility testing, and antibiotic stewardship, yet access to appropriate diagnostics remains limited in LMICs; this Review outlines the current commercial and pipeline in-vitro bacterial diagnostic landscape, evaluates phenotypic and non-phenotypic approaches, highlights infrastructure challenges that restrict testing to higher-level laboratories, and emphasizes WHO priorities for the next 3–5 years to promote innovation, equitable access, and development of simple, affordable, and decentralised solutions for reliable identification and resistance testing of priority bacterial pathogens.

Koroki T, Fujii M, Kotani Y, Yaguchi T, Shibata T, Hirata C, et al. Contamination of blood cultures drawn from arterial catheters versus venipuncture or venous catheters in critically ill patients: a systematic review and meta-analysis. Clin Infect Dis. 2026 Mar 15;82(3):446–452, doi:10.1093/cid/ciaf260

  • Summary: Arterial catheter–drawn blood cultures in critically ill patients have contamination rates similar to venipuncture-drawn cultures and may be lower than venous catheter–drawn cultures, suggesting they could be a safe alternative for blood culture collection, though the certainty of evidence is low.

Shorr AF, Kollef MH, Wunderink RG, Jauregui-Peredo LE, Bernard AC, Kim HK, et al. Diagnostic performance of point-of-care immunoassay measurements of pancreatic stone protein for sepsis detection in ICU patients: a prospective, multicenter, biomarker-blinded study. Crit Care Med. 2026 Mar 4; doi:10.1097/CCM.0000000000007087

  • Summary: In a multicenter ICU study of 466 adults, a rapid point-of-care pancreatic stone protein (PSP) assay identified sepsis within the first three days with 74.2% sensitivity, 67.8% specificity, and 71.0% accuracy; combining PSP with C-reactive protein (CRP) improved specificity to 95.2%, supporting PSP’s broad applicability as an early sepsis biomarker and the benefit of combined biomarker strategies for timely detection.

Improving Clinical Research

Zumbo G, Beltrami M, Bravo-Ferrer JM, Gutiérrez-Gutiérrez B, Rodríguez-Baño J, et al. Methodological quality assessment tool for observational studies comparing treatment effectiveness in infectious diseases: a Delphi consensus and application to studies on bloodstream infections due to carbapenem-resistant Enterobacterales. Lancet Infect Dis. 2026 Mar 23; doi:10.1016/S1473-3099(26)00058-7

  • Summary: The ASSURE-ID questionnaire, developed via a three-round Delphi process with 34 experts, provides a structured framework to assess methodological quality and bias in observational infectious disease studies; its application to 14 studies on bloodstream infections caused by carbapenem-resistant Enterobacterales revealed frequent shortcomings, including lack of protocol pre-registration, limited reporting guideline adherence, minimal handling of missing data, and inconsistent addressing of biases and confounders, underscoring the need for improved study rigor.

Gelman A, van Zwet E, Więcek W. FDA Draft Guidance for the Use of Bayesian Methods in Clinical Trials. JAMA. 2026 Mar 23; doi:10.1001/jama.2026.4178

  • Summary: The FDA draft guidance on Bayesian methods in clinical trials emphasizes the transparent use of prior information to improve trial efficiency and flexibility, particularly in pediatric and rare-disease studies. Unlike traditional frequentist approaches, the guidance allows informative priors to shift focus from strict type I error control to alternative success criteria based on risk-benefit analysis. It encourages borrowing strength from external data through meta-analysis and hierarchical modeling, while underscoring the need for clearly stated priors, prespecified data models, and simulation-based evaluation to ensure transparency, reproducibility, and regulatory rigor in trial design and interpretation.

Lee JJ, Harrell FE Jr, LaVange LM, Spiegelhalter DJ. Embracing Bayesian Methods in Clinical Trials: FDA’s Long-Awaited Draft Guidance. JAMA. 2026 Mar 23; doi:10.1001/jama.2026.4179

  • Summary: In January 2026, the FDA issued draft guidance endorsing Bayesian methods for therapeutic clinical trials, clarifying their regulatory acceptance and addressing prior misconceptions. Unlike traditional frequentist approaches that test a null hypothesis indirectly, Bayesian inference directly estimates the probability of treatment benefit by combining prior knowledge with observed data to generate a posterior distribution, offering a more clinically meaningful answer to whether a treatment works.

Evans SR, Fleming TR, Janes H, Dodd LE. Reflections on FDA Draft Guidance on Bayesian Methods in Trials—Protecting Scientific Integrity and Evidentiary Standards. JAMA. 2026 Mar 23; doi:10.1001/jama.2026.4175

  • Summary: The FDA’s draft guidance on Bayesian methods in clinical trials highlights the agency’s commitment to research integrity by providing clear standards and education on these approaches. While Bayesian methods have proven valuable in early-phase trials, diagnostics, and rare diseases, their use in late-phase confirmatory trials has been limited due to concerns that incorporating prior information could compromise randomization benefits, introduce subjective biases, and reduce robustness through strong or unverifiable assumptions.

Van Leeve J, Colacci M. Use of Deferred Consent in Randomized Clinical Trials. NEJM Evid. 2026 Mar 24;5(4): doi:10.1056/EVIDctw2400266

  • Summary: Deferred consent allows enrollment of critically ill or incapacitated patients into clinical trials before obtaining informed consent, enabling timely access to potentially beneficial interventions in emergency care settings. This review examines the ethical considerations, risks, and benefits of using deferred consent in randomized controlled trials, highlighting contexts where its use may be ethically acceptable.

Mahon N, Hays LMC, Coy E, Ainscough K, Burrell A, Gordon AC, et al. Views on consent approaches used in emergency and critical care research: a rapid, systematic review. Trials. 2026 Mar 11; doi:10.1186/s13063-026-09592-9

  • Summary: Obtaining informed consent in emergency and critical care research is often challenging, prompting the use of alternative consent models such as deferred consent, surrogate consent, or waived consent. This rapid systematic review of 145 studies from 26 countries found that alternative consent approaches are generally acceptable, especially when patients or relatives are involved in decision-making. Acceptability is influenced by prior research experience, illness severity, perceived risk, and intervention invasiveness. Pandemic contexts increased the need for flexible consent processes, while perspectives of underserved groups remain underreported and show no clear consensus.

Sidebotham D, Jones PM. Core concepts in statistics and research methods. Part 7: regression. BJA Educ. 2026 Mar 20; doi:10.1016/j.bjae.2026.02.004

  • Summary: Regression is a fundamental statistical framework that quantifies relationships between a response variable and one or more explanatory variables. Simple linear regression involves a continuous response and explanatory variables, while generalized linear models (GLMs) extend regression to accommodate diverse data types, including binary outcomes via logistic regression. Key skills include identifying response and explanatory variables, interpreting coefficients, choosing an appropriate model, and understanding regression assumptions. Regression originated with Sir Francis Galton’s 19th-century studies on heredity and regression to the mean, and today underpins most standard statistical analyses in both frequentist and Bayesian frameworks.

Augoustides JG. Platform trials in perioperative cardiothoracic and vascular practice—Is it time for development, deployment, and dissemination? J Vasc Anaesth. 2026 Feb 18; doi:10.1053/j.jvca.2026.02.024

  • Summary: Platform trials are a transformative approach to perioperative and critical care research, designed to evaluate multiple interventions under a single adaptive master protocol over extended periods. Unlike traditional randomized trials, they allow shared control groups, real-time addition or removal of treatment arms, and adaptation to evolving standards of care, resulting in significant cost and time efficiencies. Platform trials, such as the Healey trial for amyotrophic lateral sclerosis and MARLIN in low- and middle-income countries, demonstrate applicability across rare diseases, perioperative complications, and critical care settings. They support collaboration across trials, enhance patient-centered outcomes, and are particularly valuable in resource-limited environments, offering a scalable, flexible, and efficient solution to address inequities in perioperative morbidity and mortality.

Kimmoun A, de Jong A, Poole D. Ten methodological aspects to look for when critically reading randomized-controlled trials. What's New in Intensive Care. 2026 Mar 9; doi:10.1007/s00134-026-08372-y

  • Summary: This review identifies ten key methodological aspects for critically appraising randomized controlled trials (RCTs), focusing on trial trust, relevance, and design. The crucial points include checking the clinical question, population, outcomes, randomization, blinding, protocol adherence, data analysis, and potential for bias.

McIver WJ. Blinding in critical care trials with subjective outcomes: a note of caution. Acute Crit Care. 2026 Feb 5;41(1):186-188. doi:10.4266/acc.005525

  • Summary: Blinding in randomized controlled trials is critical to reducing bias, particularly when outcomes are subjective. Lack of blinding can exaggerate treatment effects, as illustrated by three recent acute and critical care trials: WATERFALL, NAVIGATE, and A2B. Key lessons include: (1) outcome assessors should be blinded when measures are subjective; (2) composite outcomes combining objective and subjective elements should be interpreted cautiously, especially if differences are driven by subjective components; and (3) when blinding is impossible, clinician-driven outcomes should be strictly protocolised and adherence reported, or hard outcomes like mortality should be used. These guiding principles help safeguard trial integrity and ensure more reliable interpretation of findings.

van Zwet EW, Harrell FE Jr, Senn SJ. An empirical assessment of the cost of dichotomization of the outcome of clinical trials. Stat Methods Med Res. 2026 Feb 5; doi:10.1002/sim.70402

  • Summary: Analysis of 21,435 randomized controlled trials from the Cochrane Database showed that 66% used binary outcomes, which have larger sample sizes, larger standard errors, and fewer statistically significant results than continuous outcomes. Many binary outcomes result from dichotomizing continuous variables, leading to avoidable information loss and inefficiency. On average, only about 60% of information is retained after dichotomization. The authors provide methods and tools to estimate information loss and adjust sample size calculations, advocating for “model continuously but interpret dichotomously” to improve trial efficiency, reduce participant burden, and maintain statistical power.

Beltran J, Etxeandia-Ikobaltzeta I, Piggott T, Akl EA, Mustafa RA, Hazlewood G, et al. New GRADE Evidence-to-Decision Framework for Pairwise and Multiple Comparisons (GRADE Guidance 45). Ann Intern Med. 2026 Mar 17; doi:10.7326/ANNALS-25-04273

  • Summary: The GRADE evidence-to-decision (EtD) framework, originally designed for pairwise comparisons, has been updated to accommodate multiple comparisons, reflecting recent GRADE guidance. The new framework includes sections for question definition, assessment—including a “net effect” criterion—and conclusion, enabling structured decision-making across multiple interventions while considering outcomes, values, cost-effectiveness, equity, acceptability, and feasibility. Network meta-analyses can inform effect estimates and rankings, but the framework provides a transparent approach to integrate these with broader decision criteria. Limitations include that usability across diverse guideline contexts has not yet been widely tested.

Moreno R, Arias López MdP, Finazzi S. The customization of general outcome prediction models: a statistical exercise or a necessity? Crit Care Sci. 2026 Mar 16;38:e20260461. doi:10.62675/2965-2774.20260461

  • Summary: Since the introduction of the APACHE II score in 1985, predicting mortality in ICU patients has become routine, forming the basis for calculating the Standardized Mortality Ratio (SMR) and, later, the Standardized Resource Use (SRU) to assess ICU performance and cost-effectiveness. These metrics are widely used for benchmarking across registries such as ANZICS and ICNARC. However, the accuracy of SMR and SRU depends on the calibration of the underlying Outcome Prediction Models (OPMs), which can drift over time and across regions due to changes in management, case mix, admission/discharge policies, and end-of-life practices. Consequently, many registries update or customize OPM coefficients annually, though these changes are often unpublished.

General Interest

White NJ, Bagcchi S. Nicholas John White. Lancet Infect Dis. 2026 Apr;26(4):339. doi:10.1016/S1473-3099(26)00125-8

  • Summary: Sir Nicholas John White, a pioneering physician and infectious disease researcher, passed away on February 1, 2026, at age 74. He was instrumental in developing and validating artemisinin-based combination therapies for malaria, leading to WHO recommendations for first-line treatment of uncomplicated and severe malaria. White held professorships at the University of Oxford and Mahidol University, directed the Mahidol Oxford Research Unit, and built a network of research sites across Asia and Africa. His contributions spanned malaria, dengue, tetanus, typhoid, and tuberculosis, influencing global health policy and saving millions of lives. Recognized internationally, he was a fellow of the Royal Society, Knight Commander of the Order of St Michael and St George, and recipient of the Canada Gairdner Global Health Award and Thailand's Prince Mahidol Award. White is survived by his wife, children, and grandchildren.

Fauntleroy K, Baron EJ, Humphries RM. In memoriam: Davise Honig Larone. J Clin Microbiol. 2026 Mar 18; doi:10.1128/jcm.01844-25

  • Summary: The editorial honors Davise Honig Larone, a highly influential clinical microbiologist who passed away on September 6, 2025, highlighting her lasting impact through her widely used textbook “Medically Important Fungi: A Guide to Identification” and her legacy as a mentor and leader in clinical mycology.

Company News

Insmed Incorporated. Insmed announces positive topline results from Phase 3b ENCORE study of ARIKAYCE® (amikacin liposome inhalation suspension) in patients with MAC lung disease. PR Newswire. March 23, 2026.

  • Summary: Insmed announced positive topline results from its Phase 3b ENCORE study evaluating ARIKAYCE® (amikacin liposome inhalation suspension) plus multidrug therapy in patients with a new occurrence of Mycobacterium avium complex (MAC) lung disease. The study met its primary endpoint—improvement in Respiratory Symptom Score at Month 13—and all multiplicity-controlled secondary endpoints, including culture conversion rates by Months 6, 12, 13, and durable conversion at Month 15. ARIKAYCE showed statistically significant improvements compared with placebo plus multidrug therapy, with a safety profile consistent with previous studies. Insmed plans to file a supplemental NDA with the FDA and submit data to Japan’s PMDA in the second half of 2026 to support potential label expansions. The ENCORE study included 425 patients across 177 global sites, assessing both efficacy and safety over a 12-month treatment period followed by 3 months for durability.

Iterum Therapeutics PLC. Iterum Therapeutics announces filing of winding up petition. GlobeNewswire. March 27, 2026.

  • Summary: Iterum Therapeutics plc (in Provisional Liquidation) filed a petition in the High Court in Ireland on March 27, 2026, to wind up the company, appointing Damien Murran and Jennifer McMahon of Teneo Restructuring (Ireland) Limited as Joint Provisional Liquidators. The petition is scheduled to be heard on April 13, 2026, and if granted, the company and its subsidiaries will be wound up and ultimately dissolved. The decision follows limited cash resources, inability to raise capital, failure to meet Nasdaq listing requirements, and unsuccessful strategic alternatives, including commercialization challenges with ORLYNVAH™ (oral sulopenem) for uncomplicated urinary tract infections. The Joint Provisional Liquidators may manage withdrawal of ORLYNVAH™ from the U.S. market in consultation with the FDA and service providers. Iterum had focused on next-generation oral and IV antibiotics targeting multi-drug resistant pathogens.
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