JAC-Antimicrobial Resistance最新文献

Background: Antimicrobial stewardship (AMS) and infection prevention and control (IPC) programs are crucial for reducing antimicrobial resistance in hospitals. Existing quality indicators (QIs) for these programs are mainly qualitative, hindering external benchmarking. PILGRIM (NCT03765528) is a prospective multinational cohort study evaluating the impact of antibiotic prescription quality on intestinal domination by healthcare-associated pathogens.

Objective: In this sub-study, we develop a quantitative scoring tool for AMS and IPC programs to facilitate standardized assessments of programs and support clinical studies.

Methods: We used a RAND-modified Delphi consensus procedure to establish a scoring system for AMS and IPC programs. The tool was tested using data collected from eight hospitals in five countries during 2019-2024. We evaluated temporal associations between scores, Clostridioides difficile cases, hand disinfectant and antibiotic use.

Results: We assessed 98 QIs, resulting in in a final set of 62 QIs (35 for AMS and 27 for IPC). For our sites, the overall median score was 29 out of 50 (IQR 28-31) for AMS and 36 out of 50 (IQR 33-38) for IPC programs. Higher-scoring sites decrease antibiotic use over time. IPC scores were positively correlated with hand disinfectant use.

Conclusion: This quantitative scoring scheme represents a promising step towards standardizing assessments of AMS and IPC programs in high-income settings, enabling external comparisons and supporting future clinical studies. Further validation is needed to refine its predictive validity and ensure its utility in diverse healthcare settings.

Antimicrobial resistance (AMR) remains one of the gravest global health threats, responsible for over 35 000 deaths annually in the EU/EEA and projected to cause nearly 2 million deaths worldwide each year by 2050. While Europe has long positioned itself as a frontrunner in the fight against AMR, growing international mobility and fragmented policy implementation continue to undermine progress. This viewpoint argues that strengthening a coordinated One Health response is essential to address the transboundary nature of antimicrobial resistance. The European response must now evolve beyond national and regional frameworks, with strengthened surveillance at borders, stronger political commitment at the continental level, to curb imported and emerging resistant infections. Only a unified, globally connected Europe can lead an effective and sustainable response to this silent pandemic.

Background and objectives: Penicillin allergy is often overdiagnosed, with a 10% reported prevalence in affluent countries. Incorrect labels lead to broad-spectrum antibiotic use, longer hospital stays and MDR infections. Understanding patients' perspectives is crucial to enhance de-labelling and ensuring penicillin use when indicated. To describe patients' experiences of being labelled as allergic to penicillin and their willingness to take penicillin after a negative challenge.

Patients and methods: Fifteen patients referred for allergy investigation were included and participated in semi-structured interviews, regardless of allergy risk or subsequent evaluation results. The data were analysed with qualitative content analysis using the Graneheim and Lundman approach.

Results: Three main categories were identified: 'Frustration over insufficient documentation and communication', 'Factors that determine whether participants want to undergo a drug challenge' and 'What happens after drug challenge? Willingness to accept penicillin after the allergy work-up'. Poor documentation led to insecurity. Trust in healthcare professionals and awareness of the negative consequences of allergy labels contributed to participants' acceptance of drug challenges. The participants were willing to take penicillin after a negative challenge, although some preferred the first dose of subsequent treatments to be administered close to advanced healthcare infrastructure.

Conclusions: Improved and comprehensive guidelines for the management of suspected penicillin allergy are necessary to enhance understanding of penicillin allergy and ensure that patients are promptly evaluated after a suspected allergic reaction with referral to an allergist if indicated.

Introduction: Globally, there has been a reported increase in the frequency of certain Escherichia coli strains carrying a broad repertoire of antimicrobial resistance genes, classified as high-risk clones. The aim of this study was to characterize the virulome and resistome of ESBL-producing E. coli strains isolated from human patients and to determine the prevalence of high-risk clones circulating in Peru.

Methods: A total of 134 ESBL-producing E. coli strains recovered from faecal samples were sequenced and analysed alongside 351 publicly available genomes from previous studies to assign phylogroups, pathotypes and sequence types (STs), as well as to predict virulence and antimicrobial resistance genes.

Results: All known E. coli phylogroups were detected, with Phylogroups A and B1 being the most frequent. Only 26% of the strains were classified as diarrhoeagenic pathotypes. Based on MLST analysis, the strains were assigned to 160 distinct STs, of which 8 have been previously identified as high-risk clones. Notably, ST10 was the most prevalent ST in the dataset and has been classified as a high-risk clone. Phylogenetic analysis revealed no clear association between E. coli phylogroups and pathotypes. In contrast, high-risk clones were primarily non-diarrhoeagenic and carried a wide array of virulence genes associated with extraintestinal infections, along with multiple antimicrobial resistance genes, particularly bla _TEM, bla _CTX-M, sul2, tetA and sul1 as well as the resistance-associated mutations gyrA (S83L) and parC.

Conclusions: These findings underscore the wide genomic diversity observed among E. coli strains, including multidrug-resistant and high-risk clones with significant potential to cause infections that pose a serious public health threat.

Objectives: Fungal peritonitis is a severe complication in peritoneal dialysis (PD) patients, frequently occurring after antibiotic exposure. This systematic review and meta-analysis assessed whether oral nystatin administered concomitantly with antibiotics reduces the incidence of antibiotic-related fungal peritonitis (ARFP) compared with no prophylaxis.

Methods: Following PRISMA guidelines, MEDLINE, PubMed and Embase were searched up to 1 October 2025 for randomized and observational studies enrolling adult PD patients who received systemic antibiotics with or without oral nystatin prophylaxis. The primary outcome was the odds of ARFP. ORs were pooled using random-effects models. This systematic review and meta-analysis was registered in PROSPERO (CRD420251154535).

Results: Four prospective observational studies and one randomized controlled trial (RCT), comprising 2060 PD patients, were included. ARFP yielded 13 events among 1044 peritonitis episodes in the nystatin-treated patients versus 31 among 1016 in the control group (OR 0.53; 95% CI, 0.18-1.57). In the two studies (one observational and one RCT) reporting prescription-level data, nystatin was significantly associated with ARFP reduction (7 events out of 2205 prescriptions in the prophylaxis group versus 16/1724; OR 0.35; 95% CI, 0.15-0.87).

Conclusions: Oral nystatin administered during antibiotic therapy was associated with a numerically lower rate of ARFP in PD patients, although all pooled estimates were based on unadjusted data and a limited number of events, thus precluding any certain causal inference. However, given its favourable safety profile and local action, nystatin may represent a valid candidate for a prophylactic strategy warranting further evaluation in contemporary, adequately powered randomized trials.

Background: Penicillin allergy (penA) records are associated with negative patient and health-system outcomes, which makes removal of incorrect penA records (penicillin allergy de-labelling; PADL) an antimicrobial stewardship and patient safety priority. We set up a nurse-run, adult, low-risk PADL outpatient clinic, supervised by an antimicrobial pharmacist.

Methods: Adult PADL guidelines were written and approved by the hospital, and PADL training was provided to nurses. Electronic adult referrals from hospital outpatient clinics and three GP surgeries in Cornwall were accepted. Patient telephone triage started from 6 January 2025, which included taking a penA-focused history, penA risk assessment and determination of PADL method. Eligible patients were invited for a direct oral penicillin challenge (DOC) test and were followed up via a telephone call 10 days after the test. The first outpatient PADL clinic was on 7 February 2025.

Results: There were 404 referrals between 27 December 2024 and 16 September 2025, of which 326 were successfully contacted. Of these, 130/326 (39.9%) had a high-risk penicillin allergy history and 5/326 (1.5%) were excluded due to cognitive impairment. Of the 326 contacts, 191 (58.6%) were categorized as low risk. Of these, 22/191 (11.5%) were de-labelled on history alone, 54/191 (28.3%) were awaiting their outpatient DOC appointment or declined attending clinic, and 115/191 (60.2%) attended clinic for DOC. Of 115 patients, 110 (95.7%) patients were successfully de-labelled and 5 (4.3%) retained their allergy status due to side effects.

Conclusions: PADL delivered by non-allergy nurses in the outpatient setting is safe and effective at removing low-risk penicillin allergy records.

Background: Antimicrobial resistance (AMR) is a significant public health challenge. The Antibiotic Guardian (AG) campaign was developed in 2014 by Public Health England (now UK Health Security Agency) to raise increase engagement in personal actions to tackle AMR and promote responsible antibiotic use. The campaign expanded through collaboration with WHO Europe, Africa CDC, South African National Department of Health and the Ministerial Advisory Committee on Antimicrobial Resistance, as well as Belgian Antibiotic Policy Coordination Committee. This study aimed to analyse international AG pledges from 2014 to 2024 with a focus on pledges made on the Africa subpages.

Methods: The AG pledge data was cleaned and sorted to exclude UK pledges. Pledges made on the Africa subpages, including the responses to the knowledge questions, were harmonized. Data sorting, cleaning and preliminary quantitative analysis tasks were performed using Microsoft Excel. Further analysis and visualization were conducted using Datawrapper.

Results: The AG campaign has received 17 053 international pledges from 194 countries across the seven continents. The Africa subpages have cumulatively reached 3997 AGs across 40 African and 21 non-African countries. South Africa, Nigeria, Uganda, Kenya and Ethiopia had the highest pledges from African countries, with most pledges from healthcare professionals. Most AGs heard about the campaign through professional networks and social media. Nearly two-thirds of AGs (61.2%) answered all five knowledge questions correctly.

Conclusion: The AG campaign has evolved into a global effort aimed at addressing AMR through behavioural change. Further promotion and audience-specific strategies are required to reach the most affected subpopulations and ensure pledges translate to reductions in the mis and overuse of antibiotics in Africa.

Background: Blood cultures (BCs) are the gold standard investigation for patients with suspected severe infection and sepsis. Yet, BCs are not consistently obtained prior to antibiotic administration, and sampling practices remain suboptimal. Optimizing BC sampling has important benefits, including reducing inappropriate antibiotic use and improving antimicrobial stewardship. Despite advances in sepsis recognition and management, a significant scope remains to improve BC sampling practices. This scoping review aimed to identify evidence on interventions used to improve BC sampling in higher economically developed countries.

Methods: Database searches of MEDLINE, CINAHL, PubMed and BMJ Open Quality were conducted for studies published between January 2015 and January 2025. Included studies were mapped to the Behaviour Change Wheel (BCW) framework.

Results: Searches identified 3746 records; 23 studies met the inclusion criteria, with two additional studies identified through reference screening. In total, 25 studies were analysed, identifying six intervention types. Common interventions included visual prompts, screening tools, education and training programmes and audit-and-feedback mechanisms. These interventions most frequently mapped to the BCW categories of Environmental Restructuring (32%), Education and Training (28%) and Enablement (25%). Outcome measures varied widely, with no consistent metrics used across studies.

Conclusions: This review identified six intervention types used to improve BC sampling practices, with Environmental Restructuring, Education and Training, and Enablement most commonly employed. Interventions were associated with improvements in timely BC collection and reduced contamination rates. However, heterogeneity in outcome measures and gaps in intervention types highlight the need for standardized metrics and more robust evaluations to optimize BC sampling practices across healthcare settings.

Background: There is a paucity of information on the burden of Klebsiella pneumoniae invasive disease (KPn-ID) in Africa. We conducted a multicentre, observational study on the clinical and microbiological epidemiology of KPn-ID in hospitalized adults in South Africa, focusing on clinical outcomes and KPn susceptibility profiles.

Methods: Surveillance for culture-confirmed KPn from blood and CSF was undertaken from 15 May 2023 to 14 May 2024. Phenotypic antimicrobial susceptibility was analysed, and the presence of carbapenemases was assessed with a lateral flow assay test.

Results: We enrolled 524 of 617 individuals with KPn-ID. The median age was 48 (IQR: 35-61) years, and 84.4% (442/524) were presumed healthcare-associated infections. Comorbidities included HIV (26.9%; 141/524) and diabetes mellitus (16.4%; 86/524). There was a high prevalence of carbapenem resistance (55.0%; 288/524), with the OXA-48 carbapenemase detected in 71.5% (181/253), and OXA-48 and NDM co-detected in 20.9% (53/253) of tested isolates. Colistin resistance was detected in 7.6% (19/251) of tested isolates. The in-hospital case fatality risk (CFR) was 56.5% (296/524). Urethral catheterization [adjusted odds ratio (aOR) 3.30; 95% CI: 1.51-7.23] and an admission quick sepsis-related organ failure assessment score of 1 to 3 (aOR 2.14; 95% CI: 1.25-3.68) were independently associated with in-hospital death. Achieving source control was associated with lower odds of death (aOR 0.18; 95% CI: 0.10-0.30).

Conclusions: We observed a high prevalence of MDR and high CFR in adults with KPn-ID. These data show the urgent need for strategies to mitigate KPn-ID in settings such as ours.