Jiun-Ling Wang

Background: Diabetic foot complications affect up to 25% of patients with type 2 diabetes (T2D) and represent a major cause of morbidity. The dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist - tirzepatide (TZP) has demonstrated superior glycemic control compared with semaglutide however, evidence regarding its effects on diabetic foot complications (DFCs) remains limited. Methods: We conducted a retrospective cohort study using the TriNetX network. Adults with T2D initiating TZP, sulfonylurea (SU), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium–glucose cotransporter-2 inhibitors (SGLT2is), and glucagon-like peptide-1 receptor agonists (GLP-1RAs) between January 2022 and July 2025 were included. Propensity score matching created balanced cohorts for four comparisons. The primary outcome was the risk of DFC - a composite of ulcers, infections, critical limb ischemia, and revascularization or amputation. Results: After matching, four cohorts included 141,002 patients per arm (TZP vs. SU), 131,449 patients per arm (TZP vs. DPP-4i), 146,321 patients per arm (TZP vs. SGLT2i), and 97,457 patients per arm (TZP vs. GLP-1RA). Compared with SU, TZP was associated with reduced diabetic foot complications (HR, 0.80; 95% CI, 0.76–0.84). Similar reductions were observed versus DPP-4i (HR, 0.83; 95% CI, 0.78–0.87) and SGLT2i (HR, 0.88; 95% CI, 0.83–0.92). No difference was found versus GLP-1RA (HR, 0.97; 95% CI, 0.91–1.03). Conclusion: TZP was associated with a reduction in diabetic foot complications compared with SU, DPP-4i, and SGLT2i, with outcomes similar to GLP-1RA. These findings suggest tirzepatide may be a valuable option for patients at risk of ulceration or amputation.

We evaluated cefiderocol activity against carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB), characterized the β-lactamase gene profiles of cefiderocol-nonsusceptible CRPA by metallo-β-lactamase (MBL) subtype, and assessed cross-resistance with comparator agents. Cefiderocol minimum inhibitory concentrations (MICs) for 890 CRPA and 1,063 CRAB isolates from the 2024 Antimicrobial Testing Leadership and Surveillance (ATLAS) program were determined by broth microdilution using iron-depleted cation-adjusted Mueller-Hinton broth. Cefiderocol nonsusceptibility was defined as MIC ≥ 8 mg/L per CLSI (intermediate + resistant). DTRPA was defined as nonsusceptible to all anti-pseudomonal β-lactams and fluoroquinolones; DTRAB was defined as nonsusceptible to carbapenems, ampicillin-sulbactam, and fluoroquinolones, reflecting species-specific susceptibility panels. CRPA isolates underwent molecular screening for bla _NDM , bla _VIM , bla _IMP , serine carbapenemase, and ESBL genes; genotype data were not available for A. baumannii . Cefiderocol susceptibility was 93.9% for CRPA and 88.5% for CRAB, respectively (nonsusceptibility 6.1% and 11.5%, respectively; OR = 2.01, P < 0.001); nonsusceptibility among DTRPA and DTRAB was 8.1% and 11.7%, respectively. Among 54 cefiderocol-nonsusceptible CRPA, 41 (76%) harbored no detectable carbapenemase gene. Nonsusceptibility among MBL-positive CRPA was exclusively attributable to bla _NDM producers (27.7%, 13/47); bla _VIM -positive ( n = 68) and bla _IMP -positive ( n = 21) isolates were uniformly susceptible. Among cefiderocol-nonsusceptible CRPA, 98.1% were co-resistant to ceftazidime-avibactam and 96.3% to ceftolozane-tazobactam.

Backgrounds: Oral health predicts adverse systemic health‐related outcomes, including future physical frailty. This study aimed to determine whether the salivary microbiome is associated with specific oral health indicators. Methods: We collected oral gargle samples from 97 patients admitted to medical wards (mean age, 65 years) and assessed their oral health status. The saliva microbiota was examined via sequencing 16S rRNA genes. Results: Among the oral health indicators, only chewing ability was associated with saliva microbiota. The alpha diversities of bacterial communities decreased as chewing ability declined. Furthermore, patients with normal and abnormal chewing ability exhibited distinct microbial compositions. The relative abundances of Lactobacillus and Limosilactobacillus were higher in the impaired chewing group, whereas Lautropia was more abundant in the normal chewing group. Conclusions: Severe chewing disability might lead to an altered saliva microbiota. This emphasises the importance of restoring chewing function when the disability occurs.

Vancomycin-intermediate Staphylococcus aureus (VISA) is a multi-drug-resistant pathogen of significant clinical concern. Various S. aureus strains can cause infections, from skin and soft tissue infections to life-threatening conditions such as bacteremia and pneumonia. VISA infections, particularly bacteremia, are associated with high mortality rates, with 34% of patients succumbing within 30 days. This study aimed to develop predictive models for VISA (including hVISA) bacteremia outcomes using data mining techniques, potentially improving patient management and therapy selection. We focused on three endpoints in patients receiving traditional vancomycin therapy: VISA persistence in bacteremia after 7 days, after 30 days, and patient mortality. Our analysis incorporated 29 risk factors associated with VISA bacteremia. The resulting models demonstrated high predictive accuracy, with 82.0–86.6% accuracy for 7-day VISA persistence in blood cultures and 53.4–69.2% accuracy for 30-day mortality. These findings suggest that data mining techniques can effectively predict VISA bacteremia outcomes in clinical settings. The predictive models developed have the potential to be applied prospectively in hospital settings, aiding in risk stratification and informing treatment decisions. Further validation through prospective studies is warranted to confirm the clinical utility of these predictive tools in managing VISA infections.