Antimicrobial resistance (AMR) is a present, pressing global public health crisis associated with rising morbidity and mortality rates due to previously curable infectious disease. Targeted drug delivery is an important approach to address AMR due to its ability to improve the therapeutic performance of antibiotics without leading to any adverse effects or organ toxicities. In this review we explore molecular mechanisms of AMR and drawbacks of conventional antibiotic therapies and discuss unique drug delivery approaches to compensate these. Nanoparticulate carrier systems, stimuli-responsive systems, antibody–drug conjugates, and CRISPR-Cas systems are some of the carrier method designs that are promising for tackling hard to treat infections related to pathogenic strains and biofilms due to their features. Many of these are among the most significant advances in the field. However, there are many challenges to be overcome, with biological limitations, scaling and regulatory challenges, etc., before they can be employed in commercial applications. Materials are being developed, and an approach standardized and applicable to future work is in development to improve the efficiency of targeted delivery systems. Controlled drug delivery, which could be the answer to an increasing AMR problem, will not only help in alerting awareness among individuals but will also help in prolonging the activity of antibiotics by providing synergistic interdisciplinary solutions. This review emphasizes the complementary role of targeted drug delivery in transitioning from laboratory investigations to clinical therapy. It addresses underrepresented aspects, including new materials, scalability, regulatory considerations, and ethical implications, while offering a roadmap for translating innovations into next-generation antimicrobials.

Background: Chronic low-grade inflammation and dyslipidemia contribute to metabolic disorders such as diabetes. Dysglycemia, an early stage of glucose dysregulation, reflects this interplay. The neutrophil-to-HDL cholesterol ratio (NHR) integrates inflammatory and lipid pathways, but its role in dysglycemia, particularly in Middle Eastern populations, remains unclear. This study evaluated the association between NHR and glycemic abnormalities, including impaired fasting glucose (IFG) and hyperglycemia (HG). Methods: A retrospective cross-sectional investigation involving 13,121 individuals at a major health setting in Saudi Arabia was conducted. The association between NHR and glycemic status was comprehensively evaluated, with subgroup analyses stratified by age and gender. Risk and diagnostic performance of NHR for dysglycemia were evaluated. Correlation and linear regression analyses were conducted to examine the relationships between NHR and fasting glucose, as well as HbA1c. Results: NHR levels were significantly associated with dysglycemia, showing progressive elevation from normoglycemia (5.30: 3.453–7.755) to IFG (6.00: 3.904–8.663) and HG (7.177: 4.917–10.17). Elevated NHR was more prevalent among individuals with dysglycemia and was associated with an increased risk of IFG (OR = 1.48, 95% CI: 1.36–1.61, p < 0.0001) and HG (OR = 2.38, 95% CI: 2.13–2.65, p < 0.0001). In the FBG context, NHR showed better discrimination of HG from NG than CRP (AUC = 0.650 vs. 0.570; p < 0.0001). Conclusions: Elevated NHR is significantly associated with dysglycemia, particularly hyperglycemia. These findings suggest that NHR may serve as a supportive tool for identifying individuals at increased risk of dysglycemia, especially in populations with limited diagnostic resources. Future longitudinal studies are warranted to validate its predictive and prognostic value in clinical practice.

Early identification of ICU patients with sepsis who are at risk of early death remains clinically important. The aspartate aminotransferase-to-platelet ratio index (APRI) is a simple laboratory-derived index, but its clinical value for very early mortality in adult ICU patients with sepsis remains insufficiently characterized. This study evaluated the association between admission APRI and short-term mortality in ICU patients with sepsis. This retrospective cohort study included 266 adults admitted to the ICU with sepsis. APRI was calculated from AST and platelet measurements obtained within 24 h of admission. Patients were categorized according to mortality timing. Associations with 7-day mortality were evaluated using logistic regression adjusted for age, sex, and comorbidity status. ROC and survival analyses were also performed. Of 266 patients, 32 died within 7 days, 88 between 8 and 28 days, and 72 after 28 days, and 74 survived. APRI was highest among patients who died within 7 days (median 1.919, IQR 0.631–5.009) compared with survivors (0.472, IQR 0.192–1.531; p = 0.0056). Higher log-transformed APRI remained associated with 7-day mortality after adjustment for age, sex, and comorbidity status (OR = 2.77, 95% CI 1.57–5.01; p = 0.0004). APRI showed modest discrimination for 7-day mortality (AUC = 0.687, 95% CI 0.580–0.793) and lower discrimination for 28-day mortality (AUC = 0.623, 95% CI 0.555–0.690). Elevated APRI was also associated with reduced short-term survival. Elevated admission APRI is independently associated with early mortality and reduced short-term survival in ICU patients with sepsis. However, its modest discrimination supports its use as an adjunct to established clinical risk assessment tools.