With limited and often toxic treatment options, carbapenem-resistant Gram-negative infections are associated with significant mortality. Cefepime-zidebactam is a promising antibiotic option undergoing a phase 3 trial that has activity against diverse antibiotic-resistant mechanisms in Gram-negative pathogens due to its β-lactam enhancer mechanism, mediating multiple PBP binding.

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections commonly cause hospital-acquired infections. The study aimed to compare the outcomes of CRKP infections between patients receiving ceftazidime avibactam +/− aztreonam and polymyxins in a hospital setting with a high prevalence of New Delhi Metallo Beta Lactamase production. Methods: We conducted a retrospective cohort study from January 2020 to September 2022 in critically ill adult patients admitted to a non-COVID-19 medical intensive care unit with CRKP infection. The patients were followed up for a total of 30 days or death, whichever was later. Results: Of a total of 106 patients included in the study, 65 patients received polymyxins and 41 patients received ceftazidime–avibactam +/− aztreonam. Higher 30-day mortality was noted in the polymyxin group (56.9% vs. 29.2%, P = 0.005). The mean time to event (mortality) in ceftazidime–avibactam +/− aztreonam was 23.9 + 1.5 days which was significantly higher compared to polymyxins (17.9 + 1.2 days, p = 0.006). On Cox regression analysis, after adjusting for the covariates, the hazard ratio for time to event with the use of polymyxin was 2.02 (95% CI: 1.03–3.9). Conclusion: Ceftazidime–avibactam + aztreonam is possibly associated with better clinical outcomes in patients infected with CRKP.

Carbapenem-resistant Enterobacterales (CRE) due to Metallo-β-lactamase (MBL) production are treated with either polymyxins or the novel combination of ceftazidime-avibactam and aztreonam (AA). This study aims to evaluate the 30-day mortality of AA in patients with BSI caused by MBL-CRE infections. In this systematic review and meta-analysis, all articles up to June 2023 were screened using search terms like 'CRE', 'MBL', 'AA' and 'polymyxins'. The risk ratio for AA vs polymyxins was pooled using a random-effect model, and the results were represented by a point estimate with a 95% confidence interval. After removing the duplicates, the titles and abstracts of 455 articles were screened, followed by a full-text screening of 50 articles. A total of 24 articles were included for systematic review, and four comparative studies were included in the meta-analysis. All four studies had a moderate or serious risk of bias. The pooled risk ratio for 30-day mortality for AA vs. polymyxins was 0.51 (95%CI: 0.34-0.76), p < 0.001. There was no significant heterogeneity. The meta-analysis from studies with a high risk of bias shows that AA is associated with lesser 30-day mortality when compared to polymyxins in patients with MBL-producing CRE BSI. Registration with PROSPERO- CRD42023433608.

• Melioidosis can involve any part of the body, often together. Since inhalation and percutaneous inoculation routes are the common modes of transmission, lung and skin are the most common sites of involvement. • While some patients present acutely with sepsis and multi-organ failure, others present with a subacute to chronic course characterised by abscess formation. • Pulmonary, osteoarticular and genitourinary abscesses have high rates of concomitant bacteremia, as opposed to central nervous system and cutaneous sites. • The antimicrobial treatment of abscesses due to melioidosis begins with an intensive phase of meropenem or ceftazidime, followed by an eradication phase with cotrimoxazole. • Abscess drainage is recommended for prostatic involvement but may be required on a case-to-case basis for abscesses at other sites as well.

Melioidosis is increasingly recognized in India, but available evidence remains fragmented across small reports. We aimed to synthesize national case-based data to describe the clinical spectrum and identify factors associated with mortality. We systematically searched PubMed, Embase, and Web of Science from inception to February 5, 2025. Case reports, case series, and observational cohorts with individual patient-level culture- or molecular-confirmed data from India were included. Two reviewers independently screened studies, extracted data using a standardized form, and assessed quality using the Joanna Briggs Institute checklist for case reports. Univariate comparisons were performed between survivors and non-survivors. The protocol was registered on PROSPERO (CRD42025640317), and PRISMA guidelines were followed. From 1983 screened records, 209 studies reporting 558 cases from 20 states were included. The mean age was 44.8 years, and 73.4% had diabetes. Bacteremia occurred in 70.1%; pulmonary disease (33.2%), bone/joint involvement (35.1%), splenic abscesses (17.7%), and central nervous system disease (13.3%) were the most common conditions. Among 498 cases with reported outcomes, mortality was 19.9%. Malignancy, pulmonary and central nervous system involvement, and bacteremia were associated with death. In India, melioidosis is widespread and often severe, with substantial mortality. Earlier recognition and improved diagnostic access are needed to reduce preventable deaths.

Invasive central nervous system (CNS) aspergillosis is acquired by either hematogenous dissemination or direct spread from a sinus infection. We describe a series of nine patients with CNS aspergillosis from a tertiary care teaching institute in North India who were treated with voriconazole alone or in combination with surgery. All patients who had clinical and radiological features consistent with fungal CNS infection, showed the presence of septate hyphae on histopathology/microscopy and were either culture positive for Aspergillus spp. or had serum galactomannan positivity were diagnosed as CNS aspergillosis. Clinical features, risk factors, diagnostic modalities, treatment details and outcome at last follow-up were recorded for all patients diagnosed with CNS aspergillosis. A total of nine patients were diagnosed with CNS aspergillosis. The median duration of presentation at our hospital was six months (IQR-2-9 months). Six patients had concomitant sinus involvement, while two patients had skull-base involvement as well. All patients were treated with voriconazole therapy, and three of these patients underwent surgery. All but one patient survived at the last follow-up (median duration was 14 months (IQR- 8-21.5). Two patients had complete resolution, and voriconazole was stopped at the last follow-up, and the rest of the patients were continued on voriconazole. Of the six patients who were continued on voriconazole, all but one had more than 50% radiological resolution on follow-up imaging. Invasive CNS aspergillosis is an important cause of CNS fungal infection that is often diagnosed late and requires long-term voriconazole-based therapy.