JAC-Antimicrobial Resistance最新文献

Background: Antimicrobial resistance (AMR) poses a global health threat requiring effective education for future prescribers. Despite its urgency, there is limited evidence about how future prescribers are educated to mitigate AMR.

Objectives: To investigate associations between AMR knowledge and (i) preferred teaching methods, (ii) self-reported competency, and (iii) recall of AMR-related curricular content among Norwegian medical and veterinary students.

Methods: A cross-sectional survey of 110 students (61 medical, 49 veterinary) from two Norwegian universities assessed knowledge, preferred teaching methods, self-reported competency and self-reported curricular coverage. Bivariate analyses and multivariable linear regression identified associations with knowledge.

Results: Formal lectures, guidelines, lab-based teaching and bedside teaching were the most preferred learning methods. Students reported that lab-based teaching had contributed to their learning about AMR, scoring higher on AMR knowledge (β = 0.89, P = 0.02), whereas those confident in knowing when to transition from IV to oral antibiotics had lower knowledge scores (β = -0.86, P = 0.031). Students reported lowest competency in antifungal-related topics.

Conclusions: The findings highlight a disconnect, where confidence does not equate to knowledge, and exposure to the curriculum alone is insufficient to ensure clinical competence. AMR knowledge is associated with perceptions about lab-based learning, and misplaced confidence in specific skills. Antifungal-related topics require more attention in curricula.

Introduction: Antibiotic-resistant infections (ARIs) disproportionately affect vulnerable populations, yet research of health inequalities in ARIs is limited. This scoping review explores the relationship between health inequalities factors and the risk of ARI in high-income countries.

Methods: We searched Ovid Embase, Ovid MEDLINE All and Google Scholar for studies from high-income countries between January 2010 and February 2024. Health inequalities factors assessed included socioeconomic status, protected characteristics and vulnerable groups. Studies on sexually transmitted, foodborne, viral and fungal infections were excluded.

Results: Of 331 papers reviewed, 18 were included. Studies were from the USA (12), UK (2), New Zealand (2) and Australia (1). Staphylococcus aureus was the most studied pathogen, with ethnicity, deprivation and age as key factors examined. In the USA, Black patients had MRSA rates 2-3 times higher than White patients, despite overall declines. Indigenous Australians also had elevated rates compared with non-indigenous populations. When socioeconomic factors and age were accounted for, racial disparities in MRSA were significantly reduced. Hispanic patients had higher rates of Streptococcus pneumoniae penicillin-resistant infections than non-Hispanic White patients. Escherichia coli resistance was more prevalent in low-income or high-deprivation groups, with ethnic minorities in New Zealand also disproportionately affected. Helicobacter pylori was most common in Māori populations compared with other ethnicities, and income inequality correlated with resistance in Enterococcus, Klebsiella and Pseudomonas across Europe.

Conclusions: We highlight the potential impact of factors associated with health inequalities on the risk of ARIs, with higher rates of resistant infection associated with ethnic minorities and income inequalities.

Background and objectives: In-depth knowledge of antibiotic treatments in animals is essential to effectively combat antimicrobial resistance. Notably, veterinary antibiotic sales in Switzerland have dropped by >50% in the past decade. However, a further breakdown by species or detailed livestock classes such as dairy or fattening cattle has so far not been possible because products are often authorized for use in multiple species and sectors. In 2020, the Swiss national monitoring system for antibiotic use (IS ABV) was introduced, which has substantially improved the availability of detailed data on antibiotic use. The aim of this study is to provide a high-level overview of IS ABV, its technical implementation and the current state of the system, highlighting its strengths and current and past weaknesses.

Methods: To achieve this, we extracted antibiotic use data from the IS ABV surveillance system and analysed prescription-level data from 2020 to 2023, applying seasonal adjustments using ARIMA time series modelling.

Results: We identified a significant decreasing trend in the number of prescriptions for companion and farm animals. In addition, the approximated reporting errors have decreased over time, indicating improved accuracy in documenting antibiotic use by veterinarians.

Conclusions: These advances highlight the system's effectiveness in improving data accuracy and in monitoring antibiotic management improvements in Swiss veterinary practices. By providing more reliable, timely data, IS ABV enables better monitoring of prescribing patterns and supports evidence-based decision-making. This enables the authorities to design targeted interventions and policies aimed at reducing unnecessary antibiotic use, thereby contributing to the fight against antimicrobial resistance.

Background: Acute respiratory infections (ARIs) account for 30% of long-term care facility (LTCF) infections, frequently leading to antibiotics over-prescription.

Objectives: This study evaluates the impact of SARS-CoV-2 testing on LTCF antibiotic prescriptions.

Methods: A retrospective study was conducted across 45 LTCFs in Vaud Canton, Switzerland, encompassing 2427 long-stay beds, from July 2021 to June 2023. Monthly data on SARS-CoV-2 tests and antibiotic prescriptions were collected. Using linear regression adjusted for Swiss viral epidemiology, we assessed the association between (i) SARS-CoV-2 testing and (ii) positive test results on antibiotic prescriptions.

Results: SARS-CoV-2 testing rates in LTCFs varied, ranging from 0.3% to 16% of residents tested per facility, peaking in January 2022, July 2022, and November 2022. Similar trends were observed for SARS-CoV-2 test positivity, except for the last testing peak. Antibiotic prescription rates fluctuated moderately, from 3.9% to 7.4% monthly, with minor peaks in December 2021 and April 2022, and a notable peak in January 2023.No significant association was found between SARS-CoV-2 testing and antibiotic prescriptions (coefficient = -0.03 [95%CI: -0.16; 0.10], P = 0.65). However, positive SARS-CoV-2 tests were negatively associated with prescriptions (coefficient = -0.28 [95%CI: -0.53; -0.03], P = 0.029); a 10% increase in positive tests is associated with a 2.8% reduction in antibiotic prescriptions, with an estimated 3.5 positive tests needed to prevent one prescription.

Conclusions: Overall testing rates showed no impact on antibiotic prescribing, but positive SARS-CoV-2 results correlated with reduced consumption, suggesting more informed prescribing practices and a reduction in unnecessary antibiotic use.

Antimicrobial stewardship (AMS) must evolve beyond specialist domains to become a routine part of everyday care. BSAC's LEAP (Leadership to Embed AMS into Practice) programme addresses this by developing leadership capacity among non-infection specialists, those closest to patients. As antimicrobial resistance (AMR) continues to threaten global health, LEAP offers a scalable model for decentralizing AMS leadership across the workforce. LEAP empowers frontline professionals to lead stewardship initiatives within their teams. This approach embeds AMS into routine practice, fostering sustainable, team-led improvement. With tailored pathways for both emerging leaders and experienced mentors, LEAP reframes stewardship as a shared responsibility. To meet the ambitions of national and global AMR strategies, investment must focus not only on systems but on the people who lead them. LEAP exemplifies how leadership development can drive meaningful change in AMS across disciplines and settings.

Background and objectives: The use of antimicrobials in human and animal health care settings is considered a major driving force behind the emergence of antimicrobial resistance, encouraging a focus on evidence-based interventions aimed at promoting behaviours aligned with antimicrobial stewardship (AMS) ideals within both sectors. The Arwain complex intervention within Wales established peer networks of 'Veterinary Prescribing Champions' (VPCs) within and between Welsh veterinary practices to facilitate AMS training, support and activity. This study evaluates AMS goal setting and implementation within continuously engaged Arwain veterinary practices (n = 34) between 2020 and 2024.

Methods: Descriptive quantitative analysis of Practice Action Plans (2020, 2024) and self-reported data on Action Plan implementation (2024), combined with qualitative analysis of participant interviews (2023) and participatory workshop feedback (2024) on challenges to implementing change, offer insight on the focus, achievements and implementation of AMS within the Arwain complex intervention.

Results: VPCs focused on behaviour-led (practice team/farm client) and structural (farm/practice-focused) changes. All practices reported at least one change goal initiated, with the majority (73%) reporting at least one fully implemented change. AMS implementation challenges included practical and cultural considerations of veterinary practices, the complexities of delivering AMS within inter-professional teams, the situated complexity of AMS on farm and the geographic, economic, regulatory, epidemiological and attitudinal factors implicit in the practice 'outer setting'.

Conclusions: The Arwain complex intervention led to successful implementation of AMS changes across participating practices, with varying complexity, abstractness and completeness. Further research into the impact on antimicrobial use is needed to evaluate and inform future policy.

Background and objective: Antimicrobial resistance (AMR) is a critical global health threat, fuelled by inappropriate antibiotic use. In Palestine, dispensing antibiotics without prescription remains common despite legal restrictions, but limited qualitative evidence exists on pharmacists' perspectives. The objective was to explore community pharmacists' practices, perceptions, and challenges in dispensing antibiotics without prescription in Palestine.

Methods: This qualitative descriptive study used semi-structured, in-depth interviews with 14 licensed pharmacists from urban, semi-urban, and rural districts of the West Bank, conducted between January and March 2025. Purposive sampling ensured variation in gender, experience, and setting. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Braun and Clarke's framework. Six major themes were identified.

Results: Participants were aware of the legal prohibition but cited weak enforcement. Daily non-prescription requests were common, especially during seasonal illnesses, driven by prior positive experiences, social recommendations, and inability to afford doctor visits. Symptom-based dispensing was used in perceived 'clear cases,' influenced by customer pressure and business competition. Public misconceptions-such as believing antibiotics treat viral infections-were widespread, with frequent incomplete dosing and reuse of leftovers. Pharmacists attempted patient education but faced time and receptiveness barriers, and often experienced ethical conflict. Regulatory oversight was minimal; participants recommended stricter inspections, public awareness campaigns, and collaborative practice models.

Conclusions: Non-prescription antibiotic dispensing in Palestine is shaped by patient demand, economic pressures, and weak regulation. Addressing these drivers requires strengthened enforcement, targeted public education, professional training, and integration of pharmacists into AMR stewardship to safeguard public health. These findings highlight the need for actionable reforms in pharmacy practice and national policy, including stricter regulatory oversight and pharmacist-led public education, to reduce inappropriate antibiotic use and strengthen AMR containment strategies.

Background: The US elderly population (≥65 years old) increased markedly in the last decades, and infections are responsible for approximately one-third of all deaths in this population. We evaluated the antimicrobial susceptibility of Enterobacterales causing infection in elderly patients in US hospitals.

Methods: Unique patient clinical isolates were consecutively collected from 72 US hospitals in 2021-2023 and tested for susceptibility by broth microdilution. Results for 10 574 Enterobacterales from elderly patients were analysed and compared with 9793 isolates from adult patients (18-64 years old). Carbapenem-resistant Enterobacterales (CRE) were screened for carbapenemases by whole-genome sequencing.

Results: All isolates from elderly patients were inhibited at aztreonam-avibactam MIC of ≤8 mg/L (>99.9% susceptible at ≤4 mg/L). Ceftazidime-avibactam and meropenem-vaborbactam were very active against Enterobacterales overall (≥99.7% susceptible) but exhibited limited activity against CRE (70.4%-71.6% susceptible). The most active agents against CRE were aztreonam-avibactam (98.8% susceptible), cefiderocol (96.3% susceptible) and tigecycline (96.3% susceptible). Susceptibility rates of isolates from the elderly were comparable (±≤ 2.6%) with those from the adult population; however, the frequencies of CRE and MDR phenotypes were lower among the elderly than adults. The most common carbapenemase among CREs from elderly patients were Klebsiella pneumoniae carbapenemases (55.6% of CRE) and NDM (24.7%); a metallo-β-lactamase was identified in 28.4% of CRE isolates.

Conclusions: Enterobacterales causing infections in the elderly population showed a similar antimicrobial resistance profile but a lower frequency of CRE and MDR isolates to those causing infection in the adults.