30-Second Takeaway
- Digital outpatient stewardship can cut ARI antibiotic use by half or more without harming safety.
- Aztreonam–avibactam retains strong global CRE activity, including MBLs, as ceftazidime–avibactam susceptibility erodes.
- Candida auris in the United States is almost universally fluconazole resistant, with notable amphotericin B resistance.
- Infections in cirrhosis and pediatric RMSF show high MDR and mortality burdens that demand context-specific management.
- Post–COVID-19 pertussis resurgence and novel C. difficile mucosal vaccines underscore how route and timing of immunity shape transmission.
Week ending February 21, 2026
Antimicrobial resistance, mucosal immunity, and high-risk infections: concise updates for ID clinicians
Digital stewardship sharply reduces ARI antibiotic prescribing in rural China without added harm
In 34 rural Guangdong township hospitals, a pragmatic cluster RCT tested a comprehensive, digitally enabled antibiotic stewardship program for acute respiratory infections. The intervention integrated clinician training, EMR-embedded point-of-care guidelines, monthly peer feedback, and smartphone-based patient education. Across 97,239 eligible ARI consultations, antibiotics were used in 26% of intervention versus 71% of control visits, a large absolute reduction. Thirty-day hospitalizations for respiratory illness or sepsis were similar between groups, indicating no detectable safety penalty from reduced prescribing.
Aztreonam–avibactam outperforms ceftazidime–avibactam against global CRE, including MBL producers
ATLAS surveillance (2019-2023) collected 109,603 Enterobacterales isolates from 63 countries, identifying 7,520 carbapenem-resistant Enterobacterales by meropenem MIC criteria. Only 49.1% of CRE were susceptible to ceftazidime–avibactam, with resistance increasing markedly over the study period and highest in Africa/Middle East. Aztreonam–avibactam showed 97.4% of CRE with MICs ≤4 mg/L, maintaining strong activity against carbapenemase producers, including metallo-β-lactamases. Reduced aztreonam–avibactam susceptibility clustered in carbapenem-resistant Escherichia and Proteus, particularly in India, underscoring emerging regional resistance. These findings support aztreonam–avibactam as a preferred option for severe CRE, coupled with tight stewardship and ongoing global surveillance.
Rectal mucosal vaccination clears C. difficile and prevents recurrence in preclinical models
This Nature study compared rectal mucosal versus intraperitoneal administration of a multivalent, adjuvanted Clostridioides difficile vaccine in experimental models. Mucosal vaccination, but not parenteral vaccination, achieved sterilizing clearance of C. difficile colonization. Rectal immunization protected against morbidity, mortality, colonic tissue damage, and recurrence of infection. Decolonization correlated with fecal IgG to vegetative surface antigens and a TH17-skewed colonic tissue-resident memory T cell response to spore antigen. Results suggest effective CDI vaccines may need to elicit local colonic mucosal immunity rather than solely systemic responses.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.