JAC-Antimicrobial Resistance最新文献

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections affecting women. The COVID-19 pandemic altered how healthcare was accessed and resulted in the rapid adoption of remote technologies. This study explored patients' experiences of consultations for UTIs in general practice during the pandemic.

Methods: Women included in this study were ≥16 years, recruited via Ipsos's online panels in England, reporting at least one episode of UTI symptoms in the previous year, and had sought a consultation with a healthcare professional. We analysed 799 responses to a free-text questions, using inductive thematic analysis, regarding their experiences.

Results: We identified key themes related to (i) the consultation mode and healthcare professional consulted, (ii) UTI assessment and management, (iii) validation of UTI symptoms and experience and (iv) concerns due to the COVID-19 pandemic. Positive aspects of care related to prompt and thorough assessment and treatment, consulting a healthcare professional (HCP) who validated their experience, while encouraging discussions about prevention and self-care. Negative aspects of care were related to long appointment waiting times, a lack of in-person consultation if desired and patients feeling uninformed and unvalidated about their UTIs.

Conclusion: This study presents evidence that positive patient experience on UTI assessment and management is determined by the HCP involved, the mode of consultation and the application of shared decision-making to determine treatment. To improve satisfaction, systems and consultations should account for these patient preferences with shared decision-making approaches, adapted for remote consultations, to support discussions around UTI investigation and management.

Background: The UK Antimicrobial Registry (UKAR) was developed to capture data on real-world usage of recently launched antimicrobial agents.

Methods: UKAR is an ongoing prospective registry of adult inpatients prescribed 11 eligible study drugs (cefiderocol, ceftaroline, ceftazidime/avibactam, ceftobiprole, ceftolozane/tazobactam, dalbavancin, delafloxacin, eravacycline, imipenem/cilastatin/relebactam, meropenem/vaborbactam and oritavancin). Data collected from participants' medical records include demographics, infection site, comorbidities, microbiology isolates and susceptibility, treatment regimen and outcomes. Primary outcome is clinical resolution of infection measured 28 days post cessation of study drug.

Results: In the first 20 months, 631 participants were recruited, 56% male, with a median age of 60 years. Overall, 44.8% of patients were treated for lower respiratory tract infection, 18.0% for systemic infections including sepsis and 11.1% for urinary tract infection. Comorbidities were common (>90%), 81% of participants had a documented history of resistant organism colonization and only a small proportion of patients received an eligible study drug while in critical care. For Gram-negative agents ceftazidime/avibactam, cefiderocol and ceftolozane/tazobactam predominated, and for Gram-positive agents 94% received dalbavancin. Empirical use was seen in 4.9% of Gram-negative and 66.2% of Gram-positive prescriptions. Where patient outcome was evaluable, infection resolution was seen in 69% and 64% of Gram-negative and Gram-positive participants, respectively.

Conclusions: The UKAR provides real-world data on the use of novel antimicrobials confirming they are sometimes used empirically as well as for directed therapy to treat both complex and common infections, and often for multiresistant pathogens. The study is a novel and important resource to support the judicious use of these drugs.

Background: Although adjunctive rifampicin and/or gentamicin have been recommended for Staphylococcus aureus prosthetic valve endocarditis, evidence regarding the evaluation of their clinical effectiveness is limited.

Objectives: To compare the clinical impact of adjunctive rifampicin without gentamicin, and adjunctive gentamicin without rifampicin therapies for S. aureus prosthetic valve endocarditis.

Methods: This retrospective study used TriNetX to evaluate multicentre electronic medical records of patients aged 18 years or older in the USA between 2016 and 2024. After propensity score matching, HRs were estimated with 95% CIs. Covariates included age, sex, ethnicity and medical comorbidities.

Results: A total of 353 and 369 patients were identified in the rifampicin and gentamicin groups, respectively. One-year all-cause mortality was observed in 87 (31.3%) and 111 (39.9%) patients in the rifampicin and gentamicin groups after propensity score matching, respectively, leading to an HR of 0.71 (95% CI, 0.54-0.94; P = 0.016). The HRs were not statistically significant for ICU admission (HR 0.93; 95% CI, 0.74-1.18; P = 0.540), recurrent endocarditis (HR 0.76; 95% CI, 0.42-1.40; P = 0.381), kidney failure (HR 0.93; 95% CI, 0.74-1.18; P = 0.540) or hepatic failure (HR 0.96; 95% CI, 0.66-1.39; P = 0.822).

Conclusions: The rifampicin-containing regimen without gentamicin was associated with reduced 1 year mortality compared with the gentamicin-containing regimen without rifampicin. Although the results should be interpreted with caution because of potential residual unmeasured confounders, including duration of antimicrobial treatment and biases, our findings provide further evidence that adjunctive gentamicin may not be routinely needed for S. aureus prosthetic valve endocarditis.

Background: Optimizing antibiotic use is a UK Government priority. This study aimed to identify which combinations of interventions are associated with meeting primary care antibiotic prescribing targets in England's National Health Service, going beyond typical evaluations of individual interventions.

Methods: Data on interventions implemented by Integrated Care Boards (ICBs) in England were collected via an online survey (October 2023 to January 2024). The survey gathered information about 61 interventions covering data monitoring, incentives, governance, staff training, guidance, diagnostics, decision support tools and public awareness-raising activities.The survey data were linked to ICB-level antibiotic prescribing data, analysed descriptively and through a set-theoretic approach (fuzzy-set Qualitative Comparative Analysis, fsQCA). Clusters of ICBs that used a common set of interventions and met prescribing targets were identified. The average prescribing rates were calculated for each cluster and compared with ICBs that did not implement those interventions.

Results: Fifty-four responses were received from staff at 29 out of 42 ICBs (69%). Locally adapted prescribing guidance was used by all ICBs meeting targets. ICBs that monitored data and used incentives, guidance and/or challenged prescribers on their behaviour had the lowest prescribing. Implementing diagnostics, staff training or public awareness-raising interventions was not associated with lower prescribing.

Conclusions: In a country that has been reducing antibiotic prescribing and implementing numerous antimicrobial stewardship interventions over the last decade, commissioning organizations that met policy targets were using combinations of a limited number of interventions by 2024. National and local efforts could therefore start prioritizing fewer interventions to further reduce prescribing.

Background: The global rise of antimicrobial resistance requires innovative and affordable wound care solutions. Moreover, managing wounds infected with priority pathogens remains a challenge. Despite the widespread availability of over-the-counter (OTC) antiseptics in wound care, comparative studies on their efficacy against biofilms or multidrug-resistant pathogens are limited.

Objectives: This study compares the ability of different OTC antiseptics to disrupt biofilms of multidrug-resistant clinical isolates of Acinetobacter baumannii and Pseudomonas aeruginosa.

Methods: The antimicrobial activity of seven antiseptics (polyhexanide, octenidine, chloroxylenol, chlorhexidine, ethanol, cetrimide, phenol) against early-stage (3-hour) and mature (24-hour) biofilms was determined by measuring reductions in colony-forming units (cfu)/biofilm while varying treatment exposure time.

Results: All OTC products significantly reduced early-stage biofilms of both pathogens below detectable limits within 5 minutes (P < 0.0001, n = 3, LOD = 100 cfu/biofilm). In mature biofilms, significant differences emerged. Polyhexanide, octenidine and cetrimide yielded modest reductions in cfu count/biofilm (0.55-0.64-log) after 5 minutes, while chloroxylenol and phenol achieved ∼2.5-log reductions; notably, chlorhexidine reduced cfu/mature biofilms below detectable limits within 5 minutes. Extended exposure (60 minutes) enhanced the efficacy of phenol and ethanol, with chloroxylenol and octenidine reducing cfu/biofilm below detectable limits.

Conclusion: OTC antiseptics are effective in eliminating early-stage biofilms; however, mature biofilms require either prolonged exposure, which may increase their toxicity and delay wound healing, or the use of potent formulations. Chlorhexidine gluconate, chloroxylenol and phenol offer an optimal balance between antibiofilm potency and tissue safety, offering promise for acute and chronic wound management particularly in low-resource settings.

Background: Most antibiotics are prescribed in the primary care setting. In response to the global threat of antimicrobial resistance (AMR), the TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) antimicrobial stewardship (AMS) training toolkit for primary care clinicians was rolled out in England in 2022. This study aimed to understand preconceived, as well as actual, factors influencing the roll out of training to improve and inform implementation strategies of this and future initiatives.

Methods: Two workshops were held: one at the launch (22 participants) in 2022 and another 18 months (14 participants) into intervention roll out, in 2024. Qualitative data were collected using the Theoretical Domains Framework to identify barriers and facilitators, and the Expert Recommendations for Implementing Change Framework to identify strategies for supporting change.

Results: Anticipated barriers, at launch, included lack of secure knowledge and, at a national level, confidence in presenting training content. Anticipated enablers were appointing regional champions and linking training to continuing professional development. Eighteen months later, barriers related to the effort needed to both implement the training and maintaining knowledge of evolving AMR evidence. Promoting the benefits of the training and financial incentives were cited as facilitators. Across both workshops, barriers were a lack of capacity and time.Purposive strategies most employed concentrated on educating stakeholders, providing support and development of stakeholder relationships. Strategies least employed were financial strategies and changing the regional level infrastructure.

Conclusions: Overall, the implementation of a national training programme requires support, both centrally and regionally, to be successful. Regional variation in priorities and practical issues should be acknowledged when implementing interventions nationwide.

Background: Use of social media to access health information is increasing. This systematic review aims to assess the availability of social media-based information related to antimicrobial resistance (AMR) and antibiotic use aimed at members of the public. It also looked to determine whether sharing information related to AMR and antibiotic use on social media improves public knowledge.

Methods: MEDLINE, Embase and PsycINFO were searched on 24 May 2024. Google Scholar was searched on 4 October 2024. All primary studies published between January 2013 and May 2024 that outlined AMR or antibiotic-related information on social media or assessed the effectiveness of social media at improving knowledge and attitudes towards AMR and antibiotic use were eligible for inclusion. Risk of bias assessment was conducted using the mixed-methods appraisal tool. A narrative synthesis was used to describe the studies.

Results: In total, 624 papers were identified with 607 records removed during de-duplication and screening. Identified papers assessed the reach of and engagement with social media posts (n = 7), attitudes towards antibiotic use (n = 4), learning materials (n = 3) and the effectiveness of social media at increasing public knowledge (n = 2). Common misconceptions were identified, including how AMR develops and the conditions that antibiotics can be used to treat.

Conclusions: This review highlights that a range of information relating to AMR and antibiotic use is available on social media, including false information. However, the impact of exposure to social media content on knowledge, attitudes and behaviours towards AMR and appropriate antibiotic use remains unclear.

Background: Chronic pulmonary aspergillosis (CPA) is a serious lung disorder caused by Aspergillus fungal infection with high morbidity and mortality. Treatment options include antifungal azoles, polyenes and echinocandins. Rezafungin is a novel, once-weekly echinocandin that may benefit CPA management in outpatient parenteral antimicrobial therapy (OPAT) services.

Objectives: To report a case where rezafungin was potentially effective in managing CPA for a patient with limited treatment options, and to estimate the health economic impact of rezafungin versus once-daily echinocandin in an OPAT setting.

Patients and methods: We discuss a patient with CPA, diagnosed in 2020, with frequent episodes of haemoptysis, dyspnoea, productive cough and lethargy with progressive bilateral pulmonary cavitatory lesions and nodules treated with rezafungin over 12 weeks via OPAT. Costs to deliver once-weekly rezafungin compared with once-daily caspofungin in the OPAT clinic were compared.

Results: Symptoms improved significantly after 12 weeks of rezafungin, with no further emergency visits, versus eight in the year prior due to CPA symptoms. Aspergillus serology (IgG) improved and computerized tomography imaging showed slight improvement in the degree of consolidation surrounding the cavities. Daily OPAT costs increased by £13.71 for rezafungin compared with caspofungin. This was offset by greater patient convenience and improved OPAT clinic capacity.

Conclusions: Rezafungin may be a novel, well-tolerated and cost-effective echinocandin treatment for CPA in patients needing OPAT and with limited treatment options. Further clinical studies are required for robust evaluation of this novel echinocandin in CPA.

Objectives: Recently, several MRSA community outbreaks occurred in the Netherlands, including one caused by an impetigo-causing MRSA strain resistant to fusidic acid. Since fusidic acid and flucloxacillin are the main treatment options for impetigo, increasing resistance limits treatment possibilities. We examined trends in fusidic acid resistance percentages among MRSA isolates in the Netherlands.

Materials and methods: Data on routine bacteriological cultures between 2016 and 2023 from 30 laboratories were extracted from the national surveillance system on antimicrobial resistance (ISIS-AR). Fusidic acid resistance percentages per year were calculated both overall and per age group for all MRSA isolates, and more specific, for the subset of MRSA isolates from wound/pus/skin samples collected by general practitioners (WPS-GP). Trends were determined using logistic regression and compared with trends among MSSA isolates.

Results: We found an increase in fusidic acid resistance among MRSA isolates from 15% (2016) to 29% (2023) (P < 0.001), which differed significantly (P < 0.001) from the trend among MSSA isolates (10%-12%). An increase was also found in MRSA WPS-GP isolates, both among young children and the population of 13-64 years old, but not among elderly. The trends remained significant after exclusion of isolates associated with known fusidic acid-resistant MRSA outbreaks, both among MRSA isolates overall (OR = 1.10, 95% CI: 1.07-1.14, P < 0.001) and among MRSA WPS-GP isolates (OR = 1.14, 1.07-1.21, P < 0.001).

Conclusions: In conclusion, an increasing trend in fusidic acid resistance was found among MRSA isolates. Since impaired treatment for impetigo might ease the spread of (fusidic acid-resistant) MRSA, extra vigilance is warranted.