Ali Amanati

Carbapenem-resistant Enterobacterales (CRE) pose significant treatment difficulties owing to their high levels of antibiotic resistance. This study investi

Healthcare-associated infections (HAIs) caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are considered a major problem in hospitals due to their resistance to the most effective classes of antibiotics. The aim of the present study was to determine the antimicrobial susceptibility patterns of P. aeruginosa isolates from clinical specimens, and the combination effect of meropenem, amikacin, and ciprofloxacin against CRPA isolates. This cross-sectional study analyzed 70 P. aeruginosa isolates collected from hospitalized patients between August and November 2023. Antimicrobial susceptibility testing was performed on all isolates, and carbapenemase production was assessed in CRPA isolates. Five carbapenemase genes (blaIMP, blaVIM, blaKPC, blaSIM, and blaOXA-48) were screened. Meropenem minimum inhibitory concentrations (MICs) were determined via microbroth dilution method, and synergistic effects of meropenem, amikacin, and ciprofloxacin were evaluated using a three-dimensional checkerboard method. The highest resistance was to colistin 52/70 (74.3%), followed by cefotaxime 33/70 (47.1%) and tobramycin 28/70 (40%). Conversely, the lowest resistance was for aztreonam 19/70 (27.1%); 26/70 (37.1%) of isolates were CRPA. The frequency of genes blaIMP and blaOXA-48 were 4/70 (5.7%) and 1/70 (1.4%) in P. aeruginosa isolates, respectively; blaKPC, blaVIM, and blaSIM were not detected. The three-dimensional checkerboard method was established on 8 selected non-susceptible carbapenem P. aeruginosa isolates and the synergistic effect was recorded for 5 of these tested isolates. This study presents a positive correlation between CRPA and multidrug resistance (MDR), including resistance to all tested antibiotics. However, synergistic effects observed in vitro with meropenem, amikacin, and ciprofloxacin combinations suggest that combination therapy holds promise for treating these infections.

Background: Severe combined immunodeficiency (SCID) is a life‐threatening disorder that requires early hematopoietic stem cell transplantation (HSCT). In regions where Bacillus Calmette–Guérin (BCG) vaccination is routinely administered at birth, disseminated BCG disease significantly complicates the clinical course in infants. Post‐HSCT, immune reconstitution inflammatory syndrome (IRIS) poses an additional challenge, particularly in patients with active mycobacterial infections and mixed chimerism. Case Presentation: We describe a female infant with T ⁻ B ⁻ NK ⁺ SCID who developed disseminated BCG disease after routine BCG vaccination. At 6 months, she underwent HSCT from an HLA‐matched sibling without a conditioning regimen, according to the EBMT/ESID guidelines for T ⁻ B ⁻ NK SCID. Donor chimerism was undetectable on two early occasions (days +14 and +28), initially raising concerns of graft failure. During this window, the patient developed paradoxical BCG‐related IRIS, progressive lymphadenitis, and fever, which ultimately coincided with the first emergence of donor cells rather than graft loss. Corticosteroids were withheld because of the risk of infection and rejection. Instead, escalation of multidrug antimycobacterial therapy (intensified by adding amikacin and clarithromycin) led to clinical improvement. Subsequent testing demonstrated stable mixed donor chimerism (21% at +40, 23% at +60, and 51% at 8 months) with progressive donor T‐cell reconstitution and the absence of graft‐versus‐host disease (GVHD). At the most recent follow‐up, ~16 months after HSCT, the patient remained clinically well. Conclusion: This case highlights the diagnostic and therapeutic dilemmas in managing SCID patients with BCG disease after HSCT. Early negative chimerism does not always predict graft failure, and paradoxical IRIS should be considered when clinical deterioration coincides with immune recovery after HSCT. Our findings suggest that conservative corticosteroid‐sparing management with intensified antimycobacterial therapy may improve outcomes.

Background and Aims Invasive cutaneous fungal infections (ICFIs) are life-threatening complications in pediatric cancer patients. This study aimed to investigate the prevalence, clinical characteristics, and outcomes of ICFIs among pediatric cancer patients hospitalized at a referral oncology teaching Hospital in Shiraz, Iran. Methods This cross-sectional study included pediatric patients with malignancies and suspected ICFIs who were admitted to the Amir Oncology Teaching Hospital between 2015 and 2022. Diagnosis was based on the EORTC/MSG criteria and confirmed using clinical, microbiological, and histopathological methods. Data were analyzed using descriptive statistics, Kaplan–Meier survival analysis, and comparative tests, with a significance threshold of p < 0.05. Results Among the 24 patients, 58.3% were boys, and 45.8% were aged 1–5 years. Acute lymphoblastic leukemia was the most common malignancy (27.3%). Mucoralean fungi (36.4%) and Aspergillus (59.1%) were the most common. The overall survival rate was 54.2%. Proven ICFIs had the poorest outcomes, with a survival probability declining to zero by month 26. Patients with lower CRP levels and febrile neutropenia had better outcomes (p < 0.001 and p = 0.041, respectively), but survival rates did not vary significantly according to sex, age, or treatment approach (monotherapy versus combination therapy). Conclusion In pediatric oncology patients, ICFIs are associated with high mortality, particularly in cases of mucormycosis or proven infections. Improving survival depends on early diagnosis, risk stratification, and rapid management, particularly in patients with neutropenia and fever.

Background: Antineoplastic agents can cause oral toxicity, including “antineoplastic agents-associated stomatitis” (AAS) and “antineoplastic agents-associated oral Candidiasis” (AAOC), in children, adults, and older cancer patients. Objective: To identify the risk of AAS and AAOC associated with using antineoplastic agents. Methods: The FDA FAERS database for spontaneously reported adverse effects of “antineoplastic agents” was searched and analysed for the occurrence of the MedDRA preferred term “stomatitis” and “oral Candidiasis” using “quantitative safety signal analysis”, which contains spontaneous safety reports collected from 1976 to the end of 2021. Results: The results of stomatitis in 27477 and oral candidiasis in 3136 case reports from the FDA database, which received antineoplastic agents during the treatment process. Among all three age groups studied, 4 and 7 antineoplastic agents were strongly associated with the occurrence of AAOC and AAS, respectively (reported odds ratio [ROR] > 100), and the lowest association with AAOC and AAS was reported in 19 and 33 antineoplastic agents, respectively (ROR < 1). Conclusion: There are several limitations to providing information on the side effects of new antineoplastic agents in drug databases. Signal detection in pharmacovigilance is a process in which safety issues, including possible drug-related side effects, are investigated. Our study highlights the gap in the database regarding the potential risk of AAOC and AAS, as reported by the FDA for new drugs.