JAC-Antimicrobial Resistance最新文献

Background: An Antimicrobial Prescribing and Stewardship (APS) Competency Framework is an important resource for enhancing the practice of prescribers, in-line with national and global priorities for tackling antimicrobial resistance. Knowledge mobilization of such a framework is essential to maximize its utilization and impact.

Objectives: To utilize a Knowledge to Action (KTA) Framework approach to mobilize knowledge of the national APS Competency Framework, assess current integration and collect feedback from course-leaders of non-medical prescribing (NMP) programs at Higher Education Institutions (HEIs) in the UK.

Methods: UK HEIs accredited to provide NMP training to experienced nurses, pharmacists, and allied health professionals were identified through review of professional regulatory websites. A Microsoft Forms^® survey with consent was developed and piloted; the final link and additional information were emailed to NMP course leads. The results were analysed using Microsoft Excel^® and NVivo15^®.

Results: Of 84 HEIs surveyed, 38 responded (45%). Over half (55%) already integrate the national APS framework in courses, with others signposting to it. Most (63%) found it helpful, though its length and detail posed challenges and some felt it lacked relevance for all students. Participation in the survey increased awareness of the APS framework and other resources for antimicrobial stewardship teaching.

Conclusions: This knowledge mobilization and evaluation demonstrated a high level of utilization of the framework within NMP programmes; feedback from users should be considered in future updates. It highlights the need for ongoing engagement with HEIs to embed AMS principles in all prescriber education to optimize antimicrobial use and reduce resistance.

Background: Correct use of antibiotics ensures necessary treatment for patients while antibiotic resistance is reduced. Respiratory tract infections (RTIs) are common in preschool children. Young children receive a large proportion of the total amount of antibiotics, and also in low-prescribing countries such as Norway.

Objectives: Explore the contacts, rate of antibiotic prescriptions and choice of antibiotics in the treatment of RTIs in preschool children in general practice from 2012 to 2019. Methods Descriptive registry study on complete population data of antibiotic prescriptions administered to Norwegian pre-school children with RTIs, in the period 2012 - 2019, after consultations with a general practitioner.

Results: The total prescription rate was reduced from 28% in 2012 to 19% in 2019. There were small yearly variations in prescription rates. Most antibiotics were prescribed to 1- and 2-year-olds. Upper RTI was the most used diagnosis and accounted for 25% of the total amount of antibiotics prescribed.Total RTI episode rate was 941 episodes/1000 children in 2012, reduced by 17% to 2019 when there were 777 episodes/1000 children. The reduction in antibiotic prescription to children with otitis was associated with a decline in episode rate.More than 81% of prescribed antibiotics were penicillins, only 16% were macrolides and 3% were other antibiotics. The use of phenoxymethylpenicillin increased in the period from 50% in 2012 to 68% in 2019.

Conclusions: There is room for improvement in adherence to guidelines and antibiotic stewardship also in low-prescribing countries. Antibiotic prescribing is closely linked to prescription rates and health-seeking behaviours, offering valuable insights for targeted antibiotic stewardship campaigns.

Globally, there is increasing evidence that incorrect penicillin allergy labels negatively affect patient outcomes, antibiotic prescribing and antimicrobial resistance, leading to growing concern about this patient safety issue and how to resolve it. While many millions of patients worldwide have incorrect penicillin allergy labels, there are too few specialist allergists and a lack of 'point-of-care' tests to address this problem. Numerous research studies now provide evidence of the feasibility and importance of widening access to penicillin allergy assessment. Researchers from two UK-based studies (SPACE and ALABAMA), in collaboration with key stakeholders including patient representatives, gave their views to shape a high-level implementation plan to facilitate widening access to penicillin allergy assessment in the UK. This Viewpoint describes the basis of the implementation plan and summarizes the key actions required for successful delivery. While the plan is intended for the UK, we hope to promote international shared learning and collaboration to address this global problem informed by the UK context.

Background: There is a resurgence of interest in bacteriophage (phage) therapy as antimicrobials, resulting from growing antimicrobial resistance to small-molecule antibiotics. Phages are bacterial viruses long studied, but there is a need for high resolution and systematic assessment of clinical dosing strategies for phages to better inform therapy.

Methods: We hypothesized that empirical in vitro assessment of clinically relevant phages facilitates pharmacodynamic-driven individualization. Three clinically relevant phage strains (LUZ19, PYO2 and E215) were evaluated as mono- or dual-phage therapy against a clinical Pseudomonas aeruginosa in 24 h static time kills and in 7-day hollow fibre infection model.

Results: PYO2 single-bolus administration achieved a bacterial log reduction of 6.82 log₁₀ cfu/mL, with eradication at 4 h. Dual-phage therapy (LUZ19 + PYO2) achieved a bacterial log reduction of 6.81 log₁₀ cfu/mL, with delayed eradication at 12 h.

Conclusions: This highlights the potential of reverse translational pharmacokinetic/pharmacodynamic-driven approaches to guide rational phage selection strategies against individual clinical isolates while identifying potential antagonistic phage-phage interactions.

Background: Increasing resistance to broad-spectrum beta-lactams and carbapenems is a significant concern in healthcare settings. This study aimed to determine the prevalence of intestinal carriage of extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacterales (CRE) in a tertiary care hospital and to evaluate the utility of long-read sequencing for carbapenem resistance surveillance.

Methods: In 2021, stool samples (n = 538) and rectal swabs (n = 256) from hospitalized patients were cultured after enrichment on selective chromogenic medium to detect ESBL and CRE carriage. CRE isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing.

Results: Among 794 patient samples, 239 (30%) Enterobacterales isolates grew on ESBL media. On CRE agar, 28 Enterobacterales were cultured, 27 confirmed carbapenem-resistant and identified as Klebsiella pneumoniae (n = 25), Escherichia coli (n = 1), and Enterobacter cloacae (n = 1). In CRE, 29.6% (8/27) were carbapenemase-producing Enterobacterales (CPE), carrying the bla _OXA-48 (n = 7) or bla _NDM-1 (n = 1) genes. The remaining 70.4% (19/27) were non-carbapenemase-producing CRE isolates (non-CP-CRE). The bla _OXA-48 gene was localized on identical IncL plasmids with an inverted Tn1999.2 transposon in non-clonally related isolates. CPE isolates exhibited distinct resistance patterns to carbapenems, β-lactam/β-lactamase inhibitor combinations, with 87.5% resistant to cefiderocol. All non-CP-CRE isolates remained susceptible to imipenem; two were resistant to meropenem and carried either five or six copies of the bla _CTX-M-15 gene along with mutations in porin genes.

Conclusions: A 30% prevalence of intestinal carriage of ESBL-producing Enterobacterales and a 3.4% carriage prevalence of CRE were found. Long-read sequencing revealed IncL plasmid-mediated dissemination of OXA-48 β-lactamase and bla _CTX-M-15 gene amplification, demonstrating its added value for antimicrobial resistance monitoring.

Background: Shared decision making (SDM) is a collaborative process between patients and prescribers and identified as a strategy to support antimicrobial stewardship. SDM can improve patient and clinician satisfaction and reduce antibiotic prescribing. However, little is known about how to implement antibiotic SDM in secondary care.

Objectives: Identify opportunities for antibiotic SDM between patients and clinicians in secondary care.

Methods: Semi-structured interviews were conducted with senior decision makers (registrar or consultant grade) and adult patients who had received antibiotics during their medical or surgical admission, recruited from three secondary care Trusts in England. Interviews explored participants' views on opportunities for SDM when prescribing antibiotics in secondary care, guided by the 'Start Smart, Then Focus' framework. Interviews were audio recorded, transcribed verbatim and analysed thematically.

Results: 18 clinicians and 20 patients were interviewed. Two themes were identified. In 'Pushing back against SDM', participants challenged the amenability and prioritization of SDM for antibiotics in inpatient settings, related to clinicians being seen as main decision makers, with patients not seeking further involvement. This was reinforced by the perceived urgency of treatment, the fast-paced hospital environment, and the view that antibiotic decisions were either too complex or too straightforward to invite shared input. In 'If not SDM, then what?', participants endorsed bi-directional communication and information provision as alternative priorities, highlighting its value.

Conclusions: SDM was not well understood or endorsed for antibiotic prescribing decision making in secondary care. Further work is warranted to educate and upskill clinicians in SDM as a concept within secondary care.

Background: Acute bacterial prostatitis (ABP) is a complicated urinary tract infection (UTI) requiring timely and appropriate antibiotic therapy. Because of growing concern over fluoroquinolone resistance, second-generation cephalosporins such as cefuroxime may offer a viable alternative.

Objectives: This study evaluates the use of cefuroxime as an empirical first-line intravenous treatment in hospitalized patients with ABP and compares outcomes following various oral antibiotic step-down regimens.

Methods: We conducted a single-centre retrospective cohort study at Clinique Saint-Pierre Ottignies, Belgium, including male patients ≥18 years diagnosed with ABP and treated empirically with intravenous cefuroxime between January 2019 and December 2023. Patients were grouped based on their oral antibiotic step-down therapy (cefuroxime, ciprofloxacin, trimethoprim-sulfamethoxazole or amoxicillin). The primary outcomes were bacterial failure and clinical recurrence within 6 months.

Results: Of 148 patients screened, 88 met inclusion criteria. No relapses were reported. Escherichia coli was the predominant pathogen (49/88); 100% were cefuroxime-susceptible, while four were fluoroquinolone-resistant. Among non-E. coli isolates, resistance to cefuroxime was significantly higher (OR 8.5, P = 0.003).

Conclusions: Empirical intravenous cefuroxime followed by oral step-down appears safe and effective for ABP, especially in the absence of known risk factors for resistant pathogens. These findings support fluoroquinolone-sparing approaches in empiric UTI management, tailored to local microbiological profiles and individual comorbidities.

Objectives: One of the biggest challenges for healthcare providers is the difficulty with screening for carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPa; P. aeruginosa), given the variety of mechanisms that can mediate carbapenem resistance in P. aeruginosa. We sought to develop an improved algorithm to screen for carbapenemase activity in P. aeruginosa using routine antimicrobial susceptibility testing readily available in most clinical microbiology laboratories.

Methods: Antibiograms of a reference set of P. aeruginosa (n = 100) with diverse phenotypic and genotypic profiles were compared to determine which antibiotics optimally screen for and differentiate CP-CRPa from CRPa and non-CRPa. The developed algorithm was then applied to 1482 clinical P. aeruginosa isolates. Carbapenemase PCR and the modified carbapenem inactivation method were performed on all meropenem-resistant P. aeruginosa isolates.

Results: The CP-CRPa screening algorithm developed here uses meropenem, ceftazidime and tobramycin. Carbapenem resistance was identified in 85 (5.7%) isolates, of which 26 (1.8%) were confirmed as CP-CRPa. bla _GES (57.7%) was the predominant carbapenemase detected, whilst bla _NDM, bla _VIM, bla _IMP and bla _KPC carbapenemases were also detected. The CP-CRPa screening algorithm was 100% sensitive (CI_95% 84.0%-100%) and 96.6% specific (CI_95% 87.3%-99.4%).

Conclusions: We present an antimicrobial susceptibility testing-based screening algorithm that uses meropenem, ceftazidime, and tobramycin to screen for CP-CRPa. When appropriate screening criteria are utilized, confirmatory testing can be significantly reduced, resulting in substantial time and resource savings, without compromising sensitivity, particularly in settings with varying carbapenemase epidemiology.

Background and objective: Antimicrobial resistance (AMR) is a global health challenge driven by inappropriate prescribing. Antimicrobial stewardship (AMS) education during undergraduate training is important to prepare future healthcare professionals for responsible prescribing, yet provision remains inconsistent across disciplines. To systematically review AMS educational interventions for undergraduate medical, pharmacy, nursing, dental, veterinary and midwifery students, and evaluate the behavioural coverage using the COM-B framework.

Methods: A protocol was registered on PROSPERO (CRD420250655653). Six databases were searched on 4 February 2025. Eligible studies evaluated AMS educational interventions for undergraduate students. Data were independently extracted in duplicate, methodological quality appraised using Medical Education Research Study Quality Instrument (MERSQI) and findings were synthesized narratively using COM-B.

Results: Of 7771 records screened, 42 studies were included, involving 8567 students across six continents. Most were single-group pre-/post-designs, with two randomized controlled trials. All studies addressed psychological capability, mainly by increasing knowledge and reasoning, while reflective motivation was supported in 25/42. Physical opportunity (20/42) and social opportunity (18/42) were less frequent, typically via structured cases or teamwork. Physical capability (9/42) and automatic motivation (2/42) were least represented, usually through simulation, supervised practice or affective engagement. MERSQI scores indicated moderate methodological quality overall.

Conclusions: Undergraduate AMS education is widespread but uneven in its coverage, with emphasis on knowledge and limited attention to skills, opportunities and motivation. Applying COM-B highlights the need for curricula to combine knowledge with rehearsal, authentic resources, teamwork, identity development and positive engagement to prepare graduates for stewardship practice.