Abstracts presenting data on cutaneous infection, wound complications, fungal disease and inflammatory dermatoses, highlighting diagnostic challenges and investigational treatment approaches.
ESCMID Global 2026 took place from April 17–21, 2026, in Munich, Germany. As a global congress focused on clinical microbiology and infectious diseases, the meeting included several findings relevant to infectious dermatology and wound care. We reviewed selected abstracts from the congress to highlight those most relevant to the field, including findings related to cutaneous infection, wound complications, fungal disease, and inflammatory dermatoses.
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Erythema migrans
Ten days of amoxicillin non-inferior to 14 days for erythema migrans in randomized Lyme borreliosis trial
What do the data show?
Erythema migrans (EM), the expanding annular skin rash that is the hallmark early manifestation of Lyme borreliosis, is typically treated with 14 days of oral amoxicillin. Whether a shorter course is equally effective has remained an open question with meaningful implications for antibiotic stewardship. This randomized, open-label trial conducted at a University Medical Center in Slovenia between 2019 and 2024 directly compared 10 versus 14 days of oral amoxicillin in 219 adults with solitary EM (SEM) defined by European criteria.
Two hundred and nineteen patients were randomized 1:1 (n=109 to 10 days, n=110 to 14 days; median age 49 years; 48.9% male), with skin culture positivity confirmed in 31.7% of those biopsied. The primary endpoint was treatment failure at 2 months, defined as persistent erythema, new objective Lyme borreliosis manifestations, or positive repeat skin biopsy, occurred in 4/106 (3.8%) in the 10-day group and 3/105 (2.9%) in the 14-day group (difference 0.9 percentage points; 95% confidence interval [CI] −4.8 to 6.7; p=0.721).
No patient in either arm developed new manifestations of Lyme borreliosis during follow-up or had a positive repeat biopsy. Unfavorable response rates at 12 months were similarly comparable at 11.2% versus 13.5% (p=0.631). Mild adverse events were frequent but statistically equivalent between arms (33.9% versus 40.0%; p=0.353).
Key clinical takeaway This trial suggests that 10 days of oral amoxicillin may be as effective and as well tolerated as the current 14-day standard for adults presenting with SEM. The authors note that shorter antibiotic courses may reduce selection for bacterial resistance, and that a shortened treatment duration could carry stewardship value. Reference: Vidić L, Zajc T, Velušček M, et al. Treatment of early Lyme borreliosis with amoxicillin for ten vs 14 days: a randomised open-label clinical trial. Presented at: ESCMID Global, Munich, Germany, 2026. Abstract. P1125/1300. Cutaneous leishmaniasis What do the data show? This pilot randomized, double-blind clinical trial from Isfahan University of Medical Sciences, Isfahan, Iran, explored whether adjunctive topical liposomal clarithromycin could improve outcomes in cutaneous leishmaniasis (CL) when added to meglumine antimoniate (Glucantime®). Sixty patients with confirmed CL lesions were randomized equally to receive 28 days of liposomal clarithromycin plus meglumine antimoniate or meglumine antimoniate plus placebo, with follow-up at 1.5, 3, and 6 months. The primary endpoint of recovery time did not reach statistical significance: 26.65 ± 5.12 days in the clarithromycin group compared with 32.84 ± 24.43 days in the placebo group (p=0.18). However, both groups showed significant within-group reductions in lesion size during follow-up. Between-group comparison favored the clarithromycin arm, with lesion size significantly smaller in the intervention group compared with placebo at final follow-up (p=0.02). A notable reduction in induration was also observed in the clarithromycin group, from 2.60 ± 0.77 to 1.0 ± 0.00. No adverse effects attributable to clarithromycin were reported. Key clinical takeaway This small pilot trial suggests that topical liposomal clarithromycin, when added to standard systemic meglumine antimoniate, could support lesion resolution in CL, with a potential advantage in lesion size reduction and a possible trend toward faster recovery. Given the small sample size, the non-significant recovery time result, and the high variability in the control arm, adequately powered confirmatory trials are warranted. Reference: Hakamifard A, Radmehr R, Abtahi Naeini B. Efficacy of adjunctive topical liposomal clarithromycin on systemic glucantime in old world cutaneous leishmaniasis: a pilot clinical study. Presented at: ESCMID Global, Munich, Germany, April 2026. Abstract. P3504/1293. Wound infections What do the data show? Burn wound infections caused by Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) strains, represent a major clinical challenge. VG111, a natural product formulation thought to have pro-healing properties, was developed and characterized at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, in collaboration with the Institute of Nano Science and Technology, Mohali, India. Minimum inhibitory concentration (MIC) assays suggested that VG111 was effective against S. aureus at a concentration of 25% v/v, while growth-kinetics analyses pointed to partial inhibition at the subinhibitory dose of 6.25% v/v. The authors highlighted an interesting finding at this subinhibitory concentration: phenotypic reversion of MRSA toward a methicillin-sensitive S. aureus (MSSA)-like phenotype. They noted that this is currently under mechanistic investigation using transmission electron microscopy (TEM)-based filamentation analysis and ethidium bromide membrane permeability assays. In addition, 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT) assays in human keratinocyte cell lines suggested biocompatibility, with cell viability exceeding 100% at treatment concentrations. This may indicate an active proliferative or pro-healing effect rather than mere cellular tolerance. VG111 was subsequently incorporated into a NaCMC-croscarmellose hydrogel matrix. The hydrogel demonstrated fluid absorption of approximately 470% and moisture donation of approximately 220%, properties the authors suggest are well suited to maintaining the moist wound environment considered optimal for burn wound healing and sustained topical drug delivery. Preliminary translational data included complete MSSA clearance across 32 canine wound cases and MRSA resolution in a post-mastectomy patient. Key clinical takeaway In this early-stage preclinical study, VG111 hydrogel presents an intriguing platform with potentially complementary antimicrobial and pro-healing properties, including activity against S. aureus, potential phenotypic MRSA-to-MSSA reversion at subinhibitory concentrations, and enhanced keratinocyte viability suggestive of a possible pro-healing effect. Reference: Chandel A, Gautam V, Ghosh D. A novel topical hydrogel formulation against burn wound infections. Presented at: ESCMID Global, Munich, Germany, 2026. Abstract. P2708/8370. Wound-healing What do the data show? Researchers at Alagappa University (Karaikudi, Tamil Nadu, India) engineered LysPSPa-IDR-1018, a fusion protein combining the antimicrobial peptide IDR-1018 with the PSPa phage-encoded endolysin, and evaluated it against multidrug-resistant (MDR) pathogens and in wound-healing models. In head-to-head in vitro testing, both the parental enzyme (LysPSPa) and the fusion construct (LysPSPa-IDR-1018) achieved approximately 97% bacterial killing and approximately 95% mature biofilm eradication at 50 µg/mL against reference and clinical strains of methicillin-resistant S. aureus (MRSA), Escherichia coli, and Pseudomonas aeruginosa, validated by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Both proteins retained full antimicrobial activity after 120 days at 4°C and 8°C and demonstrated acceptable biocompatibility in hemolysis and serum assays. The fusion construct outperformed the parental endolysin on wound-relevant endpoints. Scratch assays in human gingival fibroblasts demonstrated superior cell migration and wound closure with LysPSPa-IDR-1018, and enzyme-linked immunosorbent assay (ELISA) in RAW 264.7 macrophage cells revealed elevated interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) expression, pointing to an enhanced immunomodulatory profile that was not observed with LysPSPa alone. Key clinical takeaway This preclinical study presents an engineered endolysin, LysPSPa-IDR-1018, created by integrating the antimicrobial peptide IDR-1018 with the PSPa phage-encoded endolysin. The compound has a potential dual mechanism: bactericidal and biofilm-disrupting activity against multidrug-resistant (MDR) organisms relevant to diabetic foot ulcer (DFU) chronicity, alongside wound-healing and immunomodulatory properties. The authors suggest that it has translational potential as a next-generation therapeutic for DFU, but note that further evaluation is required to substantiate these findings. Reference: Malligarjunan N, Shanmugaraj G. LysPSPa-IDR-1018: an engineered endolysin with antimicrobial and immunomodulatory potential for diabetic foot ulcer treatment. Presented at: ESCMID Global, Munich, Germany, 2026. Abstract. P2557/818. Cutaneous mucormycosis What do the data show? Syncephalastrum racemosum is a rare Mucorales fungus, a group of molds that can enter the body through breaks in the skin and cause cutaneous infection. It is typically associated with invasive disease in immunocompromised or critically ill patients. Management typically involves amphotericin B-based antifungal therapy combined with surgical debridement. This case report from Larkin Community Hospital, Miami, FL, USA, describes a 23-year-old woman without apparent immunosuppression and known chronic comorbidities who developed a persistent lower leg skin lesion following minor trauma. Empiric systemic terbinafine produced no improvement. Skin biopsy demonstrated suppurative granulomatous dermatitis, and fungal culture identified S. racemosum. Imaging confirmed disease remained localized, and surgical excision was deemed unsuitable given the lesion’s anatomical location. Oral ketoconazole was initiated under infectious diseases guidance, and over 3 months the lesion regressed completely with full restoration of normal skin integrity. A supporting 10-year literature review (PubMed, Europe PMC, Google Scholar; 2015–October 2025) identified six published cases, all of which predominantly involved invasive disease in immunocompromised hosts treated with amphotericin B, frequently alongside surgical debridement. Key clinical takeaway Although based on a single case, this report provides an early clinical signal that S. racemosum may be a possible cause of treatment-refractory cutaneous lesions, including in young patients without apparent immunosuppression. It also describes successful management with oral azole monotherapy, without amphotericin B or surgery, in a localized, non-life-threatening presentation. Reference: Pujol Perez M, Barletta Farias RC, Llorente Fuentes R, et al. Cutaneous Syncephalastrum racemosum infection in an immunocompetent patient successfully treated with oral ketoconazole: case report and 10-year literature review. Presented at: ESCMID Global, Munich, Germany, 2026. Abstract. P5016/5729. Pyoderma gangrenosum What do the data show? This case report from University Hospital Basel, Basel, Switzerland, documents diagnostic and therapeutic challenges of pyoderma gangrenosum (PG) following joint prosthesis implantation, spanning 3 years and two separate joint replacements. A previously healthy 76-year-old developed atypical wound breakdown with symmetrical edge necrosis and painful ulceration shortly after total knee arthroplasty. Multidisciplinary evaluation involving dermatology, infectious disease, orthopedic surgery, and plastic surgery raised suspicion of PG, confirmed on biopsy by sterile neutrophilic infiltration. Immunosuppression with steroids and tumor necrosis factor-alpha (TNF-alpha) inhibitors was initiated. Despite sterile cultures across multiple biopsies, persistent wound ulceration with direct communication to the underlying prosthesis met criteria for prosthetic joint infection (PJI), necessitating a two-stage prosthesis exchange. Three years later, the same patient underwent hip arthroplasty. Despite high-dose perioperative steroids, PG recurred with a sepsis-like syndrome. Stabilization required escalation to a combination of TNF-alpha inhibitors, anakinra, and ciclosporin. Revision surgery was again required, and on this occasion Pseudomonas aeruginosa was isolated from all biopsies, confirming a true superimposed PJI. A debridement, antibiotics, and implant retention (DAIR) procedure was performed, followed by 3 months of ciprofloxacin, but infection relapsed, ultimately requiring a further two-stage exchange. Adapted immunosuppression thereafter successfully prevented further PG episodes. Key clinical takeaway This case illustrates a diagnostic and therapeutic challenge in distinguishing sterile inflammatory PG from PJI, as the two conditions share overlapping clinical features, including necrosis, ulceration, and inflammation. It also highlights that bacterial infection can coexist with PG or develop secondarily, necessitating prolonged antimicrobial management and, in some cases, implant replacement. The authors note that early recognition of PG and adequate immunosuppressive control may be important in helping to prevent severe complications. In this case, adjunctive TNF-alpha inhibitor therapy alongside corticosteroids was used to achieve sufficient control of inflammation. Reference: Jędrusik A, Romswinkel A, Von Rotz M, et al. A double-edged sword: relapsing pyoderma gangrenosum as differential diagnosis and cause of prosthetic joint infection after arthroplasty: a case report. Presented at: ESCMID Global, Munich, Germany, 2026. Abstract. 6174. Cite: ESCMID Global 2026: Selected infectious dermatology and wound care abstracts. touchDERMATOLOGY. 27 May 2026. Disclosures: This content was conducted as part of our coverage of ESCMID Global 2026 conference and does not constitute endorsement from ESCMID. This article was edited by the touchDERMATOLOGY team utilizing AI as an editorial tool (ChatGPT [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. Editor: Gina Furnival, Head of Content Already registered? Login below.
Topical liposomal clarithromycin as adjunct to glucantime reports lesion size benefit in cutaneous leishmaniasis pilot trial
A natural product hydrogel shows dual antimicrobial and pro-healing potential against burn wound infections in preclinical study
Engineered endolysin with potential dual antimicrobial and wound-healing investigated in preclinical diabetic foot ulcer model
Cutaneous mucormycosis caused by Syncephalastrum racemosum resolves with oral ketoconazole alone in immunocompetent young woman
Relapsing pyoderma gangrenosum after arthroplasty: diagnostic overlap and prosthetic joint infection risk
