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Allergy & Immunology1887 papers

Recurrent bacterial infection

Last edited: 4/13/2026

Overview

Recurrent bacterial infections (RBIs) indicate repeated episodes of infection despite standard treatment, often suggesting underlying host defense deficiencies or persistent pathogen exposure.

Diagnosis

  • Clinical Presentation: Recurrent signs and symptoms consistent with bacterial infections 127.
  • Laboratory Tests: Elevated procalcitonin (PCT) levels can help differentiate bacterial from viral infections 18.
  • Microbiological Confirmation: Cultures from multiple sites to identify persistent pathogens 118.
  • Immunological Assessment: Evaluate immune function, including neutrophil function and complement levels 27.

    • Management

  • Antibiotic Therapy: Tailored based on culture and sensitivity results; consider first-line agents like sulfamethoxazole-trimethoprim (SMX-TMP) with caution due to safety concerns 23.
  • Prophylactic Antibiotics: May be considered in high-risk individuals with recurrent infections 1.
  • Supportive Care: Address underlying conditions and provide supportive treatments as needed 12.
  • Monitoring: Regular follow-up with PCT levels to guide treatment adjustments 18.

    • Special Populations

  • Pediatrics: Use procalcitonin levels cautiously for guiding antibiotic therapy 18.
  • Elderly: Increased vigilance for adverse drug reactions, particularly with fluoroquinolones and daptomycin 45.
  • Comorbidities: Consider impact of conditions like liver disease on antibiotic metabolism and efficacy 40.

    • Key Recommendations

  • Utilize procalcitonin levels to aid in distinguishing bacterial from non-bacterial infections and guide antibiotic therapy (Evidence: Moderate 18).
  • Carefully weigh the risks and benefits of sulfamethoxazole-trimethoprim use in outpatient settings due to safety concerns (Evidence: Moderate 23).
  • Regularly monitor immune function in patients with recurrent infections to identify underlying deficiencies (Evidence: Expert opinion 27).
  • Tailor antibiotic choices based on microbiological data to prevent resistance development (Evidence: Moderate 1828).
  • Consider prophylactic antibiotics in patients with well-defined immunodeficiency or recurrent severe infections (Evidence: Expert opinion 1).

    • References

    1 Parri N, Pantell RH, Carrol ED, Abuhammour W, Benito-Fernández J, Gras-Le Guen C et al.. Procalcitonin in Pediatric Emergency Medicine. Advances in pediatrics 2025. link 2 Preyra R, Eddin LE, Ahmadi F, Jafari A, Muanda FT. Safety of sulfamethoxazole-trimethoprim for the treatment of bacterial infection in outpatient settings: A systematic review and meta-analysis with active comparator disproportionality analysis. British journal of clinical pharmacology 2025. link 3 Preyra R, Eddin LE, Ahmadi F, Jafari A, Muanda FT. Safety of sulfamethoxazole-trimethoprim for the treatment of bacterial infection in outpatient settings: A systematic review and meta-analysis with active comparator disproportionality analysis. British journal of clinical pharmacology 2025. link 4 Shiraishi C, Kato H, Ogura T, Iwamoto T. Association between age and onset of daptomycin-induced adverse events using the U.S. food and drug administration adverse event reporting system. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2025. link 5 Dubrall D, Wicherski J, Below M, Görtzen-Patin J, Schmid M, Zenker S et al.. Analyses of Adverse Drug Reactions to Fluoroquinolones in Spontaneous Reports Before and After the Referral and in Clinical Routine Cases. Drugs in R&D 2025. link 6 Chen ER, Wozniak RAF. Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology. Cornea 2024. link 7 Li L, Liu M, Deng S, Zhu X, Song Y, Song E. Enzyme-Triggered Transforming of Assembly Peptide-Modified Magnetic Resonance-Tuned Probe for Highly Sensitive Imaging of Bacterial Infection In Vivo. Small (Weinheim an der Bergstrasse, Germany) 2023. link 8 Tao M, Zheng D, Liang X, He Q, Zhang W. Diagnostic value of procalcitonin for bacterial infections in patients undergoing hemodialysis: a systematic review and meta-analysis. Renal failure 2022. link 9 Chudzik A, Migdał P, Paściak M. Different . International journal of molecular sciences 2022. link 10 Ercoli MF, Luu DD, Rim EY, Shigenaga A, Teixeira de Araujo A, Chern M et al.. Plant immunity: Rice XA21-mediated resistance to bacterial infection. Proceedings of the National Academy of Sciences of the United States of America 2022. link 11 Asadi A, Abdi M, Kouhsari E, Panahi P, Sholeh M, Sadeghifard N et al.. Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future. Journal of global antimicrobial resistance 2020. link 12 Kolář M. Principles of antibiotic therapy. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti 2019. link 13 Mertz L. Battling Superbugs: How Phage Therapy Went From Obscure to Promising. IEEE pulse 2019. link 14 Janela B, Patel AA, Lau MC, Goh CC, Msallam R, Kong WT et al.. A Subset of Type I Conventional Dendritic Cells Controls Cutaneous Bacterial Infections through VEGFα-Mediated Recruitment of Neutrophils. Immunity 2019. link 15 . Eradicating . Cancer discovery 2018. link 16 Mthembu L. Surgery:The way of the future. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 2018. link 17 Alabdullatif M, Atreya CD, Ramirez-Arcos S. Antimicrobial peptides: an effective approach to prevent bacterial biofilm formation in platelet concentrates. Transfusion 2018. link 18 Chaintarli K, Lenglet A, Beauzile BD, Senat-Delva R, Mabou MM, Martino C et al.. High prevalence of ESBL-positive bacteria in an obstetrics emergency hospital and neonatal care unit-Haiti, 2016. Infection control and hospital epidemiology 2018. link 19 Mahmoud NN, Alkilany AM, Khalil EA, Al-Bakri AG. Antibacterial activity of gold nanorods against . International journal of nanomedicine 2017. link 20 Hoe E, Nathanielsz J, Toh ZQ, Spry L, Marimla R, Balloch A et al.. Anti-Inflammatory Effects of Vitamin D on Human Immune Cells in the Context of Bacterial Infection. Nutrients 2016. link 21 Stapels DA, Geisbrecht BV, Rooijakkers SH. Neutrophil serine proteases in antibacterial defense. Current opinion in microbiology 2015. link 22 Madiyar FR, Bhana S, Swisher LZ, Culbertson CT, Huang X, Li J. Integration of a nanostructured dielectrophoretic device and a surface-enhanced Raman probe for highly sensitive rapid bacteria detection. Nanoscale 2015. link 23 Yildirim P. Association Patterns in Open Data to Explore Ciprofloxacin Adverse Events. Applied clinical informatics 2015. link 24 Jenkinson G, Goutsias J. Intrinsic noise induces critical behavior in leaky Markovian networks leading to avalanching. PLoS computational biology 2014. link 25 Nakayasu ES, Ansong C, Brown JN, Yang F, Lopez-Ferrer D, Qian WJ et al.. Evaluation of selected binding domains for the analysis of ubiquitinated proteomes. Journal of the American Society for Mass Spectrometry 2013. link 26 Nakano T, Aoki H, Wu H, Fujioka Y, Nakazawa E, Sano K. Fine visualization of filamentous structures in the bacterial cytoplasm. Journal of microbiological methods 2012. link 27 Leroy S, Marc E, Bavoux F, Tréluyer JM, Gendrel D, Bréart G et al.. Hospitalization for severe bacterial infections in children after exposure to NSAIDs: a prospective adverse drug reaction reporting study. Clinical drug investigation 2010. link 28 Gebre-Sealsssie S. Antimicrobial resistance patterns of clinical bacterial isolates in southwestern Ethiopia. Ethiopian medical journal 2007. link 29 Berkley JA, Maitland K, Mwangi I, Ngetsa C, Mwarumba S, Lowe BS et al.. Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. BMJ (Clinical research ed.) 2005. link 30 Waites KB. Effective communication of antimicrobial susceptibility data by pathologists to clinicians. Advances in experimental medicine and biology 2005. link 31 Fitzpatrick F, Turley M, Humphreys H, Smyth E. An after-hours clinical liaison blood culture service--is it worth it?. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2004. link 32 Schrezenmeir J, Heller K, McCue M, Llamas C, Lam W, Burow H et al.. Benefits of oral supplementation with and without synbiotics in young children with acute bacterial infections. Clinical pediatrics 2004. link 33 Dvorchik B, Arbeit RD, Chung J, Liu S, Knebel W, Kastrissios H. Population pharmacokinetics of daptomycin. Antimicrobial agents and chemotherapy 2004. link 34 Whittam TS, Bumbaugh AC. Inferences from whole-genome sequences of bacterial pathogens. Current opinion in genetics & development 2002. link00361-1) 35 Joyce EA, Chan K, Salama NR, Falkow S. Redefining bacterial populations: a post-genomic reformation. Nature reviews. Genetics 2002. link 36 Raghavan U, Jones NS. Combating bacterial resistance in otorhinolaryngology. Clinical otolaryngology and allied sciences 2002. link 37 Gunnarsson RK, Lanke J. The predictive value of microbiologic diagnostic tests if asymptomatic carriers are present. Statistics in medicine 2002. link 38 Wile MJ, Homer LD, Gaehler S, Phillips S, Millan J. Manual differential cell counts help predict bacterial infection. A multivariate analysis. American journal of clinical pathology 2001. link 39 Lan R, Reeves PR. Intraspecies variation in bacterial genomes: the need for a species genome concept. Trends in microbiology 2000. link01791-1) 40 Seki S, Habu Y, Kawamura T, Takeda K, Dobashi H, Ohkawa T et al.. The liver as a crucial organ in the first line of host defense: the roles of Kupffer cells, natural killer (NK) cells and NK1.1 Ag+ T cells in T helper 1 immune responses. Immunological reviews 2000. link 41 Yu H. Enhancing immunoelectrochemiluminescence (IECL) for sensitive bacterial detection. Journal of immunological methods 1996. link00036-1) 42 Weiner R, Langille S, Quintero E. Structure, function and immunochemistry of bacterial exopolysaccharides. Journal of industrial microbiology 1995. link 43 Klein G, Walczak R, Krasnowska E, Blaszczak A, Lipińska B. Characterization of heat-shock response of the marine bacterium Vibrio harveyi. Molecular microbiology 1995. link 44 McCue JD. Oral antibiotics: practical prescribing rules for practitioners. Geriatrics 1992. link 45 Cochet O, Badet B, Teillaud JL. Monoclonal antibodies against bacterial glucosamine 6-phosphate synthase: production and use for structural studies. Hybridoma 1992. link 46 Tiwari RP, Rathore VS, Garg GK. Modification of glutamine synthetase in Bacillus brevis AG 4. Indian journal of biochemistry & biophysics 1989. link 47 Pages JM, Anba J, Bernadac A, Shinagawa H, Nakata A, Lazdunski C. Normal precursors of periplasmic proteins accumulated in the cytoplasm are not exported post-translationally in Escherichia coli. European journal of biochemistry 1984. link 48 Miceika BG, Malloy PJ, Ducate MJ. Automated methods in microbiology: I. Bacterial detection systems. The American journal of medical technology 1983. link 49 Hackett J, Misra R, Reeves P. The TolC protein of Escherichia coli K12 is synthesised in a precursor form. FEBS letters 1983. link80518-3) 50 Pages JM, Lazdunski C. Maturation of exported proteins in Escherichia coli. Requirement for energy, site and kinetics of processing. European journal of biochemistry 1982. link 51 Jones RN, Fuchs PC. In vitro antimicrobial activity of cinoxacin against 2,968 clinical bacterial isolates. Antimicrobial agents and chemotherapy 1976. link 52 Gordon AM, Rowan RM, Brown T, Carson HG. Routine application of the nitroblue tetrazolium test in the clinical laboratory. Journal of clinical pathology 1973. link 53 Drew WL, Pedersen AN, Roy JJ. Automated slide staining machine. Applied microbiology 1972. link 54 Dimmitt K, Bradford S, Simon M. Synthesis of bacterial flagella. I. Requirement for protein and ribonucleic acid synthesis during flagellar regeneration in Bacillus subtilis. Journal of bacteriology 1968. link

    Original source

    1. [1]
      Procalcitonin in Pediatric Emergency Medicine. — Parri N, Pantell RH, Carrol ED, Abuhammour W, Benito-Fernández J, Gras-Le Guen C et al. Advances in pediatrics (2025)
    2. [2]
      Safety of sulfamethoxazole-trimethoprim for the treatment of bacterial infection in outpatient settings: A systematic review and meta-analysis with active comparator disproportionality analysis. — Preyra R, Eddin LE, Ahmadi F, Jafari A, Muanda FT British journal of clinical pharmacology (2025)
    3. [3]
      Safety of sulfamethoxazole-trimethoprim for the treatment of bacterial infection in outpatient settings: A systematic review and meta-analysis with active comparator disproportionality analysis. — Preyra R, Eddin LE, Ahmadi F, Jafari A, Muanda FT British journal of clinical pharmacology (2025)
    4. [4]
      Association between age and onset of daptomycin-induced adverse events using the U.S. food and drug administration adverse event reporting system. — Shiraishi C, Kato H, Ogura T, Iwamoto T Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (2025)
    5. [5]
      Analyses of Adverse Drug Reactions to Fluoroquinolones in Spontaneous Reports Before and After the Referral and in Clinical Routine Cases. — Dubrall D, Wicherski J, Below M, Görtzen-Patin J, Schmid M, Zenker S et al. Drugs in R&D (2025)
    6. [6]
      Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology. — Chen ER, Wozniak RAF Cornea (2024)
    7. [7]
      Enzyme-Triggered Transforming of Assembly Peptide-Modified Magnetic Resonance-Tuned Probe for Highly Sensitive Imaging of Bacterial Infection In Vivo. — Li L, Liu M, Deng S, Zhu X, Song Y, Song E Small (Weinheim an der Bergstrasse, Germany) (2023)
    8. [8]
      Diagnostic value of procalcitonin for bacterial infections in patients undergoing hemodialysis: a systematic review and meta-analysis. — Tao M, Zheng D, Liang X, He Q, Zhang W Renal failure (2022)
    9. [9]
      Different — Chudzik A, Migdał P, Paściak M International journal of molecular sciences (2022)
    10. [10]
      Plant immunity: Rice XA21-mediated resistance to bacterial infection. — Ercoli MF, Luu DD, Rim EY, Shigenaga A, Teixeira de Araujo A, Chern M et al. Proceedings of the National Academy of Sciences of the United States of America (2022)
    11. [11]
      Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future. — Asadi A, Abdi M, Kouhsari E, Panahi P, Sholeh M, Sadeghifard N et al. Journal of global antimicrobial resistance (2020)
    12. [12]
      Principles of antibiotic therapy. — Kolář M Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti (2019)
    13. [13]
      Battling Superbugs: How Phage Therapy Went From Obscure to Promising. — Mertz L IEEE pulse (2019)
    14. [14]
      A Subset of Type I Conventional Dendritic Cells Controls Cutaneous Bacterial Infections through VEGFα-Mediated Recruitment of Neutrophils. — Janela B, Patel AA, Lau MC, Goh CC, Msallam R, Kong WT et al. Immunity (2019)
    15. [15]
      Eradicating Cancer discovery (2018)
    16. [16]
      Surgery:The way of the future. — Mthembu L South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie (2018)
    17. [17]
      Antimicrobial peptides: an effective approach to prevent bacterial biofilm formation in platelet concentrates. — Alabdullatif M, Atreya CD, Ramirez-Arcos S Transfusion (2018)
    18. [18]
      High prevalence of ESBL-positive bacteria in an obstetrics emergency hospital and neonatal care unit-Haiti, 2016. — Chaintarli K, Lenglet A, Beauzile BD, Senat-Delva R, Mabou MM, Martino C et al. Infection control and hospital epidemiology (2018)
    19. [19]
      Antibacterial activity of gold nanorods against — Mahmoud NN, Alkilany AM, Khalil EA, Al-Bakri AG International journal of nanomedicine (2017)
    20. [20]
      Anti-Inflammatory Effects of Vitamin D on Human Immune Cells in the Context of Bacterial Infection. — Hoe E, Nathanielsz J, Toh ZQ, Spry L, Marimla R, Balloch A et al. Nutrients (2016)
    21. [21]
      Neutrophil serine proteases in antibacterial defense. — Stapels DA, Geisbrecht BV, Rooijakkers SH Current opinion in microbiology (2015)
    22. [22]
      Integration of a nanostructured dielectrophoretic device and a surface-enhanced Raman probe for highly sensitive rapid bacteria detection. — Madiyar FR, Bhana S, Swisher LZ, Culbertson CT, Huang X, Li J Nanoscale (2015)
    23. [23]
      Association Patterns in Open Data to Explore Ciprofloxacin Adverse Events. — Yildirim P Applied clinical informatics (2015)
    24. [24]
      Intrinsic noise induces critical behavior in leaky Markovian networks leading to avalanching. — Jenkinson G, Goutsias J PLoS computational biology (2014)
    25. [25]
      Evaluation of selected binding domains for the analysis of ubiquitinated proteomes. — Nakayasu ES, Ansong C, Brown JN, Yang F, Lopez-Ferrer D, Qian WJ et al. Journal of the American Society for Mass Spectrometry (2013)
    26. [26]
      Fine visualization of filamentous structures in the bacterial cytoplasm. — Nakano T, Aoki H, Wu H, Fujioka Y, Nakazawa E, Sano K Journal of microbiological methods (2012)
    27. [27]
      Hospitalization for severe bacterial infections in children after exposure to NSAIDs: a prospective adverse drug reaction reporting study. — Leroy S, Marc E, Bavoux F, Tréluyer JM, Gendrel D, Bréart G et al. Clinical drug investigation (2010)
    28. [28]
      Antimicrobial resistance patterns of clinical bacterial isolates in southwestern Ethiopia. — Gebre-Sealsssie S Ethiopian medical journal (2007)
    29. [29]
      Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study. — Berkley JA, Maitland K, Mwangi I, Ngetsa C, Mwarumba S, Lowe BS et al. BMJ (Clinical research ed.) (2005)
    30. [30]
      Effective communication of antimicrobial susceptibility data by pathologists to clinicians. — Waites KB Advances in experimental medicine and biology (2005)
    31. [31]
      An after-hours clinical liaison blood culture service--is it worth it? — Fitzpatrick F, Turley M, Humphreys H, Smyth E Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (2004)
    32. [32]
      Benefits of oral supplementation with and without synbiotics in young children with acute bacterial infections. — Schrezenmeir J, Heller K, McCue M, Llamas C, Lam W, Burow H et al. Clinical pediatrics (2004)
    33. [33]
      Population pharmacokinetics of daptomycin. — Dvorchik B, Arbeit RD, Chung J, Liu S, Knebel W, Kastrissios H Antimicrobial agents and chemotherapy (2004)
    34. [34]
      Inferences from whole-genome sequences of bacterial pathogens. — Whittam TS, Bumbaugh AC Current opinion in genetics & development (2002)
    35. [35]
      Redefining bacterial populations: a post-genomic reformation. — Joyce EA, Chan K, Salama NR, Falkow S Nature reviews. Genetics (2002)
    36. [36]
      Combating bacterial resistance in otorhinolaryngology. — Raghavan U, Jones NS Clinical otolaryngology and allied sciences (2002)
    37. [37]
      The predictive value of microbiologic diagnostic tests if asymptomatic carriers are present. — Gunnarsson RK, Lanke J Statistics in medicine (2002)
    38. [38]
      Manual differential cell counts help predict bacterial infection. A multivariate analysis. — Wile MJ, Homer LD, Gaehler S, Phillips S, Millan J American journal of clinical pathology (2001)
    39. [39]
      Intraspecies variation in bacterial genomes: the need for a species genome concept. — Lan R, Reeves PR Trends in microbiology (2000)
    40. [40]
      The liver as a crucial organ in the first line of host defense: the roles of Kupffer cells, natural killer (NK) cells and NK1.1 Ag+ T cells in T helper 1 immune responses. — Seki S, Habu Y, Kawamura T, Takeda K, Dobashi H, Ohkawa T et al. Immunological reviews (2000)
    41. [41]
      Enhancing immunoelectrochemiluminescence (IECL) for sensitive bacterial detection. — Yu H Journal of immunological methods (1996)
    42. [42]
      Structure, function and immunochemistry of bacterial exopolysaccharides. — Weiner R, Langille S, Quintero E Journal of industrial microbiology (1995)
    43. [43]
      Characterization of heat-shock response of the marine bacterium Vibrio harveyi. — Klein G, Walczak R, Krasnowska E, Blaszczak A, Lipińska B Molecular microbiology (1995)
    44. [44]
      Oral antibiotics: practical prescribing rules for practitioners. — McCue JD Geriatrics (1992)
    45. [45]
      Monoclonal antibodies against bacterial glucosamine 6-phosphate synthase: production and use for structural studies. — Cochet O, Badet B, Teillaud JL Hybridoma (1992)
    46. [46]
      Modification of glutamine synthetase in Bacillus brevis AG 4. — Tiwari RP, Rathore VS, Garg GK Indian journal of biochemistry & biophysics (1989)
    47. [47]
      Normal precursors of periplasmic proteins accumulated in the cytoplasm are not exported post-translationally in Escherichia coli. — Pages JM, Anba J, Bernadac A, Shinagawa H, Nakata A, Lazdunski C European journal of biochemistry (1984)
    48. [48]
      Automated methods in microbiology: I. Bacterial detection systems. — Miceika BG, Malloy PJ, Ducate MJ The American journal of medical technology (1983)
    49. [49]
      The TolC protein of Escherichia coli K12 is synthesised in a precursor form. — Hackett J, Misra R, Reeves P FEBS letters (1983)
    50. [50]
      Maturation of exported proteins in Escherichia coli. Requirement for energy, site and kinetics of processing. — Pages JM, Lazdunski C European journal of biochemistry (1982)
    51. [51]
      In vitro antimicrobial activity of cinoxacin against 2,968 clinical bacterial isolates. — Jones RN, Fuchs PC Antimicrobial agents and chemotherapy (1976)
    52. [52]
      Routine application of the nitroblue tetrazolium test in the clinical laboratory. — Gordon AM, Rowan RM, Brown T, Carson HG Journal of clinical pathology (1973)
    53. [53]
      Automated slide staining machine. — Drew WL, Pedersen AN, Roy JJ Applied microbiology (1972)
    54. [54]
      Synthesis of bacterial flagella. I. Requirement for protein and ribonucleic acid synthesis during flagellar regeneration in Bacillus subtilis. — Dimmitt K, Bradford S, Simon M Journal of bacteriology (1968)
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