Early Access

Antimicrobial resistance (AMR) and medical waste pollution are critical, concurrent challenges in modern healthcare that demand integrated, sustainable infection control strategies. Conventional wound dressings primarily composed of petroleum-based plastics not only contribute to long-lasting environmental waste but also fall short in effectively managing biofilm-associated infections. In response, biodegradable antimicrobial hydrogels derived from renewable polymers such as cellulose, alginate, chitosan, and silk fibroin have emerged as eco-friendly alternatives. These hydrogels mimic the extracellular matrix (ECM), maintain a moist wound environment, and promote tissue regeneration. Their antimicrobial efficacy is enhanced by green agents such as chitosan, plant extracts, and biosynthesized nanoparticles which disrupt microbial membranes and inhibit biofilm formation while supporting fibroblast viability. Smart hydrogels enable responsive, localized drug release tailored to the wound microenvironment, minimizing systemic antibiotic use and reducing the risk of AMR. Despite promising preclinical outcomes, widespread clinical adoption remains limited by challenges in sterilization, regulatory approval, and production costs in acute wound care such as burns injury. Hybrid composites, integrating natural and synthetic polymers, alongside cross-sector collaboration, may facilitate scalable, sustainable solutions. Ultimately, these smart antimicrobial hydrogels represent a synergistic advancement toward effective infection control and environmentally responsible acute wound care. This review aims to summarize recent advances in sustainable antimicrobial hydrogels, focusing on nature-derived hydrogel matrices, environmentally friendly antimicrobial functionalization strategies, mechanisms of infection control, and challenges associated with their clinical translation.

Keywords: Hydrogels, antimicrobial, wound healing

Viral pneumonia is an important reason of hospitalization and death in adults, but its clinical course differs based on the virus and the host. Older age, frailty, chronic cardiopulmonary disease, and immune status are major determinants of disease severity and recovery. Treatment also differs between viruses and stage of the infection. In influenza cases, neuraminidase inhibitor treatment was associated with lower mortality, with the greatest benefit when treatment was started within 2 days of onset of symptoms. Dexamethasone reduces mortality in COVID-19 requiring respiratory support, whereas corticosteroids should not be used routinely for other respiratory viral infections. For RSV, ribavirin is used mainly in selected severely immunocompromised patients, although the evidence is largely observational and several new antivirals are under investigation. No antiviral treatment has established clinical efficacy for human metapneumovirus and parainfluenza pneumonia. Bacterial infection may be present at admission or develop later during hospitalization. This distinction is clinically important because the risk of bacterial infection and the need for antibiotics vary with the virus, host factors, disease severity, and timing of illness. Cardiovascular, thrombotic, and invasive fungal complications may also occur. Acute cardiac events were reported in 22.4% of adults aged ≥50 years hospitalized with RSV, while invasive pulmonary aspergillosis occurred in 19% of adults admitted to the ICU with severe influenza in a multicenter cohort. Long-term consequences include persistent respiratory symptoms, functional decline, readmission, and worsening of chronic cardiopulmonary disease, particularly in older adults. These outcomes are not assessed consistently across different respiratory viruses. Viral pneumonia should therefore be assessed as a changing clinical course, from early risk and treatment decisions to complications and recovery after discharge.

Keywords: Viral pneumonia, COVID-19, RSV, respiratory tract infections, influenza

Objective: Staphylococcus aureus bacteremia (SAB) carries a substantial risk of infective endocarditis (IE), a serious complication associated with increased morbidity and mortality. Because early diagnosis of IE is critical, echocardiographic evaluation, particularly transesophageal echocardiography, is frequently recommended in patients with SAB. However, performing echocardiography in all patients may not be feasible or necessary. Therefore, reliable risk stratification tools are needed.

Materials and Methods: We retrospectively analyzed 243 patients with SAB. Clinical, microbiological, and laboratory data were collected. The diagnostic performances of VIRSTA, PREDICT-1, and PREDICT-5 scores were evaluated using receiver operating characteristic curve analysis.

Results: IE was diagnosed in 29 patients (11.9%). The VIRSTA score demonstrated strong discriminative ability (AUC 0.901), outperforming PREDICT-1 (AUC 0.662) and PREDICT-5 (AUC 0.691). At a cut-off value of> 4.5, VIRSTA achieved a sensitivity of 96.4% and a negative predictive value of 99.2%.

Conclusions: The VIRSTA score showed superior diagnostic performance compared to PREDICT scores and demonstrated excellent rule-out capability for IE in patients with SAB. It may serve as a reliable tool for risk stratification and clinical decision-making.

Keywords: Infective endocarditis, staphylococcus aureus bacteremia, VIRSTA score, PREDICT score, risk stratification, echocardiography

Objective: Cytomegalovirus (CMV) DNAemia remains an important complication after hematopoietic stem cell transplantation (HSCT). This study aimed to describe the clinical, virological, treatment-related characteristics, and outcomes of HSCT recipients who developed CMV DNAemia requiring preemptive antiviral therapy at a center where routine letermovir prophylaxis was unavailable.

Materials and Methods: This retrospective cohort study included adult allogeneic or autologous HSCT recipients followed between January 1, 2021, and June 1, 2025. Among 222 screened patients, 46 met the center-specific criteria for preemptive treatment, and 51 CMV DNAemia episodes were evaluated. In allogeneic HSCT recipients, CMV DNA was monitored weekly during the first 100 days after transplantation using quantitative real-time polymerase chain reaction in EDTA-anticoagulated whole-blood samples. Demographic, transplantation-related, virological, treatment, and outcome data were analyzed.

Results: CMV DNAemia requiring treatment occurred in 46 patients (20.7%). The median age was 43 years (IQR, 29-54). The most common underlying diagnoses were acute myeloid leukemia in 13 patients (28.3%) and acute lymphoblastic leukemia in 12 (26.1%). Allogeneic HSCT was performed in 41 patients (89.1%). Forty-four of 51 episodes (86.3%) occurred within the first 100 days after transplantation. The median time to first CMV DNA detection was 43 days (IQR, 36-56 ), and the median viral load at treatment initiation was 2,546 copies/mL (IQR, 1,577-10,245). Intravenous ganciclovir was the initial therapy in 47 episodes (92.2%). The median treatment duration was 18 days (IQR, 10-28) and the median time to PCR negativity was 20 days (IQR, 10–28). Five patients died during follow-up (10.9%).

Conclusion: CMV DNAemia requiring preemptive therapy occurred predominantly during the early post-transplant period. These findings highlight the importance of close, specimen-consistent virological monitoring using a consistent specimen type and assay, together with timely initiation of preemptive therapy based on center-specific thresholds when letermovir prophylaxis is unavailable.

Keywords: Hematopoietic stem cell transplantation, cytomegalovirus, CMV DNAemia, preemptive therapy

Objective: Aminoglycosides remain useful in selected severe Gram-negative infections, but creatinine changes during treatment require timely review. We evaluated how large language models (LLMs) handled an aminoglycoside renal-safety task in septic intensive care unit (ICU) encounters.

Materials and Methods: We performed a retrospective simulation using MIMIC-IV v3.1 as the primary cohort and eICU-CRD v2.0 as an independent cohort evaluation. Nine open-weight and three proprietary LLMs received time-causal creatinine history and available clinical context and returned CONTINUE or DISCONTINUE; DISCONTINUE meant hold for immediate reassessment. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. The primary outcome was the non-hold rate in a direct query at the first qualifying measurement. Pre-trigger holds, holds in KDIGO-negative encounters, and time to hold were separate outcomes. A secondary query supplied the KDIGO rule.

Results: MIMIC-IV included 57 exposures (36 KDIGO-positive); eICU-CRD included 34 (17 KDIGO-positive). All 1,272 direct-trigger and threshold-aware calls were valid. Median primary non-hold rates were 45.8% (range, 19.4%–91.7%) and 26.5% (range, 5.9%–47.1%), respectively. Model heterogeneity was present in MIMIC-IV (Q=95.17, 11 df, P<0.001) and eICU-CRD (Q=22.04, 11 df, P=0.024). Median threshold-aware non-hold rates were 29.2% and 23.5%. In a post hoc 16-case subset, 181/192 model-case sets were unanimous across three repetitions; alternate-prompt concordance was 169/192.

Conclusion: This is an offline evaluation. It does not establish causality or clinical appropriateness, and it does not compare models with clinicians. A transparent rule check and prospective human oversight would still be needed.

Keywords: Sepsis, aminoglycosides, acute kidney injury, medication safety, large language models, intensive care units

Objective: In clinical practice, consultation requests are frequently triggered by elevated inflammatory markers despite the absence of clear clinical findings suggestive of infection or inflammatory disease. Because these markers are nonspecific, their interpretation without adequate clinical assessment may result in low-yield consultations and unnecessary diagnostic investigations. Real-world data evaluating consultation outcomes in this specific patient population remain limited. 

Materials and Methods: A total of 123 consultation records between 01.02.2021 and 01.02.2024 were reviewed retrospectively. The unit of analysis was the consultation record; the database included 122 unique patients. Clinical characteristics, laboratory values, diagnoses established after consultation, and follow-up laboratory results were assessed. Diagnostic performance was evaluated using ROC analysis, and variables associated with infectious diagnosis and diagnostic yield were examined using multivariable logistic regression.

Results: An infectious diagnosis was established in 50 records (40.7%), a rheumatologic diagnosis in 14 (11.4%), and another noninfectious/nonrheumatologic diagnosis in 22 (17.9%); no additional diagnosis was identified in 37 records (30.1%). CRP levels were higher among records with an infectious diagnosis (median 33.0 mg/L vs. 19.5 mg/L; p=0.009). The AUC for CRP was 0.640 (95% CI: 0.540–0.741), and the AUC for the multivariable model was 0.666 (95% CI: 0.568–0.765). At a CRP cut-off of 77 mg/L, sensitivity was 34.0% and specificity was 91.7%. Pathologic physical examination findings were independently associated with establishment of a clinically meaningful diagnosis (OR 5.00, 95% CI: 1.90–13.15; p=0.001).

Conclusion: Inflammatory markers have limited diagnostic value when interpreted in isolation. Clinical assessment, particularly physical examination findings, was more strongly associated with diagnostic yield than inflammatory markers. Therefore, elevated inflammatory markers should be interpreted as supportive findings rather than stand-alone triggers for consultation requests.

Keywords: C-reactive protein, acute-phase proteins, infectious diseases, rheumatology, consultation

Objective: Severe COVID-19 is associated with pneumonia, acute respiratory distress syndrome, septic shock, and multiorgan failure. High mobility group box-1 (HMGB1) is a damage-associated molecular pattern involved in inflammatory responses and hypoxia-related tissue injury. This study aimed to investigate the relationship between serum HMGB1 levels and chest computed tomography (CT) findings, intensive care unit (ICU) requirement, and mortality in patients with COVID-19.

Materials and Methods: This observational study included adult patients hospitalized with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. According to chest CT findings, patients were classified into four groups based on the presence and extent of pulmonary involvement (no involvement, <33%, 33–66%, and >66%). Serum HMGB1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Clinical, laboratory, radiological, ICU admission, and mortality outcomes were analyzed.

Results: A total of 251 patients (121 females, 130 males; mean age 52.2 ± 19.0 years) were included. Serum HMGB1 levels increased progressively with radiological severity, from 909.2 ± 222.1 pg/mL in patients without lung involvement to 3662.9 ± 679.4 pg/mL in those with severe lung involvement (p = 0.001). HMGB1 levels were also higher in ICU patients and non-survivors (p = 0.001 for both). HMGB1 correlated with inflammatory and organ injury markers, showing the strongest correlation with C-reactive protein (CRP) (r = 0.692, p = 0.001). In multivariate analysis, HMGB1 remained independently associated with lung involvement (OR 1.021, 95% CI 1.008–1.034; p = 0.001). ROC analysis demonstrated limited discrimination for lung involvement (AUC = 0.392; cut-off ≥1847.54 pg/mL) and severe lung involvement (AUC = 0.420; cut-off ≥2477.54 pg/mL).

Conclusion: HMGB1 may serve as a complementary inflammatory biomarker reflecting pulmonary involvement and disease severity in COVID-19. ROC-derived cut-off values may facilitate risk stratification; however, further prospective studies are required to validate their clinical utility.

Keywords: COVID-19, HMGB1 protein, lung diseases, tomography, x-ray computed, disease severity, intensive care units, mortality

Objective: Brucellosis remains common in endemic regions and has diverse clinical manifestations. This study evaluated the demographic, clinical, and temporal characteristics of adult brucellosis cases over a ten-year period, with particular attention to patterns observed during the COVID-19 years.

Materials and Methods: This retrospective single-center study included adults (≥18 years) diagnosed with brucellosis between 2014 and 2023 at a tertiary-care hospital in Central Anatolia. Demographic characteristics, exposure history, symptoms, laboratory findings, focal involvement, microbiological results, treatment regimens, and outcomes were evaluated. Seasonal and annual distributions were examined, and 2020–2022 was operationally defined as the COVID-19 period.

Results: A total of 255 patients were included (mean age, 48.2 ± 15.3 years; 74.9% male). Unpasteurized dairy consumption and occupational exposure were reported in 82.8% and 71.0% of patients, respectively. Admissions were most frequent between May and August (54.1%), and 167 cases (65.5%) were recorded during 2020–2022. Median symptom duration was longer during 2020–2022 than during the remaining study years [30 days (IQR, 7–75) vs. 15 days (IQR, 7–30); p=0.029]. Disease-stage distribution also differed between the periods (p=0.031), while the hospitalization rate was lower during 2020–2022 (20.4% vs. 40.9%; p<0.001). Focal involvement was identified in 37.3% of patients, and osteoarticular involvement was the most frequent focal manifestation (30.2%). Blood culture positivity was 12.9% among 70 hospitalized patients from whom cultures were obtained. Sixteen patients discontinued treatment prematurely, six of whom experienced disease recurrence; relapse after treatment completion occurred in one patient.

Conclusion: Brucellosis continues to be a major public health problem in endemic regions. Osteoarticular involvement is common. The COVID-19 period was associated with increased admissions in our center.

Keywords: Brucellosis, endemic diseases, osteoarticular diseases, COVID-19

Ochrobactrum species are aerobic, non-fermenting Gram-negative bacilli that are increasingly recognized as causes of healthcare-associated infections. Among them, Ochrobactrum intermedium remains a rare human pathogen and poses therapeutic challenges due to its resistance to multiple antimicrobial agents. We report a case of hospital-acquired sepsis caused by O. intermedium bacteremia in an 82-year-old woman with advanced pancreatic cancer. Clinical resolution was achieved following removal of the central venous catheter and a seven-day course of intravenous meropenem. This case underscores the role of O. intermedium as an emerging opportunistic pathogen in immunocompromised patients.

Keywords: Bacteremia, Ochrobactrum intermedium, catheter-related bloodstream infection, healthcare-associated infection

Gardnerella vaginalis (G. vaginalis) pneumonia in men is very rare, with most reported cases occurring in critically ill patients with major predisposing conditions. We describe a man in his 60s with poorly controlled diabetes mellitus who developed G. vaginalis pneumonia complicated by septic shock after an influenza-like illness in the setting of household influenza exposure. He required mechanical ventilation, and G. vaginalis was isolated from both sputum and blood cultures. Empirical meropenem, vancomycin, and azithromycin were de-escalated to intravenous ampicillin according to susceptibility testing, followed by oral clindamycin, for a total treatment duration of 6 weeks. Despite the absence of trauma, prolonged mechanical ventilation before onset, or a clear aspiration event, he developed severe pneumonia with lung abscess formation and achieved full clinical and radiographic recovery.

Keywords: Gardnerella vaginalis, pneumonia, septic shock

The clinical presentation of ocular cat-scratch disease (CSD) is heterogeneous. Here, we report a case of CSD with atypical ocular manifestations to enhance clinical awareness of this condition. A 6-year-old girl presented with decreased visual acuity in the left eye. Ophthalmic examination revealed extensive exudative retinal detachment, a large yellow-white granulomatous lesion in the posterior retina. The diagnosis of ocular CSD was subsequently confirmed by metagenomic sequencing. The patient received intravenous azithromycin and oral rifampicin, along with intravitreal injections of conbercept and ceftazidime. Retinal reattachment was observed within 3 weeks. This case highlights atypical clinical manifestations of ocular CSD.

Keywords: Cat-scratch disease, extensive serous retinal detachment, bartonella henselae

Anaphylactic shock associated with hydatid cysts is rare but potentially fatal usually occurrs following cyst rupture. We report the case of a 23-year-old man who developed sudden anaphylaxis without evidence of cyst rupture. Imaging demonstrated hepatic hydatid cysts, and the diagnosis was supported by a positive indirect hemagglutination test. After successful stabilization, surgical treatment was planned. During surgery, a second anaphylactic episode occurred despite no visible rupture. The cysts were excised completely, and surgical and histopathological findings confirmed hepatic hydatid disease. Albendazole therapy was initiated postoperatively. This case underscores that hydatid disease should be considered in patients with unexplained anaphylaxis, particularly in endemic regions, even in the absence of apparent cyst rupture.

Keywords: Hydatid cyst, anaphylaxis, liver, echinococcus, spontaneous

Plasmodium falciparum is the most virulent malaria species, associated with life-threatening complications. We report a 25-year-old male returning from an endemic region presenting with fatigue, nausea, and diarrhea initially diagnosed as viral gastroenteritis. One day later, he developed headache and clinical deterioration requiring readmission. Although meningitis and encephalitis were considered due to neurological symptoms and travel history, peripheral blood smear revealed P. falciparum gametocytes, confirming the diagnosis. Antimalarial therapy was initiated promptly. This case highlights the importance of travel history and considering malaria in atypical presentations

Keywords: Cerebral malaria, plasmodium falciparum, imported malaria, post-artesunate delayed hemolysis, travel medicine

Syphilis, caused by Treponema pallidum, is known for its wide spectrum of clinical presentations and its ability to mimic other diseases. We present the case of a 61-year-old man referred through a suspected cancer pathway due to an anal ulcer, systemic symptoms, and a spiculated lung nodule, with prior history of intestinal spirochetosis and a negative syphilis serology at that time.

Imaging suggested anal malignancy, prompting a full oncologic workup, however, anal biopsies confirmed Treponema pallidum, and further serology testing was consistent with syphilis.

This case highlights the diagnostic challenges associated the diagnostic overlap between syphilis, intestinal spirochetosis, and malignancy.

Keywords: Spirochetosis, syphilis, anal ulcer, treponema pallidum