JAC-Antimicrobial Resistance最新文献

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.

Background: There are concerns with the availability of substandard antibiotics across Africa, including Ethiopia, exacerbating high levels of antimicrobial resistance (AMR). There are ongoing initiatives across Africa to reduce their availability to reduce AMR, including Pan-African registration, coordination with Interpol, and increasing surveillance. Consequently, the objective of the study was to evaluate the quality of different brands of clarithromycin tablets currently marketed in Ethiopia as a key antibiotic.

Methods: A total of 120 tablets of 12 different brands of clarithromycin 500 mg tablets were purchased from 12 different community pharmacies. Quality control tests, including visual inspection, thickness, diameter, hardness, friability, weight variation, disintegration, dissolution, and assays, were conducted at the Ethiopian Pharmaceutical Company's drug quality control laboratory on the sourced tablets. Tests were performed in accordance with the United States Pharmacopoeia (USP) and the World Health Organization's procedures.

Results: The identification test results confirmed the presence of the active pharmaceutical ingredients. The weight variation tests showed compliance with the USP limits. All clarithromycin brands and tablets met the USP requirements for hardness and disintegration times. The percentage content of all brands and tablets ranged from 95.14% to 100.44%, meeting the USP specifications. The dissolution tests also met required USP limits alongside factor (f1) factor (f2) values, which were within acceptable ranges.

Conclusion: As a result, all tested clarithromycin brands conformed with the required quality standards and were of acceptable quality. Consequently, these different brands of clarithromycin can be used to effectively treat patients and support ongoing national efforts to ensure antibiotic quality and strengthen AMR containment strategies.

Background: Antimicrobial resistance (AMR) poses a significant public health threat. Individuals in contact with the criminal justice system, including individuals in custody, prisons, jails or youth offending institutions, may be particularly vulnerable due to living conditions, behaviours and pre-existing health issues. This review assesses bacterial AMR and antibiotic use in this population.

Methods: A rapid systematic scoping review was conducted (OSF: https://doi.org/10.17605/OSF.IO/XHCFJ). Embase, Medline and Scopus were searched for studies published between 1 January 2010 and 28 September 2023. One author screened all records, with 10% dual screened. Included studies examined AMR bacteria or antibiotic use among people in contact with the criminal justice system (including people in custody, prisons, jails or youth offending institutes). Study quality was assessed using the Newcastle-Ottawa Scale and STROBE AMS checklist. Findings were synthesized narratively as evidence was limited and heterogeneous, which prohibited planned meta-analyses.

Results: Sixteen papers met inclusion criteria; eight were at lower risk of bias. Three studies examined antibiotic use, reporting common inappropriate prescribing (n = 1) and associations between recent antibiotic use and resistant infections (n = 2). Fourteen papers reported AMR findings, most with a focus on Mycobacterium tuberculosis and Staphylococcus aureus. Drug-resistant TB prevalence in prison populations ranged from 5.2% to 37% (n = 4). Methicillin resistant Staphylococcus aureus colonization ranged from 8.1% to 8.8% (n = 4). Other bacteria examined included Salmonella spp., Acinetobacter spp., Group A Streptococcus, and Mycoplasma genitalium.

Conclusions: People in contact with the criminal justice system face heightened risks of resistant bacterial infections. However, with only three studies addressing antibiotic use, evidence is limited. Addressing AMR in this group requires collaborative and targeted public health interventions.

[This corrects the article DOI: 10.1093/jacamr/dlaf211.].

Background: Antimicrobial stewardship programs (ASPs) are essential to improve antibiotic prescribing. This study evaluated the impact of a post-prescription audit and feedback intervention on carbapenem prescribing appropriateness in a large university hospital.

Methods: This retrospective observational study utilized interrupted time series (ITS) analysis, employing an Autoregressive Integrated Moving Average (ARIMA) model, to assess carbapenem prescribing across three consecutive phases: a 12-month pre-intervention, a 6-month intervention, and a 6-month post-intervention follow-up. Carbapenem prescribing appropriateness was retrospectively evaluated using an in-house developed algorithm, based on international and national guidelines and institutional protocols. The intervention involved bedside consultations by infectious diseases specialists employing a post-prescription audit with face-to-face feedback.

Results: We evaluated 1825 carbapenem therapies, primarily prescribed for suspected/confirmed bloodstream infections (46%, 843/1825). Among these, 458 (25%) were deemed inappropriate, mainly due to unnecessarily broad-spectrum use (72%, 331/458). The ITS-ARIMA model showed an immediate 11% reduction in the rate of inappropriate prescriptions during the first month of intervention phase (P = 0.001), followed by a non-significant downward trend during the remaining intervention period. However, an immediate 14.9% increase in inappropriate prescriptions was observed at the onset of the post-intervention phase (P = 0.001), indicating a rebound effect after the withdrawal of the active stewardship intervention.

Conclusions: Implementing a post-prescription audit and face-to-face feedback intervention was associated with a short-term improvement in carbapenem prescribing appropriateness. We observed a reduction in the trend of inappropriateness, although this change was not statistically significant. Future studies should investigate strategies for implementing sustainable ASPs optimizing human resources and time investment.