SUMMARYThe unprecedented floods that affected Rio Grande do Sul state, Brazil, in 2024 had significant repercussions on public health, particularly infectious diseases. In the weeks following the floods, 7,818 confirmed cases of leptospirosis, 10 outbreaks of diarrheal diseases, and 1,370 incidents involving venomous animals were reported, among other conditions. These events disrupted healthcare networks, caused critical delays in diagnosis, and impaired vaccination campaigns, emphasizing the need for resilient public health systems. This report describes the 2024 climate disaster in Rio Grande do Sul, Brazil, marked by severe flooding and its repercussions on infectious diseases. We detail the epidemiological impact across zoonoses, waterborne and vector-borne diseases, skin and soft tissue infections, respiratory fungal infections, and antimicrobial resistance. The measures implemented by healthcare systems and scientific societies to mitigate these effects are presented, along with key lessons learned from the event. Considering the increasing frequency of extreme weather events due to climate change, this review aims to provide a comprehensive framework for infectious disease preparedness and response, offering critical insights for global application.

SUMMARYThe interplay between the gut and skin microbiomes and their influence on skin cancer development has garnered significant attention. The gut and skin microbiomes, composed of bacteria, fungi, and viruses, play vital roles in immune modulation, inflammation regulation, and maintaining skin health. Dysbiosis in either microbiome may contribute to inflammatory skin conditions and cancer development through the gut-skin axis. The gut microbiota influences immune responses, skin barrier function, and carcinogenesis via microbial metabolites, such as short-chain fatty acids. These compounds impact systemic inflammation, immune cell activity, and response to immunotherapy, particularly in melanoma and non-melanoma skin cancers. Emerging evidence links distinct microbial profiles to skin cancer progression, with specific taxa associated with advanced stages. Conversely, certain skin commensals exhibit potential anti-tumor effects. In addition, microbial imbalances correlate with tumorigenesis via inflammatory and metabolic pathways. Advancements in microbiome profiling have further elucidated these associations, offering diagnostic and therapeutic opportunities. Potential interventions include probiotic therapies to restore microbial balance and enhance immunotherapy efficacy. However, the intricate dynamics of the gut-skin axis necessitate further investigation into causal mechanisms, microbial metabolite impacts, and personalized therapeutic strategies. This review highlights the dualistic role of the gut and skin microbiomes in skin cancer, emphasizing their diagnostic and therapeutic potential while proposing future research directions to unravel their complexities and clinical implications.

SUMMARYCoagulase-negative staphylococci (CoNS) are a group of bacteria commonly found on human skin and mucous membranes. Traditionally regarded as low-virulence microorganisms, they have gained recognition as significant pathogens in healthcare-associated infections, particularly among immunocompromised individuals and patients with indwelling medical devices. In diabetic foot infections (DFIs), CoNS can play a substantial role, particularly following previous antibiotic treatments or in the presence of indwelling devices. DFIs are usually polymicrobial, involving a mixture of aerobic and anaerobic bacteria. Although is recognized as the major pathogen, especially in Western countries, CoNS are increasingly emerging as significant pathogens in DFIs, including osteomyelitis. Their presence may complicate treatment by increasing the microbial burden and harboring antibiotic resistance mechanisms. The treatment of DFIs involving CoNS often requires a combination of antibiotics targeting both gram-positive and gram-negative bacteria, selected according to the severity of the infection and results of antibiotic susceptibility testing. This review aims to highlight the growing importance of CoNS in DFIs, discussing their pathogenic mechanisms, clinical implications, and the necessity for healthcare providers to consider their involvement in order to ensure effective treatment and successful patient outcomes. This narrative review aims to underscore the growing clinical relevance of CoNS in DFIs by exploring their pathogenic mechanisms, diagnostic challenges, and therapeutic implications. It emphasizes the need for clinicians to recognize CoNS as potential pathogens rather than mere contaminants and highlights the ongoing difficulty in distinguishing true infection from colonization. This distinction is critical for accurate diagnosis, appropriate antimicrobial stewardship, and the development of improved treatment strategies.

SUMMARYDrug-resistant tuberculosis (DR-TB) causes substantial morbidity and mortality and has hindered progress toward TB elimination. This slowed progress toward the WHO End TB Strategy's targets was exacerbated by lower TB detection during the COVID-19 pandemic. To inform research and development priorities, we conducted a narrative review of global DR-TB epidemiology and strategies for DR-TB prevention, diagnostics, and treatment. Gaps remain in DR-TB diagnosis, TB drug susceptibility testing (DST), and treatment. The review also shows that DR-TB causes significant post-disease disability, particularly chronic lung disease, impacting quality of life. Newer oral regimens for multidrug-resistant TB are shorter and more effective than traditional regimens. New antibiotics under development may help overcome remaining safety and tolerability issues, while novel advanced therapeutics and precision medicine offer hope to those failing treatment. Emerging diagnostics include rapid DST for second-line drugs, but a paradigm shift is needed to ensure novel DSTs become available as new drugs are introduced. Person-centered research is urgently needed to accelerate the response to DR-TB amidst the global threat of antimicrobial resistance, yet global investment in TB prevention and care currently falls short of need. A holistic approach to interventions to improve DR-TB prevention and care is needed, encompassing all health system components and their interactions, including a One Health approach and consideration of the wider determinants of health.

SUMMARYSex disparities in bacterial infections pose significant challenges in clinical microbiology, influencing diagnostic approaches, antimicrobial stewardship, and patient outcomes. Males frequently exhibit heightened severity in conditions like -associated gastritis and outbreaks, whereas females face amplified risks during reproductive phases for pathogens, such as and spp. Beyond genetic and behavioral factors, the bidirectional sex hormone-gut microbiome axis emerges as a key mechanistic driver: estrogens bolster innate immunity and microbial diversity (e.g., enriching short-chain fatty acid-producing taxa like ), while androgens and progesterone impose immunosuppressive effects, altering colonization resistance and virulence modulation. Microbial contributions-via β-glucuronidase-mediated hormone deconjugation, bile acid biotransformations, and metabolite signaling-further calibrate host responses, as evidenced in recurrence and enterohemorrhagic virulence upregulation. This review synthesizes epidemiological, preclinical, and emerging clinical data, highlighting the axis's role in pathogen-specific immune evasion and dysbiosis-driven exacerbations. Clinically, these insights advocate for sex-stratified microbiome diagnostics (e.g., 16S rRNA sequencing for risk profiling) and targeted therapies, including hormone-modulated probiotics to restore barrier function, fecal microbiota transplantation to curb antibiotic-associated vulnerabilities, and selective estrogen receptor modulators to enhance clearance in high-risk cohorts. Despite advances, gaps in human longitudinal studies and pathogen-strain interactions limit translation. Future research integrating multi-omics with clinical trials could refine precision interventions, optimizing infection management in diverse populations and aligning with evolving demands for personalized microbiology.

SUMMARYContaminated hospital sink drains are significant reservoirs for healthcare-associated pathogens and are frequently linked to outbreaks in medical settings. Pathogens such as multidrug-resistant and carbapenem-resistant Enterobacterales thrive in biofilms, which are notoriously difficult to eradicate. Preventing patient exposure to these pathogens poses a unique and complex challenge for infection control practitioners as effective solutions lie at the intersection of environmental engineering and infectious disease. This narrative review explores the characteristics, complexities, and challenges of wastewater biofilms in sink drains and traps in healthcare settings, their resistance to standard cleaning and disinfection methods, and potential pathways for pathogen spread to patients and other areas of wastewater premise plumbing. We emphasize the need for scientifically based guidance on sink drain decontamination approaches and examine current barriers to developing such guidance. Furthermore, we summarize reports from the medical literature on sink drain decontamination and mitigation strategies implemented in both outbreak and non-outbreak settings, alongside relevant studies on biofilm management from the engineering and basic science disciplines. Finally, we highlight ongoing gaps in research and guidelines, stressing the need for multidisciplinary approaches that integrate infection control and engineering solutions. This review aims to equip healthcare epidemiologists, infection preventionists, and facility personnel with pertinent insights to mitigate sink drain-related outbreaks effectively.

SUMMARYCOVID-19 convalescent plasma (CCP) was the first specific therapy deployed for treating SARS-CoV-2 infection. CCP was successfully deployed in both resource-poor and resource-rich countries, establishing that convalescent plasma (CP) is a feasible option for combating the next pandemic. CCP reduced mortality and progression to hospitalization when used early in the disease with high-titer units. This knowledge was gained from a worldwide effort that included more than 50 countries. However, the deployment of CCP was haphazard and varied among countries. Clinical studies suffered from a lack of standardization regarding study design, CCP antibody dosing, timing of administration, and participant disease severity. Unfortunately, the hard-won knowledge from the serum therapy era in the early 20th century, which indicated that effective antibody therapy requires early use in the disease with a sufficient antibody dose, was largely forgotten. Many studies tested CCP late in the disease or without sufficient antibody titer and thus reported negative findings. Trial heterogeneity made it difficult to combine the results of studies. However, despite tremendous heterogeneity in study design and participant populations, meta-analysis revealed strong signals of efficacy when given early with high antiviral-specific antibody levels. When the next pandemic occurs, humanity is likely to resort to CP again. To avoid another chaotic rollout, planning for CP use should begin well before that emergency arrives and must involve both physician education on the principles of antibody therapy and clinical trial designs that test its efficacy in optimal conditions, which include early use with sufficient antibody doses.

With improved uptake and earlier initiation of effective antiretroviral therapy (ART), the landscape of chronic kidney disease (CKD) among people with HIV (PWH) has substantially evolved. HIV-driven kidney diseases, particularly HIV-associated nephropathy (HIVAN), have largely disappeared in regions with widespread ART availability. However, CKD remains an important comorbidity among PWH because of the increased prevalence of age-related conditions such as diabetes and hypertension, which are established CKD risk factors. Whether contemporary ART regimens that have lower metabolic and kidney toxicity will lower this burden over time remains unclear. In low-resourced areas, these age-related conditions are compounded by persistent disparities in access to ART, co-infections, and limited resources for CKD screening and management. Early detection and management of CKD are crucial to slowing CKD progression and averting its related cardiovascular complications. The past several years have ushered in several new therapies that both lower the risk for CKD progression and adverse cardiovascular events, underscoring the importance of kidney function and albuminuria testing in those at high risk of CKD or CKD progression. For PWH who unfortunately progress to end-stage kidney disease, kidney transplantation now offers improved survival but requires careful management of immunosuppressive regimens and infectious complications. This review will discuss the current understanding of the epidemiology, pathogenesis, diagnosis, and management of kidney diseases in PWH.

SUMMARY is a frequent cause of hospital-acquired infections and is notable both for its virulence and its resistance to multiple antibiotics. In the absence of head-to-head clinical trials and availability of all potential options on a global basis, we have systematically analyzed potential antibiotics for carbapenem-resistant . Monotherapy with ceftazidime-avibactam, imipenem-cilastatin-relebactam, cefiderocol, or high doses of ceftolozane-tazobactam is generally considered an acceptable option for serious infections due to carbapenem-resistant . The role of testing combinations of antimicrobial agents for susceptibility is uncertain, as is the administration of nebulized colistin or amikacin in patients with ventilator-associated pneumonia. With regard to new therapies, 10 clinical trials are underway or have been completed on bacteriophage therapy for infections. However, no phage options are yet widely approved for use. Other new options in clinical trials include beta-lactam antibiotics combined with new beta-lactamase inhibitors and antibody-based therapies.

SUMMARYTwenty years after the first description of human bocavirus 1 (HBoV1) as a respiratory pathogen, significant progress has been made in both clinical and basic research; however, important clinical, diagnostic, and molecular challenges remain before bocavirus pathobiology is fully understood. The discovery of HBoV1 and its notorious prolonged shedding have challenged the new sensitive multiplex PCR panel-based diagnostic testing that replaced the old antigen assays, leading to erroneous classification of HBoV1 as an innocent bystander. Both sophisticated diagnostics and cytopathic effects in cell culture have now confirmed HBoV1 to be a common cause of upper and lower respiratory tract infections, mainly in children. While many questions have been answered, new questions have emerged as our understanding of parvoviruses has significantly expanded over the past two decades. In this review, key findings from 20 years of clinical, basic, and applied research on human bocaviruses are summarized and open questions highlighted to guide future investigations.

SUMMARYDespite the clinical relevance of major tuberculous pathogens to domestic animals and humans, the understanding of mycobacterial transmission modes, pathways, and interactions in their natural habitats remains very limited. The reason for this is primarily because ecological and evolutionary concepts have not yet been widely applied to the understanding of these bacteria. Most existing research on mycobacterial transmission is not founded on hypothesis testing but rather tends to accept the most recent explanation and turn it into a canonical fact. In this comparative review, we discuss plausible alternative hypotheses against a null hypothesis of environmental origin to intensify research on mycobacterial pathogens and their capacity to spread in the context of global change. We highlight a major bias in perceptions of mycobacterial infection transmission, with most work concentrating only on the contagious stage of tuberculous clones. We suggest broadening the field to include research on environmental non-tuberculous mycobacteria and their life histories. A deeper understanding of mycobacterial ecology and evolution is more important now than ever, considering the vast diversity of known and unknown mycobacterial species in natural ecosystems. Infectious disease medicine, veterinary science, and public health surveillance should take a more integrative disease ecology approach to enhance the development of new approaches for control of these animal and human pathogens.

SUMMARYThe penem and carbapenem antibiotics provide some of the broadest spectrum coverage available and generally should only be used when narrower options are unavailable. The majority of available carbapenems can only be administered parenterally, but two orally administered penems (faropenem and sulopenem) and one orally administered carbapenem (tebipenem) are in increased use due to approvals in new markets. These oral agents have a spectrum of activity similar to widely used parenteral carbapenems but are simpler to administer than intravenous agents and will likely experience rapid increases in their rates of use as they are approved in new markets. In this review, we discuss their spectra of activity, pharmacokinetics, pharmacodynamics, clinical efficacy, toxicity, antimicrobial stewardship considerations, and potential clinical applications.

SUMMARYDengue is an acute mosquito-borne viral disease that is highly prevalent throughout the tropical world. The geographic footprint of the four dengue viruses (DENV-1 to -4) that cause this disease and their mosquito vector is expanding, extending into North America and Mediterranean Europe. Furthermore, although dengue has historically been a disease that disproportionately affects children, changing population demographics and increasing travel to and from the tropics have contributed to a growing incidence in adults. Dengue in adults, particularly older adults, brings fresh and complex challenges to case management. Although dengue is now a vaccine-preventable disease, the efficacy profiles of licensed vaccines as well as those in late-stage clinical development suggest that vaccination alone would not fully retard the global expansion of dengue. Other countermeasures, including antiviral drugs, will be needed. This paper reviews the molecular interplay underlying dengue pathogenesis, including from virological and immunological perspectives, which are foundational for developing antiviral therapies and new vaccines. It also reviews the hurdles facing antiviral development and discusses new insights on dengue immunity that can guide the deployment of imperfect vaccines to begin reversing the global burden of dengue.

SUMMARYMany yeast species causing life-threatening invasive infections that were formerly classified in the genus have been reclassified due to their evolutionary and phylogenetic relationships elucidated by DNA sequencing methods that are increasingly using whole genomes. This review explores the evolving taxonomy, epidemiology, and clinical implications of clinically relevant, rare, emerging and Saccharomycotina yeasts that have recently been reclassified from . This article highlights the urgent need for intensified research efforts to enhance knowledge and improve outcomes in the management of infections caused by these yeasts. Communicating results from molecular phylogenetic studies of yeasts, which lead to their reclassification, is of great importance to the medical mycology community to implement such results in clinical practice.

SUMMARYAntimicrobial resistance (AMR) poses a significant threat to global public health. Surveillance is a fundamental method for controlling AMR and guiding clinical decisions, public health interventions, and policymaking. Whole-genome sequencing (WGS) provides a comprehensive and accurate understanding of AMR mechanisms, gene profiling, and transmission dynamics. Public health authorities, academic scholars, hospitals, and laboratories have increasingly employed WGS-based surveillance for retrospective, real-time, and prospective monitoring of AMR and investigations of outbreaks. WGS-based surveillance has improved the accuracy and effectiveness of disease and AMR surveillance by identifying hidden transmissions and sources missed by conventional methods and by rapidly investigating and deploying infection control interventions. However, WGS analysis involves a complex combination of workflows of next-generation sequencing and bioinformatics data analysis, making it difficult to effectively compare surveillance results. It is crucial to understand the limitations of our existing WGS analyses by implementing rigorous validation practices across different WGS analyses, developing practice guidelines, and establishing appropriate quality assurance measures. These efforts will aid in the development of reliable and robust WGS systems, the harmonization and standardization of surveillance programs, and the development of public data sharing and governance frameworks. Despite these challenges, the expansion of WGS-based AMR surveillance is expected to be driven by technological advances, standardization efforts, and the recognition of its advantages among stakeholders. The integration of genomic data with nongenomic information, as well as interdisciplinary collaborations will further enhance knowledge regarding AMR and promote the development of countermeasures.

SUMMARY spp. are members of the order and are widely found in humans, animals, and the environment. Some species, particularly are highly pathogenic and are among the most frequent causes of urinary tract and bloodstream infections. spp. possess a variety of virulence factors, such as swarming and urease activity, leading to persistent and severe infections. An increasing resistance to antibiotics has been reported for isolates and poses a substantial threat to global health. In recent years, several new spp. have been described, but their potential as pathogens has not yet been determined. Here, we provide an update on the taxonomy, virulence factors, and antibiotic resistance of spp.

SUMMARYSexual transmission of enteric infections (STEIs) among men who have sex with men (MSM) has been reported since the 1960s and is increasingly recognized since the widespread adoption of multiplex molecular diagnostics. However, the overall burden of sexually transmitted enteric infections has been difficult to ascertain, as the public health response to these infections and identification of transmission networks fall between the traditional groupings of sexually transmitted and foodborne diseases. The global emergence of extensively drug-resistant and infections among MSM and the potential for cross-over between different at-risk populations underscores the importance of timely diagnosis, appropriate treatment, and the need to consider community-level education and testing. Moreover, the possible impact of pre- and post-exposure prophylaxis for HIV and sexually transmitted infections on STEI is presently uncertain. This review examines our evolving understanding of STEI, discusses specific pathogens of urgent importance, and prioritizes areas for further study.

SUMMARYPeriprosthetic joint infection (PJI) is a significant complication of arthroplasty. Implicit in the diagnosis of PJI is the presence of organisms in what should be a sterile milieu. Given limits to culture-based PJI diagnosis, optimal utilization of culture in the diagnostic approach to PJI needs clarification. Culture is important in confirming a PJI diagnosis and characterizing the infecting microorganism(s) to inform management. As part of the development of a unified definition of PJI (by a group representing multiple scientific societies), a systematic review was performed to inform the role of culture in the definition of PJI. In addition, a comprehensive review on synovial fluid and periprosthetic tissue collection for culture, and associated culture methodology and results interpretation, was performed to inform best practices. Gaps in the literature were identified to develop research priorities.

The bacterial species covered in this review are taxonomically diverse. , a well-known infectious agent of pediatric bacteremia and osteomyelitis as well as septic arthritis in children aged 6-36 months, is the focus of this review. Recent advances in molecular diagnostic tools have allowed new aspects of pathogenesis and transmission to be investigated since the last review of in this journal. Asymptomatic oropharyngeal colonization with noninvasive strains can be distinguished from invasive clones, so that a positive detection in the oropharynx can be assumed to be compatible with a clinical entity caused by . Furthermore, novel and uncommon infections could be attributed to . Clinical and microbiological aspects of the other spp. and of the genera , , , , , , , , , , and are discussed separately. The identification of most genera by phenotypic methods is difficult. Direct microscopy and phenotypic key reactions, as well as commercially available systems, allow identification of the frequently encountered human species. If accurate identification of uncommon isolates is a concern, molecular methods, such as 16S ribosomal RNA gene PCR/sequencing, are necessary. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry can also be helpful. Besides infections with only one infectious agent, all mentioned genera are often found in mixed infections. The accompanying bacteria and the clinical presentation might guide the antibiotic choice. In general, it can be said that empirical treatment of infections with the fastidious gram-negative rods based on the clinical picture sometimes fails due to antibiotic resistance. Susceptibility testing should be performed on all isolates according to the CLSI or EUCAST guidelines in order to adjust treatment if necessary.

SUMMARYLaboratory-acquired infections (LAIs), particularly those from high-risk viruses, pose significant threats to exposed individuals and to the general public. In this review, we evaluate the existing evidence for viral LAI prevention, including available vaccinations, post-exposure prophylaxis (PEP), and follow-up procedures following occupational exposure to Risk Group 3 and 4 viral infectious agents within clinical testing laboratories. This review provides guidance on the therapeutic options and follow-up, all essential for preparedness planning and timely management in the event of exposure.