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  • Partnering with Profound: Winning on the AI Stage

    Partnering with Profound: Winning on the AI Stage

    We are entering a new era in how people find and evaluate information. For the first time in decades, the primary gateway to knowledge is shifting, with the move from traditional web search to AI assistants. A large and rapidly growing number of people now start their journey by asking ChatGPT, Perplexity, Grok, Claude or Gemini for advice on what to buy, where to go and which brands to trust.

    The mechanics behind these answers are fundamentally different from traditional search. AI assistants don’t serve up a list of ranked links; they generate a single, authoritative, probabilistic response based on what they “know” about your brand. The traffic, backlinks and click-throughs that shaped traditional SEO carry less weight. For companies, this is a new competitive arena, and it demands new tools to measure and improve how they appear where buying decisions are now being made.

    Profound is building that solution. Its platform lets companies see exactly how they appear across AI assistants, create the right content to improve visibility, and deploy AI marketing agents that give one marketer the power of an entire agency. From monitoring and analytics to creating content and executing campaigns, Profound is building the marketing command center for the AI era.

    Launched less than a year ago, James Cadwallader, Dylan Babbs, and the team have moved at remarkable speed. They have launched a broad set of products, gained traction in every major sector, and become the leader of this emerging category with customers including Fortune 10 companies, Ramp, U.S. Bank, Indeed, MongoDB, DocuSign, Chime, Clay and Plaid. Customers have reported transformative results; Ramp, for example, saw a 7x increase in AI brand visibility for their accounts payable product.

    We are excited to partner with James, Dylan and their fast-growing team by leading their Series B. As search shifts from blue links to direct AI answers, every company will need Profound to remain competitive. We look forward to supporting them in their mission to build the essential AI marketing platform for the age of superintelligence.

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  • Study identifies biomarkers that could help predict and manage chronic kidney disease

    Study identifies biomarkers that could help predict and manage chronic kidney disease

    Biomarkers that could help predict and manage chronic kidney disease (CKD) have been identified in a new study led by the University of Surrey.

    The research, funded by Kidney Research UK, and as part of the National Unified Renal Translational Research Enterprise (NURTuRE) CKD study, leveraged data on 2,884 adult CKD patients from across 16 nephrology centres – in which specialists study, prevent, diagnose and treat kidney disease.

    The study, which has been published by the Journal of the American Society of Nephrology, examined 21 biomarkers linked to kidney damage, fibrosis, inflammation and cardiovascular disease.

    Chronic kidney disease affects millions worldwide and is a major global health issue which is characterized by the gradual loss of kidney function over time, leading to serious health complications.

    While established risk factors like age, sex, ethnicity, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) remain strong predictors, the research found that a combination of biomarkers, namely sTNFR1, sCD40, UCOL1A1, could be key for predicting kidney failure. A different combination of biomarkers including hs-cTnT, NT-proBNP, suPAR were instead comparably good at predicting all-cause mortality (death from any cause).

    Our research shows that these novel biomarker models offer predictive results comparable to established methods, but the key finding here is that we can use these biomarkers to understand the underlying mechanisms of disease progression, potentially paving the way to more personalized treatments and medicines for CKD patients.”


    Dr. Tony Onoja, lead author of the study and Research Fellow, University of Surrey

    The biomarker signatures identified provide insights into the underlying disease mechanism and associated processes linked to CKD’s progression, including extracellular matrix accumulation, chronic inflammation, and cardiovascular stress. These insights could inform the development of new targeted therapies and more personalized treatments.

    Professor Nophar Geifman, senior author of the study and Professor of Health and Biomedical Informatics at the University of Surrey said:

    “Our study demonstrates that specific biomarkers can offer a more nuanced understanding of a patient’s disease progression and mortality risk and the disease’s ongoing activity. Further research is needed to evaluate how these biomarkers change in response to current treatments, and their clinical utility in patient care and in personalized medicine.”

    Source:

    Journal reference:

    Onoja, A., et al. (2025). Biomarkers of Kidney Failure and All-Cause Mortality in CKD. Journal of the American Society of Nephrology. doi.org/10.1681/asn.0000000767.

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  • Matt Redman, Brooke Ligertwood, Joe L. Barnes Unite for Nashville Worship Night

    Matt Redman, Brooke Ligertwood, Joe L. Barnes Unite for Nashville Worship Night

    On October 11th, worship leader and songwriter Matt Redman will bring WOR/TH, a one-day worship and theology seminar, to Belmont University in Nashville.

    (more…)

  • What are Dua Lipa and Reese Witherspoon reading this summer? Seven celebrity book club recommendations for August | People

    What are Dua Lipa and Reese Witherspoon reading this summer? Seven celebrity book club recommendations for August | People

    Bookworm Summer — synonymous with hours of reading, the luxury of having free time in your schedule, and books as the must-have accessory — is one of this summer’s dominant trends. Many celebrities are helping cement it through their book clubs. Since Oprah Winfrey launched her Oprah’s Book Club in the 1990s, stars like actress Reese Witherspoon and singer Dua Lipa have followed suit, creating their own — Reese’s Book Club and Service 95, respectively. Beyond recommending books each month, they foster a community of readers and a space where they share their passion for literature.

    Below are six August picks from celebrity book clubs that, thanks to their influence, land their monthly selections on bestseller lists.

    1. Dua Lipa: ‘This House of Grief’ by Helen Garner

    Whether intentionally or not, Dua Lipa is creating a new postmodern, digital literary canon — something Spotify has recognized, having hosted the singer’s literary podcast on its platform since last June. The recommendations from her book club, Service 95, are not aimed at an elite audience, nor do they include only classic authors; they are predominantly female and embrace a variety of genres.

    “I absolutely love reading, I love the idea of sharing how books make people feel… books are really important to me and if I can share that in some way, then I feel like I’m on the right track,” the artist told the British edition of Elle magazine on June 5, 2023.

    The artist’s recommendation for August is not a new release: it is the 2014 book This House of Grief by Helen Garner. The book tells the story of the murder conviction of a man accused of driving his car into a dam, causing the drowning deaths of his three children, who were in the back seat of the vehicle.

    “Helen takes us inside the real-life trial of Robert Farquharson and invites us to join her as she sits through days of detailed evidence, weeks of witness testimony and years of appeals. What she reveals along the way is not simply a courtroom drama but a sharp and forensic analysis of the human condition,” the singer said about the 300-page book in a message on Instagram, where she has 88.1 million followers.

    She continued: “This is what really drew me to Helen’s writing. She’s not looking for monsters — her interest lies with ordinary people who seem to have been pushed beyond their emotional limits. As the trial progresses, I found myself questioning my own reactions, asking myself less, Did he do it? and instead, Is it possible to have empathy for this man, even if he did the worst thing imaginable?”

    “Although Helen has been writing for almost 50 years, her work is new to me and it’s a thrilling discovery. She’s one of the most fascinating writers I have come across in recent years, and I’m sure that, like me, you’ll find yourself diving into her back catalogue,” the singer concluded.

    2. Dakota Johnson: ‘Make Your Way Home’ by Carrie R. Moore

    Actress Dakota Johnson launched TeaTime, her book club under the umbrella of the production company TeaTime Pictures, in February 2024. Its recommendations focus on debut female authors and female perspectives, aiming to create critical reading spaces.

    In August, Johnson and her followers are reading Make Your Way Home (2025), a book of 11 short stories by Carrie R. Moore. “It’s a beautiful debut collection of stories set across the American South, featuring characters who struggle to find love and belonging in the wake of painful histories,” the actress posted on the book club’s Instagram profile, which has 85,400 followers.

    The message continued: “Make Your Way Home follows Black men and women who grapple with the homes that have eluded them. A preteen pregnant alongside her mother refuses to let convention dictate who she names as the father of her child. Centuries after slavery separated his ancestors, a native Texan tries to win over the love of his life despite the grip of a family curse. A young deaconess who falls for a new church member wonders what it means when God stops speaking to her. And at the very end of the South as we know it, two sisters seek to escape North to freedom.“

    According to TeaTeim, the book “explores themes of belonging, inheritance, and deep intimacy.”

    3. Oprah Winfrey: ‘Bridge of Sighs’ by Richard Russo

    The general concept of celebrity book clubs is the same, but each host develops it in their own way. In terms of reach and infrastructure, the benchmark is Oprah Winfrey’s Oprah’s Book Club. It has been running for 28 years, recommending over 100 books, and thanks to its creator’s popularity, it boosts the sales of every selection.

    “My next pick is Bridge of Sighs by Richard Russo,“ Oprah Winfrey told her Instagram followers, where she has more than 22 million followers. ”It’s a powerful story about unrequited love, life-long friendships, epic family drama, and the grip of the past. One man’s small-town life takes a turn when a trip to Venice reopens old wounds and forgotten dreams. It makes you wonder: Can you truly overcome your destiny?”

    4. Reese Witherspoon: ‘Once Upon a Time in Dollywood’ by Ashley Jordan

    For her book club, actress and producer Reese Witherspoon selects books written by women, with women at the center of the plot and protagonists who save themselves, “because that’s what women do. No one’s coming to save us,” she told The New York Times on May 26, 2024.

    The Oscar-winning actress built an empire from Reese’s Book Club by merging it in 2017 with her media company Hello Sunshine and starting a process of acquiring and selling film and TV rights for the books she recommends. Examples of adaptations under her belt include Wild (2014), Gone Girl (2014), and the first season of Big Little Lies (2017).

    For August, she’s picked up Once Upon a Time in Dollywood (2025) by Ashley Jordan. “It’s about this Haitian-American playwright. And she’s burned out on her life in the city in New York. So she goes down to her grandmother’s tiny little cabin in Chattanooga, Tennessee, where there happens to be a very handsome guy that lives next door,” she said in a video on Instagram, where she has more than 30 million followers. “It’s funny and it’s real, and you feel like you’re talking to one of your best friends.”

    In the accompanying message, Witherspoon wrote, “Ashley’s voice is vibrant, funny, and full of heart. I read this in one sitting, it’s that good!”

    5. Emma Roberts: ‘How to Lose Your Mother’ by Molly Jong-Fast

    To share her immense love of reading, Emma Roberts founded Belletrist in 2017 with her best friend Karah Preiss. “I started posting books on my Instagram and one day I was like, We should really do this for real,” the actress told Elle magazine on April 11 of that year.

    “The most important thing for us is to keep it organic, and to always pick books that we love and believe people would want to read,” she continued. “To us it’s really about spotlighting people that excite us, and that could be someone as famous and prolific as Joan Didion or it could be someone who has never written a book before.”

    For August, Emma Roberts book club has picked How to Lose Your Mother (2025) by Molly Jong-Fast. “Molly Jong-Fast is the only child of a famous woman, writer Erica Jong, whose sensational book Fear of Flying [in 1973] launched her into second-wave feminist stardom,“ explained the Belletrist Instagram post.

    ”She grew up yearning for a connection with her dreamy, glamorous, just out of reach mother, who always seemed to be heading somewhere that wasn’t with Molly. When, in 2023, Erica was diagnosed with dementia just as Molly’s husband discovered he had a rare cancer, Jong-Fast was catapulted into a transformative year.”

    6. Natalie Portman: ‘A Different Kind of Power’ by Jacinda Ardern

    “Reading stories is one of the first ways we start practicing empathy. We feel for characters in stories as we might for ourselves or our own friends.” With these words, actress Natalie Portman welcomes everyone to her book club, Natalie’s Book Club.

    Her book club includes interviews with writers recommended by the actress and monthly book recommendations.

    “I try to find books that deepen our connection to ourselves and to each other,” she says on the website. “Seeing yourself reflected in a character can be just as eye-opening as empathizing with a character who you might not readily identify with.”

    So far, the actress has not recommended any reading for August. However, she did for last month. Her pick was A Different Kind of Power (2025), by former New Zealand prime minister Jacinda Ardern.

    “I can’t think of a better time to read Jacinda Ardern’s memoir — the story of how she became New Zealand’s 40th prime minister, but it is also a story of motherhood, vulnerability, how to lead with compassion. Thank you for writing this book and for inspiring us to reimagine what power and leadership can look like,” Portman wrote on her book club’s Instagram page, which has 175,000 followers.

    7. Jenna Bush Hager: ‘My Other Heart’ by Emma Nanami Strenner

    As a passionate reader, Jenna Bush Hager founded Read With Jenna in 2019. “Our mission is to highlight debut and diverse writers,” the Today show co-host shared with People magazine on August 4. “Diverse stories, stories that haven’t always historically been published or listened to, I think is really important… We want to make sure that all of America is really represented in the stories that we’re sharing.”

    Authors featured on Read With Jenna range from Toni Morrison to Sandra Cisneros.

    For this August, Bush Hager has chosen My Other Heart (2025) by Emma Nanami Strenner: “This novel is full of motherhood and friendship and identity and loss — I fell in love with each character and was grasping for more with every chapter,” she said in a message on Instagram.

    She continued: “Set between Pennsylvania and Japan, the story follows a mother who was devastatingly separated from her daughter, and two best friends on the brink of adulthood, each searching for where they come from—and where they belong. When the three paths finally intersect in an unforgettable climax, we are left with a story full of heart, honesty, and power. It’s intelligent, moving, and just so gorgeously written.”

    Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition


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  • China Sends Houthis Dual-Use Technology to Boost Influence and Undercut the US • Stimson Center

    China Sends Houthis Dual-Use Technology to Boost Influence and Undercut the US • Stimson Center

    Editor’s Note: Mohammad Salami, a Pakistani academic, has written for Stimson in the past on Iran’s energy woes, its efforts to control Internet access, and the role of sanctions in limiting its ability to function as a hub for trade.

    By Barbara Slavin, Distinguished Fellow, Middle East Perspectives Project

    China has adopted a pragmatic approach to the Houthis in Yemen, balancing economic and security interests with minimal direct involvement to maintain a controlled level of instability that protects its shipping interests in the Red Sea at the expense of the U.S. and its allies.

    “Why would China help us address the Houthis problem when it obviously distracts and depletes us?” Elbridge Colby, then the incoming administration’s nominee for Under Secretary of Defense for Policy, asked in October 2024 while analyzing Chinese policy toward the Yemeni group.

    China has not given formal recognition to the Houthis, a militant faction that has taken control of much of Yemen since 2014. But by providing the Houthis with dual-use technologies such as satellite imagery and drone components, Beijing complicates U.S. maritime security efforts.  

    To manage this delicate position, China employs indirect diplomacy and dual messaging: avoiding direct criticism of the Houthis while emphasizing civilian ship protection. For instance, in January 2024, China refrained from blaming the Houthis for Red Sea instability but called for maritime safety. In February of that year, it deployed its 46th Navy Fleet to the region, yet abstained from a UN resolution condemning the Houthis just a month earlier.

    Overall, China’s strategy is built on three pillars: securing commercial interests in the Red Sea, countering U.S. influence, and coordinating with regional powers such as Saudi Arabia.

    China views economy and trade as central to its national interests, and any threat to commercial routes is treated with strategic urgency. With over 60 percent of European Union-China trade passing through the Suez Canal, the Red Sea’s security is critical for Beijing. While many countries have rerouted ships via the Cape of Good Hope — incurring two-week delays, nearly $1 million in added fuel costs per trip, and a 30 percent increase in overhead — China has adopted a different strategy to secure safe passage for its vessels.

    Reports, including documents from the U.S. Treasury’s Office of Foreign Assets Control (OFAC), suggest Chinese coordination with Iran, which backs the Houthis, or directly with senior Houthi figures such as Mohamed Ali Al-Houthi to ensure that Chinese ships are not targeted. This quiet understanding has paid off for Beijing. Despite an 85 percent drop in general Red Sea shipping and a 66 percent decline in Suez Canal traffic, Chinese shipping tonnage has significantly increased, according to Lloyd’s List data as of January 2024.

    The collapse in March 2025 of a brief Gaza ceasefire has not deterred owners and operators from returning to the Red Sea. Total volumes, measured by gross tonnage, almost doubled in the first quarter of this year as steeply discounted Russian and Iranian oil competed to supply the Chinese market.

    By leveraging its ties with the Houthis, China has transformed the Red Sea crisis into an opportunity, gaining a competitive economic edge over global rivals. As noted as early as late 2023 by the South China Morning Post, China’s reluctance to join US-led maritime patrols stems from this strategic advantage: Why participate in securing a route that currently serves as a benefit? Ultimately, Beijing has used the Red Sea disruption to outmaneuver competitors and expand its influence in global trade without direct military involvement.

    Challenging the US

    China views the Middle East — particularly Yemen, Gaza, and the Red Sea — as a key arena in which to test and challenge the US-led global order. Beijing sees Yemen not only as a place to assert solidarity with the Palestinians, on whose behalf the Houthis say they are conducting their maritime attacks, but also as a strategic zone for advancing geopolitical competition with the United States. Its policy toward the U.S. is guided by three “no’s”: no cooperation, no support, and no direct confrontation. This helps China maintain plausible neutrality while still undermining the Western rules-based system.

    In China’s view, the global order — especially amid an ongoing US-China trade war — is no longer fair. Beijing believes a shift toward a more multipolar international structure is both necessary and inevitable. In this context, China sees the Houthis and Yemen’s capital city of Sana’a as important strategic pieces in reshaping regional alignments. The instability caused by Houthi actions is not necessarily viewed negatively by China, especially if it weakens the perceived credibility and control of the United States.

    While avoiding open defiance of U.S. sanctions, China has been linked to material support for the Houthis: In April 2025, the U.S. sanctioned Chang Guang Satellite Technology Company for providing satellite imagery to the Houthis, threatening U.S. interests in the Red Sea. In August, Yemeni authorities in Aden found drone kits on a commercial ship that originated in China.

    At the same time, China benefits from continued U.S. military entanglement in the Middle East, which prevents Washington from fully pivoting to Asia. U.S. involvement in Middle East conflicts, China believes, weakens U.S. focus on more critical fronts for Beijing, such as the South China Sea and Taiwan. Meanwhile, China’s stance on the Red Sea mirrors its approach to Gaza: discredit U.S. policies, emphasize neutrality, and appeal to Arab and Global South audiences.

    China’s stance toward the Houthis has also shifted in response to changing regional dynamics, particularly the recent de-escalation between Arab states and Iran. Previously aligned with Saudi Arabia and the United Arab Emirates — its key economic partners — Beijing has adopted a more pragmatic approach now that those states have distanced themselves from direct conflict with the Houthis. This shift reflects a strategy of moving from a passive “wait and see” stance to actively exploring potential gains from the new regional balance.

    The Houthis, meanwhile, view China favorably, seeing it as a powerful, anti-imperialist force aligned against U.S. dominance. This perception enhances China’s political leverage and provides an opening for greater involvement in Yemen’s economy. The Houthis hope China will invest in their territories and incorporate them into Beijing’s broader regional economic initiatives. Houthi political bureau member Ali al-Qahoum has voiced support for deeper cooperation with China, Russia, and the BRICS nations as a way to undermine U.S. power and help dismantle the unipolar world order.

    China’s policy has evolved from one of neutrality to a form of “silent support” — quietly backing the Houthis while avoiding overt confrontation with international norms. This shift is grounded in China’s economic interests, alignment with regional de-escalation efforts, and opposition to U.S. influence in the Middle East. However, Beijing faces a delicate balancing act if the Houthis grow increasingly destabilizing and regional tensions, especially between Iran and Israel, continue to rise.

    Dr. Mohammad Salami is a research associate at the International Institute for Global Strategic Analysis (IIGSA). His areas of expertise include politics and governance, security, and counterterrorism in the Middle East, especially the Persian Gulf region. @moh_salami

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  • NASA’s Hubble Telescope captures cosmic tarantula in never-seen-before photos

    NASA’s Hubble Telescope has captured stunning, never-seen-before imagery of a cosmic tarantula located 161,000 light-years away.

    The breathtaking photography caught 30 Doradus, nicknamed Tarantula Nebula because of its dusty filament, in staggering detail, including a cluster of young stars shining pale blue.

    Located in the Large Magellanic Cloud, a small satellite galaxy of the Milky Way, the Tarantula Nebula is a giant star formation where new stars are born in huge numbers.

    It spans across roughly 1,000 light-years, making it the biggest and brightest star-forming region in our local group of galaxies, meaning it’s a firm favourite among star gazers and astronomers studying the formation of stars.

    On 11 August, NASA took to Instagram to share a never-seen-before photo of the extraordinary cosmic tarantula which perfectly shows where it earned its title.

    “Don’t get caught in the Tarantula Nebula. See the thin filaments of gas and dust that snake through this image like a web? That’s where the Tarantula Nebula gets its name,” the agency wrote in the caption.

    “Located about 160,000 light-years from Earth, in the Large Magellanic Cloud (a small galaxy orbiting our own Milky Way), the Tarantula Nebula is the largest and brightest star-forming region in our area. It’s home to the biggest stars we’ve ever discovered, some 200 times more massive than the Sun.”

    The Hubble Space Telescope has spent a lot of time studying the the Tarantula Nebula, ‘not just for its stunning sights, but for what it can tell us about how stars are born’.

    Back in 2022, NASA released breathtaking images of the same star formation from the James Webb Telescope, which led to a revelation for astronomers regarding the age of certain stars.

    Tarantula Nebula star formation captured in 2022 (NASA, ESA, CSA, STScI, Webb ERO Production Team)

    Tarantula Nebula star formation captured in 2022 (NASA, ESA, CSA, STScI, Webb ERO Production Team)

    In the centre of the image is a cavity, caused by a group of very large, young stars which are blasting intense light and strong winds of particles.

    The only parts of the nebula that can survive this blasting are the densest clumps of gas and dust. Those tough clumps are getting slowly sculpted into long pillar shapes that seem to point toward the star cluster.

    Within the pillars are baby stars, called protostars, which remain wrapped in thick cloud of dust that they will eventually break free from, before shaping the nebula themselves.

    One very young star was caught doing exactly this by Webb’s Near-Infrared Spectrograph, proving astronomers who believed the star to be slightly older wrong.

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  • Last-gasp shot secures Iceland quarter-finals berth, Czechia enhance chances with big win over Japan

    Spain led by one goal with 20 seconds left in a crucial match against Iceland, but conceded two goals in the last 16 seconds to concede a 32:31 loss against the Nordic side. Both teams qualified to the quarter-finals, at Serbia’s expense.

    In Group IV of the main round, Czechia needed to erase a 13-goal deficit against Egypt and they did their part, securing a 42:27 against Japan, forcing the hosts to take at least a point against Denmark to qualify for the quarter-finals.

    Main round
    Group II 
    Spain vs Iceland 31:32 (15:15)  

    Spain struggled in the opening minutes, unable to find clear shooting positions. When Jens Sigurdarson added two more saves to his tally, Iceland capitalised to break away and open a four-goal lead. It was clear Spain needed a tactical shift, which arrived after a time‑out.  

    Switching to a 5–1 defence, Spain began to disrupt Iceland’s rhythm, successfully isolating their centre back. That defensive change paved the way for a comeback, and midway through the first half Sergio Sánchez Vidán scored to make it 8:9.  

    Spain kept pressing, looking to push Iceland to a breaking point. When they finally levelled at 11:11, the match was back on even terms. With both sides showing 54% attacking efficiency, the statistics told the story of a first half that was evenly matched — Spain growing stronger towards the break, and Iceland losing a touch of focus.  

    Spain’s momentum carried into the second half, as they opened with a 2:0 run to claim a 17:15 lead — their first of the match. From there, it became a nip‑and‑tuck battle, with both sides briefly holding narrow leads, underlining the high stakes.  

    The drama continued right to the end. Goalkeeper Sigurjón Bragi Atlason stood tall for Iceland when they needed him most, turning a 24:25 deficit into a 28:27 lead. But nothing could prepare the crowd for the final twists.  

    The title holders stole possession twice in quick succession, punishing Iceland for playing without a goalkeeper and snatching the lead at 31:30. Iceland levelled again, and then one costly Spanish mistake — a missed shot on an empty goal — left the door open. With just seven seconds remaining, Ágúst Gudmundsson struck for his ninth goal of the match, almost on the buzzer, sealing two vital points for Iceland.  

    The result pushed both teams into the quarter-finals, eliminating Serbia before their final group game against Saudi Arabia.  

    Player of the Match: Ágúst Gudmundsson (Iceland)  

    Group IV
    Japan vs Czechia 27:42 (12:19)

    Missing out on a win against Egypt was always going to be costly for Czechia, which had a three-goal lead with three minutes left on the clock in the main round opener. But the European side still had a fighting chance.

    First, they needed to win against Japan. Then, they needed Egypt to lose against Denmark. And in the process, a 13-goal difference had to be wiped out, as the African champions enjoyed bigger wins against their opponents.

    Easier said than done for Czechia, but they surely threw off  the match knowing exactly what they needed, as they were leading 11:4 after 15 minutes. Sure, Japan were in no man’s land after their previous losses, but they still produced some high-quality handball throughout the competition.

    And Czechia continued to pounce, continously finding new sollutions in attack, until they hit a wall and failed to score for five minutes and 21 seconds. A Japan 3:0 run cut the gap to only four goals, 14:10, but at the end of the first half, Czechia were still running away with the win, leading 19:12, and applying some pressure to Egypt.

    There was still a mountain to be climbed, as at that point the gap was only six goals to Egypt, which were slated to end the day against Denmark, therefore every possible goal was important for the European side, which missed some crucial chances to open the first eight-goal lead between the 34th and the 36th minutes.

    A 7:2 run, though, fueled by two goals from Daniel Mahušek and Ondřej Šíma, helped Czechia exert even more pressure in their duel with Egypt, as they opened up a 11-goal lead, 31:20, with 12 minutes to go, playing their part excellently in order to boost their chances of progression to the quarter-finals.

    Not only Czechia did cancel Egypt’s advantage in goal difference, they did it in style, with seven of their goals coming on fast breaks, while probably delivering their best attacking performance of the competition, finishing the match with a 70% attacking efficiency, while goalkeeper Kryštof Pleva had 15 saves, for a 38% saving efficiency.

    The 42:27 Czechia win means that the European side improved drastically their chances of progression, needing only Denmark to win against Egypt, to secure their maiden quarter-finals appearance at the IHF Men’s Youth World Championship.

    Japan’s third consecutive loss sees the Asian side now heading to the Placement Matches 13-16, where they are due to face Saudi Arabia.

    Player of the Match: Ondřej Šíma (Czechia)

    President’s Cup
    Group III
    Faroe Islands vs Argentina 26:26 (15:14)

    The Faroe Islands made a strong start against Argentina in their bid for a second President’s Cup victory, and for almost 20 minutes, it looked well within reach. In that spell, the Faroese led by as many as four goals (12:8), using a 7‑on‑6 attack to maintain their advantage.  

    However, late saves from Simon Viera and a series of rushed Faroese attacks stalled what had been an impressive half. Argentina found fresh energy, stepped up a gear, and in the closing stages of the first period, narrowed the gap to just one goal — setting up a fascinating second half.  

    Argentina levelled early after the restart and, driven by their top scorer Nicolás La Delfa, claimed their first lead since the opening minutes. The Faroe Islands lacked the sharpness to wrest control back, while Argentina pressed hard for what would have been a notable win at Egypt 2025.  

    With ten minutes remaining, the teams were locked at 21:21, but this time it was the Faroe Islands chasing as Argentina edged closer to victory. Yet in the very last second, Rúnar Hammer stunned the South Americans with a decisive strike to secure a draw.  

    The Faroe Islands will continue in the Placement Matches 17–20, while Argentina move on to the Placement Matches 21–24.  

    Player of the Match: Rúnar Hammer (Faroe Islands)

    Group IV
    Bahrain vs Tunisia 29:29 (15:16)

    Thanks to Mohamed Abdulhusan’s string of saves in the closing minutes, Bahrain salvaged a draw against Tunisia. However, it was the African side who topped the group on goal difference and will continue fighting for the President’s Cup in the Placement Matches 17–20, while Bahrain will proceed to the Placement Matches 21–24.

    While his Tunisian colleague Mohamed Chabchoub made 11 saves and was named Player of the Match, Abdulhusan had a big impact in the last quarter of the game after coming on as a substitute. He saved six of eight shots for a 75% save rate, denying the African side a single goal in the last 10 minutes.

    The opening half featured a very tight contest, as neither team could pull clear by more than two goals. Bahrain were the better side in the opening minutes, taking a 4:2 lead, but Tunisia held a 14:12 advantage nearly six minutes before the break.

    Two goals from Ali Aryash then launched Bahrain’s 3:0 run, handing them a 14:14 lead. But the African side netted twice in the closing minute of the half, heading to the dressing room with a one‑goal cushion.

    The pattern of the game did not change after the restart, as both rivals took turns in the lead but were unable to create even a two‑goal gap for a long time. When Bahrain missed a few shots — including one from the seven‑metre line — Tunisia gained momentum, and a strong 5:0 run saw them take a 28:23 lead with 12 minutes remaining.

    But the fight was not over. Abdulhusan’s vital saves, combined with Salman Alshowaikh’s goals, helped Bahrain draw level in the 58th minute. However, neither team could score in the remaining time, and they ultimately shared the spoils in this thriller.

    Player of the Match: Mohamed Chabchoub (Tunisia)

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  • Michelin-Starred Chef Giorgio Locatelli on His New Caravaggio-Inspired Cuisine

    Michelin-Starred Chef Giorgio Locatelli on His New Caravaggio-Inspired Cuisine

    Art

    Maxwell Rabb

    Portrait of Giorgio Locatelli in front of Caravaggio’s Supper at Emmaus (ca. 1601). Photo by Lisa Linder. Courtesy of the National Gallery.

    For the Michelin-starred chef Giorgio Locatelli, the most important thing a restaurant can serve isn’t a dish or a perfect wine pairing but the feeling of eating among others. “The sharing of food—the sense of conviviality—is something that makes us feel better,” he told Artsy recently over the phone.

    A similar sentiment could apply to the collective ritual of viewing art at museums: people gathering in one place, drawn by beauty and history. At his new eponymous restaurant at London’s eminent National Gallery, Locatelli hopes to provide guests an opportunity to experience “quietness and relaxation” after exploring the museum’s collection, which includes the likes of Paul Cézanne through to Canaletto and J.M.W. Turner. With his menu, Locatelli hopes to complement the visual stimuli. “The flavor is what is needed here, just to equalize, as I say, the stimulation that you get in the gallery, which is very visual,” he said. “I want to do that with the taste.”

    Interior view of Locatelli at the National Gallery. Photo by Lisa Linder. Courtesy of the National Gallery.

    Doing things with taste is something Locatelli knows a thing or two about. Acclaimed for his refined cooking that blends traditional recipes with contemporary presentation, Locatelli is among the most celebrated Italian chefs working today. His roots in London’s food scene run deep. He was awarded Michelin stars for his two restaurants in the city: Locanda Locatelli, opened in 2002, and Zafferano, opened in 1999. He’s also a frequent presence on television and bestseller lists, and now he’s taking his renowned gastronomy into one of London’s most hallowed institutions.

    The 80-seat restaurant—which is accompanied by an espresso and maritozzi bar named Bar Giorgio—is situated in the newly restored Sainsbury Wing of the gallery, which houses masterworks like Sandro Boticelli’s Venus and Mars (ca. 1485) and Matteo di Giovanni’s The Assumption of the Virgin (ca. 1474). But despite the lofty surroundings, Locatelli’s aims to “lighten up a little bit” with a menu he describes as “democratic and commercial.” Critics seem to agree: “Come for the The Entombment by Michelangelo […] and stay for the orecchiette with nettle pesto on the first-floor mezzanine next to the gift shop,” wrote The Guardian’s Grace Dent in a recent review.

    The restaurant’s launch prompts the notion of the chef as artist: After all, chefs combine creativity, technique, and sensory expression to create something that engages people emotionally and aesthetically. One could argue that instead of canvas and clay, their medium is food…

    Locatelli gently pushes back against the characterization. “I never felt like an artist. I felt like an artisan—somebody that can express his emotion through the dishes, or his experiences of life through the dishes,” he clarified. Chefs are too pressed for time, too pressured by costs, and too restricted by delivery to access the same type of creativity as an artist, he says. But art does play a core role in his approach to the restaurant.

    Take Michelangelo Merisi da Caravaggio’s The Supper at Emmaus (1601), one of the leading lights in the National Gallery’s collection. The colossal masterpiece depicts a risen Jesus Christ seated at a simple wooden table with two disciples, captured the instant they recognize him. Harsh light sharpens the scene—their startled gestures, the bread and fruit, and the jutting basket—while Christ’s open hand and the warm, domestic setting give the moment a striking sense of invitation. “The fact that you don’t need to be cultured, you don’t need to be rich, you don’t need to be something in order to see God,” Locatelli observed. The basket teeters at the table’s edge, he notes, “so you are invited to be part of this scene.”

    The restaurant serves a loaf of bread whole, a subtle nod to the loaf at the edge of the table in Supper at Emmaus. The intention is for it to be broken and passed around the table. “It’s one piece of bread…you open it up and give a piece to everybody who’s having dinner with you,” he said.

    This September, Locatelli will go a step further and debut a menu inspired by Caravaggio in commemoration of the artist’s 454th birthday.

    Interior view of Locatelli at the National Gallery. Photo by Lisa Linder. Courtesy of the National Gallery.

    Servings will be drawn directly from the painter’s life and imagery. The tasting menu opens with an artichoke dish in a nod to a notorious incident in which Caravaggio smashed a plate into a waiter’s face after a quarrel over how the vegetable was prepared. The main course references the still-life elements embedded in Caravaggio’s paintings, particularly the chicken on the table of Supper at Emmaus. Locatelli’s version features guinea fowl with grapes, a combination drawn from the textures and colors of the fruit and meat in the dramatic painting. Dessert is still taking shape, but Locatelli envisions it as the most theatrical plate of the evening, “bloody” in color, with chiaroscuro-like shadows worked into the presentation. “That was the painting that really inspired me, because it was an expression of the moment,” he said.

    Beyond Caravaggio, art is a continual source of inspiration and engagement for Locatelli. “A lot of artists really have great respect for chefs because the artist wants to produce an emotion when he makes his art,” Locatelli said. “Food is part of life. Life is part of art. Art is part of food and so on.”

    Portrait of Giorgio Locatelli. Photo by Lisa Linder. Courtesy of the National Gallery.

    While he jokes that “I don’t even have enough space in my house,” Locatelli notes that he owns a spinning painting by Damien Hirst, gifted to him after he cooked a private dinner for the artist. He names British artists Gary Hume and Rebecca Warren, as well as contemporary Italian sculptor Jago, among the artists he admires most. In Naples, Locatelli met Jago, who is known for realistic marble sculptures, and he left a particular impression. “To see this big piece of marble turning into sculpture was one of the most incredible experiences in my life,” Locatelli said.

    Locatelli often draws on art for ideas: Joan Miró’s “practicality” and dynamic compositions sparked new ideas for plating dishes, and John Constable’s layered greens, which are delicately depicted in his famed landscapes, once inspired a salad. “There was such a beauty on this green coming out,” he recalled, saying that he immediately “really tried to get by using natural color.”

    Photo by Lisa Linder. Courtesy of the National Gallery.

    Ingredients, for the chef, are themselves works of art: “The greatest artist overall is nature. Nature is the greatest artist that we can ever imagine.” For Locatelli, food and art are meant to be shared experiences. Just as the basket in Caravaggio’s scene seems to extend toward the viewer, inviting them in, a museum invites people to stand side by side before a work; a table invites them to sit together over a meal.

    “[We] try to really celebrate this great sense of conviviality, which is something that puts us on a different level than every other mammal, where the biggest guys eat first, the other ones eat after,” Locatelli said. “As humans, we have been sharing our food.”

    MR

    MR

    Maxwell Rabb

    Maxwell Rabb is Artsy’s Staff Writer.

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  • Why trusting the process is my thing

    Why trusting the process is my thing

    Her U.S. Classic to U.S. Championships process has been out in the open.

    But Rivera has also made changes behind the scenes, one of the most notable coming on the vault.

    After struggling with keeping her head in while she twisted – something that can make a gymnast get “caught up” in the air and stop spinning – Rivera took a unique step back, opting to train Yurchenko one-and-a-halves instead of her typical double twist.

    Because of the different amount of rotation required for the two vaults (the one-and-a-half requires more because of its forward landing), gymnasts who compete double twists often only train full-twisting variations, not the one-and-a-half.

    But for Rivera, something clicked.

    “I know it sounds kind of crazy, but it helps my mind a lot,” she said. “I wasn’t blocking really, it was kind of mental. But right when I started going through the one-and-a-half, I kind of flipped the switch.”

    Her turn in Paris has flipped another switch: her confidence level.

    Rivera says even just watching Biles, Lee, Jordan Chiles and Jade Carey in practice taught her important lessons.

    “I still talk to them, and they give me really good advice,” she says of her Paris teammates. “They just tell me to do myself, do what I do in the gym and believe in myself.

    “The way that they practised helped me, too,” Rivera continued. “They look so confident, and they’re like, ‘Oh, I know I’m gonna hit,’ so it kind of gave me that confidence as well. It’s really been helping me this year.”

    Her journey is far from over – even this year, as she prepares for October’s World Championships in Jakarta. But one thing’s for sure: Rivera’s faith and belief in her process will continue to carry her forward as she leads Team USA into the future.

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  • Exploring the Association of Antimicrobial Use with Serratia marcescen

    Exploring the Association of Antimicrobial Use with Serratia marcescen

    Introduction

    Serratia marcescens a facultative anaerobic Gram-negative bacillus belonging to the Serratia genus within the Enterobacteriaceae family, is a significant opportunistic pathogen in hospitals. Widely distributed in hospital environments, S. marcescens is hard to fully eradicate via physical or chemical disinfection. Its high virulence enables it to cause respiratory, urinary tract, bloodstream infections, meningitis, and surgical site infections, especially in patients undergoing invasive procedures, surgeries, with weakened immunity, or experiencing trauma.1 It spreads rapidly among hospitalized patients and has triggered numerous nosocomial outbreaks.2,3 According to CHINET data,4,5 the detection rate of S. marcescens increased from 0.99% (2483 strains) of all clinically isolated strains in 2019 to 1.15% (5120 strains) in 2023, marking a 16.16% rise. In recent years, the emergence of multidrug-resistant S. marcescens, including those resistant to carbapenems,6,7 has made detecting and controlling its spread a tough challenge.

    Currently, international data on the evolution of resistance in S. marcescens relative to antimicrobial exposure are limited, and this is also a relatively unexplored area in the research of S. marcescens. Antimicrobial selective pressure is a key driver of bacterial resistance. Our research endeavors to innovatively explore the macro-level quantitative relationship between the two. Theoretically, antimicrobial use precedes bacterial resistance.8,9 This study will explore the correlation between S. marcescens resistance rates and antimicrobial Defined Daily Doses (DDDs) from the previous quarter, aiming to inform strategies for curbing S. marcescens resistance and optimizing antimicrobial use in clinical practice.

    Materials and Methods

    Strain Source

    S. marcescens strains isolated from patients (2021–2024) were collected under strict aseptic conditions, including sputum, throat swabs, bronchoalveolar lavage fluid, blood, urine, pleural effusion, peritoneal effusion, and drainage fluid, and cultured according to the National Clinical Laboratory Procedures (4th edition).10 For identical strains isolated multiple times from a single patient sample, only the initial susceptibility result per drug was retained. Colonizing or contaminating strains were excluded to avoid confounding true pathogens, based on at least two of the following clinical-microbiological discordance criteria: (1) Absence of infection-related symptoms (eg, fever, purulent discharge, leukocytosis, or imaging findings); (2) Clinical improvement despite in vitro resistance to empiric antibiotics; (3) Spontaneous resolution without antibiotic therapy. The quality control strains used were Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853, provided by the Clinical Laboratory Center of the National Health and Family Planning Commission. The study was approved by the Hospital Ethics Committee (NO. 2025-L104) (In Q1 2021 and Q3 2023, our hospital did not perform statistical analysis due to insufficient S. marcescens detections).

    Strain Identification and Antimicrobial Susceptibility Testing

    Strain identification and susceptibility testing were performed using the VITEK-2 system (BioMerieux, France) and validated by the Kirby-Bauer disk diffusion method. Quality control included: (1) daily calibration with control strains (Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853); (2) retesting ≥5% of strains per batch (minimum 5 strains); (3) recalibration and data review if results deviated from CLSI 2024 standards.11 Results were interpreted as susceptible, intermediate, or resistant, with resistance rate calculated as the percentage of resistant strains among total strains. Testing was conducted by our hospital’s microbiology lab, with data managed by the Infection Control Department.

    Antibacterial Drug Usage Data

    The hospital HIS rational drug use system collects data on the use of antibacterial drugs. The WHO-defined daily dose (DDD) serves as the standard reference for calculating antimicrobial agents’ consumption in DDD units. DDDs quantify prescribing frequency, with higher values indicating stronger clinical preference for an agent. The calculation formula is as follows:

    DDDs = Annual drug total consumption/Drug DDD value.

    Data Analysis

    Data analysis used SPSS 27.0 and R 4.5.1: (1) Pearson correlation analysis (significance level α=0.05) was conducted to assess the relationship between the resistance rate of S. marcescens and DDDs of antimicrobials. (2) Multiple linear regression was used to explore independent, linear correlations. The model used S. marcescens resistance rate as the dependent variable and statistically significant antimicrobial DDDs from the previous quarter as independent variables. The stepwise method was applied for variable selection. It requires linear relationships, independent and normally distributed residuals, homoscedasticity, and no multicollinearity among independent variables. (3) The final regression model is subjected to threefold validation. Bayesian analysis used Markov Chain Monte Carlo (MCMC) simulation (10,000 iterations; weakly informative priors) in SPSS 27.0. Significance required: 95% credible interval excluding zero and posterior probability >0.95. Bootstrap Validation: Conduct 3000 BCa resamples; require original coefficient within 95% CI and CI not crossing zero. Winsorized Regression: Apply 1% bilateral winsorization, re-model. Accept if |Δβ%|<10% and p<0.05 remains significant (Δβ% = [(β_winsorized − β_original)/β_original] × 100%) and the significance level (p<0.05).

    Results

    Isolation Rate of S. marcescens

    In the past four years, 16190 strains of pathogens were detected in our hospital, among which 522 strains of S. marcescens were isolated, accounting for 3.22% of the total number of bacteria. The total χ² value was 16.365, less than the critical value (21.026), P>0.05, and there was no significant difference in the isolation rate of S. marcescens. The total number of pathogens and S. marcescens detected in each quarter are shown in Table 1. It can be seen that the detection rate of S. marcescens is 1.96%–4.35%. Of the 522 isolates of S. marcescens, 452 (86.59%) came from respiratory tract, 31 (5.94%) from blood flow, 29 (5.56%) from urine, and the remaining 10 (1.91%) from other sources. According to the statistics of the departments submitted for examination, the top 3 departments with the number of isolates of S. marcescens were 265 (50.77%) in surgery, 139 (26.63%) in ICU and 85 (16.28%) in internal medicine.

    Table 1 Detection of Serratia marcescens

    Usage of Antibacterial Drugs

    The DDDs of commonly used antimicrobial agents in the past four years are shown in Table 2.

    Table 2 The DDDs of Commonly Used Antimicrobial Agents

    β-lactam antibiotics continue to dominate, with high DDDs for piperacillin tazobactam, cefoperazone-sulbactam, and levofloxacin. Over the four years, the usage of cefuroxime, piperacillin-tazobactam, and gentamicin showed a significant upward trend.

    Drug Resistance of S. marcescens

    The isolates of S. marcescens were highly susceptible to amikacin and tigecycline, with resistance rates below 5%. They also showed susceptibility to piperacillin-tazobactam, ceftazidime, ertapenem, imipenem, meropenem, trimethoprim-sulfamethoxazole, and tigecycline, with resistance rates below 10%. Resistance to cefuroxime exceeded 90%, while resistance to amoxicillin-clavulanate remained above 60%. From 2021 to 2024, resistance rates to ceftriaxone, ceftazidime, cefoxitin, imipenem, meropenem, ertapenem, and ceftazidime decreased overall, while resistance to levofloxacin increased. For more details, as shown in Table 3.

    Table 3 Drug Resistance of Serratia marcescens

    Pearson Correlation Analysis

    Pearson correlation analysis showed that S. marcescens resistance to ceftazidime, cefoperazone-sulbactam, and imipenem correlated with the DDDs of multiple antibiotics. In contrast, resistance to amoxicillin-clavulanic acid, cefuroxime, cefoxitin, cefepime, amikacin, and levofloxacin each correlated with only one antibiotic’s DDD (Table 4).

    Table 4 Correlation of Serratia marcescens Resistance Rates (Columns) with Antibiotic DDDs (Rows)

    Table 5 Linear Regression Analysis of Serratia marcescens Resistance and DDDs

    Correlation Analysis

    To assess independent linear correlations, we utilized multiple linear regression models. Models 1–3 included multiple independent variables, while Models 4–9 incorporated single independent variables. Table 5 shows the key parameters and test values for each regression model: regression coefficients (β) quantify the impact of independent variables on the dependent variable (p<0.05 indicates significance), the F-value assesses overall model significance, VIF<5 demonstrates low multicollinearity, R² represents explanatory power, and a Durbin-Watson value near 2 confirms residual independence. Diagnostic plots for Models 1–3 are shown in Figures 1–3. The standardized residual histograms (Figures 1a, 2a and 3a) approximate a normal distribution across all groups. The normal probability (P-P) plots (Figures 1b, 2b and 3b) demonstrate points clustering closely along the diagonal line, confirming the normality of residuals. The residual scatter plots (Figures 1c, 2c and 3c) show evenly distributed points within the ±3 range for all groups, indicating homoscedasticity and absence of influential outliers.

    Figure 1 Regression diagnostic plots for Model 1. (a). Histogram of standardised residuals (normality assessment), (b). Normal Q-Q plot (residual normality verification), (c). Scatterplot of Residuals versus fitted values (homoscedasticity assessment).

    Figure 2 Regression diagnostic plots for Model 2. (a). Histogram of standardised residuals (normality assessment), (b). Normal Q-Q plot (residual normality verification), (c). Scatterplot of Residuals versus fitted values (homoscedasticity assessment).

    Figure 3 Regression diagnostic plots for Model 3. (a). Histogram of standardised residuals (normality assessment), (b). Normal Q-Q plot (residual normality verification), (c). Scatterplot of Residuals versus fitted values (homoscedasticity assessment).

    Robustness Verification

    The final regression model is subjected to threefold validation (Table 6). Multiple robustness validations consistently demonstrated negative correlations for IPM-RR/GEN, CFS-RR/GEN, CFX-RR/TZP, and FEP-RR/CXM. Bayesian posterior means were less than zero (95% HPD excluding zero), Bootstrap confidence intervals were entirely negative, and Winsorized regression coefficients were highly consistent with the original model, with minimal changes such as +0.41% for IPM-RR/GEN.

    Table 6 Robustness Verification

    The robustness validation for the AMC-RR/MEM and LVX-RR/GEN groups supports the original positive trend. Bayesian analysis shows posterior means significantly greater than zero, and Winsorized regression reinforces this with positive coefficients and confidence intervals excluding zero. Bootstrap results are borderline, primarily reflecting insufficient estimation precision rather than a change in effect direction. All three validation methods have consistent positive point estimates, with effect sizes exceeding the clinical threshold (|β| > 0.02), confirming the biological validity of the positive trend.

    The triple validation showed consistent negative trends for CAZ-RR/TZP, CXM-RR/TZP, and AMK-RR/TZP. Bayesian and Winsorized regression results were statistically significant, while Bootstrap analysis results were borderline, reflecting limited estimation accuracy due to the sample size. The effect sizes were small (|β| < 0.005) and did not reach the clinical threshold (|β| > 0.02), but the consistent trends warrant validation through enhanced analytical approaches in future investigations.

    Discussion

    S. marcescens, first identified in 1819 by Venetian pharmacist Bartolomeo Bizio, was initially seen as a low-pathogenicity environmental saprophyte. However, its pathogenic potential was revealed in the 1950s through fatal urinary tract infections. It can cause infections in multiple systems, including respiratory, neurological, abdominal, cardiovascular, musculoskeletal, and ocular.12 Recently, S. marcescens has gained attention as an emerging pathogen worldwide, provoking infections and outbreaks in debilitated individuals, particularly newborns and patients in ICU.13 S. marcescens resists disinfectants, persists in the environment, and colonizes medical devices and surfaces. Its invasiveness and antimicrobial resistance make it a major hospital-acquired pathogen.

    In the past four years, a total of 522 strains of S. marcescens were detected in our hospital, accounting for 3.22% of the total bacterial count in the hospital. The clinical isolated samples of S. marcescens mainly come from the respiratory tract, accounting for 86.59%, and the proportion of samples from blood, urine, secretions, ducts, etc. is relatively small. This suggests that when the immune system is weakened, the respiratory tract is a common site for S. marcescens infection, calling for clinical prevention and control. This finding aligns with relevant literature.14,15 The presence of S. marcescens can exacerbate the condition of patients with compromised immune systems.16 Furthermore, studies have indicated that this bacterium may lead to severe acute infections, resulting in respiratory distress even in individuals with normal immune function.17 S. marcescens is mainly found in surgical and intensive care unit (ICU), emphasizing the need for better infection control. This aligns with Chen Jian et al’s findings.18 Major risk factors include serious underlying diseases, major surgeries, ventilator use, tracheostomies, invasive exams, and prolonged high-dose antibiotics, which are common among ICU and surgical patients.

    S. Marcescens contains R factors or R plasmids that can carry multiple resistance genes, leading to its natural resistance to first generation cephalosporins, ampicillin, and macrolides.18 The study showed that S. marcescens had a resistance rate of over 90% to cefuroxime and a high resistance rate to amoxicillin-clavulanic, consistent with Li Jin et al.19 The isolated strains of S. marcescens showed sensitivity to cefoperazone-sulbactam, cefepime, ertapenem, imipenem, meropenem, amikacin, trimethoprim-sulfamethoxazole, and tigecycline, with a resistance rate of less than 10%, consistent with previous reports.20 S. marcescens shows high sensitivity to amikacin and tigecycline, with resistance rates below 5%. Compared with the national data of bacterial resistance monitoring in CHINET in 2023,4 the resistance rate of 522 strains of S. marcescens to cefuroxime is slightly higher than the national average level. The drug sensitivity results to ceftriaxone, ceftazidime, levofloxacin, amikacin, trimethoprim-sulfamethoxazole, and tigecycline are relatively consistent with the national data, while the resistance rate to cefepime, cefoxitin, cefoperazone-sulbactam, ertapenem, imipenem and meropenem is lower than the national level. Clinically, third-generation cephalosporins, aminoglycosides, and quinolones treat S. marcescens infections, with carbapenems for severe MDR strains. Overuse of carbapenems has coincided with an increasing detection rate of carbapenem-resistant S. marcescens, hindering control and treatment.21 Notably, studies demonstrate that S. marcescens exhibits intrinsic resistance to polymyxins. Studies show S. marcescens is naturally resistant to polymyxins,6 if it also produces carbapenemases, treatment gets harder.22 Clinicians should choose antibiotics wisely to control and prevent outbreaks of S. marcescens infections.

    Reports indicate that developing a new antimicrobial drug from research to clinical use generally takes 5 to 10 years. In contrast, bacteria can develop resistance in as few as 2 years.23 Thus, slowing bacterial resistance is just as critical as enhancing antimicrobial drug efficacy. The study showed resistance to cefoperazone-sulbactam and imipenem had independent negative linear relationships with gentamicin DDDs; resistance to cefoxitin correlated negatively with piperacillin-tazobactam DDDs; resistance to cefepime showed a negative association with cefuroxime DDDs. These four relationships were strongly supported by consistent results from Bayesian, Bootstrap, and Winsorized regression. In addition, amoxicillin-clavulanic resistance positively correlated with meropenem DDDs, and levofloxacin resistance positively correlated with gentamicin DDDs. These positive trends were supported by triple robustness testing. Concurrently, analyses of S. marcescens isolates revealed negative linear correlations of resistance to ceftazidime, cefuroxime, and amikacin with piperacillin-tazobactam DDDs. Although these associations were directionally consistent across all robustness validation methods, their effect sizes fell below prespecified clinical thresholds, warranting further studies to explore these potential relationships. The recurrent involvement of piperacillin-tazobactam in resistance patterns warrants attention. Existing studies have shown that S. marcescens has the ability to form biofilms, which can hinder antibiotic penetration, alter bacterial metabolic states, and thus enhance bacterial drug resistance.24 Although research on S. marcescens is limited, studies on other Gram-negative bacteria can offer insights. Research has demonstrated that use of piperacillin-tazobactam reduces rates of ceftazidime-resistant Klebsiella pneumoniae, which is similarly a member of the Enterobacteriaceae family.25 The mechanism may be related to biofilm inhibition. Studies have shown that sub-minimal inhibitory concentration (sub-MIC) concentrations of piperacillin-tazobactam can effectively reduce biofilm formation by inhibiting the adhesiveness and motility of Escherichia coli,26 and reduce Pseudomonas aeruginosa biofilm formation in a dose-dependent manner, with the strongest inhibitory effect at MIC/2 concentration.27 Whether increased use of piperacillin-tazobactam reduces S. marcescens resistance to ceftazidime by inhibiting biofilm-mediated resistance barriers remains unclear, and relevant mechanisms require further research through constructing in vitro biofilm models and conducting in vivo antibacterial experiments. Zhao Ningqiu et al28 found that different antimicrobial agents may share resistance mechanisms, such as overexpression of efflux pumps, changes in cell membrane permeability, inactivation of antimicrobial compounds, and modification of their targets. These mechanisms can cause cross-resistance or co-resistance between drugs.

    From a biological perspective, these associations may involve complex mechanisms. Negative correlations may reveal potentialistic synerg inhibitory effects between antimicrobial drugs, suggesting that increased use of certain drugs can suppress the rise in resistance to target drugs, indicating that rational combination or rotation of antimicrobial drugs can effectively reduce resistance risks. Positive correlations suggest the presence of cross-resistance or co-resistance mechanisms, implying that increased use of one class of antimicrobial drugs may simultaneously or subsequently lead to increased resistance to other structurally or functionally similar drugs. Hospitals should optimize antibiotic management strategies, including targeted antibiotic rotation, limiting high-risk drug use, and adhering to data-driven guidelines. These measures can improve patient care, curb the spread of S. marcescens resistance, and preserve the long-term efficacy of essential antimicrobials.

    The resistance mechanisms of S. marcescens are complex, as it inherently exhibits resistance to multiple antibiotics, such as polymyxin and cephalothin. It can produce specific β-lactamases induced by drugs, include cephalosporinase (AmpC), extended-spectrum β-lactamases (ESBLs), carbapenemases, etc. These enzymes are capable of hydrolyzing the β-lactam ring of β-lactam antibiotics, rendering the antibiotics inactive and thus enabling the bacteria to develop resistance to the corresponding antibiotics. Research on carbapenem resistance mainly focuses on serine carbapenemases, such as KPC enzyme, OXA-48, and metallo-enzymes.29 The resistance genes encoding carbapenemases in S. marcescens are mainly KPC-2,30 NDM-1,31 IMP-1, IMP-10, and it may carry multiple resistance genes, presenting a multi-drug-resistant phenotype.32 Relevant reports have shown that the synergistic effect of high-yield chromosome-mediated loss of AmpC enzyme and porin resulting in decreased permeability can also cause drug resistance to carbapenilic antibiotics.33 Moreover, reduced outer membrane permeability and overactive efflux pumps in the inner membrane are key contributors to increased drug resistance in S. marcescens.34

    Currently, there is a scarcity of global data regarding how S. marcescens develops resistance in response to antimicrobial exposure. This aspect remains a relatively unexplored area within S. marcescens research. Our study used multiple linear regression to analyze the independent, linear correlation between S. marcescens resistance rates and antibiotic use one quarter in advance. We also validated our results using three methods: Bayesian, which enhances reliability; Bootstrap, which improves model adaptability; Winsorized regression, which controls the impact of outliers. Our quarterly time-series design (longitudinal study) is more effective at capturing macro trends compared to cross-sectional studies.9,35 However, the limited observation period restricts the number of data points in similar longitudinal studies.36,37 To compensate, we optimized our methodology through triple validation to ensure model stability. Future research could further investigate the impact of continuous antibiotic use on resistance through randomized controlled trials and explore resistance mechanisms. We hope this study offers a unique perspective to guide antibiotic management.

    The rapid emergence and spread of resistant bacteria in hospitals are due to multiple factors, including improper antimicrobial use creating high selective pressure, inconsistent infection control measures leading to patient-to-patient transmission, inter-hospital transfer of resistance, and complex links between resistance and antimicrobial use.38 Clinicians should strictly control antimicrobial use, standardize dosages and durations, and avoid misuse that can trigger resistance. Tailoring treatments based on infection type and susceptibility results can reduce resistance risks. Healthcare facilities need to enhance resistance monitoring, strengthen multidisciplinary collaboration, and enforce strict antimicrobial use regulations. Regular analysis of resistance data can guide rational prescribing. Infection control measures, including “one use, one disinfection”, isolating patients with resistant infections, and using dedicated equipment, are essential. Hand hygiene training and rapid response to clustered cases are crucial to break transmission chains. Understanding the correlation between S. marcescens resistance rates and antimicrobial use is crucial for clinical resistance control.

    Conclusion

    Over the past four years, our hospital identified 522 S. marcescens strains (3.22% of all isolates), with 86.59% from respiratory samples. This indicates that the respiratory tract is a common site for S. marcescens infection, necessitating clinical prevention and control measures. Most strains were sensitive to cefoperazone-sulbactam, cefepime, ertapenem, imipenem, meropenem, amikacin, trimethoprim-sulfamethoxazole, and tigecycline, with resistance rates <10%. Our study found significant correlations between S. marcescens resistance and antibiotic usage. Negative correlations showed that strategic antimicrobial use can reduce resistance rates, while positive correlations indicated higher co-resistance risks. These results highlight the need for hospitals to implement antibiotic rotation, limit high-risk drug use, and enhance supervision to improve patient outcomes and curb resistance.

    Highlights

    1. This study is the first to deeply investigate the macro-level quantitative relationship between S. marcescens drug resistance and antibiotic use, filling a research gap in this area.

    2. Using multiple linear regression models, we identified independent linear correlations between S. marcescens resistance rates and the use of various antibiotics.

    3. Our findings provide a scientific basis for rational and optimized antibiotic use in clinical practice, helping to delay the emergence of resistant bacteria and combat the threat of antibiotic resistance.

    Ethics Approval

    This study was reviewed and approved by the Ethics Committee of Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine (NO. 2025-L104). Informed consent was obtained from the patient.

    Acknowledgments

    We are grateful to Dr Ren-ai Xu for his invaluable guidance and support throughout this research. We also thank Ms Leping Liu for her helpful comments and suggestions.

    Disclosure

    The authors report no conflicts of interest in this work.

    References

    1. Duan XK, Liu WF, Xiao YY, et al. Exploration of the feasibility of clinical application of phage treatment for multidrug-resistant Serratia marcescens-induced pulmonary infection. Emerg Microbes Infect. 2025;14(1):2451048. doi:10.1080/22221751.2025.2451048

    2. Hanczvikkel A, Tóth Á, Kopcsóné Németh IA, et al. Nosocomial outbreak caused by disinfectant-resistant Serratia marcescens in an adult intensive care unit, Hungary, February to March 2022. Euro Surveill. 2024;29(26):2300492. doi:10.2807/1560-7917.ES.2024.29.26.2300492

    3. Muyldermans A, Crombé F, Bosmans P, et al. Serratia marcescens outbreak in a neonatal intensive care unit and the potential of whole-genome sequencing. J Hosp Infect. 2021;111:148–154. doi:10.1016/j.jhin.2021.02.006

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