JAC-Antimicrobial Resistance最新文献

Background and objectives: There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data.

Methods: We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models.

Results: The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9-6.5) and 4.1 days (95% CI: 3.8-4.5) for Enterobacterales, 4.9 days (95% CI: 4.5-5.4) and 3.1 days (95% CI: 2.6-3.6) for enterococci, and 6.3 days (95% CI: 5.3-7.3) and 9.8 days (95% CI: 9.1-10.5) for S. aureus.

Conclusions: Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.

Objective: To assess the antibiotic resistance and beta-lactam resistance genes among bacterial isolates from clinical, river water and poultry samples.

Methods: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were isolated from clinical, poultry and river water samples collected during 2020-22. They were subjected to antimicrobial susceptibility tests following the CLSI guidelines. The bacteria were screened for β-lactam resistance genes bla _TEM, mcr-1, mecA and bla_NDM-1 .

Results: Among 2835 clinical samples, E. coli was the most frequently isolated bacterium (10.3%, 292), followed by S. aureus (6.0%, 169) and P. aeruginosa (4.0%, 143). Of the E. coli isolates, 64.4% exhibited multidrug resistance (MDR) and 43.8% were extended-spectrum β-lactamase (ESBL) producers, with 44.5% and 16.4% harbouring the blaTEM and mcr-1 genes, respectively. Among S. aureus isolates, 80.9% of methicillin-resistant strains (MRSA) carried the mecA gene, while 30.1% of metallo-β-lactamase (MBL)-producing P. aeruginosa were positive for the blaNDM-1 gene. In poultry samples, 30.4% of E. coli isolates harboured the blaTEM gene among 128 ESBL producers, and the prevalence of colistin-resistant isolates carrying mcr-1 was higher than in clinical samples. In contrast, the occurrence of ESBL-producing E. coli and MRSA, along with their associated resistance genes, was lower in water samples.

Conclusions: This study demonstrated widespread multidrug resistance (MDR) and ESBL production among clinical, poultry and river water bacterial isolates in the Kathmandu valley. Colistin-resistant E. coli carrying the mcr-1 gene, methicillin-resistant S. aureus (MRSA) with mecA and metallo-β-lactamase (MBL)-producing P. aeruginosa harboring blaNDM-1 were detected across sources. These findings emphasize an urgent One Health approach to curb the growing threat of antimicrobial resistance in the region.

Background: Although Japanese guidelines recommend fluoroquinolones (FQs) and cephalosporins for AUC (acute uncomplicated cystitis) treatment, the emergence of FQ-resistant uropathogens and inappropriate use of antibiotics may lead to treatment failure (TF), and increased healthcare costs. There is a need to understand the epidemiology, treatment patterns, and healthcare cost implications associated with AUC in Japan.

Methods: This retrospective cohort study used the Japanese Medical Database Centre database (1 October 2015-30 November 2021). Female patients (≥18 years) had an AUC diagnosis in the same month as ≥1 oral antibiotic prescription claim in the outpatient setting. The population was stratified into cohorts by TF status and history of AUC recurrence prior to index (pre-index recurrence). Baseline demographics were evaluated in the 12-month pre-index period and age standardized prevalence of AUC was calculated. Treatment patterns and AUC-related costs [2022 Japanese Yen (¥)], were reported for the post-index follow-up period.

Results: Of 71 476 total patients, 62.46% were aged <50 years. Patients had evidence of TF (n = 3742; 5.24%) and pre-index recurrence (n = 3206; 4.49%). The age standardized prevalence of AUC (2016-2021) decreased from 8.62% to 6.02%, with up to 3.9 million women affected each year. A high proportion of patients with TF received FQs (45.48%) and third generation cephalosporins (43.37%). The mean total AUC-related costs were ¥14 905 and pharmacy costs were ¥1059 per patient, per index AUC episode.

Conclusion: Healthcare providers should consider the cost implications for patients with antibiotic TF or a history of AUC recurrence when selecting antibiotics for empiric treatment in Japan.

Aim: Multidrug-resistant (MDR) Gram-negative bacilli pose a significant threat in neonatal care. This study aimed to evaluate the point prevalence and molecular characteristics of intestinal MDR colonization in neonates at Muhimbili National Hospital, Tanzania.

Method: We conducted a point prevalence study with faecal samples from 51 neonates born ≥26 weeks gestational age (41% girls, mean 31.6 ± 3.8 weeks) admitted to the neonatal intensive care unit (NICU) at Muhimbili National Hospital on 17 May 2022. The median age at sampling was 8 days (interquartile range 11 days). Samples were cultured on chromogenic agar, and positive colonies underwent antimicrobial susceptibility testing. Whole-genome sequencing and plasmid analysis using Optical DNA Mapping (ODM) were performed on carbapenem-resistant isolates.

Results: Among the 51 neonates, 31 (60.7%) were colonized by ESBL-producing Klebsiella pneumoniae (EP-KP) and/or Escherichia coli (EP-EC). Of these, 15 isolates were carbapenem-producing Enterobacteriaceae (CPE) harboring bla _NDM-5, bla _CTX-M-15, and eight also carried bla _OXA-181. The most prevalent carbapenemase-producing Klebsiella pneumoniae (CP-KP) sequence type (ST) was ST437, part of the high-risk clonal complex CC11, while the most common carbapenemase-producing E. coli (CP-EC) was ST167. Both CP-KP and CP-EC were MDR isolates encoding bla _CTX-M-15 and bla _NDM-5. Optical DNA Mapping showed that the bla _NDM-5 encoding plasmids in at least six carbapenem-producing isolates (four KP ST437 and two EC ST167) were similar, suggesting plasmid transfer.

Conclusion: A high prevalence of colonization with high-risk clones was observed in neonates, highlighting the urgent need for strengthened MDR-surveillance, infection control, and antibiotic stewardship in the NICU at MNH.

Objectives: To survey the current antibiotic and antifungal drug practices of UK neonatal intensive care units (NICUs), and to identify antibiotic preferences and policies for treatment of early- and late-onset sepsis (EoS and LoS), meningitis, and antifungal prophylaxis.

Methods: Between January and May 2024, we contacted all 53 tertiary-level UK NICUs via telephone and/or e-mail. We requested a copy of each unit's guidelines for antibiotic treatment of EoS and LoS, and antifungal prophylaxis.

Results: We obtained guidelines from 53/53 (100%) units. A penicillin and aminoglycoside combination was the consistent first-line recommendation for EoS in 51/53 (96%) units. Only a minority (11/53; 21%) units specified any second-line antibiotic regimen for EoS, though most (44/53; 83%) specifically recommended amoxicillin for suspected listeriosis. For LoS, almost all NICUs (52/53; 98%) provided specific guidance on empirical first-line antibiotic treatment, with empirical narrow-spectrum antibiotics as first-line LoS treatment for term neonates in 42/53 (79%) NICUs and for preterm neonates in 41/53 (77%) NICUs. Fifty-four percent (29/53) of units included specific LoS recommendations for neonates with indwelling central venous catheters. Sixty-six percent (35/53) of NICUs included cefotaxime in their empirical meningitis regimens. Eighty-five percent (45/53) of units had clear guidelines for antifungal prophylaxis.

Conclusions: While EoS treatment was consistent across units, there remained wide variation in antibiotic regimens used for LoS and meningitis, and for neonates with indwelling central venous catheters. Guidelines specific to preterm neonates were limited. The practice of routine antifungal prophylaxis has been more prevalent since the last UK survey in 2006-07 but is still neither universal nor consistent.

Objectives: ESBLs are an important cause of third generation cephalosporin resistance in Enterobacterales. However, there is a paucity of data on ESBLs in blood stream infections (BSI) in Laos. The aim of this study was to investigate the presence of ESBL-producing Escherichia coli (ESBLEC) and ESBL-producing Klebsiella pneumoniae (ESBLKP) in blood cultures submitted to Mahosot Hospital, Laos and how these have changed over 18 years.

Methods and materials: This retrospective observational study included blood cultures from patients presenting with fever to Mahosot Hospital between 2000 and 2018. Full identification and antibiotic susceptibility testing was carried out on positive bottles. ESBL production was determined using the double-disc method. Patient clinical and residence data were included in univariable and multivariable analyses to identify risk factors for having an ESBL.

Results: From 52 249 blood culture sets collected over the 18-year period, 222 (0.42%) were positive for an ESBLEC or ESBLKP. The proportion of E. coli and K. pneumoniae isolates that were ESBL positive increased from 3.2% in 2000 to 35.4% in 2018. While there was a steady increase seen in ESBLEC over the 18-year period, ESBLKP have remained at ∼7% of K. pneumoniae isolates. Most ESBLs were community acquired. From univariable analysis, factors positively associated with an ESBL isolate included chronic renal failure, renal stones and having taken an antibiotic in the week before the blood sample.

Conclusion: With a rising trend of ESBLEC in Laos, controlling unregulated antibiotic usage in the community will be pivotal to stopping further increases.

Introduction: This study aims to assess the impact of proactive Infectious Disease Specialist (IDS) interventions, in addition to standard antimicrobial stewardship (AMS) practices, triggered by real-time microbiological alerts, on improving the appropriateness and timeliness of antimicrobial prescriptions in hospitalized patients with bloodstream infections (BSIs).

Methods: We conducted a prospective, single-center, pre-post interventional study at the University Hospital of Modena, Italy. Adult inpatients with monomicrobial BSIs between June 2022 and March 2023 were included. During the intervention phase (November 2022-March 2023), real-time microbiological alerts were automatically delivered to IDS consultants, who proactively reviewed therapy. Primary outcomes included the time to effective therapy (TTE) and the time to appropriate therapy (TTA). Secondary outcomes encompassed the duration of antimicrobial therapy, 14 and 30-day mortality from BSI, and hospital length of stay.

Results: A total of 446 BSI episodes were analyzed (211 pre-intervention, 235 post-intervention). Post-intervention, the rate of appropriate therapy significantly increased (97.4% versus 76.2%, P < 0.001), and TTE was significantly shorter (0.63 versus 0.87 days, P = 0.022). No statistically significant reduction in TTA was observed (1.97 versus 2.37 days, P = 0.081). Early IDS intervention (<48 h) was associated with the shortest TTE and TTA. No significant differences were observed in mortality or hospital stay. Kaplan-Meier analysis showed a higher probability of receiving effective and appropriate therapy earlier in the post-intervention phase (log-rank test P = 0.014; 0.072, respectively). Subgroup analysis showed TTE improvements across MDR pathogens.

Conclusions: A proactive intervention of IDS, based on automatic microbiological alert, in addition to routine AMS activities, is significantly associated with improved prescription appropriateness, reducing TTE.

Background: Dentists are responsible for 10% of all antibiotic prescriptions. It is estimated that, in certain situations, up to 80% of antibiotic prescriptions in dentistry may be inappropriate. The aim of this study was to explore Spanish dentists' attitudes, perceptions, and contextual factors influencing antibiotic use and misuse in clinical practice.

Methods: From July to December 2022, we conducted focus groups with 31 dentists from Spain Data were analysed using thematic analysis with a pragmatic orientation to address the research objectives. Inclusion criteria required participants to be dentistry graduates or oral medicine specialists (stomatologists) and actively working as dentists. The sample was selected through key informants and the snowball method. We ensured methodological quality by adhering to the COREQ checklist.

Results: We formed seven synchronous online focus groups with 31 participants. Dentists acknowledged the problem of antibiotic resistance, identifying fear, working conditions and burnout and patient trust as factors contributing to inappropriate prescribing. Despite this awareness, dentists did not see themselves as key agents of change in combating antibiotic resistance. However, they expressed interest in further education on the topic.

Conclusions: These findings underscore the need for educational interventions that highlight dentists' role in antimicrobial stewardship. By situating these interventions within the One Health framework, dentists can be empowered to translate their leadership in oral health into active participation in the prudent use of antibiotics. Strengthening this role has practical implications for multidisciplinary strategies to combat antimicrobial resistance.