Anti-Infective Agents - Volume 24, Issue 1, 2026

Mpox is a zoonotic disease caused by the Mpox virus, an Orthopoxvirus primarily infecting small mammals. Historically endemic to Central and West Africa, Mpox has emerged globally in recent years, likely linked to the cessation of smallpox vaccination programs. This review aims to provide a comprehensive synthesis of current knowledge on Mpox, focusing on its molecular biology, epidemiological trends, and therapeutic strategies to address recent global outbreaks.

The review integrates data from recent case studies, epidemiological reports, and clinical trials to examine the virus's genetic diversity, modes of transmission, and global spread. Additionally, it explores the efficacy and accessibility of vaccines and antiviral treatments, with particular attention to challenges in low-resource settings.

Analysis highlights the global Mpox outbreak from 2022 to 2023, during which 1,285 confirmed cases across 28 non-endemic countries were reported. This outbreak emphasizes the virus's capacity for global spread, its clinical manifestations, and the effectiveness of available treatment options. The review also identifies gaps in understanding Mpox’s genetic evolution and treatment scalability.

This review underscores the critical need for further research into Mpox's transmission mechanisms, genetic evolution, and therapeutic approaches. Addressing challenges related to vaccine distribution and antiviral access, particularly in low-resource settings, is essential for managing future outbreaks effectively.

Urinary tract infections (UTIs) caused by Escherichia coli are a significant healthcare concern, particularly in catheterized patients, where biofilm formation enhances bacterial survival and antibiotic resistance. Virulence factors such as the fimH gene, which encodes for adhesin proteins, play a pivotal role in biofilm formation and pathogenicity. This study aims to detect antibiotic resistance patterns, biofilm formation, and fimH gene in E. coli isolated from urine samples of catheterized patients.

E. coli from urine cultures was isolated and identified through standard biochemical tests. Biofilm production by uropathogenic E. coli isolates was assessed using the microtiter plate method. The antimicrobial susceptibility of the biofilm-producing isolates was determined using the Kirby-Bauer disk diffusion method. Detection of the fimH gene (adhesin) in E. coli isolates was conducted using Polymerase Chain Reaction (PCR). The interrelations between biofilm formation, virulence gene presence, and antibiotic resistance in these isolates were analyzed.

Out of 49 E. coli samples, 36 were found to be biofilm producers. These biofilm producers were categorized into strong, moderate, and weak, with 7 weak, 11 moderate, and 18 strong producers. Among these, the fimH gene was present in 27 isolates. The biofilm-producing E. coli exhibited high resistance to ampicillin, ciprofloxacin, and tetracycline.

The fimH gene plays a crucial role in the adherence of biofilm-producing E. coli to indwelling catheters, contributing to their resistance to commonly used antibiotics

Bempedoic acid (BA) is a well-known lipid-lowering agent which inhibits the HMG-CoA reductase enzyme. It contains various chemical groups in its structure, which are responsible for antimicrobial potential. The study investigates the antimicrobial activity of BA against pathogenic bacteria, including Bacillus subtilis, Enterococcus faecalis, Salmonella typhi, and Staphylococcus aureus.

The disc diffusion method was employed for this study. Initially, Mueller Hinton Agar (MHA) was prepared according to the standard formulation provided by Himedia. Specifically, 38 grams of MHA powder was dissolved in 1 liter of distilled water. The medium was then sterilized by autoclaving at 121°C and 15 psi for 15 minutes using an autoclave (Gentek India Pvt. Ltd.). After sterilization, the medium was poured into sterile glass Petri dishes inside a laminar airflow cabinet (Toshiba, India) under aseptic conditions, with each plate receiving 30 ml of the medium. The plates were left to solidify in the laminar flow. Once solidified, the bacterial inoculum was evenly spread across the surface of the agar using a sterile cotton swab. Ten minutes after inoculation, discs were placed onto the agar using sterile forceps. Each disc was loaded with 25 μl of sample at three different concentrations: 100 mg/ml, 50 mg/ml, and 25 mg/ml. The samples were allowed to diffuse into the agar, after which the plates were sealed with parafilm and incubated at 37°C for 24 hours.

BA lacked significant activity against Bacillus subtilis but exhibited notable inhibition against Enterococcus faecalis (zone of inhibition: 11 ± 0.00 mm at 50 mg/kg), Salmonella Typhi (10 ± 0.00 mm at 50 mg/kg and 100 mg/kg), and Staphylococcus aureus (significant activity at 100 mg/kg).

Comparative analysis revealed BA exhibited efficacy comparable to that of ciprofloxacin in certain cases. Molecular studies highlighted BA's ability to mitigate bacterial virulence by disrupting mechanisms, such as pro-inflammatory protein synthesis and mitochondrial genomic integrity, especially in Enterococcus faecalis. These findings underscore BA’s selective antimicrobial properties, suggesting its potential for therapeutic application in managing polymicrobial infections, gastrointestinal pathologies, and systemic diseases.

The pharmacodynamic profile suggests BA exerts its antimicrobial effects by targeting bacterial virulence mechanisms, including the suppression of pro-inflammatory responses and the disruption of mitochondrial genomic stability. These attributes position BA as a promising candidate for further pharmacological development, especially as a potential adjunct to conventional antibiotics for managing drug-resistant and opportunistic infections. Further in vivo validation and clinical studies are warranted to establish its therapeutic potential and safety profile.

Ciprofloxacin hydrochloride (CH) is a widely used fluoroquinolone antibiotic. Accurate, cost-effective methods are essential for its routine quality control. This study aimed to develop and validate simple UV spectrophotometric and spectrofluorimetric methods for quantifying CH in bulk and pharmaceutical formulations.

UV analysis was performed at 271 nm, while fluorescence measurements were taken at 335 nm (excitation) and 416 nm (emission) in phosphate buffer (pH 7). Validation was conducted in accordance with the International Council for Harmonisation (ICH) guidelines for linearity, accuracy, precision, Limit of Detection (LOD), Limit of Quantification (LOQ), robustness, and solution stability. Results were compared with an official HPLC method.

Both methods demonstrated excellent linearity in the range of 0.4-2.0 × 10^-5 M (r² = 0.9999). The limits of detection (LOD) and quantification (LOQ) were 0.64/1.95 × 10^-6 M for the UV method and 0.66/1.99 × 10^-6 M for the fluorescence method. Recovery values ranged from 99.27% to 99.92% (UV) and 98.60% to 100.32% (fluorescence), with %RSD values below 2%, indicating good precision. Robustness testing revealed minimal effects from deliberate variations in experimental conditions, and the results showed strong agreement with the compendial HPLC method.

UV spectrophotometric and spectrofluorimetric methods proved to be accurate, sensitive, and reproducible. The UV method is ideal for basic lab setups, while fluorescence offers greater sensitivity for lower concentrations. Comparable results with HPLC confirm their suitability.

Validated UV and fluorescence methods provide efficient, accurate, and low-cost alternatives to HPLC for quality control of CH in pharmaceutical analysis.

The cost of an antibiotic may significantly increase personal expenses, which affects a country's total gross domestic product (GDP). The percentage of lost GDP per person of the Iraqi population due to the cost of antibiotics was studied.

A prescriptive study was conducted to assess the cost of common prescription antibiotics in Iraq based on data obtained from 32 pharmacies in four Iraqi governorates. The cost of antibiotics based on the total GDP of patients was determined as a percentage.

The specialization of physicians and the type and form of antibiotics were the effective factors associated with the impact of the cost of antibiotics on the GDP per person in Iraq. A high percentage of GDP per person was reduced by the cost of antibiotics prescribed by pediatricians and otolaryngologists (ENT) (64.18% and 56.19%, respectively). Cefpodoxime and ciprofloxacin were the costliest types of antibiotics with greater GDP reduction. Based on the form, syrups and tablets were the most expensive antibiotics. Amoxicillin had forms costing between 27.02% and 77.69% of the total GDP per patient, while chloramphenicol had only one form, drops.

The cost of antibiotics has a major impact on the overall GDP of the population of Iraq. This effect is significantly influenced by the specialization of physicians, and the type and the form of antibiotic. Restricting the prescription of unnecessary antibiotics and expensive types is highly recommended to lower the cost and burden on the GDP of Iraqis.

Honey is a natural product that has been widely used for its therapeutic effects.

The purpose of this study was to evaluate and compare the antibacterial activity of Jordanian honey (Sidr and Jabali) with Manuka honey against Staphylococcus aureus and Escherichia coli.

The antibacterial and antibiofilm activities were evaluated using agar well diffusion assay, minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), growth curve, time-kill curve, microtiter plate assay and reverse transcription polymerase chain reaction (RT-qPCR).

Agar well diffusion assay showed that Sidr and Jabali honey had antibacterial activity at 20% (w/v) and 25% (w/v) respectively compared with Manuka at 20% (w/v) against both bacteria. The MIC values for both Manuka and Sidr honey were 20% (w/v) and 25% (w/v) for Jabali honey against both bacteria. The MIC50 values for both Manuka and Sidr honey were 20% (w/v) and 25% (w/v) for Jabali honey against both bacteria. Whereas, the MIC90 values against S. aureus were 25% (w/v) for both Manuka and Sidr honey and 50% (w/v) for Jabali honey. While the MIC90 values against E. coli were 50% (w/v) for both Manuka and Sidr honey and 75% (w/v) for Jabali honey. The MBC values for Manuka and Sidr honey were 25% (w/v) and 50% (w/v) for Jabali honey against both bacteria. The growth curve of S. aureus and E. coli was reduced after exposure to all the tested honeys at MIC. In the time-kill curve assay, S. aureus cells were significantly (P<0.05) decreased to 4.5-log10, 4-log10, and 3.34-log10 after incubation with Manuka, Sidr, and Jabali honey respectively compared to untreated. Meanwhile, after E. coli cells were treated with Manuka, Sidr and Jabali honeys, the number of cells was significantly (P<0.05) decreased to 4.7-log10, 4-log10 and 3.6-log10 reduction respectively compared to untreated. The lowest concentration 20% (w/v) of all the tested honey was able to inhibit and eradicate S. aureus and E. coli biofilms. The RT-qPCR analysis showed that the range of gene expression of argF, purC, pykA, fabG, scdA, adh and menB in S. aureus was between 4.8-6.3-fold, 3.9-5.9-fold and 3.5-5.6-fold after exposure to Manuka, Sidr and Jabali honey respectively. In addition, the range of gene expression of yifO (bsmA), rpoS, ycfR (BhsA), tnaA and evgA in E. coli was between 4.6-6.3-fold, 4.1-5.8-fold and 4-5.4-fold after exposure to Manuka, Sidr and Jabali honey respectively.

Among the all-tested honey, Manuka showed the highest total antibacterial activities against both bacteria. This study demonstrated that Sidr and Jabali honey has antibacterial and antibiofilm activities compared with Manuka honey. This study revealed that Sidr and Jabali honey inhibits both of S. aureus and E. coli planktonic and biofilm through the downregulation of genes required for cell envelope stability and motility.

Chalcone-based compounds display potential antifungal activity. They are considered to be versatile pharmacophores that can be utilized for the designing and development of numerous bioactive lead compounds. In this work, some new chalcone derivatives were synthesized, which are expected to possess antifungal activity, making them potentially useful for treating fungal infections.

The rate at which fungi develop resistance to antifungals is outpacing the discovery of new antifungal classes. Developing new compounds with the same behavior but improved pharmacological action has proven to be a significant challenge for scientists. Therefore, discovering novel drugs is crucial for combating health problems and enhancing the quality of human life. For this reason, in this study, we synthesized new chalcones and evaluated their antifungal activity.

In the initial phase, in silico studies were employed to predict the physicochemical properties and biological activities of chalcone derivatives. A new series of chalcones was synthesized using synthetic methodologies, and characterization techniques, such as spectroscopy and chromatography, were employed to confirm the identity and purity of the compounds. The antifungal potential of chalcones was checked by the zone inhibition method (Kirby-Bauer method) using Candida albicans and Candida parapsilosis strains. Subsequently, molecular docking against fungal targets was performed to elucidate the binding interactions, providing valuable insights into the structure-activity relationship, and cytotoxicity studies were performed to assess the potential toxicity of these compounds.

The target compounds (Ca-Ce) were successfully synthesized and characterized by spectroscopic and analytical methods. The findings from the computational properties and activity against fungal stains like Candida albicans and Candida parapsilosis revealed that the newly synthesized chalcones exhibit significant antifungal potential.

The newly synthesized chalcones, especially Cc and Ce, exhibited antifungal activity nearly equivalent to that of standard drugs.

The growing problem of antibiotic-resistant bacteria in clinical environments has driven increased interest in bacteriophage therapy, where viruses specifically target and destroy harmful bacteria. This research explores the therapeutic potential of bacteriophages isolated to combat multi-drug-resistant Pseudomonas aeruginosa, using Galleria mellonella larvae as an experimental model. In vitro susceptibility to multiple antibiotics was assessed using the double agar overlay technique. Additionally, the survival rate of the larvae was analyzed to determine the phages' capacity to combat bacterial infection in G. mellonella. Bacteriophage therapy was employed to treat moth wax larvae that were infected with Multidrug-resistant Pseudomonas aeruginosa.

Resistance to commonly used antibiotics has been steadily increasing over the past few decades, and it has been observed to vary depending on the alternative method employed, such as bacteriophage therapy.

The study focused on the Pseudomonas aeruginosa strain PP31, a Multidrug-Resistant Gram Negative bacterium that was obtained from biomedical waste at ICF Hospital in Tamil Nadu, India. Galleria mellonella larvae infected with this multidrug-resistant strain of Pseudomonas were employed for treatment using bacteriophage.

It was found that a single phage might infect a particular strain of bacteria in the host. It was demonstrated that MDR Pseudomonas aeruginosa infected larvae must be treated with a single specific phage dose (20 µL, 10⁴ PFU/mL) at 6 – hour intervals in order to achieve a 95% survival rate for in vivo research. By counting the number of germs in the larvae, the results were confirmed.

Our research shows that although phages were shown to be highly contagious in vitro, specific phage dosages were required for effective treatment in living animals.

The purpose of this study was to develop and evaluate novel antimicrobial Schiff base and its transition metal complexes.

Antibiotics that were often used to treat microorganisms are no longer effective against them because of developed resistance. It is believed that newly developed Schiff bases and their transition metal complexes could function well as antimicrobial agents and have considerable pharmacological efficacy.

In this study new Schiff base ligand was synthesized by taking the 1:1 stoichiometric ratio of 2, 4-dinitrophenyl hydrazine and dimethyl tetraphthalate, with ethanol serving as the solvent subsequently its Co (II) and Cd (II) Complexes were created by reacting the synthesized Schiff base ligand with the corresponding metal salts in the form of chlorides.

All of the target compounds' structures were evaluated using sophisticated analytical techniques, such as elemental analysis, FT-IR, ¹H and ¹³C NMR, and LCMS. In order to determine each compound's biological potential as an antimicrobial agent, its effectiveness was also assessed. The results of the molecular docking studies were found to be compatible with biological potential. At concentrations of 100–250 ppm, the zones of inhibition were observed to be between 9–20 mm for ligands and 10-23 mm for complexes. The outcome showed that, in comparison to the Schiff base ligand, metal complexes have superior biological activity.

The current study provided a unique method for creating novel and physiologically active Schiff bases and their transition metal complexes. The findings demonstrate that the compounds produced are a promising antimicrobial mediator against contemporary human illnesses. Additionally, it may pave the way for further research on drug-resistant microbes with potential biological applications.

Surgical site infections (SSIs) are the most common surgery related complication in healthcare worldwide. Infections due to carbapenem resistant Klebsiella pneumoniae are increasing dramatically with significant impact on surgical patients.

The aim of this study was to detect blaKPC and efflux pump genes in K. pneumoniae isolated from infected surgical wounds.

A study including 291 patients was conducted at Birat Medical College Teaching Hospital (BMCTH), Biratnagar, from October 2021 to October 2022. Specimens were collected from the patients with SSIs under aseptic conditions and sent to the microbiology laboratory. K. pneumoniae was identified by VITEK 2. The presence of carbapenemase was phenotypically screened by the modified carbapenem inactivation method (mCIM). blaKPC and efflux pump genes were detected by polymerase chain reaction (PCR).

A total of 134 (46%) specimens were culture positive, out of which 24 (30%) were identified as K. pneumoniae with 11 (45.8%) isolates resistant to carbapenem. Tigecycline and colistin were the most effective drugs against K. pneumoniae. Among these isolates, seven were found to be mCIM positive. blaKPC was absent in all mCIM-positive isolates, however, efflux pump genes (acrA and acrB) were detected in all of the carbapenem-resistant isolates.

A high prevalence of carbapenem-resistant K. pneumoniae could be attributed to the efflux pump genes. This finding suggests that the AcrAB efflux pump may be the major virulence factor that can contribute to multidrug-resistant strains.