Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Acta microbiologica et immunologica Hungarica
Characteristics of fungaemia caused by Trichosporon species in South-Eastern Europe
The incidence of fungaemia caused by rare yeasts, particularly Trichosporon species, is rising globally, posing diagnostic and therapeutic challenges-especially in immunocompromised patients. This systematic review aims to analyse the epidemiology, diagnostic approaches, antifungal susceptibility, and clinical outcomes of Trichosporon fungaemia (TF) in South-Eastern Europe, including Turkey. A comprehensive search was conducted in PubMed and Scopus in August 2025. A total of 59 cases from 12 studies were identified, with Trichosporon asahii being the most prevalent species (86.4%). Cases originated from Turkey (79.7%), Greece (18.6%), and Croatia (1.7%). Diagnostic techniques varied, with phenotypic methods still widely used. MALDI-TOF MS and DNA sequencing were mainly applied as confirmatory methods. Haematologic disorders were the most frequently reported underlying conditions among the patients. Sixteen breakthrough fungaemia cases-occurring despite empirical or prophylactic antifungal therapy-were identified. Although rare, TF represents a severe infection with significant mortality in South-Eastern Europe. Early and accurate species identification-facilitated by advanced diagnostic tools-is crucial for effective management. In addition to diagnostic difficulties, treatment is also challenging. Voriconazole appears to be the preferred antifungal agent, even in breakthrough fungaemia cases. Enhanced awareness, routine use of molecular diagnostics, and ongoing epidemiological monitoring are essential to improve patient outcomes.
1 June 2026
Read appraisal →International health
Global trends in travel-related antimicrobial resistance: a systematic review, 2020-2024
Antimicrobial resistance (AMR) is a growing global health threat, with international travel playing a key role in the spread of resistant bacteria. This systematic review examines trends in travel-associated AMR from 2020 to 2024. A search of PubMed, Scopus and Web of Science identified 10 studies involving 359 AMR isolates. Using the Newcastle-Ottawa scale, the study quality was assessed and findings were synthesised to identify patterns in prevalence, diversity and geographic spread. Results revealed a consistent rise in travel-associated AMR, particularly from regions such as Southeast Asia and Africa, which acted as major sources of diverse resistant pathogens. These include extended spectrum beta-lactamase-producing Escherichia coli, multidrug-resistant (MDR) Corynebacterium diphtheriae and colistin-resistant Enterobacterales. The number of MDR strains increased over time, making up 15.3% of cases by 2024. Healthcare exposure during travel emerged as a significant risk factor. Overall, the prevalence and diversity of AMR bacteria linked to travel have risen steadily, highlighting the urgent need for global cooperation. Enhanced surveillance, antimicrobial stewardship, infection control measures and international collaboration are essential to curb the spread of these dangerous pathogens.
11 May 2026
Read appraisal →Annals of medicine
A comprehensive review of regulatory mechanisms of novel enterotoxin genes in Staphylococcus aureus from meat sources
BACKGROUND AND AIMS: Meat-borne Staphylococcus aureus (S. aureus) remains a leading global foodborne pathogen harbouring novel enterotoxin genes (NEGs) encoding superantigenic toxins with conditionally enhanced pathogenicity, representing a critical food safety hazard. This review characterizes NEG features, pathogenic mechanisms, multi-layered regulatory networks, and identifies key research challenges. METHODS: We systematically searched PubMed, Embase and the Web of Science Core Collection to synthesize molecular and multi-omics evidence (ChIP-seq, RNA-seq, CRISPR-Cas9) characterizing NEG classification, pathogenic mechanisms, multi-level regulatory networks (transcriptional, post-translational, environmental), and geographical distribution patterns in meat-derived S. aureus. RESULTS: NEGs comprise superantigenic and tissue-targeting subgroups mediating pathogenicity via cytotoxicity, intestinal microenvironment disruption, and immune evasion. Regulation involves a complex network of Agr/σB/SarA/Rot-mediated transcriptional control, phosphorylation/lactylation modifications and environmental sensing, exhibiting marked geographical divergence. Current limitations include technical resolution constraints, insufficient physiological model fidelity and incomplete regulatory crosstalk elucidation. CONCLUSIONS: Future research should prioritize transcription factor interaction mechanisms, growth-toxin correlation prediction models and multi-omics-based network decipherment. This review provides a foundational framework for NEG research to inform food safety risk assessment and targeted contamination control strategies.
10 May 2026
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