Shuroug A. Alowais

Introduction: Chemotherapy remains a cornerstone of cancer treatment, but is frequently accompanied by adverse effects that can affects patients’ quality of life. In Saudi Arabia, patients’ understanding of chemotherapy regimens and related toxicities is not well characterized. This study aimed to evaluate chemotherapy awareness among cancer patients and examine its association with hospital admissions and emergency department (ED) visits. Methods: This cross-sectional descriptive study was conducted at a tertiary hospital in Saudi Arabia, between year of 2022 to 2023. Adult cancer patients receiving at least one chemotherapy cycle were interviewed using a validated, investigator-developed questionnaire assessing beliefs and knowledge about cancer diagnosis, treatment regimens, and side effects. Awareness levels were classified as highly aware or not/low aware based on self-reports verified against electronic medical records (EMR). Descriptive statistics summarized demographic characteristics, while independent t-tests compared mean awareness scores between groups. Negative binomial regression examined associations between awareness levels, hospital admissions, and ED visits, adjusting for demographic covariates, with a sensitivity analysis additionally adjusting for advanced (stage IV) disease. Results: A total of 270 participants were enrolled (mean age 52 years; 61.1% female). Breast (33.7%) was the most common diagnosis, with 48.1% at stage IV disease. Overall, 69.3% of patients were classified as highly aware. Highly aware patients demonstrated significantly greater knowledge of treatment goals, chemotherapy regimens, and side effects. Greater awareness was associated with higher rates of ED visits and hospital admissions in adjusted analyses. Female gender and limited English fluency were also significant predictors of higher hospital admissions. Conclusion: Most oncology patients demonstrated high awareness of their chemotherapy. Awareness was not independently associated with emergency visits or hospital admissions; instead, female gender and limited English proficiency were the principal correlates of higher utilization. Structured patient education is needed to translate awareness into effective self-management and reduce healthcare utilization.

Background: Antimicrobial resistance (AMR) poses a critical global health threat, necessitating the discovery of novel antimicrobial agents. Traditional medicinal plants have long been used for managing infectious diseases, yet scientific validation of their efficacy remains limited for many species. This systematic review synthesizes existing evidence on the antimicrobial activities of nine medicinal plants traditionally used: Lepidium sativum , Saussurea costus, Rhus tripartita , Chenopodium murale, Pyrus communis , Argemone ochroleuca , Trigonella hamosa , Galium odoratum , and Erucaria hispanica . Methods: Following PRISMA guidelines, a comprehensive search was conducted in Google Scholar for studies published between 1 January 2000–1 August 2025. Search terms combined each plant’s scientific name with antimicrobial-related keywords (“antimicrobial,” “antibacterial,” “antifungal”) and study type filters (“ in vitro ,” “ in vivo ”). Only English-language studies investigating the antibacterial or antifungal activity of extracts or isolated metabolites from the target species were included. Clinical trials, reviews, case reports, and non-English publications were excluded. Data extraction captured microorganism type and strain, plant part studied, extraction method, antimicrobial assay, and reported activity (MIC, MBC, or inhibition zone). Results: A total of fifty-six eligible studies were included in the review. The evidence indicated that antibacterial and antifungal activities varied among the studied species. L. sativum , S. costus , R. tripartita , and C. murale were relatively well investigated, with findings showing broad-spectrum activity against both Gram-positive and Gram-negative bacteria. In contrast, P. communis , A. ochroleuca , and T. hamosa demonstrated antibacterial effects on both bacterial groups; however, they require further research. Several plants displayed notable antifungal effects, particularly against Candida spp., though results varied depending on extraction method, plant part, and microbial strain. Notably, studies employing advanced extraction techniques such as supercritical fluid extraction and green synthesis of nanoparticles, particularly silver nanoparticles, frequently reported enhanced antimicrobial efficacy compared to conventional solvent extracts. These nanoparticle formulations often exhibited larger inhibition zones and lower MIC values, highlighting their potential to potentiate the bioactivity of plant extracts. Conclusion: This review highlights the antimicrobial potential of the selected medicinal plants and supports their traditional use in managing infectious diseases. Standardized methodologies and bioactive compound isolation are recommended to facilitate their future development as candidates for combating AMR pathogens. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251047619 .

Background: Urinary tract infections (UTIs) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) present increasing therapeutic challenges, especially in regions with limited access to novel β-lactam/β-lactamase inhibitors. Colistin remains a salvage therapy in such cases; however, data describing its real-world efficacy and nephrotoxicity in urinary infections are limited. Methods: We conducted a retrospective cohort study of adult patients who received intravenous colistin (colistimethate sodium) for culture-confirmed UTIs at a tertiary academic medical center in Riyadh, Saudi Arabia. The primary outcome was colistin-induced acute kidney injury (AKI), defined as an increase in serum creatinine of ≥ 26 μmol/L from baseline per the AKIN creatinine criterion. Secondary outcomes included microbiologic failure, clinical failure, and in-hospital mortality. Multivariable logistic regression was used to identify independent predictors of AKI. Results: Among 102 patients, the median age was 80 years (IQR, 72– 84), and 46% were male. Klebsiella pneumoniae (44.9%) and Pseudomonas aeruginosa (20.4%) were the most common pathogens. Over half (52%) were exposed to concomitant nephrotoxic agents. Colistin-induced AKI occurred in 15 patients (14.7%). Chronic kidney disease was more frequent among those who developed AKI (73% vs. 26%, p< 0.001); however, no independent predictors were identified in multivariable analysis. In a sensitivity analysis using CKD as a binary covariate, CKD was independently associated with AKI (adjusted OR 19.17; 95% CI, 3.03– 121.30; p=0.002). Clinical failure occurred in 12.7% and microbiologic failure in 2.9% of patients. Conclusion: In this cohort of patients with MDR-GNB UTIs, intravenous colistin was associated with favorable clinical and microbiological outcomes. The observed incidence of AKI was lower than previously reported in the literature, though this should be interpreted cautiously given the small number of events and the high prevalence of baseline renal impairment and nephrotoxic co-exposures. The infographic is divided into three sections: study population, treatment and outcomes. The study population section describes patients with multidrug-resistant gram-negative urinary tract infections, totaling 102 individuals. The median age is 80 years, with 33.3 percent having chronic kidney disease and 52.0 percent exposed to nephrotoxic agents. The treatment section details intravenous colistin, specifically colistimethate sodium (CMS). The median duration of treatment is 10 days, with a median loading dose of 4 mg per kg (range 2.5 to 5) and a median maintenance dose of 2.9 mg per kg per day (range 1.95 to 4.35). The outcomes section lists clinical failure at 12.7 percent, microbiological failure at 2.9 percent, culture negative results in 5 days, afebrile status in 1 day and colistin-induced acute kidney injury at 14.7 percent.Infographic on study population, treatment and outcomes of intravenous colistin for urinary tract infections.

Introduction: Multidrug-resistant (MDR) gram-negative pathogens pose a major therapeutic challenge, particularly in settings with limited antimicrobial options. Tigecycline is frequently used as salvage therapy. However, evidence regarding the optimal tigecycline regimen, whether used as monotherapy or in combination, remains uncertain. This study aimed to describe the characteristics, clinical, and microbiological outcomes of these cases. Methods: Retrospective, single-center study of adult hospitalized patients treated with tigecycline for MDR Acinetobacter baumannii , extended-spectrum β-lactamase (ESBL)-producing Escherichia coli , and ESBL- or Carbapenem-Resistant Enterobacterales Klebsiella pneumoniae . Patients were categorized into tigecycline monotherapy or combination therapy groups. The primary outcomes were clinical success and 30-day mortality. Multivariable logistic regression was used to identify predictors of outcomes. A sensitivity analysis excluding bloodstream and urinary tract infections was performed due to pharmacokinetic limitations of tigecycline. Results: Two hundred eighty were included; 116 (41.4%) received tigecycline monotherapy and 164 (58.6%) received combination therapy. Patients receiving combination therapy had higher illness severity and higher intensive care unit admissions. Overall clinical success was achieved in 53.2% of patients with a higher rate in the monotherapy group (64.7%, p = 0.001), and 30-day mortality was 26.1%. After adjustment, tigecycline monotherapy was not independently associated with clinical success or mortality. Sensitivity analyses excluding bloodstream and urinary tract infections showed consistent results. Conclusion: In this real-world cohort of severely ill patients with MDR gram-negative infections, no outcome advantage was observed with tigecycline combination therapy after adjustment. Clinical outcomes were primarily driven by illness severity and infection characteristics rather than treatment strategy.

Purpose: Daptomycin-approved dosing is based on actual body weight (ABW). However, the pharmacokinetics and pharmacodynamics of daptomycin are altered in obese patients, leading to increased daptomycin exposure owing to incomplete distribution into excess body tissues. Data regarding the use of alternative weight descriptors for daptomycin dosing are limited. This study aimed to investigate the effectiveness and safety of daptomycin in obese patients by using adjusted body weight (AdjBW). Methods: This retrospective multicenter cohort study in Saudi Arabia compared the outcomes of obese patients who received daptomycin based on AdjBW with those of obese and non-obese patients who received daptomycin based on ABW. The main outcomes included clinical cure, overall in-hospital mortality, and 30-day mortality. The safety outcomes were evaluated. Multivariate logistic regression was used to control for confounding variables. Results: A total of 293 patients met the inclusion: 43 patients in AdjBW group, 54 in the ABW group, and 196 in the non-obese group. When comparing the AdjBW and ABW obese groups, no statistically significant difference was observed in clinical cure (83.7% vs 77.8%; p = 0.461; OR, 0.1.47; 95% CI, 0.52– 4.12), overall in-hospital mortality (23.3% vs 35.2%; p = 0.200; OR, 0.56; 95% CI, 0.23– 1.37), or 30-day mortality (16.3% vs 27.8%; p = 0.174; OR, 0.51; 95% CI, 0.19– 1.38). Creatine phosphokinase elevation (8.6% vs 6%; p = 0.651) was similar between the two groups. Similar outcomes were observed when comparing the AdjBW and non-obese groups. Conclusion: Treatment with daptomycin based on AdjBW in obese patients had similar effectiveness and safety outcomes as treatment with daptomycin based on ABW in obese and non-obese patients. Therefore, future prospective studies are warranted.

Background: Candidozyma auris has emerged globally as a multidrug-resistant pathogen with high rates of colonization and potential for invasive infection. Understanding the progression from colonization to infection and associated outcomes is limited. This study aimed to describe the characteristics and outcomes of C. auris-colonized patients and identify risk factors for progression to infection. Methods: We conducted a single-center retrospective case–control study of hospitalized patients with documented C. auris colonization at a tertiary care center (2018–2024). Cases were patients who progressed to a fungal infection (infection group), while controls remained colonized (colonized group). Demographics, comorbidities, device use, prior antimicrobial exposure, microbiologic characteristics, and outcomes were compared. Results: Among 334 C. auris-colonized patients, 44 (13.2%) progressed to infection. The median age was 66.4 years. Those in the infection group had higher Charlson Comorbidity Index (5.9 ± 3.1 vs. 4.79 ± 2.7, p = 0.0112) and were more likely to have central line (90.9% vs. 71.7%, p = 0.0067), mechanical ventilation (77.3% vs. 60.34%, p = 0.0306), parenteral nutrition (6.82% vs. 1.72%, p = 0.0395), and abdominal surgery (13.64% vs. 4.83%, p = 0.0217). In multivariate analysis, abdominal surgery was the only independent predictor of infection (OR 4.08; 95% CI 1.1–15.1; p = 0.03). In-hospital mortality was significantly higher in the infection group (65.9% vs. 33.1%, p < 0.0001). Conclusions: Approximately one in eight colonized patients developed C. auris infection. Recent abdominal surgery independently predicted progression, while infection was associated with higher mortality and prolonged hospitalization, underscoring the need for targeted prevention in high-risk patients.

Background: Remdesivir is associated with hepatotoxicity and acute kidney injury (AKI). The objective of this study was to assess the hepatotoxicity and AKI with remdesivir. Method: This is a multicenter, retrospective cohort study for adult patients who used remdesivir for COVID-19 from 3/2020 to 10/2021. The study was conducted at Rhode Island Hospital, Rhode Island, United States. Data were analyzed with descriptive statistics as well as logistic regression analysis using STATA 18. Results: A total of 1635 patients were evaluated for hepatotoxicity: 337 developed hepatotoxicity, and 1298 had normal hepatic function. The overall median frequency of hepatotoxicity occurred in 319 patients (19.5%). Patient age (OR 1.02, 95% CI: 1–1.04, p = 0.02) and selective serotonin reuptake inhibitors (SSRIs) use (OR 1.7, 95% CI: 1.1–2.6, p = 0.01) were potential risk factors for remdesivir-associated hepatotoxicity. In contrast, being male gender was protective against remdesivir-associated hepatotoxicity (OR 0.63, 95% CI: 0.47–0.87, p = 0.02). The frequency of AKI with remdesivir occurred in 280 patients (17.3%). Conclusions: The frequency of hepatotoxicity was 19.5%, and the frequency of AKI was 17.3%. Increasing age and using SSRIs were risk factors for remdesivir-associated hepatotoxicity, while male gender was a protective factor. Clinicians should vigilantly monitor hepatic and renal functions for patients using remdesivir, especially in elderly patients.

Inducible AmpC β-lactamases in Gram-negative Enterobacterales pose therapeutic challenges. Although carbapenems are the preferred treatment, other antibiotics can serve as a viable alternative. Studies comparing treatment options report varied outcomes. This study evaluates 30-day mortality, treatment failure, and length of hospitalization in patients with AmpC-producing Enterobacterales bacteremia. This retrospective cohort study included adult patients with bacteremia caused by AmpC-producing Enterobacterales. Exclusion criteria included: therapy duration < 72 h, coinfection, resistant isolates, and death within 72 h of diagnosis. Patients were divided into definitive carbapenem and noncarbapenem therapy. The primary outcome was 30-day mortality, while secondary outcomes evaluated treatment failure and length of hospitalization. Statistical analysis used descriptive statistics, group comparisons, and logistic regression. Of 214 screened patients, 80 met the inclusion criteria. Enterobacter cloacae (60%) was the predominant pathogen, primarily originating from line-related infections (55%). Carbapenems were the primary empirical (45%) and definitive (75%) therapies; 30-day mortality was higher in the non-carbapenem group (20% versus 3.3%, p = 0.08). Treatment failure was significantly higher in the non-carbapenem group (20% versus 1.6%, p < 0.01). The mean hospital stay was longer in the carbapenem group (26 ± 38.40 days) than the non-carbapenem group (11.15 ± 7.15 days, p = 0.87). Older age was significantly associated with higher mortality (odds ratio (OR) 1.07, 95% confidence intervals (CI): 0.98-12.20, p = 0.015). Carbapenem use was significantly associated with improved survival, highlighting its importance in treatment strategies. Age significantly affects survival, stressing the need for personalized treatments. Further research and strategies are needed to address clinical failures and enhance antimicrobial stewardship.

Background: Brucellosis is a major zoonotic infection that warrants treatment with antibiotic therapy. Current treatment recommendations include using either dual or triple therapy with antibiotics active against brucella species. This study aims to evaluate the effectiveness and safety of dual and triple antibiotic therapy for treating brucellosis. Methods: This is a retrospective cohort study for patients with confirmed Brucellosis infection from 2015 to 2024. The primary outcome was the achievement of a favorable response. Secondary outcomes were treatment failure, 90-day mortality, relapse of brucella infection, hospital re-admission, and adverse drug reactions (ADRs). Baseline characteristics were reported as means with standard deviations. All the statistical tests are shown as odds ratios (ORs) with 95% confidence intervals (CIs). Results: In total, 966 patients were screened and 287 met the inclusion criteria: 164 patients in the dual therapy group and 123 patients in the triple therapy group. Achievement of a favorable response was not statistically different between the dual therapy and triple therapy groups; 87.3% vs. 90.5%, OR 1.2 (0.48–3.02, p = 0.42). No patient died in either treatment group. Treatment failure, mean duration of hospitalization, brucella relapse, hospital re-admission, and the mean time to defervescence were not statistically different between dual and triple therapy groups. Adverse drug reactions were numerically higher in the triple therapy group. Conclusions: Dual therapy was equally effective for the treatment of patients with brucellosis compared to the triple therapy regimens. Although not statistically significant, there more ADRs in the triple therapy group compared to those receiving dual therapy. Thus, dual antibiotic therapy is efficacious, less costly, and associated with fewer ADRs compared to triple antibiotic therapy.