Issue: Newsletter 14 | February 15, 2026

Randomised Controlled Trials

Trial Protocols / Trial Ideas

Pipitone G, Granata G, Maraolo AE. Which trials do we need? The never-ending quest for an oral switch regimen in culture-negative prosthetic valve infective endocarditis. Clin Microbiol Infect. 2026 Feb 9; doi:10.1016/j.cmi.2026.02.002

• Summary: Reducing unnecessary intravenous (IV) catheters—by switching to oral therapy when clinically appropriate—can help prevent healthcare-associated and catheter-related infections while improving patient comfort and lowering nursing workload and hospitalization costs.

Desoubeaux G, Mikulska M, Lemaignen A, Gyan E, Stemler J, Vanbiervliet Y, et al. Which trial do we need? Defining the optimal duration of antifungal therapy for invasive pulmonary aspergillosis. Clin Microbiol Infect. 2026 Feb 7; doi:10.1016/j.cmi.2026.01.030

• Summary: While randomised controlled trials have clearly defined anti-infective treatment durations for many infections, optimal duration for invasive aspergillosis—a predominantly pulmonary infection most often due to Aspergillus fumigatus and a WHO priority pathogen—remains uncertain because evidence is largely non–duration-focused and non-RCT, despite ~300,000 annual global cases (mainly in hematology and allogeneic HCT patients), high short-term mortality (34.5% at 6 weeks; 42.5% at 3 months), prolonged follow-up often up to a year, and an estimated ~16% relapse risk.

Antibiotic Therapy Reviews

Gomez-Villegas SI, Miller WR, Arias CA. Current Management of Serious Infections due to Vancomycin-resistant Enterococci. Infect Dis Clin North Am. 2026 Jan 21; doi:10.1016/j.idc.2025.12.004

• Summary: This review outlines why vancomycin-resistant enterococci (VRE) are prominent and persistent healthcare-associated pathogens, explains the mechanisms and epidemiology of vancomycin resistance and GI colonization as a precursor to infection, discusses the debated impact of resistance on clinical outcomes, reviews approaches to persistent/recurrent enterococcal bacteremia and when to pursue echocardiography for infective endocarditis (especially with E faecalis), highlights ampicillin–ceftriaxone dual β-lactam therapy as standard of care for complicated E faecalis infections with caution for particular resistant phenotypes (eg, PRASEF), and summarizes emerging options such as bacteriophage therapy alongside risk-stratified treatment selection.
  

Ibrahim T, Burhan M, Naveed MA, Ali A, Shahid ZUA, Nizam F, et al. Safety and efficacy of gepotidacin in urinary tract infection: a GRADE-assessed systematic review and meta-analysis. J Antimicrob Chemother. 2026 Feb;81(2):dkaf469. doi:10.1093/jac/dkaf469

• Summary: This PRISMA systematic review and random-effects meta-analysis of three Phase 3 RCTs (EAGLE-2, EAGLE-3, EAGLE-J; n=3510 women) found that oral gepotidacin achieved higher composite therapeutic success and microbiological eradication than nitrofurantoin for acute uncomplicated UTI (RR 1.20 and 1.14 respectively, minimal heterogeneity), but caused more mild-to-moderate gastrointestinal adverse events (notably diarrhoea and nausea) with serious adverse events rare and similar, supporting gepotidacin as an effective oral option while emphasising the need for ongoing tolerability and resistance monitoring.
  

Bleibtreu A, Bennis Y, Dinh A, Dupont H, Friggeri A, Jeannot K, et al. Role of Cefiderocol in the Treatment of Carbapenem-Resistant Nonfermenting Gram-Negative Bacilli (Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia) Infections: An Expert Statement. Infect Dis Ther. 2026 Jan 31; doi:10.1007/s40121-026-01301-y

• Summary: A French multidisciplinary expert consensus review concludes that cefiderocol is a useful option for severe multidrug-resistant nonfermenting gram-negative infections (notably Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa), with evidence suggesting lower nephrotoxicity and possibly lower mortality versus colistin-based regimens in A. baumannii, reliable activity for S. maltophilia as an alternative to TMP-SMX/fluoroquinolones, and a role for difficult P. aeruginosa after newer β-lactam failure (with caution for NDM producers), emphasizing MIC-guided selection and PK/PD-optimized dosing (eg, prolonged/continuous infusion and early therapeutic drug monitoring), particularly in high-inoculum disease or augmented renal clearance.
  

Manesh AS. Current management strategies for hypervirulent Klebsiella. Infect Dis Clin North Am. 2025 Dec 22; doi:10.1016/j.idc.2025.11.005

• Summary: Hypervirulent Klebsiella pneumoniae (HvKp) causes severe, rapidly progressive community-acquired invasive disease (notably liver abscess, endophthalmitis and other metastatic infections) with early mortality risk, yet lacks standardized diagnostic criteria—so clinicians rely on high suspicion plus imperfect tools like the string test and hypervirulence genes/capsule types—promptly screen for often occult metastatic complications (especially in patients with Asia-Pacific/South Asian exposure or higher-risk ethnicities), and manage with appropriate antibiotics alongside aggressive source control (preferably percutaneous drainage for liver abscess), while the growing convergence of hypervirulence and multidrug resistance and the need for a validated consensus definition remain key gaps.

PK/PD and Drug Dosing

de Hoop-Sommen MA, Freriksen JJ, van der Heijden JE, Jacobs J, Oosterlaan Y, Staring CM, et al. Do the redefined EUCAST susceptibility categories warrant adjustment of paediatric antibiotic dosages? Pragmatic physiologically based pharmacokinetic modelling of four commonly used agents. J Antimicrob Chemother. 2026 Feb;81(2):dkaf463. doi:10.1093/jac/dkaf463

• Summary: Using verified physiologically based pharmacokinetic modelling for amoxicillin, ceftazidime, cefuroxime, and ciprofloxacin, this study found that standard paediatric regimens already produce equal or higher antibiotic exposures than adults receiving EUCAST “susceptible, increased exposure” (‘I’) doses—especially in neonates/infants—suggesting routine paediatric dose escalation is unnecessary, while highlighting that probability of target attainment can still be age- and pathogen-dependent and may warrant individualized dosing by drug–microorganism combination.
  

Liu Y, Zhang SS, Chen JH, Zhu JW, Miao HJ, Chen F, et al. Biomarker-informed PBPK modelling of meropenem in paediatric severe pneumonia: implications for target-site PK/PD. J Antimicrob Chemother. 2026 Feb;81(2):dkaf500. doi:10.1093/jac/dkaf500

• Summary: This study developed and validated a physiologically based pharmacokinetic model to predict unbound meropenem concentrations in both plasma and epithelial lining fluid (ELF), showing that lung penetration varies with physiological/inflammatory factors and that ELF %fT>MIC is more variable and more closely associated with survival than plasma exposure (significant in children), while simulations suggest prolonged infusions can improve ELF target attainment for susceptible organisms (MIC ≤4 mg/L) when penetration is adequate but are insufficient for high-MIC pathogens or poor lung penetration, supporting infection-site–targeted dosing optimization in pneumonia.
  

Schmidt JJ, Hagemann J, Hillebrand U, Scherneck S, Sörgel F, Kinzig M, et al. Pharmacokinetics of cefiderocol during prolonged intermittent kidney replacement therapy in two patients with septic shock. J Antimicrob Chemother. 2026 Feb;81(2):dkaf496. doi:10.1093/jac/dkaf496

• Summary: In two critically ill case patients receiving cefiderocol during prolonged intermittent kidney replacement therapy (PIKRT) plus Seraph 100 hemoperfusion, measured LC–MS/MS pharmacokinetics showed substantial extracorporeal removal by PIKRT (median dialyser clearance ~81 mL/min; 40%–68% of the administered dose recovered in spent dialysate) but negligible clearance by Seraph 100, suggesting cefiderocol dose escalation or use of near-normal renal function dosing may be needed during intensive PIKRT to avoid underexposure.
  

Hansen JU, Arrazuria R, Hoover JL, Kerscher B, Huseby DL, Sordello S, et al. The COMBINE pneumonia model: a multicenter study to standardize a mouse pneumonia model with Pseudomonas aeruginosa and Klebsiella pneumoniae for antibiotic development. Antimicrob Agents Chemother. 2026 Jan 14; doi:10.1128/spectrum.03464-25

• Summary: This multicentre preclinical study established and validated a standardized neutropenic mouse pneumonia model for Klebsiella pneumoniae and Pseudomonas aeruginosa by applying a consensus protocol to 32 isolates, selecting 15 meeting predefined virulence/survival criteria and confirming reproducible growth of eight strains across independent sites, then depositing these into the DSMZ/COMBINE strain repository to enable more comparable, clinically relevant antibiotic efficacy testing while supporting 3R animal-research principles.
  

Shah S, Peng L, Clarke LG, Balasubramani GK, Smith BJ, Shields RK, et al. Evaluating hypoalbuminaemia thresholds associated with delayed blood sterilization among patients receiving cefazolin or antistaphylococcal penicillins for MSSA bacteraemia. J Antimicrob Chemother. 2026 Feb;81(2):dkaf498. doi:10.1093/jac/dkaf498

• Summary: In this multicentre retrospective cohort of 285 adults with persistent MSSA bacteraemia despite active therapy, bootstrap-supported Cox modelling identified serum albumin ≤3.0 g/dL as the optimal hypoalbuminaemia threshold and, after propensity weighting, this level was associated with significantly slower blood culture clearance versus albumin >3 g/dL (HR 0.6, 95% CI 0.44–0.81), including in a population with high rates of endocarditis and injection drug use.

Beta-Lactamases and Other Resistance Mechanisms

Castañeda-Barba S, Top EM, Stalder T. Plasmids, a molecular cornerstone of antimicrobial resistance in the One Health era. Nat Rev Microbiol. 2024;22:18-32. doi:10.1038/s41579-023-00926-x

• Summary: This One Health-focused review explains how plasmids enable horizontal transfer of antibiotic resistance genes across environmental, animal, human and clinical habitats, and synthesizes emerging eco-evolutionary evidence on how selective pressures, spatial structure, environmental heterogeneity, temporal variation and microbiome interactions shape the emergence, persistence and global spread of multidrug-resistance plasmids in pathogens.
  

Falcone M, Tiseo G, Shields RK. Resistance development to new anti-gram negatives during treatment: geographical epidemiology and risk factors. Clin Microbiol Infect. 2026 Feb 7; doi:10.1016/j.cmi.2026.01.031

• Summary: This review synthesizes 15 years of evidence on treatment-emergent resistance in carbapenem-resistant Enterobacterales (CRE) during or after exposure to newer agents (including ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, aztreonam-avibactam, eravacycline and plazomicin), highlighting that data are sparse and inconsistently defined (often lacking dosing/duration and cross-resistance details), that resistance is most well documented with ceftazidime-avibactam via Ω-loop KPC variants (e.g., KPC-31), is uncommon but reported for meropenem-vaborbactam and imipenem-relebactam in selected European cases, and for cefiderocol and aztreonam-avibactam particularly in NDM-producing strains (linked to iron transporter defects, PBP3 substitutions, increased blaNDM copy number, and PBP3/CMY mutations), and concludes that the clinical impact is likely underestimated and should be mitigated through PK/PD optimization and therapeutic drug monitoring, timely source control, and stewardship-driven rational use of novel antibiotics.
  

Karakonstantis S, Tziolos RN, Paneta M, Kritsotakis EI. Global and regional prevalence of metallo-β-lactamases in carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis. J Antimicrob Chemother. 2026 Mar;81(3):dkag037. doi:10.1093/jac/dkag037

• Summary: This 2020–2024 systematic review and meta-analysis of 233 studies (58,676 carbapenem-resistant Acinetobacter baumannii isolates) estimated a global metallo-β-lactamase (MBL) prevalence of 5.3% in CRAB with strong regional clustering—highest in the Eastern Mediterranean (42.1%) and Africa (36.1%), moderately high in South-East Asia (17.9%), and <1% in Europe, the Americas and Western Pacific—found higher MBL prevalence in 2020–2024 versus 2012–2019 (7.2% vs 4.2%; adjusted OR 2.3), identified NDM as the dominant MBL (global prevalence 1.7%), and concludes that despite low global levels, regional hotspots threaten last-resort/new antibiotic effectiveness and require sustained surveillance, stringent infection control and antimicrobial stewardship.

Adverse Effects from Antimicrobial Agents

Stevenson E, Ponder M, Daniels L, Jones T, Bartelt L, Van Duin D, et al. Impact of eravacycline on fibrinogen. J Antimicrob Chemother. 2026 Mar;81(3):dkag030. doi:10.1093/jac/dkag030

• Summary: In a retrospective cohort of 39 hospitalized adults receiving eravacycline (mostly for nontuberculous mycobacterial infection, many transplant recipients), fibrinogen reductions were common—33% had ≥50% decline by a median of 10 days, 79% had ≥25% decline, and 49% developed hypofibrinogenaemia <200 mg/dL—while bleeding was infrequent and minor (10%), supporting baseline and at least weekly fibrinogen monitoring during therapy.
  

Maertens J, Birne R, Felton T, Neofytos D, Hoenigl M. Liposomal amphotericin B and renal safety: review of the evidence and clinical considerations. J Antimicrob Chemother. 2026 Feb;81(2):dkaf473. doi:10.1093/jac/dkaf473

• Summary: This review highlights that while liposomal amphotericin B has substantially less renal toxicity than amphotericin B deoxycholate, nephrotoxicity remains clinically important—especially with higher or prolonged dosing, concurrent nephrotoxins, or pre-existing kidney disease—and recommends risk-based screening and monitoring, routine IV saline prophylaxis, consideration of potassium/magnesium supplementation, and potentially nephro-sparing alternative dosing strategies (eg, intermittent regimens or selected single high-dose induction approaches) pending further evidence.
  

Ishigo T, Suzuki A, Ibe Y, Fujii S, Fukudo M, Yoshida H, et al. Development of a risk prediction model for vancomycin-associated acute kidney injury: a multicentre retrospective study. J Antimicrob Chemother. 2026 Mar;81(3):dkag012. doi:10.1093/jac/dkag012

• Summary: In a retrospective multicentre cohort of 847 vancomycin-treated patients (AKI 11.7% within 14 days), AKI incidence did not differ significantly by baseline renal function category, and a practical AKI risk score was derived in which concomitant piperacillin–tazobactam and vasopressors (each 2 points) plus higher Day-2 vancomycin AUC (500–600 µg·h/mL: 1 point; >600: 3 points) stratified patients from low (<5%) to very high (up to 67%) predicted AKI risk.
  

Liu W, Dickson HG, Dimitri H, Pani YS, Ramanathan J, West D, et al. The effect of oral ciprofloxacin at conventional doses on the QT interval in a tertiary outpatient setting. J Antimicrob Chemother. 2026 Mar;81(3):dkag020. doi:10.1093/jac/dkag020

• Summary: In a retrospective analysis of 88 outpatients receiving conventional-dose oral ciprofloxacin with baseline and follow-up 12‑lead ECGs at theoretical steady state, there was no significant change in QT or Bazett-corrected QTc (despite poor inter-rater reliability for raw QT measurements), and a QT nomogram showed high agreement for identifying prolongation cut points, supporting ECG monitoring mainly for patients with higher clinical risk factors.

Antibiotic Stewardship and Hospital in the Home

Stoorvogel HH, Damsté C, Dansen CW, Van Wolfswinkel ME, Wertheim HF, Schouten JA, et al. Factors promoting or hindering self-administered outpatient parenteral antimicrobial therapy: a systematic literature review. J Antimicrob Chemother. 2026 Feb;81(2):dkaf490. doi:10.1093/jac/dkaf490

• Summary: This PROSPERO-registered systematic review (23 studies, 2000–2024) identified 238 behavioural determinants affecting the full self-administered OPAT pathway—from whether clinicians offer it to patient acceptance, training and performance—and found that stakeholders’ cognitions/affect, collaboration and communication, contextual factors, and available resources/skills consistently shaped implementation, with notable evidence gaps around determinants of offering S-OPAT and caregiver perspectives.
  

Wilson RC, Gilchrist MJ, Cele R, d’Arc S, Mills EA, Ndhlovu C, et al. Exploring the opportunity for therapeutic drug monitoring (TDM) and precision dose antimicrobials in an outpatient antimicrobial therapy (OPAT) service: a prospective observational study. J Antimicrob Chemother. 2026 Feb;81(2):dkaf484. doi:10.1093/jac/dkaf484

• Summary: In a prospective pilot PK–PD study of 39 UK OPAT patients receiving common IV agents (mainly ceftriaxone and ertapenem) or oral linezolid, measured peak/trough total and unbound concentrations showed generally acceptable pharmacodynamic target attainment—particularly with all β-lactams meeting conservative targets—and demonstrated that therapeutic drug monitoring is feasible in OPAT even without on-site laboratory analytics, supporting future precision-dosing workflows.
  

Saade A, Pilmis B, Jacquier H, Lafaurie M, Sellier P, Michonneau D, et al. Management and outcomes of Stenotrophomonas maltophilia recovered from deep-site clinical specimens: a bicentric retrospective cohort study. J Antimicrob Chemother. 2026 Mar;81(3):dkag021. doi:10.1093/jac/dkag021

• Summary: In a bicentric retrospective cohort of 131 patients with deep-site Stenotrophomonas maltophilia isolates (often immunocompromised, frequently polymicrobial), 28-day mortality was 20% and strongly associated with severity markers such as mechanical ventilation (HR 4.13), while propensity-weighted analyses found no significant survival benefit from “appropriate” targeted therapy (mainly TMP-SMX or fluoroquinolones), underscoring the challenge of distinguishing infection from colonization and the need for careful clinical judgment before treating.
  

Lee H, Moon SM, Song KH, Choi SJ, Kim YK, Kim ES, et al. National Pilot Program for Antimicrobial Stewardship in the Republic of Korea. JAMA Netw Open. 2026 Jan 29;9(1):e2555843. doi:10.1001/jamanetworkopen.2025.55843

• Summary: This special communication describes South Korea’s first government-coordinated national antimicrobial stewardship pilot (launched Nov 2024 for hospitals ≥300 beds), which standardizes multidisciplinary AMS team requirements, audit-and-feedback and surveillance/reporting systems, and performance-linked funding within the national AMR action plan, demonstrating early feasibility and governance integration while highlighting ongoing workforce, readiness, and awareness gaps that must be addressed for scale-up.
  

Hamilton RA, Cockayne D, Garraghan F, Seaton RA, Gilchrist M, Patel S, et al. Development of a capability framework for antimicrobial stewardship specialist health professionals working in the NHS in England: utilizing Delphi methodology. J Antimicrob Chemother. 2026 Feb;81(2):dkaf438. doi:10.1093/jac/dkaf438

• Summary: Using a UK modified Delphi process, this study distilled 922 candidate statements into a consensus 45-statement, multi-professional antimicrobial stewardship specialist capability framework for the NHS—organized into Professional Practice, Leadership/Management, Education, and Research/Quality Improvement domains—with practice descriptors and development resources to support benchmarking, workforce planning, and career development across adult and paediatric services.
  

Murri R, Del Vecchio P, Giovannenze F, Frondizi F, Leanza GM, Taddei E, et al. Does it still make sense to talk about carbapenem-sparing? Clin Microbiol Infect. 2026 Feb 9; doi:10.1016/j.cmi.2026.01.033

• Summary: Because carbapenems and β-lactam/β-lactamase inhibitor combinations (BLBLIs) are both WHO-listed medically important antimicrobials, and carbapenems have long been considered “last-line” therapy for severe ESBL-producing Enterobacterales infections, ongoing debate about subtle differences in efficacy has driven a “carbapenem-sparing” strategy that promotes using alternatives such as BLBLIs or extended-spectrum cephalosporins whenever appropriate to preserve carbapenem activity.
  

Catteau L, Smith A, Roubaud Baudron C, Karlin D, Yoo SH, Fantoni M, et al. End-of-life antibiotic stewardship: perspectives from the ESCMID Study Groups for Antimicrobial Stewardship and Infections in the Elderly. Clin Microbiol Infect. 2026 Feb 10; doi:10.1016/j.cmi.2026.01.034

• Summary: Antibiotics are commonly used in end-of-life care—where goals shift from cure to comfort—with up to 80% of hospice/palliative patients receiving them in their final weeks despite often limited benefit, because while they may sometimes palliate symptoms (e.g., dysuria from UTI or pain/malodor from skin infections), they can also cause harms (adverse reactions, C. difficile, IV line complications, and burdensome medicalization) and uniquely contribute to societal risks by promoting antimicrobial resistance and transmission of multidrug-resistant organisms.

Infection Prevention / Antibiotic Prophylaxis

Fonton P, Sierra R, Martischang R, Nguyen A, Cherkaoui A, Andrey DO, et al. Epidemiological and molecular surveillance of multiresistant Citrobacter freundii complex in a tertiary care hospital: a retrospective cohort study. J Infect Dis. 2026 Feb 4; doi:10.1093/infdis/jiag066

• Summary: In a 2017–2022 retrospective genomic-epidemiological investigation at Geneva University Hospitals of 103 ESBL/carbapenemase-producing Citrobacter freundii complex cases (mostly hospital-acquired and detected on rectal screening), long-read WGS revealed high strain diversity but identified multiple multi-species transmission clusters, with 37% of patients linked to putative clonal spread and 21% to plasmid-mediated dissemination of key resistance genes (eg, blaCTX-M-15 and blaOXA-48/181 on IncHI2/IncM1/IncX3 plasmids), supporting routine inclusion of C. freundii in AMR surveillance to detect silent nosocomial transmission.
  

Kang Y, Guan X, Chen D; Guideline working group of Chinese Society of Critical Care. Practice guideline on the prevention and treatment of central line-associated bloodstream infection: Part 1––Diagnosis and prevention. J Intensive Med. 2026 Jan 22; doi:10.1016/j.jointm.2025.10.008

• Summary: This updated Chinese Society of Critical Care Medicine guideline (Part 1) uses GRADE-informed systematic reviews and expert consensus to deliver 52 recommendations for adult ICU patients with central venous catheters, focusing on standardizing CLABSI diagnosis and prevention practices in light of new evidence and evolving antimicrobial resistance to reduce infection rates and improve outcomes.
  

Kang Y, Guan X, Chen D; Guideline working group of Chinese Society of Critical Care. Practice guideline on the prevention and treatment of central line-associated bloodstream infection: Part 2 – Treatment. J Intensive Med. 2026 Jan 22; doi:10.1016/j.jointm.2025.10.009

• Summary: The Chinese Society of Critical Care Medicine updated CLABSI guideline (Part 1) sets the stage for Part 2 on catheter management after infection and antimicrobial treatment.
  

Drugeon B, Mihala G, Schults J, Bigaud B, Guenezan J, Batiot G, et al. Chlorhexidine vs povidone-iodine and incidence of catheter-related infections: a systematic review and meta-analysis. JAMA Netw Open. 2026 Feb 12;9(2):e2558954. doi:10.1001/jamanetworkopen.2025.58954

• Summary: In a systematic review and network meta-analysis of 16 randomised trials including 7,803 patients and 11,985 intravascular catheters, alcohol-based skin antiseptics (especially isopropyl alcohol rather than ethanol) reduced catheter-related infection outcomes versus aqueous formulations, and chlorhexidine outperformed povidone-iodine—particularly higher-concentration chlorhexidine (≥1%), which was associated with markedly lower catheter-related bloodstream infection and catheter colonization rates—supporting high-concentration chlorhexidine in isopropyl alcohol as the preferred first-line antiseptic before catheter insertion, with alcoholic povidone-iodine or aqueous options reserved when chlorhexidine or alcohol cannot be used.

Gastrointestinal Tract Infections

Grome HN, Brandenburg JM, Kent AG, Curtis L, Raymond RE, Ansari U, et al. Extraintestinal Invasive Escherichia coli Infections in the US. JAMA Netw Open. 2026 Feb 2;9(2):e2557201. doi:10.1001/jamanetworkopen.2025.57201

• Summary: Using active population-based surveillance across nine US sites (>7.2 million population) in June–August 2023, this cohort study identified 1345 extraintestinal invasive E coli cases (annualized incidence 74.7/100,000, much higher in adults ≥60 years), largely bloodstream infections often linked to urinary tract sources, with substantial resistance (13.8% ESBL-producing, 25.9% ciprofloxacin-resistant, 28.8% TMP-SMX–resistant) and O25B as the most common O serotype among sequenced isolates, underscoring a major community burden and need for prevention and AMR mitigation.
  

Jakanov MK, Gainollina GG, Zhakiev BS, Topchiev MA, Kurmanbayev BA. Necrotic pancreatitis: modern approaches to the prevention of infected necrosis. Front Med. 2026 Jan 13;12:1695035. doi:10.3389/fmed.2025.1695035

• Summary: This review on necrotizing pancreatitis summarizes current understanding of its pathogenesis and epidemiology and focuses on preventing infected necrosis, highlighting strong evidence for early enteral nutrition, ongoing controversy and inconclusive trial/meta-analysis data on selective digestive decontamination and antibiotic prophylaxis due to heterogeneous designs and regimens, and emerging risk stratification (including machine learning) to target preventive measures, while emphasizing the need for rigorous studies to define optimal timing, duration, and choice of prophylactic strategies.
  

Xu Y. Infection-targeted innovations in anastomotic leak management: endoscopic advances, antimicrobial biomaterials, and precision strategies. Ann Med. 2026 Jan 23; doi:10.1080/07853890.2026.2619218

• Summary: This narrative review on gastrointestinal anastomotic leak management emphasizes infection-targeted approaches, noting that established endoscopic techniques—especially endoscopic vacuum therapy—achieve high closure rates (74–94.4%) and reduce sepsis in cohort studies and meta-analyses, while emerging innovations such as antibiotic-eluting hydrogels, reversible endoscopic bypass methods, and AI-based prediction models show early promise but need stronger clinical validation to enable a shift toward proactive, precision prevention.

Bone and Joint Infections

Dieterle MG, Cinnamon K, Kessler M, Yandre J, Kakumanu S. A Bone To Pick: Navigating the Impact of Penicillin Allergy Labels on Bone and Joint Infections. Curr Infect Dis Rep. 2026;28:4. doi:10.1007/s11908-026-00875-5

• Summary: This review explains that although about 10% of Americans carry a penicillin allergy label, up to 90% can tolerate penicillins on testing, and unassessed labels in bone and joint infection care are linked to worse outcomes (eg, more surgical site/periprosthetic infections, longer stays, higher mortality and resistant/C. difficile infections) by driving avoidance of first-line beta-lactam prophylaxis and therapy, supporting routine penicillin allergy evaluation and de-labeling with alternative antibiotic guidance only for confirmed allergy.
  

Matsuo T, Borgonovo F, Lahr BD, Petri F, Igwilo-Alaneme R, Alvarez Mulett SL, et al. Clinical Manifestations, Long-Term Trends, and Risk Factors for Treatment Failure in Native Vertebral Osteomyelitis: A 26-Year Mayo Clinic Experience. Clin Infect Dis. 2026 Feb 4; doi:10.1093/cid/ciag048

• Summary: In a 26-year Mayo Clinic multicentre retrospective cohort of 1,255 adults with native vertebral osteomyelitis (1999–2024), patients became more medically complex and microbiology shifted with rising Gram-negative isolates (6% to 14%) while 1-year treatment failure declined (16% to 10%), and competing-risk modelling identified diabetes and multilevel disease as predictors of failure, supporting early risk stratification and multidisciplinary management with close follow-up for high-risk patients.
  
• Editorial Commentary:
  Zimmerli W. The Management of Native Vertebral Osteomyelitis Remains Unchanged: Are Additional Trials Necessary? Clin Infect Dis. 2026 Feb 4; doi:10.1093/cid/ciag049

CNS Infections

Wang J, Ma Y, Shi X, Han Y, Zhang Y, Diao Z, et al. A Multicenter Evaluation of Metagenomic Sequencing for Pathogen Detection in Central Nervous System Infections. Clin Microbiol Infect. 2026 Jan 27; doi:10.1016/j.cmi.2026.01.015

• Summary: In a 127-laboratory evaluation using a standardized 15-sample CSF reference panel, CSF metagenomic NGS showed high overall accuracy (mean F1-score 0.98) but errors were mainly driven by experimental contamination causing false positives and reduced sensitivity for RNA viruses causing false negatives, with workflow choices materially affecting performance—pelleting generally worsening detection, while DNase-based microbial enrichment and Kraken2 improving accuracy for DNA viruses, bacteria, fungi and atypical pathogens—highlighting the need for stronger contamination control and optimized RNA virus detection to improve clinical reliability.
  

Shao Y, Lan X, Chen M, Wang M, Guo Q. Nationwide emergence of cefotaxime-resistant Neisseria meningitidis via interspecies gene transfer from penA795-bearing Neisseria commensals in China. Clin Microbiol Infect. 2026 Feb 2; doi:10.1016/j.cmi.2026.01.026

• Summary: This article highlights a post–COVID-19 resurgence of invasive meningococcal disease alongside increasing penicillin and fluoroquinolone resistance, and raises concern about emerging third-generation cephalosporin resistance driven by horizontal gene transfer of the mosaic penA795 allele (encoding a modified PBP2), which can confer reduced susceptibility/resistance to both penicillin and cefotaxime in Neisseria meningitidis.
  

Serogroup Switching in Neisseria meningitidis with Dual Antibiotic Resistance. N Engl J Med. 2026 Jan 7;394:199-201. doi:10.1056/NEJMc2507652

• Summary: This NEJM letter reports the emergence in the US of dual penicillin- and fluoroquinolone-resistant Neisseria meningitidis clonal complex 23 ST-3587 undergoing capsular serogroup switching, describing a California case with a serogroup W isolate genetically clustered within the established resistant serogroup Y clade and two additional closely related Texas isolates that were serogroup B, indicating ongoing clonal spread with antigenic shift that could affect surveillance and vaccine strategy.
  

Demir KK, Cheng MP, Nelson J. Changing Course. Clin Infect Dis. 2026 Jan 28; doi:10.1093/cid/ciaf720

• Summary: This case report describes a 74-year-old immunosuppressed man with ESRD on dialysis and chronic prednisone who presented with weeks of fever and neurocognitive symptoms and was found to have a hypermetabolic cavitary lung mass with widespread PET-avid subpleural/omental and soft-tissue deposits plus multiple rim-enhancing brain and spinal cord lesions with suspected ventriculitis and an intramedullary T5 abscess, mimicking metastatic malignancy but raising concern for disseminated infection with CNS involvement.
  

Smith D, Garikipati R, Bastug K, Broach JR, Schneper L, Sheldon K, et al. Paenibacillus dendritiformis as a cause of destructive meningitis in infants. N Engl J Med Evid. 2026 Feb 3; doi:10.1056/EVIDpha2500297

• Summary: This report highlights Paenibacillus dendritiformis as an emerging cause of invasive infection in young infants in the United States, describing two cases with severe neurologic manifestations and emphasizing that Paenibacillus infections carry a high risk of neurologic sequelae, may not be covered by standard empiric regimens for infant bacteremia/meningitis, and often require neurosurgical intervention.

Respiratory Tract Infections

Mira P, Dyrhovden R, Tellevik MG, Eagan TM, Krause A, Lopez-Martinez O, et al. Microbial Detection in Community Acquired Pleural Space Infection Using the BioFire Joint Infection Panel and Individual PCR Assays. Clin Infect Dis. 2026 Jan 31; doi:10.1093/cid/ciag050

• Summary: In 162 pleural fluid samples from community-acquired pleural infections (Mayo Clinic and Haukeland University Hospital), the off-label BIOFIRE Joint Infection Panel supplemented with three targeted in-house PCRs detected pathogens in 96.8% of cases (complete microbial profiles in 70.8%), outperforming culture (31.9% detected; 15.3% complete profiles) and performing comparably to 16S rRNA PCR/sequencing (92.2% detected; 87.0% complete profiles), supporting rapid panel-based molecular diagnostics to streamline pleural infection management.

Bacteraemia and Endocarditis

Guerreiro GS, Fustiga J, Póvoa P. Duration of antibiotic therapy: with or without biomarkers? Acute Crit Care. 2025 Dec 29; doi:10.4266/acc.002525

• Summary: This review discusses why optimal antibiotic duration should move beyond fixed “one-size-fits-all” courses by linking bacterial growth kinetics and antibiotic pharmacodynamics to pragmatic stopping strategies—fixed-duration, biomarker-guided, clinical course–based, and a newer “double-trigger” approach—to better tailor treatment length while supporting stewardship.
  

Solera JT, Aparicio-Minguijón E, Domínguez-Pérez L, Muñoz P, Vázquez-Alen P, Álvarez-Uría A, et al. Baseline Antithrombotic Therapy and Intracranial Hemorrhage Risk in Infective Endocarditis: A Multicenter Prospective Cohort Study. Clin Infect Dis. 2026 Feb 6; doi:10.1093/cid/ciag067

• Summary: In a prospective multicentre cohort of 3,236 patients with definite left-sided infective endocarditis, baseline anticoagulation (aRR 1.83) and especially combined antiplatelet-plus-anticoagulant therapy (aRR 2.45) were independently associated with higher 30-day intracranial haemorrhage risk versus no antithrombotic therapy (while antiplatelet therapy alone was not and ischaemic stroke rates were similar), and combined therapy also predicted higher 1-year mortality (aHR 1.21), supporting early neurologic risk stratification incorporating antithrombotic exposure, organism (S. aureus/Candida), and cerebrovascular history.
  

Gupta A, Iordanov R, Auguste A, Van Enk J, Shah MM, Richardson BT, et al. Melioidosis complicated by native valve endocarditis in a traveler returning from Thailand to the United States. Clin Infect Dis. 2026 Feb 10; doi:10.1093/cid/ciag003

• Summary: This case report describes a traveler returning from Thailand to the United States who developed fatal native aortic valve endocarditis due to Burkholderia pseudomallei (melioidosis), a very rare cause of endocarditis with only 14 prior cases reported, complicated by embolic stroke and subdural empyema.
  

Soo JZY, Lim TP, Ho JJY, Tong SYC, Lye DC, Davis JS, et al. Effect of in vitro synergy and additivity of vancomycin or daptomycin plus an anti-staphylococcal β-lactam for methicillin-resistant Staphylococcus aureus bacteraemia on mortality: pre-planned analysis from CAMERA2. Clin Microbiol Infect. 2026 Feb 9; doi:10.1016/j.cmi.2026.01.032

• Summary: In a post-hoc analysis of 150 patients from the randomised CAMERA2 trial of MRSA bloodstream infection treated with vancomycin or daptomycin plus an anti-staphylococcal β-lactam, isolates showing positive in vitro interactions (synergy/additivity) on checkerboard testing were associated with lower 14-day mortality (2.9% vs 12.8%) but not lower 90-day mortality (32% vs 34%), suggesting synergy testing might help target combination therapy to patients most likely to benefit, though results are hypothesis-generating and need confirmation in a dedicated randomised trial.

Mycobacterial Infections

Solovyeva AV, Volchenkov GV, Ponomarenko OI, Kuznezova TA, Somova TR, Belova EV, et al. Implementing a Program of Comprehensive Tuberculosis Preventive Treatment: Safety, Effectiveness, and Acceptability of Moxifloxacin or Bedaquiline Use for Contacts Exposed to Drug-Resistant Strains. Clin Infect Dis. 2026 Feb 3; doi:10.1093/cid/ciaf701

• Summary: In a retrospective cohort of 403 adults and high-risk groups (including people with HIV and homelessness) receiving tuberculosis preventive treatment in Vladimir, Russia (2019–2020) with regimens tailored to index-case drug susceptibility (including 4-month moxifloxacin and 3-month bedaquiline for MDR/pre-XDR exposures), no life-threatening adverse reactions or deaths occurred, 3-month bedaquiline had the highest completion (95.2%) and lowest ADR rates compared with 3HP, and TB incidence during 12-month follow-up was about fourfold higher among eligible contacts who declined TPT than among those who initiated it.
  

Ryckman TS, Shrestha S, Fojo AT, Kasaie P, Dowdy DW, Kendall EA. Modeling the Impact of Case Finding for Tuberculosis: The Role of Infection Dynamics. J Infect Dis. 2026 Jan 30; doi:10.1093/infdis/jiag050

• Summary: Using two calibrated TB transmission models for a high-burden setting (India) that differed only by whether they allowed clearance of Mycobacterium tuberculosis infection, the authors show that incorporating clearance implies more recent infection/transmission and therefore predicts much larger long-term benefits from biennial active case-finding campaigns (≈45% vs 11% TB incidence reduction at 10 years), suggesting transmission-reducing interventions may be more impactful than standard models estimate.
  

Wang W, Li F, Mo W, Liu Z, Xu J, Li Y, et al. Granulomas microenvironment-guided sono-immunotherapy to treat and prevent recurrence of tuberculosis. Nat Commun. 2026; doi:10.1038/s41467-026-69420-1

• Summary: Combining bioinformatic profiling of human TB granuloma and blood immune microenvironments (linking suppressed macrophage/dendritic TLR–NF-κB signaling and heightened lymphocyte negative regulation with treatment failure/recurrence) with a targeted therapeutic approach, this study develops mannose-modified semiconducting nano-immunostimulants activated by ultrasound to generate ROS that kill M. tuberculosis in granulomas while releasing antigens and delivering a TLR7 agonist to boost durable innate/adaptive immunity and prevent relapse/reinfection in preclinical models.
  

Dorji T, Tshering K, Adhikari L, Jamtsho T, Bhujel P, Lhaden P, et al. Extensive Endemic Transmission of Multidrug-Resistant Mycobacterium tuberculosis in Bhutan: A Retrospective Genomic-Epidemiological Study. Open Forum Infect Dis. 2026 Jan 29;13(1):ofaf802. doi:10.1093/ofid/ofaf802

• Summary: Whole-genome sequencing of a national sample of TB isolates from Bhutan (2018–2022; 203 genomes passing QC) found that most drug-resistant cases were MDR-TB dominated by lineage 2 and that 71% of sequences fell into 12 genomic clusters—driven by a large, countrywide, highly clonal MDR cluster—indicating that Bhutan’s MDR-TB burden is largely due to recent local transmission rather than repeated importation and supporting targeted contact tracing, screening, and investment in TB genomics for policy action.
  

Wang Y, Li R, Cai L, Jin L, Cui J, Ma Z, et al. Accuracy of rapid quantitative PCR on tongue swabs for pulmonary tuberculosis in sputum-scarce patients: a prospective multicentre diagnostic study. Clin Infect Dis. 2026 Feb 9; doi:10.1093/cid/ciag071

• Summary: In a prospective multicentre study of 625 sputum-scarce presumptive TB patients in China, MTB PCR on tongue swabs showed high accuracy versus bronchoalveolar-lavage reference testing (≈80% sensitivity and ≥97.6% specificity against MRS/Xpert), and modelling suggested tongue-swab PCR can improve overall case detection compared with sputum-only Xpert when sputum scarcity is common, supporting this non-invasive approach while highlighting the need to further optimize sampling and assay sensitivity for low-bacillary-load disease.
  

Manzoor F, Rhee C, Baker MA, Klompas M. Mycobacterium tuberculosis Transmission in Healthcare Settings: A Systematic Review of Frequency, Risk Factors, and Exposure Conditions. Clin Infect Dis. 2026 Jan 30; doi:10.1093/cid/ciag053

• Summary: This systematic review of 86 studies (1,083 TB source patients; 35,698 exposed individuals) found healthcare-associated M. tuberculosis transmission is relatively uncommon—especially in settings meeting modern ventilation standards—but is strongly linked to prolonged close exposure, lack of N95 use, frequent direct care, and absence of negative-pressure ventilation, with most documented transmissions occurring after >8 hours’ cumulative unprotected exposure, supporting risk-stratified contact investigations using an >8-hour-without-respirator exposure definition.
  

Gopalaswamy R, Subbian S. The power of resistance: mechanisms of antimicrobial resistance in Mycobacterium tuberculosis and its impact on tuberculosis management. Clin Microbiol Rev. 2026 Jan 7; doi:10.1128/cmr.00194-25

• Summary: This comprehensive review frames drug-resistant tuberculosis as a dynamic host–pathogen spectrum shaped by granuloma biology and pharmacokinetic heterogeneity, synthesizing intrinsic, acquired, and phenotypic tolerance mechanisms of Mycobacterium tuberculosis (eg, lipid-rich envelope, efflux, drug-modifying enzymes, target/activation mutations and cross-resistance), highlighting diagnostic gaps such as heteroresistance detection, and advocating precision TB management using expanded molecular diagnostics plus therapeutic drug monitoring and PK/PD modelling to optimize modern regimens (including bedaquiline, pretomanid and linezolid) alongside host-directed and resistance-preventing adjunctive strategies.
  

Zhao L, Zhang Y, Liu R, Ni B, Bi L. Comprehensive review and reflective evaluation of cell therapies for tuberculosis. Clin Microbiol Rev. 2025 Dec 15; doi:10.1128/cmr.00232-25

• Summary: This review argues that current TB regimens—limited by long courses, toxicity, adherence issues, drug resistance and persistent post-cure lung dysfunction—are overly pathogen-centric and therefore surveys decades of clinical, animal and in vitro evidence on cell- and cytokine-based host-directed therapies as potential adjuncts to improve outcomes and support more integrated strategies to end tuberculosis.
  

Sun L, Fang M, Chen Y, Jiao W, Zou T, Long X, et al. A blood-based Xpert host response assay for diagnosis and differentiation of active and latent tuberculosis in children and adolescents: A multi-center, prospective study. J Infect. 2026 Feb;92(2):106678. doi:10.1016/j.jinf.2026.106678

• Summary: In a multicentre prospective Chinese study of 780 children/adolescents evaluated for TB/LTBI, the 3-gene Xpert MTB Host Response (MTB-HR) blood assay produced age- and severity/lesion-associated TB scores and showed moderate accuracy for active TB diagnosis versus clinical comparators (AUC ~0.65–0.79 overall; sensitivity 75.9% and specificity 70.5% at a ≤2.675 cutoff) with better performance in children <5 years (AUC 0.885), and TB scores changed after treatment initiation, suggesting potential utility for child-friendly triage and treatment monitoring (with possible sensitivity gains when combined with IGRA).
  

Kuhlin J, Stadler JAM, Grint DJ, Court R, Meintjes G, Mtwa N, et al. Treatment adherence with an oral nine-month regimen for rifampicin-resistant tuberculosis in South Africa. Clin Infect Dis. 2026 Feb 9; doi:10.1093/cid/ciag069

• Summary: In a prospective cohort of 209 South Africans with pulmonary rifampicin-resistant TB starting an all-oral 9–12-month regimen, adherence measured via digital pillbox plus directly observed therapy was high in month 1 (93–100%) but overall median adherence through 9 months was 82% (72% by pillbox alone), with trajectory modelling identifying four distinct patterns—including two majority groups with only small declines and two groups with major drops to ~50% adherence by month 3 (23%) or month 6 (12%)—and declining adherence associated with exclusive ambulatory care, receiving the shorter regimen only, and age under 40, suggesting targeted support for higher-risk patients.
  

Campbell JI, Brooks MB, Dankovchik J, Giebultowicz S, Falkenstein A, Angier H, et al. Uncovering household tuberculosis infection testing and care patterns using a novel bioinformatics linkage strategy. Clin Infect Dis. 2026 Feb 11; doi:10.1093/cid/ciag079

• Summary: Using US community health center data (2014–2022), investigators linked 35,772 “sentinel” patients with positive TST/IGRA results to 129,432 household members and found that only 26.1% of household members were tested within two years (9.3% of those tested were positive and only 20.6% of positives were prescribed TB preventive treatment), with sentinel patient treatment strongly associated with household members being tested (aOR 1.16) and especially being prescribed treatment (aOR 9.68), suggesting households are an underused but potentially effective setting to identify and treat latent TB infection even without a known TB disease index case.

Infections in Neonates and Children

Chevalier A, Ben Khedher M, Tran A, Coin M, Pousse M, Tazie A, et al. Genomic determinants of Bacillus cereus and outcomes of infection in preterm neonates: a multicentre retrospective study. Clin Microbiol Infect. 2026 Feb 3; doi:10.1016/j.cmi.2026.01.023

• Summary: In a retrospective multicentre French study of 40 Bacillus cereus group bloodstream/CSF isolates from preterm neonates (2010–2021), outcomes were poor (42.5% septic shock; 37.5% mortality) and whole-genome sequencing identified seven species—mainly Bacillus paranthracis and B. cereus sensu stricto—with B. cereus sensu stricto carrying more virulence determinants and associated with higher day 7/28 mortality, while specific toxin/virulence genes (eg, hblCDAB, nprB, asbABCDEF, essC/esxA) correlated with death and cesH with survival, supporting WGS-based species/virulence profiling for NICU risk stratification and infection control.

Skin and Soft Tissue Infections

Sartelli M, Coccolini F, Labricciosa FM, Al-Hasan MN, Buonomo L, Cheadle WG, et al. Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in Surgery. J Trauma Acute Care Surg. 2026 Feb;100(2):320-331. doi:10.1097/TA.0000000000004833

• Summary: This multidisciplinary, evidence-based position statement provides practical best-practice guidance for first-line management of adult necrotizing soft-tissue infections, emphasizing rapid recognition and urgent, complete surgical debridement (including amputation when needed) alongside targeted antibiotics, hemodynamic support, and coordinated multidisciplinary care through acute management and subsequent wound care/reconstruction.
  

Kassee C, Dabaja-Younis H, Richard L, Golden AR, Zhong Z, Allen V, et al. Invasive Group A Streptococcal disease in persons experiencing postpandemic homelessness in Canada. JAMA Netw Open. 2026 Feb;9(2):e2559147. doi:10.1001/jamanetworkopen.2025.59147

• Summary: In population-based surveillance from Toronto/Peel (2022–2023; 503 cases), invasive group A streptococcal infections surged after COVID-19 among both persons experiencing homelessness (PEH) and housed adults, but incidence was 70.7-fold higher in PEH (rising from 270 to 451 per 100,000/year), with PEH less often immunocompromised yet more likely to inject drugs, have nonintact skin and present with soft tissue infection, lower adjusted odds of death, and a markedly different strain distribution (PEH dominated by emm49/74/80/82/92 vs housed adults more often emm1/emm12), underscoring distinct epidemiology and the need for targeted prevention such as vaccination.

Sexually Transmitted Infections

Unemo M, Golparian D, Elango V, Bettiol E, Piddock LJV, Srinivasan S, et al. Microbiological analysis and whole-genome sequencing of Neisseria gonorrhoeae from the microbiological failures in the international, zoliflodacin, phase 3, clinical trial for treatment of uncomplicated urogenital gonorrhoea: a retrospective, genomic, observational study. Lancet Microbe. 2026 Feb 5; doi:10.1016/j.lanmic.2025.101270

• Summary: This retrospective genomic analysis of paired baseline and test-of-cure Neisseria gonorrhoeae isolates from the phase 3 zoliflodacin trial found no evidence of zoliflodacin resistance selection among protocol-defined microbiological failures (baseline and TOC MICs remained low and no resistance-associated mutations emerged), while whole-genome sequencing showed that 23% of zoliflodacin failures (and the single ceftriaxone/azithromycin failure) involved different strains at test-of-cure suggesting reinfection, and that most remaining failures lacked a clear microbiological explanation, supporting routine WGS in future gonorrhoea treatment trials to distinguish reinfection from true failure and better characterize resistance.

Fungal Infections and Antifungal Agents

Pérez MA, Hoffmann WJ, Pérez JC, Adelman MW. Invasive Candidiasis in Critically Ill Patients: Fundamental Concepts and Future Directions. Chest. 2025 Dec 30; doi:10.1016/j.chest.2025.12.020

• Summary: This review outlines invasive candidiasis in ICU patients—ranging from candidemia to deep-seated (often intraabdominal) infection—with high mortality and a shifting species landscape toward more non-albicans Candida including outbreak-prone C. auris, emphasizes that clinical features mimic bacterial sepsis so risk-based testing is crucial, notes limitations of culture-based diagnostics and the promise (but cost/validation barriers) of newer rapid molecular assays, and summarizes current first-line echinocandin therapy with azole step-down in selected cases and emerging agents for multidrug-resistant species.
  

Jones MN, Nigo M, Casarin S, Kurian J, Sanghvi A, Hsu E, et al. Utilization of Intensive Care Interventions in Critically Ill Patients With Candidemia Versus Bacteremia: A Multicenter Retrospective Cohort Study. Crit Care Med. 2026 Feb;54(2):246-256. doi:10.1097/CCM.0000000000006963

• Summary: In a multicentre Houston ICU cohort of 1509 ICU-onset bloodstream infections (2016–2023), candidemia (19.2%) occurred later in the ICU stay and was associated with higher contemporaneous ICU support (mechanical ventilation, vasopressors, CRRT) and higher unadjusted 30-day mortality than bacteremia, but after adjustment candidemia was not an independent mortality predictor in the primary cohort (though it was in MIMIC-IV), suggesting empiric antifungals should be considered when high-resource ICU patients are started on empiric antibiotics for suspected BSI.
  

Harrison TS, Walsh TJ. Time to re-evaluate combination antifungal therapy for invasive aspergillosis and other invasive mycoses. Lancet Infect Dis. 2026 Feb 5; doi:10.1016/S1473-3099(26)00004-6

• Summary: This Personal View argues that despite a key RCT narrowly missing conventional statistical significance, the overall laboratory and clinical evidence supports triazole–echinocandin combination therapy (eg, voriconazole plus anidulafungin) for immunocompromised patients with proven/probable invasive aspergillosis, as a strategy to reduce high mortality and counter rising triazole resistance while calling for renewed evaluation of other antifungal combinations.
  

Smadu SG, Tetradov SC, Ene L, Oprisan C, Lazăr DȘ, Florescu SA. Diagnostic Biomarkers for Invasive Candidiasis: A Clinician-Oriented Review. J Fungi. 2026;12(1):55. doi:10.3390/jof12010055

• Summary: This narrative review (1990–2025) summarizes clinically used non-culture biomarkers for invasive candidiasis and proposes an integrated diagnostic pathway, emphasizing that blood cultures have limited sensitivity (~50%) while PCR can provide earlier, highly specific detection (≈91%–98% specificity but with cost/species-coverage limits) and serologic assays such as mannan/anti-mannan (sensitivity/specificity ~83%/86%) and 1,3-β-D-glucan (~73%/80%) can support earlier diagnosis in high-risk patients to expedite antifungal therapy.
  

Klyasova G, Solopova G, Abdalla J, Popova M, Ar MC, Sungur M, et al. Early Antifungal Treatment in Immunocompromised Patients, Including Hematological and Critically Ill Patients. J Fungi. 2026;12(1):59. doi:10.3390/jof12010059

• Summary: This multidisciplinary consensus (47 Delphi-agreed statements based on 2013–2023 literature) recommends risk-stratified early empiric/targeted antifungal initiation for suspected invasive candidiasis, aspergillosis, and mucormycosis in immunocompromised and critically ill patients—guided by local epidemiology, close monitoring and potential class switching for deterioration/toxicity, and IV-to-oral transition decisions informed by infection type, therapeutic drug monitoring availability, and clinical response.
  

Kontoyiannis DP, Walsh TJ. Mucormycosis. N Engl J Med. 2026 Feb 11;394:684–698. doi:10.1056/NEJMra2412565

• Summary: Mucormycosis is a WHO high-priority, rapidly invasive and often lethal Mucorales fungal infection affecting severely immunocompromised patients, people with diabetes, and even immunocompetent patients after major trauma (with emerging risks such as COVID-19, CAR T-cell therapy and ibrutinib), presenting in multiple syndromes (e.g., rhino-orbital/cerebral, pulmonary, gastrointestinal, cutaneous and disseminated forms) and requiring urgent multidisciplinary management with early detection/staging, prompt antifungal therapy (liposomal amphotericin B first-line, oral triazoles as alternatives), aggressive surgical debridement, and reversal of immune/metabolic drivers, while ongoing work on rapid molecular diagnostics, new antifungals and host-/antivirulence-directed therapies may improve outcomes—particularly in hyperendemic settings like India where burden is far above the global average.
  

Lötscher J, Baarts J. Pulmonary mucormycosis. N Engl J Med. 2026 Feb 11;394:699. doi:10.1056/NEJMicm2511883

• Summary: A hospitalized 49-year-old man with acute myeloid leukemia developed prolonged neutropenic fever and CT findings of bilateral reversed halo signs consistent with invasive fungal infection, was treated with amphotericin B with mucorales PCR positivity from bronchoalveolar lavage, showed imaging changes with neutrophil recovery, underwent surgical resection with angioinvasive hyphae on histopathology and tissue PCR confirming Rhizomucor pusillus pulmonary mucormycosis, and was discharged on isavuconazole secondary prophylaxis before proceeding to allogeneic stem-cell transplantation.
  

Chiu C-Y, Hicklen RS, Ostrosky-Zeichner L, Sheth SA, Tan C, Weinberg JS, et al. An unintended consequence: a review of iatrogenic central nervous system mold infections and outbreaks. Clin Microbiol Rev. 2026 Feb 10; doi:10.1128/cmr.00282-25

• Summary: This literature review (through July 2025) identified 905 iatrogenic central nervous system mold infections, predominantly linked to five outbreaks after spinal/epidural injections with contaminated medicines or supplies (96% of cases), found that angioinvasive molds (especially Fusarium solani and Aspergillus spp.) were associated with more strokes/hemorrhage, aneurysms and higher mortality than other molds, highlighted outbreak case-finding approaches (symptom-based vs universal lumbar puncture and/or screening MRI) and the utility of cerebrospinal fluid (1→3)-β-D-glucan for preemptive diagnosis, and noted generally poor outcomes after neurosurgical-related infections (35% 90-day mortality) with frequent long-term neurologic sequelae despite antifungals plus source control.
  

Steinbrink JM, Friedman DZ, Thompson GR, Kauffman CA, Alexander BD, Hanson K, et al. Fungal diagnostic stewardship in immunocompromised populations: a focus on molds and dimorphic fungi. Clin Microbiol Rev. 2026 Feb 12; doi:10.1128/cmr.00242-25

• Summary: This review argues that as invasive fungal diseases and antifungal use rise in immunocompromised patients, fungal “diagnostic stewardship” is needed to guide appropriate use of commonly used mold and dimorphic fungal assays by reducing unnecessary testing, improving test selection and strategies to avoid diagnostic errors, and thereby improving patient care and outcomes.

Virulence

Li Y, Dong H, Liu X, Shen Y, Li R, Qin S. IS26-mediated chromosomal integration of virulence plasmid fragments in ST2237 carbapenem-resistant Klebsiella pneumoniae. J Antimicrob Chemother. 2026 Feb;81(2):dkag018. doi:10.1093/jac/dkag018

• Summary: A hospital surveillance study in Henan, China identified two blaKPC-positive ST2237 (K19) carbapenem-resistant Klebsiella pneumoniae bloodstream isolates with insertion-sequence–mediated chromosomal integration of fragments from a p17-15-vir-like virulence plasmid carrying key hypervirulence genes (including rmpA2 and iuc), representing the first report of these virulence determinants in ST2237 CRKP and raising concern that stable chromosomal integration could promote persistence and increasing virulence over time.

Host Factors in Infection

Liu H, Song Y, Lv Y, et al. Baseline serum matrix metalloproteinase-8 and 28-day mortality in sepsis at ICU admission. Crit Care. 2026;30:51. doi:10.1186/s13054-026-05877-2

• Summary: In a single-centre Chinese cohort of 274 consecutive ICU patients meeting Sepsis-3 criteria (Sept 2023–Oct 2025), this letter evaluates whether serum MMP-8 measured at ICU admission—an early neutrophil-derived inflammatory biomarker—is independently associated with 28-day mortality using adjusted Cox regression (including age, comorbidities and SOFA) and whether adding MMP-8 improves prognostic discrimination via ROC analysis.
  

Kim J, Kim GL, Lemenze A, Parker D. TLR4–MyD88–NF-κB signaling in the airway epithelium promotes Acinetobacter baumannii clearance. J Infect Dis. 2026 Feb 4; doi:10.1093/infdis/jiag061

• Summary: Using mouse models with pharmacologic inhibition and airway epithelium–specific RelA (p65) knockouts, this study shows that epithelial TLR4–MyD88–NF-κB signaling is required for effective pulmonary clearance of Acinetobacter baumannii by driving early expression of neutrophil chemokines (eg, G-CSF, GM-CSF, CCL20) and neutrophil recruitment, with exogenous chemokines restoring recruitment but only partly rescuing clearance, indicating additional epithelial NF-κB–dependent defense mechanisms.

Diagnostics

Wu S, Xu C, Fu Y, Zhang L, Zhang L. Diagnostic performance of droplet digital PCR for detecting pathogens and resistance genes in patients with suspected bloodstream infections. Infect Drug Resist. 2026 Jan 31;19:1–10. doi:10.2147/IDR.S570142

• Summary: In a prospective tertiary-hospital study in China of 50 patients with suspected bloodstream infection, droplet digital PCR on blood outperformed blood culture for early pathogen/ARG detection (higher positivity 64% vs 30%, sensitivity 86.7%, and much faster turnaround ~27 vs 71 hours) and in clinical examples enabled earlier targeted therapy such as switching to ceftazidime–avibactam after rapid detection of blaKPC/Klebsiella pneumoniae, supporting ddPCR as a rapid diagnostic tool that can improve antimicrobial stewardship by accelerating appropriate escalation/de-escalation.
  

van Hal SJ, Goeman E, Davidson Y, Frances F, Whiley DM, Lahra MM. Neisseria meningitidis MenY ST-1466 harbouring N. gonorrhoeae 16S rRNA allele causing false-positive Aptima® gonococcal NAAT results. Clin Microbiol Infect. 2026 Feb 2; doi:10.1016/j.cmi.2026.01.027

• Summary: This piece contrasts two closely related pathogenic Neisseria species, explaining that Neisseria meningitidis is usually a nasopharyngeal commensal that can occasionally cause invasive meningococcal disease, whereas Neisseria gonorrhoeae is an obligate urogenital pathogen with distinct clinical and epidemiological patterns.
  

Peri AM, O’Callaghan K, Rafiei N, Chatfield MD, Manesh A, Paterson DL. Time to blood culture positivity predicts metastatic infection in patients with bloodstream infection and correlates with persistence of detectable pathogens in the bloodstream by culture independent systems. Clin Microbiol Infect. 2026 Jan 30; doi:10.1016/j.cmi.2026.01.024

• Summary: This article introduces evidence that blood culture time to positivity in bloodstream infection may be linked to outcomes such as mortality and possibly metastatic complications—most studied in Staphylococcus aureus bacteraemia—while noting that findings across studies remain inconsistent and the metastatic infection association is understudied.
  

Daniels CN, Martin BK, Nahar KS, Rahman KM, Sutton JM, Bock LJ. Development of an impedance-based fast antimicrobial susceptibility test for Neisseria gonorrhoeae. J Antimicrob Chemother. 2026 Feb;81(2):dkaf493. doi:10.1093/jac/dkaf493

• Summary: This proof-of-principle study developed an impedance-based rapid phenotypic antimicrobial susceptibility test (iFAST®) for Neisseria gonorrhoeae that produced ceftriaxone, ciprofloxacin and azithromycin susceptibility results concordant with EUCAST/published MIC data after ~4 hours’ exposure (reportable within <8 hours overall), and also generated dose–response data for novel agents like zoliflodacin and gepotidacin, suggesting a feasible faster AST approach to support targeted therapy and reduce unnecessary broad-spectrum use.

Improving Clinical Research

Savitz DA, Pearce N, Rothman KJ. Hill's considerations are not causal criteria. J Clin Epidemiol. 2026 Feb;190:112087. doi:10.1016/j.jclinepi.2025.112087

• Summary: This methodological commentary argues that Bradford Hill’s considerations are often misapplied as a causal “checklist,” and emphasizes that modern epidemiologic causal inference should instead evaluate competing explanations using contemporary tools (eg, quantitative bias analysis and triangulation) rather than scoring criteria, since causality is not an algorithmic label but an inference strengthened as alternative bias and chance explanations are systematically ruled out.
  

Theodosiou A, Bogaert D, Cleary D, Lorimer J, Spector T, Jones C, et al. Microbiome research in practice: priorities for clinical translation and impact. Clin Microbiol Infect. 2026 Jan 31; doi:10.1016/j.cmi.2026.01.021

• Summary: Drawing on an interdisciplinary Royal Society–funded expert workshop (Oct 2024), this review proposes a translational roadmap for safe, effective, and equitable microbiome-based interventions, prioritizing (1) scientific credibility via large-scale multiomic/strain-level characterization and harmonized trial endpoints and reporting, (2) practical viability through fit-for-purpose regulation, diversified investment, and capacity building, and (3) sustained stakeholder engagement with clinicians, patients, policymakers and the public to ensure confidence, relevance, and fair implementation as microbiome therapies and diagnostics expand.
  

Coleman L, Wullert K. Improving regulations for human subjects research. N Engl J Med. 2026 Feb 11;394:716–721. doi:10.1056/NEJMsb2516485

• Summary: This piece argues that US human-subjects research regulations, though designed to protect participants, have become overly complex and fragmented—delaying study start-up, increasing administrative burden, and distracting from core scientific and ethical goals—while pandemic-era adaptations (rapid IRB review, accelerated data sharing, streamlined decisions) showed greater flexibility is possible, and it uses the 2025 National Academies report on simplifying research regulations to highlight key regulatory pain points for physician-scientists and propose federal and institutional actions to sustainably reduce unnecessary inefficiencies outside emergencies.

General Interest

Berra L, Kamenshchikov N, Tal A, Safaee Fakhr B, Rezoagli E, Thomson R, et al. The therapeutic potential of high-dose inhaled nitric oxide for antimicrobial effects: a narrative review and future directions. Intensive Care Med Exp. 2026 Feb 5;14:13. doi:10.1186/s40635-026-00852-1

• Summary: This narrative review summarizes early mechanistic and clinical evidence (27 mostly early-phase studies) that high-dose inhaled nitric oxide (>20 ppm) may have antimicrobial/antiviral activity for lower respiratory tract infections—including drug-resistant bacterial pneumonia, COVID-19, nontuberculous mycobacteria and bronchiolitis—via direct killing, biofilm disruption and host-response effects, while outlining safety considerations and research priorities to define optimal dosing, delivery (hospital and home), and efficacy in larger trials.
  

Mahor S, Gupta H. Serratia species as paratransgenic vehicles: potential applications in vector-borne disease control. Clin Microbiol Rev. 2026 Feb 2; doi:10.1128/cmr.00280-25

• Summary: This review evaluates Serratia species as paratransgenic platforms for vector control, summarizing laboratory evidence that engineered strains can stably colonize and spread in insect populations while expressing antipathogen effectors (eg, scorpine, MP2, fusion constructs, AmLip) that markedly reduce Plasmodium development, and outlines key translational requirements—biosafety, genetic stability, horizontal gene transfer surveillance, non-target impact assessment, and community/regulatory engagement—needed before responsible field evaluation.
  

Karlin D, Vijayan T. The path ahead: Building community between palliative care and infectious disease teams. Clin Microbiol Infect. 2026 Feb 2; doi:10.1016/j.cmi.2026.01.029

• Summary: This perspective highlights how complex infections—often involving multidrug-resistant organisms and burdensome isolation and healthcare fragmentation—can dominate the trajectory of advanced cancer, underscoring the importance of early advance care planning to align antibiotic use, hospitalization decisions, and end-of-life goals with patients’ preferences.
  

Surana A, Bhattacharya R, Verma A, et al. Pan-resistant Pseudomonas aeruginosa septic shock in a critically ill patient: a case report. Clin Med Insights Case Rep. 2026;19:1–5. doi:10.1177/1179547625141109

• Summary: This case report describes a 66-year-old man who died from refractory septic shock and multiorgan failure caused by pan-drug-resistant Pseudomonas aeruginosa (resistant to cefiderocol with borderline colistin MIC), illustrating the limited effectiveness and dosing constraints of last-line agents in renal failure/CRRT and underscoring the urgent need for new therapies alongside rigorous antimicrobial stewardship and infection prevention.
  

Jung RG, Gupta A, Stotts C, McNeely C, Mihic A, Hanycz S, et al. Prognostic factors associated with mortality in septic shock: a systematic review and meta-analysis. Lancet Respir Med. 2026 Jan 28; doi:10.1016/S2213-2600(25)00397-2

• Summary: This large systematic review and meta-analysis (95 studies; 4.83 million patients) identified factors independently associated with early mortality in septic shock (~33% early mortality), including older age, Black race, cirrhosis, malignancy and higher comorbidity burden, acute kidney injury and higher severity scores (APACHE II/SAPS II/SOFA), and treatment/biochemical markers such as invasive ventilation, norepinephrine use and higher lactate, supporting their use for risk stratification and goals-of-care discussions.
  

McLellan F. Abraham Verghese: the body as text. Lancet. 2026 Jan 31;407(10527):484. doi:10.1016/S0140-6736(26)00154-6

• Summary: This profile traces infectious diseases physician-writer Abraham Verghese’s formative journey from medical training disrupted by civil war in Ethiopia through pivotal work as a nursing assistant in New Jersey, completion of his medical degree at Madras Medical College, and subsequent US residency and ID fellowship leading to his faculty career in Tennessee, situating him within the tradition of doctor-authors.
  

Lim JT, Chong C-S, Chang C-C, Mailepessov D, Dickens B, Lai YL, et al. Dengue suppression by male Wolbachia-infected mosquitoes. N Engl J Med. 2026 Feb 11; doi:10.1056/NEJMoa2503304

• Summary: In a Singapore cluster-randomised trial (15 geographic clusters) releasing wAlbB Wolbachia-infected male Aedes aegypti, the intervention markedly suppressed wild-type mosquito populations and reduced symptomatic laboratory-confirmed dengue compared with control clusters, with dengue positivity 6% vs 21% after ≥6 months and an estimated protective efficacy of ~71–72% (OR ~0.28–0.29) over 3–12+ months of exposure.
  

Nyberg ST, Frank P, Ahmadi-Abhari S, Pentti J, Vahtera J, Ervasti J, et al. Adult obesity and risk of severe infections: a multicohort study with global burden estimates. Lancet. 2026 Feb 9; doi:10.1016/S0140-6736(25)02474-2

• Summary: In pooled Finnish cohorts (67,766 adults) with replication in UK Biobank (479,498 adults), obesity was consistently associated with higher risk of severe infection across 925 infectious diseases and pathogen types—class III obesity conferred about a threefold higher risk of infection-related hospitalisation and death compared with healthy weight and any obesity (classes I–III) had a pooled hazard ratio of 1.7 for severe (fatal or non-fatal) infection—and modelling using global obesity prevalence estimated that obesity accounted for 8.6% of infection-related deaths worldwide in 2018, 15.0% in 2021, and 10.8% in 2023 (roughly one in ten globally).
  
• Editorial Commentary:
  Sørensen TIA, Osler M. Mutually reinforced burdens of obesity and infections. Lancet. 2026 Feb 9; doi:10.1016/S0140-6736(25)02605-4

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