MaltSci 麦伴科研

Appearance

Popular Reports / Clinical Medicine

This report is written by MaltSci based on the latest literature and research findings

How is bacterial infection treated? ​

Abstract ​

Bacterial infections pose a significant global health challenge, contributing to substantial morbidity and mortality, particularly among vulnerable populations. The emergence of antibiotic resistance has complicated treatment options, leading to a pressing need for innovative strategies to combat resistant infections. This review provides a comprehensive overview of bacterial infections, including their types, epidemiology, and the impact of antibiotic resistance on public health. Traditional antibiotic treatment strategies, while effective, are increasingly hindered by the rise of multidrug-resistant (MDR) strains. The mechanisms of antibiotic action and resistance are explored, alongside alternative therapies such as bacteriophage therapy, immunotherapy, and the role of vaccination. Furthermore, the review emphasizes the critical importance of infection control measures and antibiotic stewardship programs in optimizing antibiotic use and preventing the spread of resistance. The integration of these multifaceted approaches is essential for developing effective treatment strategies against bacterial infections, ultimately aiming to improve patient outcomes and address the global health crisis posed by antibiotic resistance.

Outline ​

This report will discuss the following questions.

  • 1 Introduction
  • 2 Overview of Bacterial Infections
    • 2.1 Types of Bacterial Infections
    • 2.2 Epidemiology and Impact on Public Health
  • 3 Antibiotic Treatment Strategies
    • 3.1 Mechanisms of Action of Antibiotics
    • 3.2 Classes of Antibiotics and Their Applications
  • 4 Antibiotic Resistance
    • 4.1 Mechanisms of Resistance
    • 4.2 Impact of Resistance on Treatment Outcomes
    • 4.3 Strategies to Combat Resistance
  • 5 Alternative and Adjunct Therapies
    • 5.1 Phage Therapy
    • 5.2 Immunotherapy
    • 5.3 Role of Vaccination
  • 6 Infection Control and Prevention
    • 6.1 Importance of Infection Control Measures
    • 6.2 Role of Antibiotic Stewardship Programs
  • 7 Conclusion

1 Introduction ​

Bacterial infections are a major global health concern, accounting for significant morbidity and mortality across diverse populations. The complexity of treating these infections is exacerbated by the emergence of antibiotic resistance, which has rendered many conventional treatment options ineffective. In recent years, the World Health Organization has classified antibiotic resistance as one of the top ten global public health threats, urging the need for immediate and comprehensive strategies to combat this issue [1][2]. Bacterial infections can lead to severe health complications, especially in vulnerable populations, including the elderly, immunocompromised individuals, and those with chronic illnesses [3]. Therefore, understanding the mechanisms of bacterial pathogenesis, the pharmacodynamics of antibiotics, and the dynamics of host-pathogen interactions is critical for improving treatment outcomes.

The significance of addressing bacterial infections cannot be overstated. As antibiotic resistance continues to rise, healthcare providers are increasingly faced with the challenge of managing infections caused by multidrug-resistant organisms (MDROs). The absence of new antibiotics in the pipeline and the limited effectiveness of existing agents necessitate a paradigm shift in how we approach the treatment of bacterial infections [4][5]. Innovative treatment strategies, including the use of bacteriophages, immunotherapies, and the development of novel antimicrobial agents, are gaining attention as potential solutions to this escalating crisis [2][6].

Current research highlights the need for a multifaceted approach to treating bacterial infections. This includes a thorough understanding of the various types of bacterial infections, their epidemiology, and their impact on public health. In this review, we will first provide an overview of bacterial infections, detailing the types and epidemiological trends that inform treatment strategies. We will then explore antibiotic treatment strategies, including the mechanisms of action of different antibiotic classes and their clinical applications. The review will also address the pressing issue of antibiotic resistance, discussing its mechanisms, impact on treatment outcomes, and strategies to combat it [7][8].

Furthermore, we will examine alternative and adjunct therapies that are emerging as promising options in the fight against bacterial infections. These include phage therapy, immunotherapy, and the role of vaccination in preventing infections [2][9]. Infection control and prevention measures, including antibiotic stewardship programs, will also be emphasized, as they play a critical role in optimizing antibiotic use and mitigating resistance [10][11].

In conclusion, the treatment of bacterial infections is an evolving field that requires continuous research and innovation. By integrating insights from various treatment modalities and understanding the underlying mechanisms of resistance, we can develop more effective strategies to combat bacterial infections and improve patient outcomes. This report aims to elucidate these complexities and provide a comprehensive overview of the current landscape in the treatment of bacterial infections.

2 Overview of Bacterial Infections ​

2.1 Types of Bacterial Infections ​

Bacterial infections are a significant threat to human health, and their treatment has become increasingly complex due to the rise of antibiotic resistance. Various strategies have been developed to manage these infections effectively.

Traditionally, bacterial infections have been treated with antibiotics, which are designed to target and kill bacteria or inhibit their growth. However, the emergence of multidrug-resistant (MDR) strains has limited the efficacy of conventional antibiotics. For instance, bacteria such as Enterobacterales have developed resistance mechanisms, particularly through the production of enzymes like extended spectrum β-lactamases or AmpC-type β-lactamases, which render many antibiotics ineffective [12].

To combat this issue, alternative treatment strategies have been explored. These include:

  1. Antibiotic Adjuvants: These are compounds that enhance the effectiveness of existing antibiotics. They can potentiate the effects of antimicrobials in resistant bacteria or target bacterial virulence factors [7].

  2. Immunotherapy: This approach seeks to harness the body’s immune system to fight infections. By enhancing the immune response, immunotherapy can potentially overcome the challenges posed by antibiotic-resistant bacteria [9].

  3. Bacteriophage Therapy: Bacteriophages are viruses that specifically infect and kill bacteria. This method offers a promising alternative, especially for infections caused by antibiotic-resistant strains [2].

  4. Nanotherapeutics: Nanoparticles with immunoregulatory functions are being developed to treat bacterial infections. These can enhance the immune response and provide targeted delivery of antimicrobial agents [6].

  5. Drug Repurposing: Existing drugs, originally designed for other diseases, are being evaluated for their antibacterial properties. This strategy has shown promise in finding new treatments for recalcitrant bacterial infections [5].

  6. Combination Therapy: Using multiple drugs in tandem can enhance treatment efficacy and reduce the likelihood of resistance developing [2].

In the context of specific bacterial infections, such as those seen in cirrhotic patients, timely and appropriate antibiotic treatment is crucial. Studies indicate that early diagnosis and the use of broad-spectrum antibiotics can significantly reduce mortality rates associated with infections like spontaneous bacterial peritonitis [13].

Moreover, advancements in diagnostic technologies, such as rapid diagnostic tests, are critical in ensuring that the correct treatment is administered promptly. The integration of these technologies with treatment strategies, including closed-loop therapies that combine detection and treatment, represents a forward-thinking approach in managing bacterial infections [1].

In summary, the treatment of bacterial infections involves a multifaceted approach that combines traditional antibiotics with innovative alternatives and supportive therapies. This evolving landscape reflects the urgent need to address the challenges posed by antibiotic resistance and ensure effective management of bacterial infections.

2.2 Epidemiology and Impact on Public Health ​

Bacterial infections represent a significant public health challenge, causing substantial morbidity and mortality worldwide. They are responsible for over 17 million deaths annually, with severe infections such as tuberculosis, pneumonia, and nosocomial infections posing particularly high risks. The increasing prevalence of antibiotic resistance exacerbates this issue, complicating treatment options and leading to higher healthcare costs and prolonged hospital stays [3][14].

Traditional treatment of bacterial infections primarily involves the use of antibiotics. However, the effectiveness of these conventional therapies is increasingly strained due to the rise of multidrug-resistant (MDR) bacteria. The World Health Organization has identified a list of critical pathogens for which new antibiotics are urgently needed, as many infections are becoming untreatable [15]. The growing resistance to antibiotics has been attributed to factors such as over-prescribing, misuse in agriculture, and inadequate patient adherence to treatment regimens [5][16].

In response to the escalating threat of antibiotic resistance, there has been a concerted effort to explore alternative treatment strategies. Recent innovations include the development of targeted and responsive delivery systems for both antibiotics and alternative therapies. These alternatives encompass a variety of agents, such as antimicrobial peptides, bacteriophages, and repurposed drugs, which have shown promise in overcoming resistance mechanisms [1][17]. For instance, bacteriophages, which are viruses that specifically target bacteria, have emerged as a potential solution for treating resistant infections [18].

Another innovative approach is the use of polymeric nanoparticles and microneedles for drug delivery. These systems enhance the pharmacokinetic profiles of existing antibiotics and facilitate the delivery of novel antibacterial agents directly to the site of infection, potentially improving efficacy while minimizing side effects [11][14]. Furthermore, research into anti-virulence therapies aims to inhibit the pathogenicity of bacteria without directly killing them, thus reducing the selective pressure that leads to resistance [16].

In addition to these therapeutic innovations, the management of bacterial infections increasingly incorporates rapid diagnostic technologies. These advancements allow for quicker identification of pathogens and their resistance profiles, enabling clinicians to tailor treatment strategies more effectively [19].

Overall, the treatment of bacterial infections is evolving in response to the challenges posed by antibiotic resistance. While traditional antibiotics remain a cornerstone of therapy, the integration of alternative strategies and technologies is crucial for improving patient outcomes and addressing the public health crisis posed by resistant bacterial strains.

3 Antibiotic Treatment Strategies ​

3.1 Mechanisms of Action of Antibiotics ​

Bacterial infections are primarily treated through the use of antibiotics, which are low-molecular-weight bioactive agents that have been pivotal in managing bacterial diseases for over 70 years. The efficacy of antibiotics is based on several distinct mechanisms of action, which can be categorized into four main types:

  1. Inhibition of Bacterial Cell Wall Biosynthesis: Antibiotics such as penicillins and cephalosporins target the synthesis of the bacterial cell wall, which is essential for maintaining the structural integrity of the bacterium. By inhibiting the enzymes involved in cell wall synthesis, these antibiotics cause the bacteria to become osmotically unstable and ultimately lead to cell lysis.

  2. Disruption of Cell Membrane Integrity: Some antibiotics, like polymyxins, interact with the bacterial cell membrane, disrupting its integrity. This disruption results in increased permeability, leading to leakage of essential cellular components and eventual cell death.

  3. Suppression of Nucleic Acid Synthesis: Antibiotics such as fluoroquinolones and rifamycins inhibit the synthesis of DNA and RNA. Fluoroquinolones target bacterial DNA gyrase, preventing DNA replication, while rifamycins inhibit RNA polymerase, obstructing transcription processes.

  4. Inhibition of Protein Synthesis: Antibiotics like tetracyclines, macrolides, and aminoglycosides target the bacterial ribosome, thereby inhibiting protein synthesis. This can prevent the bacteria from producing essential proteins required for growth and replication.

Despite the effectiveness of these mechanisms, the emergence of antibiotic resistance has become a significant challenge. Bacteria can develop resistance through various strategies, including modifications of drug target sites, increased efflux of antibiotics, and enzymatic inactivation of the drugs. For instance, certain bacteria can produce β-lactamases, enzymes that hydrolyze β-lactam antibiotics, rendering them ineffective [20][21].

The growing threat of antibiotic-resistant bacteria necessitates innovative treatment strategies. Recent research has explored combination therapies, which involve using multiple antibiotics or combining antibiotics with non-antibiotic agents to enhance efficacy and mitigate resistance development [22]. Moreover, alternative therapeutic approaches, such as anti-virulence strategies that target bacterial pathogenesis without killing the bacteria, are gaining attention [16].

In summary, while antibiotics remain the cornerstone of bacterial infection treatment through their various mechanisms of action, the rise of antibiotic resistance highlights the urgent need for novel therapeutic strategies and a better understanding of bacterial biology to develop effective treatments against resistant strains.

3.2 Classes of Antibiotics and Their Applications ​

The treatment of bacterial infections has traditionally relied on the use of antibiotics, which are classified into various categories based on their mechanism of action and spectrum of activity. However, the emergence of antibiotic resistance has significantly complicated these treatment strategies, necessitating a reevaluation of how bacterial infections are managed.

Antibiotics are broadly categorized into several classes, each with specific applications. For instance, beta-lactams, which include penicillins and cephalosporins, are commonly used to treat a wide range of infections due to their efficacy against various gram-positive and some gram-negative bacteria. Aminoglycosides, on the other hand, are primarily effective against aerobic gram-negative bacteria and are often used in serious infections such as sepsis.

Tetracyclines and macrolides are also important classes; tetracyclines have a broad spectrum of activity and are often used for respiratory tract infections, while macrolides are frequently prescribed for atypical pneumonia and certain skin infections. Fluoroquinolones are notable for their effectiveness against a variety of pathogens, including some multidrug-resistant strains, making them a critical option in treating complicated infections.

Despite the success of these antibiotics, their effectiveness is increasingly threatened by antibiotic resistance, which arises from various factors including the overuse and misuse of these drugs in both healthcare and agriculture[23]. This has led to a significant rise in multidrug-resistant (MDR) bacteria, prompting a search for alternative treatment strategies.

In light of this, new therapeutic approaches are being explored. These include anti-virulence therapies that aim to inhibit the pathogenic mechanisms of bacteria rather than directly killing them. This approach targets specific bacterial virulence factors, potentially reducing the selective pressure that leads to resistance[16]. Additionally, combination therapies that utilize multiple antibiotics or integrate non-antibiotic agents are being researched to enhance treatment efficacy and mitigate resistance development[24].

Furthermore, alternative strategies such as bacteriophage therapy, probiotics, and the use of antimicrobial peptides are gaining traction. Bacteriophages, which are viruses that infect bacteria, can be used to specifically target and eliminate pathogenic bacteria without affecting beneficial microbiota[25]. Probiotics and postbiotics are being investigated for their role in restoring microbiota balance and preventing infections[26].

Nanotechnology is also playing a pivotal role in the development of new drug delivery systems that can enhance the localization and effectiveness of antibiotics at infection sites, potentially overcoming some of the challenges posed by systemic antibiotic use[27].

In conclusion, while traditional antibiotic treatment remains a cornerstone of bacterial infection management, the increasing prevalence of antibiotic resistance necessitates a multifaceted approach that includes the development of new antibiotics, alternative therapies, and innovative drug delivery systems. This comprehensive strategy aims to not only treat existing infections but also to prevent the further emergence of resistant bacterial strains.

4 Antibiotic Resistance ​

4.1 Mechanisms of Resistance ​

Bacterial infections are treated primarily through the use of antibiotics; however, the emergence of antibiotic resistance has significantly complicated this approach. Antibiotic resistance occurs when bacteria evolve mechanisms to withstand the effects of drugs that once effectively treated them. This resistance can arise through several mechanisms, which include:

  1. Modulation of Porins: Bacteria can prevent antibiotics from entering by altering the structure of their outer membrane porins, effectively reducing drug influx. This is particularly relevant for Gram-negative bacteria, where the outer membrane serves as a barrier to many antibiotics [28].

  2. Efflux Pumps: Many bacteria have developed efflux pumps that actively expel antibiotics from the cell, thereby decreasing the intracellular concentration of the drug and its effectiveness. Overexpression of these pumps can lead to resistance against multiple classes of antibiotics [28].

  3. Mutations of Drug Targets: Bacteria can mutate the specific targets that antibiotics bind to, rendering the drugs ineffective. For example, mutations in the penicillin-binding proteins can confer resistance to beta-lactam antibiotics [28].

  4. Biofilm Formation: Some bacteria can form biofilms, which are protective layers that shield them from both the immune response and antibiotic treatment. Bacteria in biofilms can be significantly more resistant to antibiotics than their planktonic counterparts [28].

  5. Horizontal Gene Transfer (HGT): Bacteria can acquire resistance genes from neighboring bacteria through mechanisms such as transformation, transduction, or conjugation. This process allows for the rapid spread of resistance traits within bacterial populations [28].

  6. Production of Enzymes: Certain bacteria produce enzymes that can inactivate antibiotics. For instance, beta-lactamases are enzymes that hydrolyze beta-lactam antibiotics, making them ineffective [28].

Addressing antibiotic resistance requires a multifaceted approach. Potential strategies include:

  • Development of New Antibiotics: While this is a critical area of focus, the high cost and time associated with bringing new antibiotics to market is a significant challenge. Moreover, bacteria can quickly adapt to new antibiotics, necessitating ongoing research [28].

  • Targeting Resistance Mechanisms: Instead of solely focusing on developing new antibiotics, researchers are exploring ways to inhibit the mechanisms that confer resistance, such as efflux pump inhibitors or agents that disrupt biofilm formation [28].

  • Bacteriophage Therapy: Utilizing bacteriophages, which are viruses that specifically target bacteria, represents a promising alternative treatment modality for antibiotic-resistant infections [28].

  • Immunotherapy: Approaches that enhance the host immune response to eliminate bacterial infections are gaining traction. This includes the use of monoclonal antibodies and therapeutic vaccines [29].

  • Nanotechnology: Advances in nanotechnology are being explored to improve antibiotic delivery and efficacy, as well as to develop new antimicrobial agents that can circumvent resistance mechanisms [27].

The ongoing rise of antibiotic-resistant bacteria necessitates urgent and innovative strategies to effectively manage bacterial infections and preserve the efficacy of existing antibiotics.

4.2 Impact of Resistance on Treatment Outcomes ​

The treatment of bacterial infections has become increasingly complicated due to the emergence of antibiotic resistance, which significantly impacts clinical outcomes. The widespread use and misuse of antibiotics have led to the development of resistant bacterial strains, resulting in infections that are more difficult to treat. For instance, infections caused by resistant bacteria can lead to up to two-fold higher rates of adverse outcomes compared to infections caused by susceptible strains, which include increased morbidity and mortality, longer hospital stays, and higher medical costs [30].

In the context of antibiotic resistance, the management of bacterial infections requires a multifaceted approach. Currently available oral antibiotics, such as penicillins, cephalosporins, macrolides, trimethoprim/sulfamethoxazole, and clindamycin, still offer effective therapeutic options. However, the effectiveness of these agents may no longer be guaranteed, necessitating updated management strategies for patients experiencing treatment failures due to antibiotic-resistant bacteria [31]. For example, proposed management schemes for infections due to antibiotic-resistant bacteria include novel diagnostic strategies like tympanocentesis and treatment algorithms that incorporate the use of amoxicillin in combination with amoxicillin/clavulanate [31].

The consequences of antibiotic resistance extend beyond individual patients to the healthcare system and society at large. Increased healthcare resource utilization and costs, coupled with reduced hospital activity, are direct results of managing infections caused by resistant bacteria [30]. The negative impact of antibiotic resistance is profound, as it not only complicates treatment but also leads to delays in effective therapy, resulting in worse clinical outcomes [30].

In response to these challenges, alternative therapeutic strategies are being explored. Immunotherapy, which has shown promise in cancer treatment, is now being investigated for its potential to treat bacterial infections [9]. Additionally, approaches such as drug repurposing, anti-virulence therapies, and the use of bacteriophages are being developed to combat infections caused by multidrug-resistant bacteria [4][32].

Overall, the increasing prevalence of antibiotic-resistant bacteria necessitates a shift in treatment paradigms, emphasizing the need for innovative strategies and the judicious use of existing antibiotics to improve treatment outcomes and mitigate the impact of resistance [30][31].

4.3 Strategies to Combat Resistance ​

Bacterial infections are traditionally treated with antibiotics, which have been crucial in managing infectious diseases. However, the emergence of antibiotic resistance has posed a significant challenge, necessitating the exploration of alternative strategies to combat resistant bacterial infections.

Recent literature highlights several innovative approaches aimed at addressing antibiotic resistance. One prominent strategy is the development of immunotherapeutic agents, including monoclonal antibodies, therapeutic vaccines, and cellular therapies. These immunotherapies provide advantages such as enhanced specificity, long-term effects, and the potential to overcome existing resistance mechanisms [29]. Additionally, the formulation and delivery of these agents using nanoparticles and liposomes have been explored to improve their efficacy [29].

Beyond immunotherapy, various non-antibiotic therapeutic strategies are being investigated. These include bacteriophages, which are viruses that specifically target bacteria, and have been utilized as a historical treatment for bacterial infections [33]. Phage therapy can be particularly effective when combined with antibiotics, targeting bacterial resistance and virulence determinants [33]. Other promising strategies include the use of probiotics, antimicrobial peptides, and the manipulation of the microbiome to restore balance and combat pathogenic bacteria [4].

The application of nanotechnology has also emerged as a critical area in the fight against antibiotic resistance. Nanoparticles can enhance the delivery of antimicrobial agents and improve their effectiveness against resistant strains [27]. These strategies can include the development of nanomedicines that combine traditional antibiotics with novel delivery systems, enhancing their therapeutic efficacy [27].

Combination therapies represent another promising approach, where multiple therapeutic modalities are employed concurrently. This can include the use of antibiotic adjuvants that enhance the efficacy of existing antibiotics by inhibiting resistance mechanisms [7]. Additionally, targeting bacterial virulence factors through anti-virulence strategies can mitigate the impact of infections without directly killing bacteria, thereby reducing selective pressure for resistance [16].

Moreover, the understanding of bacterial resistance mechanisms is crucial for developing effective countermeasures. Mechanisms such as efflux pumps, reduced membrane permeability, and antibiotic inactivation highlight the need for targeted strategies to overcome these barriers [34]. Research is increasingly focusing on molecular approaches, including CRISPR technology and metabolic manipulation, to sensitize bacteria to existing treatments [3].

In conclusion, combating antibiotic resistance requires a multifaceted approach that encompasses immunotherapy, phage therapy, nanotechnology, combination therapies, and a deep understanding of resistance mechanisms. These strategies collectively aim to restore the efficacy of treatments for bacterial infections and address the pressing public health challenge posed by antibiotic-resistant pathogens [22][29][34].

5 Alternative and Adjunct Therapies ​

5.1 Phage Therapy ​

The treatment of bacterial infections is increasingly challenged by the rise of antibiotic-resistant strains, necessitating the exploration of alternative and adjunct therapies. Phage therapy, which utilizes bacteriophages—viruses that specifically infect and lyse bacteria—has emerged as a promising strategy to combat these resistant infections.

Phage therapy operates on the principle of high specificity; bacteriophages target specific bacterial pathogens, thereby minimizing collateral damage to beneficial microbiota. This specificity is a double-edged sword; while it allows for targeted treatment, it also requires careful selection of appropriate phages for effective application against the intended bacterial strains [35]. The therapeutic use of phages has gained renewed interest due to the increasing prevalence of multidrug-resistant (MDR) bacteria, with clinical cases demonstrating successful outcomes, such as recovery from severe infections caused by panresistant Pseudomonas aeruginosa and multidrug-resistant Acinetobacter [35].

In recent years, several initiatives have been launched to facilitate the integration of phage therapy into clinical practice. For instance, a national phage bank was established in Belgium, and the University of California, San Diego, created Innovative Phage Applications and Therapeutics (IPATH) to advance phage therapy in the United States [35]. Such efforts underscore the potential of phage therapy as a component of personalized medicine, particularly in life-saving treatments for patients with severe bacterial infections [35].

The historical context of phage therapy reveals that it was widely utilized before the antibiotic era but fell out of favor in Western medicine following the introduction of antibiotics. However, as antibiotic resistance becomes a critical global health issue, phage therapy is being re-evaluated and has shown promising results in various clinical trials [36].

Challenges remain in the implementation of phage therapy, including regulatory hurdles, the potential for bacteria to develop resistance to phages, and the need for standardized protocols for phage preparation and administration [37]. Additionally, the combination of phage therapy with antibiotics has been suggested as a synergistic approach to enhance treatment efficacy, particularly for infections that are resistant to conventional antibiotics [38].

Research is ongoing to address these challenges and to optimize phage therapy through genetic engineering and phage cocktail development. By selecting and combining phages, researchers aim to create more effective treatment options that can outsmart bacterial resistance [39].

In summary, phage therapy represents a significant advancement in the fight against antibiotic-resistant bacterial infections, with its ability to target specific pathogens and the potential for integration into personalized treatment regimens. Continued research and development in this field may provide essential alternatives to traditional antibiotic therapies, offering hope for patients facing severe bacterial infections in an era of increasing antimicrobial resistance [40] [41].

5.2 Immunotherapy ​

The treatment of bacterial infections has increasingly focused on alternative and adjunct therapies, particularly immunotherapy, in response to the rising challenge of antimicrobial resistance. Immunotherapy represents a promising strategy to enhance the body's immune response against pathogens, thereby providing a complementary approach to traditional antibiotic treatments.

Immunotherapeutic agents include monoclonal antibodies, therapeutic vaccines, cellular therapies, and immunomodulators. These agents have been developed to target various bacterial pathogens, including multiantibiotic-resistant strains such as Pseudomonas aeruginosa, Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA) [29]. The advantages of immunotherapy over conventional antibiotics include enhanced specificity, long-term effects, the ability to overcome resistance mechanisms, broad applicability, potential for combination therapies, personalized medicine, and reduced toxicity [29].

Recent advancements have also explored various formulation and delivery strategies to improve the efficacy of immunotherapeutic agents. These strategies include the use of nanoparticles, liposomes, and cellular vehicles, along with diverse administration routes to enhance targeting and therapeutic outcomes [29]. Furthermore, immunotherapy can be combined with traditional antibiotics, which may potentiate their effects and prolong the lifespan of existing antimicrobial agents [7].

In the context of specific bacterial infections, innovative approaches have emerged. For instance, in urinary tract infections (UTIs), innate immunomodulation therapy has shown promise by selectively inhibiting overactive immune responses while enhancing protective antimicrobial defenses [42]. This dual approach aims to mitigate excessive immune reactions that can lead to tissue pathology while bolstering the body’s ability to fight infections.

Additionally, the concept of anti-adhesion therapies has been developed, which focuses on preventing bacteria from adhering to host cells and tissues. This strategy does not kill the bacteria but instead inhibits their ability to cause harm, which is crucial for managing infections [43]. These methods can involve the use of probiotics, dietary supplements, and other agents that interfere with the interactions between bacterial adhesins and host receptors.

The exploration of host-directed therapies is another avenue being investigated, where the host's immune system is modulated to facilitate the clearance of infections [7]. This approach is particularly relevant in the context of rising antimicrobial resistance, as it aims to enhance the natural defenses of the host rather than relying solely on antibiotics.

Overall, the integration of immunotherapy and other alternative strategies represents a vital component in the evolving landscape of bacterial infection treatment. These approaches not only provide potential solutions to combat resistant pathogens but also pave the way for more effective and personalized treatment modalities in the future [6][9][29].

5.3 Role of Vaccination ​

The treatment of bacterial infections has evolved significantly due to the increasing challenge posed by antibiotic resistance. Vaccination has emerged as a critical strategy in this landscape, providing a means to prevent infections before they occur. Prophylactic vaccines against various bacterial pathogens are urgently needed, particularly as antibiotic resistance continues to escalate, complicating treatment options for many infectious diseases [44].

Vaccination against bacterial infections presents unique challenges compared to viral infections. Bacteria are complex organisms with a variety of antigens, many of which have unclear immunogenic potential. For example, while vaccines against extracellular bacteria, such as those causing tetanus, pertussis, and diphtheria, have been successfully developed, targeting intracellular bacteria poses greater difficulties. Effective immune responses against these pathogens often require T cell-mediated responses, which are not easily elicited by traditional vaccines [44].

Recent advancements in vaccine technology, including mRNA vaccines, offer promising avenues for the prevention of bacterial infections. The success of mRNA vaccines in combating viral infections has prompted research into their application against bacterial pathogens. However, the complexity of bacterial biology and their interaction with host immunity necessitates careful consideration in vaccine design [45]. Studies have shown that mRNA vaccines have been developed and tested in animal models against various bacterial pathogens, with ongoing efforts to enhance their effectiveness [45].

In addition to traditional vaccination strategies, innovative approaches are being explored to enhance the immune response against bacterial infections. These include the development of vaccines that utilize novel adjuvants, rationally designed antigens, and even bacterial outer membrane vesicles. Such advancements could significantly improve the efficacy of vaccines targeting multidrug-resistant bacteria [10].

Moreover, alternative treatment strategies that complement vaccination efforts are also gaining attention. These include the use of anti-adhesion therapies, which prevent bacteria from adhering to host tissues, thus hindering their ability to cause infection. Such therapies could serve as adjunctive treatments alongside vaccination to bolster overall infection control [46].

In summary, vaccination plays a vital role in the prevention of bacterial infections, especially in the context of rising antibiotic resistance. Continued research and development in vaccine technologies, alongside complementary therapeutic strategies, are essential to address the growing threat of bacterial pathogens and ensure effective management of infectious diseases in the future [29][44].

6 Infection Control and Prevention ​

6.1 Importance of Infection Control Measures ​

Bacterial infections are a significant public health concern, particularly due to the increasing rates of antibiotic resistance. The treatment of bacterial infections typically involves a combination of traditional antibiotics and innovative therapeutic strategies to enhance effectiveness and mitigate resistance.

Conventional treatment primarily relies on antibiotics, which have been the cornerstone of bacterial infection management. However, the rise of multidrug-resistant (MDR) bacteria necessitates the exploration of alternative approaches. The literature indicates that treatment options now extend beyond standard antibiotics to include a variety of strategies aimed at overcoming resistance mechanisms and improving patient outcomes.

Recent innovations in detection and treatment have focused on enhancing the identification of bacterial pathogens through advanced biosensors, which utilize electrochemical, optical, and mass-based technologies to improve sensitivity and specificity [1]. Alongside improved detection, there is a significant emphasis on targeted and responsive delivery systems for both antibiotics and alternative therapeutics, including repurposed drugs, antimicrobial peptides, and bacteriophages [2].

One of the promising areas of research is the development of antibiotic adjuvants, which are substances that can enhance the effectiveness of existing antibiotics. This includes antiresistance drugs that can potentiate the action of antibiotics in resistant strains [7]. Furthermore, the exploration of immunotherapy, which aims to boost the host's immune response to fight infections, is gaining traction as a viable alternative treatment strategy [9].

The use of bacteriophages—viruses that specifically target bacteria—has emerged as a noteworthy alternative to traditional antibiotics. Phage therapy has shown potential in treating infections caused by antibiotic-resistant bacteria, although it is not without limitations, such as a narrow host range and regulatory challenges [47].

Moreover, the management of bacterial infections in specific populations, such as patients with cirrhosis, underscores the complexity of treatment strategies. These patients often require tailored antibiotic regimens that account for their unique vulnerabilities to infections and the impact of antibiotic resistance [3].

Emerging strategies also include the use of nanoparticles and nanotherapeutics, which can enhance drug delivery and efficacy against bacterial infections [6]. Additionally, the development of novel drug delivery systems, such as microneedles, offers a non-invasive method for administering antibiotics, thereby improving patient compliance and therapeutic outcomes [11].

In summary, the treatment of bacterial infections is evolving, incorporating a multifaceted approach that includes traditional antibiotics, innovative detection methods, immunotherapies, bacteriophage therapy, and novel drug delivery systems. The continued exploration of these alternatives is critical to addressing the challenges posed by antibiotic resistance and ensuring effective management of bacterial infections in the future.

6.2 Role of Antibiotic Stewardship Programs ​

Antibiotic stewardship programs (ASPs) play a critical role in the management of bacterial infections by optimizing antibiotic use, thereby minimizing the development of antibiotic resistance and enhancing patient outcomes. These programs are designed to ensure that antibiotics are prescribed only when necessary and that the most appropriate agent, dose, and duration are utilized.

A comprehensive approach to antibiotic stewardship involves several key strategies. First, the selection of appropriate antimicrobial agents is paramount. This includes tailoring therapy based on the specific pathogens involved, which can be informed by microbiological diagnostics. Studies indicate that the implementation of diagnostic stewardship initiatives, such as the use of clinical decision support systems and guidelines for urine culture orders, can effectively reduce unnecessary antibiotic prescribing, particularly in cases like urinary tract infections where diagnosis can be challenging (Morado & Wong, 2022) [48].

Furthermore, education of healthcare providers is essential. Prescriber education can improve the appropriateness of antibiotic prescriptions, as many studies have shown that a significant proportion of antibiotic use (up to 50% in some cases) is unnecessary or inappropriate (Fishman, 2006) [49]. Multidisciplinary teams, including infectious disease specialists and clinical pharmacists, are recommended to enhance the effectiveness of stewardship programs. Such teams can engage in prospective audits with feedback to prescribers, which has been shown to optimize antimicrobial use and reduce costs associated with inappropriate prescriptions (Lesprit & Brun-Buisson, 2008) [50].

Another effective strategy within ASPs is the restriction of certain antibiotics, which can prevent the emergence of resistant strains. This may involve preauthorization requirements for specific high-risk antibiotics or implementing formulary restrictions. Such measures have been endorsed by national organizations and have demonstrated positive effects on optimizing antimicrobial therapy (Griffith et al., 2012) [51].

Moreover, the integration of infection control measures is vital. Evidence suggests that antibiotic stewardship programs are more effective when combined with robust infection control practices, such as hand hygiene interventions, which significantly lower the incidence of infections caused by antibiotic-resistant bacteria (Baur et al., 2017) [52].

The implementation of these stewardship strategies is not only beneficial for reducing the incidence of infections caused by resistant organisms but also contributes to overall healthcare cost savings. For instance, antibiotic stewardship has been associated with a 51% reduction in the incidence of infections and colonization with multidrug-resistant Gram-negative bacteria (Baur et al., 2017) [52].

In summary, antibiotic stewardship programs are integral to the effective management of bacterial infections. They employ a multifaceted approach that includes optimizing drug selection, educating healthcare providers, implementing restrictive policies, and integrating infection control practices. Such comprehensive programs are essential for preserving the efficacy of existing antibiotics and ensuring better health outcomes for patients.

7 Conclusion ​

The treatment of bacterial infections has evolved significantly in response to the increasing challenge posed by antibiotic resistance. This review highlights the multifaceted approach required to effectively manage bacterial infections, which now extends beyond traditional antibiotics to include innovative alternatives such as bacteriophage therapy, immunotherapy, and the use of novel drug delivery systems. The significant rise in multidrug-resistant (MDR) bacteria necessitates the exploration of new therapeutic strategies, including antibiotic adjuvants, combination therapies, and anti-virulence approaches. Additionally, the importance of rapid diagnostic technologies and infection control measures, including antibiotic stewardship programs, cannot be overstated, as they play a critical role in optimizing treatment and mitigating resistance. As research continues to advance, the integration of these diverse strategies will be crucial in addressing the public health crisis posed by bacterial infections and ensuring improved patient outcomes in the future.

References ​

  • [1] Carly Deusenbery;Yingying Wang;Anita Shukla. Recent Innovations in Bacterial Infection Detection and Treatment.. ACS infectious diseases(IF=3.8). 2021. PMID:33733747. DOI: 10.1021/acsinfecdis.0c00890.
  • [2] Ritam Das;Komal Kotra;Pulkit Singh;Belinda Loh;Sebastian Leptihn;Urmi Bajpai. Alternative Treatment Strategies for Secondary Bacterial and Fungal Infections Associated with COVID-19.. Infectious diseases and therapy(IF=5.3). 2022. PMID:34807451. DOI: 10.1007/s40121-021-00559-8.
  • [3] Javier Fernández;Salvatore Piano;Michele Bartoletti;Emmanuel Q Wey. Management of bacterial and fungal infections in cirrhosis: The MDRO challenge.. Journal of hepatology(IF=33.0). 2021. PMID:34039482. DOI: 10.1016/j.jhep.2020.11.010.
  • [4] Alan R Hauser;Joan Mecsas;Donald T Moir. Beyond Antibiotics: New Therapeutic Approaches for Bacterial Infections.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America(IF=7.3). 2016. PMID:27025826. DOI: 10.1093/cid/ciw200.
  • [5] Adrián Rangel-Vega;Lawrence R Bernstein;Edna Ayerim Mandujano-Tinoco;Silvia Julieta García-Contreras;Rodolfo García-Contreras. Drug repurposing as an alternative for the treatment of recalcitrant bacterial infections.. Frontiers in microbiology(IF=4.5). 2015. PMID:25914685. DOI: 10.3389/fmicb.2015.00282.
  • [6] Dongliang Yang;Meng Ding;Yanni Song;Yanling Hu;Weijun Xiu;Lihui Yuwen;Yannan Xie;Yingnan Song;Jinjun Shao;Xuejiao Song;Heng Dong. Nanotherapeutics with immunoregulatory functions for the treatment of bacterial infection.. Biomaterials research(IF=9.6). 2023. PMID:37481650. DOI: 10.1186/s40824-023-00405-7.
  • [7] Erin E Gill;Octavio L Franco;Robert E W Hancock. Antibiotic adjuvants: diverse strategies for controlling drug-resistant pathogens.. Chemical biology & drug design(IF=3.3). 2015. PMID:25393203. DOI: 10.1111/cbdd.12478.
  • [8] Despoina Koulenti;Andrew Song;Aaron Ellingboe;Mohd Hafiz Abdul-Aziz;Patrick Harris;Emile Gavey;Jeffrey Lipman. Infections by multidrug-resistant Gram-negative Bacteria: What's new in our arsenal and what's in the pipeline?. International journal of antimicrobial agents(IF=4.6). 2019. PMID:30394301. DOI: 10.1016/j.ijantimicag.2018.10.011.
  • [9] Timothy R McCulloch;Timothy J Wells;Fernando Souza-Fonseca-Guimaraes. Towards efficient immunotherapy for bacterial infection.. Trends in microbiology(IF=14.9). 2022. PMID:34253452. DOI: 10.1016/j.tim.2021.05.005.
  • [10] Stephen J Baker;David J Payne;Rino Rappuoli;Ennio De Gregorio. Technologies to address antimicrobial resistance.. Proceedings of the National Academy of Sciences of the United States of America(IF=9.1). 2018. PMID:30559181. DOI: 10.1073/pnas.1717160115.
  • [11] Huishan Zheng;Changzhou Jin;Baozhu Feng;Meilian Ning;Ziyan Cai;Qiulong Zhang;Jianmin Chen. Antimicrobial microneedles: Advances, mechanisms, and applications in combating bacterial infections.. International journal of pharmaceutics(IF=5.2). 2025. PMID:40783023. DOI: 10.1016/j.ijpharm.2025.126028.
  • [12] Simone Meini;Carlo Tascini;Marco Cei;Emanuela Sozio;Gian Maria Rossolini. AmpC β-lactamase-producing Enterobacterales: what a clinician should know.. Infection(IF=3.6). 2019. PMID:30840201. DOI: 10.1007/s15010-019-01291-9.
  • [13] Edna Strauss. The impact of bacterial infections on survival of patients with decompensated cirrhosis.. Annals of hepatology(IF=4.4). 2013. PMID:24516916. DOI: .
  • [14] Amanda Cano;Miren Ettcheto;Marta Espina;Ana López-Machado;Yolanda Cajal;Francesc Rabanal;Elena Sánchez-López;Antonio Camins;Maria Luisa García;Eliana B Souto. State-of-the-art polymeric nanoparticles as promising therapeutic tools against human bacterial infections.. Journal of nanobiotechnology(IF=12.6). 2020. PMID:33129333. DOI: 10.1186/s12951-020-00714-2.
  • [15] Elisabete Machado;João Carlos Sousa. New Antibiotics for Treating Infections Caused by Multidrug-Resistant Bacteria.. Antibiotics (Basel, Switzerland)(IF=4.6). 2025. PMID:41148688. DOI: 10.3390/antibiotics14100997.
  • [16] Julia A Hotinger;Seth T Morris;Aaron E May. The Case against Antibiotics and for Anti-Virulence Therapeutics.. Microorganisms(IF=4.2). 2021. PMID:34683370. DOI: 10.3390/microorganisms9102049.
  • [17] Jiaqi Li;Huangliang Zheng;Sharon Shui Yee Leung. Pulmonary Delivery of Emerging Antibacterials for Bacterial Lung Infections Treatment.. Pharmaceutical research(IF=4.3). 2023. PMID:36123511. DOI: 10.1007/s11095-022-03379-8.
  • [18] Shawna McCallin;Zuzanna Drulis-Kawa;Tristan Ferry;Jean-Paul Pirnay;Ran Nir-Paz; . Phages and phage-borne enzymes as new antibacterial agents.. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases(IF=8.5). 2025. PMID:37866680. DOI: 10.1016/j.cmi.2023.10.018.
  • [19] Hui Li;Michael Morowitz;Neal Thomas;Pak Kin Wong. Rapid Single-Cell Microbiological Analysis: Toward Precision Management of Infections and Dysbiosis.. SLAS technology(IF=3.7). 2019. PMID:31448654. DOI: 10.1177/2472630319858922.
  • [20] Aleksandra Baran;Aleksandra Kwiatkowska;Leszek Potocki. Antibiotics and Bacterial Resistance-A Short Story of an Endless Arms Race.. International journal of molecular sciences(IF=4.9). 2023. PMID:36982857. DOI: 10.3390/ijms24065777.
  • [21] Tanvir Mahtab Uddin;Arka Jyoti Chakraborty;Ameer Khusro;Bm Redwan Matin Zidan;Saikat Mitra;Talha Bin Emran;Kuldeep Dhama;Md Kamal Hossain Ripon;Márió Gajdács;Muhammad Umar Khayam Sahibzada;Md Jamal Hossain;Niranjan Koirala. Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects.. Journal of infection and public health(IF=4.0). 2021. PMID:34756812. DOI: 10.1016/j.jiph.2021.10.020.
  • [22] Aref Yarahmadi;Hamide Najafiyan;Mohammad Hasan Yousefi;Elham Khosravi;Ehsan Shabani;Hamed Afkhami;Seyed Soheil Aghaei. Beyond antibiotics: exploring multifaceted approaches to combat bacterial resistance in the modern era: a comprehensive review.. Frontiers in cellular and infection microbiology(IF=4.8). 2025. PMID:40176987. DOI: 10.3389/fcimb.2025.1493915.
  • [23] Shashi B Kumar;Shanvanth R Arnipalli;Ouliana Ziouzenkova. Antibiotics in Food Chain: The Consequences for Antibiotic Resistance.. Antibiotics (Basel, Switzerland)(IF=4.6). 2020. PMID:33066005. DOI: 10.3390/antibiotics9100688.
  • [24] Wei Zong;Shengjie Xie;Hongtao Chu;Shuang Han;Xunan Zhang. Beyond traditional antibacterial agents: Novel approaches to combat resistant pathogens.. European journal of medicinal chemistry(IF=5.9). 2025. PMID:41240616. DOI: 10.1016/j.ejmech.2025.118362.
  • [25] Vikram K Raghu;Rita Sico;Jeffrey A Rudolph;George V Mazariegos;Judy Squires;James E Squires. Sarcopenia prevalence in pediatric intestinal transplant recipients: Implications on post-transplant outcomes.. Pediatric transplantation(IF=1.4). 2022. PMID:35187765. DOI: 10.1111/petr.14256.
  • [26] Matteo Puccetti;Styliani Xiroudaki;Maurizio Ricci;Stefano Giovagnoli. Postbiotic-Enabled Targeting of the Host-Microbiota-Pathogen Interface: Hints of Antibiotic Decline?. Pharmaceutics(IF=5.5). 2020. PMID:32635461. DOI: 10.3390/pharmaceutics12070624.
  • [27] Junjie Zhang;Ming Liu;Haiyang Guo;Shuwen Gao;Yanling Hu;Guisheng Zeng;Dongliang Yang. Nanotechnology-driven strategies to enhance the treatment of drug-resistant bacterial infections.. Wiley interdisciplinary reviews. Nanomedicine and nanobiotechnology(IF=8.2). 2024. PMID:38772565. DOI: 10.1002/wnan.1968.
  • [28] Niranjana Sri Sundaramoorthy;Prakash Shankaran;Vidhya Gopalan;Saisubramanian Nagarajan. New tools to mitigate drug resistance in Enterobacteriaceae - Escherichia coli and Klebsiella pneumoniae.. Critical reviews in microbiology(IF=5.1). 2023. PMID:35649163. DOI: 10.1080/1040841X.2022.2080525.
  • [29] Alex Odoom;Abdul-Halim Osman;Christian K O Dzuvor. Recent Advances in Immunotherapeutic and Vaccine-Based Approaches for the Treatment of Drug-Resistant Bacterial Infections.. ACS infectious diseases(IF=3.8). 2025. PMID:40315159. DOI: 10.1021/acsinfecdis.5c00001.
  • [30] N D Friedman;E Temkin;Y Carmeli. The negative impact of antibiotic resistance.. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases(IF=8.5). 2016. PMID:26706614. DOI: .
  • [31] M Green;E R Wald. Emerging resistance to antibiotics: impact on respiratory infections in the outpatient setting.. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology(IF=4.7). 1996. PMID:8814039. DOI: 10.1016/S1081-1206(10)63250-4.
  • [32] Esaú López-Jácome;Rafael Franco-Cendejas;Héctor Quezada;Rosario Morales-Espinosa;Israel Castillo-Juárez;Bertha González-Pedrajo;Ana María Fernández-Presas;Arturo Tovar-García;Vanesa Angarita-Zapata;Paula Licona-Limón;Mariano Martínez-Vázquez;Rodolfo García-Contreras. The race between drug introduction and appearance of microbial resistance. Current balance and alternative approaches.. Current opinion in pharmacology(IF=4.2). 2019. PMID:31136908. DOI: 10.1016/j.coph.2019.04.016.
  • [33] Stephen T Abedon. Phage Therapy: Combating Evolution of Bacterial Resistance to Phages.. Viruses(IF=3.5). 2025. PMID:40872808. DOI: 10.3390/v17081094.
  • [34] Shengwei Sun;Xueyingzi Chen. Mechanism-guided strategies for combating antibiotic resistance.. World journal of microbiology & biotechnology(IF=4.2). 2024. PMID:39122871. DOI: 10.1007/s11274-024-04106-8.
  • [35] Teiji Sawa;Kiyoshi Moriyama;Mao Kinoshita. Current status of bacteriophage therapy for severe bacterial infections.. Journal of intensive care(IF=4.7). 2024. PMID:39482746. DOI: 10.1186/s40560-024-00759-7.
  • [36] Xavier Wittebole;Sophie De Roock;Steven M Opal. A historical overview of bacteriophage therapy as an alternative to antibiotics for the treatment of bacterial pathogens.. Virulence(IF=5.4). 2014. PMID:23973944. DOI: 10.4161/viru.25991.
  • [37] David B Olawade;Oluwaseun Fapohunda;Eghosasere Egbon;Oladipo A Ebiesuwa;Sunday Oluwadamilola Usman;Alaba O Faronbi;Sandra Chinaza Fidelis. Phage therapy: A targeted approach to overcoming antibiotic resistance.. Microbial pathogenesis(IF=3.5). 2024. PMID:39477033. DOI: 10.1016/j.micpath.2024.107088.
  • [38] Anca M Segall;Dwayne R Roach;Steffanie A Strathdee. Stronger together? Perspectives on phage-antibiotic synergy in clinical applications of phage therapy.. Current opinion in microbiology(IF=7.5). 2019. PMID:31226502. DOI: 10.1016/j.mib.2019.03.005.
  • [39] Agnès Oromí-Bosch;Jyot D Antani;Paul E Turner. Developing Phage Therapy That Overcomes the Evolution of Bacterial Resistance.. Annual review of virology(IF=8.3). 2023. PMID:37268007. DOI: 10.1146/annurev-virology-012423-110530.
  • [40] Bo Wang;Lin Du;Baiping Dong;Erwen Kou;Liangzhe Wang;Yuanjie Zhu. Current Knowledge and Perspectives of Phage Therapy for Combating Refractory Wound Infections.. International journal of molecular sciences(IF=4.9). 2024. PMID:38791502. DOI: 10.3390/ijms25105465.
  • [41] Beata Zalewska-Piątek. Phage Therapy-Challenges, Opportunities and Future Prospects.. Pharmaceuticals (Basel, Switzerland)(IF=4.8). 2023. PMID:38139765. DOI: 10.3390/ph16121638.
  • [42] Daniel Butler;Ines Ambite;Murphy Lam Yim Wan;Thi Hien Tran;Björn Wullt;Catharina Svanborg. Immunomodulation therapy offers new molecular strategies to treat UTI.. Nature reviews. Urology(IF=14.6). 2022. PMID:35732832. DOI: 10.1038/s41585-022-00602-4.
  • [43] Daniel Cozens;Robert C Read. Anti-adhesion methods as novel therapeutics for bacterial infections.. Expert review of anti-infective therapy(IF=3.8). 2012. PMID:23253323. DOI: 10.1586/eri.12.145.
  • [44] Anke Osterloh. Vaccination against Bacterial Infections: Challenges, Progress, and New Approaches with a Focus on Intracellular Bacteria.. Vaccines(IF=3.4). 2022. PMID:35632507. DOI: 10.3390/vaccines10050751.
  • [45] Alina Khlebnikova;Anna Kirshina;Natalia Zakharova;Roman Ivanov;Vasiliy Reshetnikov. Current Progress in the Development of mRNA Vaccines Against Bacterial Infections.. International journal of molecular sciences(IF=4.9). 2024. PMID:39684849. DOI: 10.3390/ijms252313139.
  • [46] Arezoo Asadi;Shabnam Razavi;Malihe Talebi;Mehrdad Gholami. A review on anti-adhesion therapies of bacterial diseases.. Infection(IF=3.6). 2019. PMID:30276540. DOI: 10.1007/s15010-018-1222-5.
  • [47] Jiaxi Lin;Fangyuan Du;Miao Long;Peng Li. Limitations of Phage Therapy and Corresponding Optimization Strategies: A Review.. Molecules (Basel, Switzerland)(IF=4.6). 2022. PMID:35335222. DOI: 10.3390/molecules27061857.
  • [48] Faiza Morado;Darren W Wong. Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections.. Antibiotics (Basel, Switzerland)(IF=4.6). 2022. PMID:35326771. DOI: 10.3390/antibiotics11030308.
  • [49] Neil Fishman. Antimicrobial stewardship.. The American journal of medicine(IF=5.3). 2006. PMID:16735152. DOI: 10.1016/j.amjmed.2006.04.003.
  • [50] Philippe Lesprit;Christian Brun-Buisson. Hospital antibiotic stewardship.. Current opinion in infectious diseases(IF=4.0). 2008. PMID:18594284. DOI: 10.1097/QCO.0b013e3283013959.
  • [51] Milena Griffith;Michael Postelnick;Marc Scheetz. Antimicrobial stewardship programs: methods of operation and suggested outcomes.. Expert review of anti-infective therapy(IF=3.8). 2012. PMID:22149615. DOI: 10.1586/eri.11.153.
  • [52] David Baur;Beryl Primrose Gladstone;Francesco Burkert;Elena Carrara;Federico Foschi;Stefanie Döbele;Evelina Tacconelli. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.. The Lancet. Infectious diseases(IF=31.0). 2017. PMID:28629876. DOI: 10.1016/S1473-3099(17)30325-0.

MaltSci Intelligent Research Services ​

Search for more papers on MaltSci.com ​

Bacterial Infection · Antibiotic Resistance · Alternative Therapies · Infection Control · Public Health

© 2025 MaltSci