Journal of global antimicrobial resistance最新文献_第3页

Antibacterial resistance in urinary samples from long-term care-facility and community-dwelling older people in Gauteng, South Africa 南非豪登省长期护理机构和社区居住老年人尿液样本中的抗菌药物耐药性

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.jgar.2026.01.012

Olivia Labuschagne , Stephanie Leigh , Chanel Kingsburgh , Christopher David Williams

Objective

Older populations (≥ 60 years) are frequent users of health care services, often vulnerable to infections and antimicrobial resistance (AMR). Urinary tract infection is often diagnosed in this cohort based on non-specific or atypical symptoms, yet empirical therapy seldom considers the potential influence of residential setting on resistance patterns. This study therefore aimed to quantify and compare the in vitro AMR profiles of urinary pathogens from these two settings and assessed temporal resistance trends to inform antimicrobial stewardship priorities.

Methods

A retrospective analysis was conducted using anonymised microbiology data from Ampath Laboratories in Gauteng. Urine cultures collected from older adults (≥60 years) between 2015 and 2023 were included. The five most common uropathogens were analysed. Resistance differences between long-term care facility (LTCF) and community samples were assessed using univariate and multivariable logistic regression models adjusting for age, sex, inpatient status, and sampling year. Temporal trends were evaluated using Kendall tau-b.

Results

A total of 50 704 urine cultures were analysed, of which 18.81% were from LTCFs. Escherichia coli and P. mirabilis showed consistently higher resistance in LTCF isolates. In E. coli, LTCF residence was associated with increased resistance to ciprofloxacin (adjusted OR 1.26; 95% CI 1.18–1.34), nitrofurantoin (1.55; 1.38–1.75), ceftriaxone (1.24; 1.14–1.34), amoxicillin/clavulanic acid (1.11; 1.05–1.19), and co-trimoxazole (1.10; 1.03–1.18). P. mirabilis showed similar patterns, with higher resistance to ciprofloxacin (2.16), gentamicin (1.64), fosfomycin (1.72) and co-trimoxazole (1.49). Trend analysis showed increasing fosfomycin resistance from E. coli isolates in both LTCFs (3.74% to 6.18%) and community settings (2.75% to 3.74%) and rising ceftriaxone resistance in community isolates (13.32% to 17.60%).

Conclusions

LTCF residence was independently associated with higher AMR in several common urinary pathogens. These findings suggest that empirical urinary tract infection regimens commonly used in community-dwelling older adults may be inadequate for LTCF residents. Setting-specific antibiograms, improved diagnostic stewardship, and strengthened antimicrobial stewardship interventions are needed to support appropriate prescribing. Further studies incorporating patient-level clinical factors are warranted to refine empirical treatment recommendations for older adults across care settings.

背景：老年人（≥60岁）是卫生保健服务的频繁使用者，往往易受感染和抗微生物药物耐药性（AMR）的影响。尿路感染（UTI）的诊断通常基于非特异性或非典型症状，但经经验治疗很少考虑居住环境对耐药性模式的潜在影响。因此，本研究旨在量化和比较这两种情况下泌尿系统病原体的体外AMR谱，并评估时间耐药趋势，以告知抗菌素管理（AMS）的优先事项。方法：采用来自豪登省Ampath实验室的匿名微生物学数据进行回顾性分析。纳入2015年至2023年间收集的老年人（≥60岁）尿液培养。分析了五种最常见的泌尿系统病原体。使用单变量和多变量logistic回归模型评估LTCF和社区样本之间的耐药性差异，该模型调整了年龄、性别、住院情况和采样年份。使用Kendall's tau-b来评估时间趋势。结果：共分析尿培养物50,704份，其中18.81%来自ltcf。大肠杆菌和变形杆菌在LTCF分离株中始终表现出较高的耐药性。在大肠杆菌中，LTCF的存在与对环丙沙星（校正OR 1.26; 95% CI 1.18-1.34）、呋喃妥英硝基（1.55;1.38-1.75）、头孢曲松（1.24;1.14-1.34）、阿莫西林/克拉维酸（1.11;1.05-1.19）和复方新诺明（1.10;1.03-1.18）的耐药性增加有关。P. mirabilis对环丙沙星（2.16）、庆大霉素（1.64）、磷霉素（1.72）和复方新诺明（1.49）的耐药性较高。趋势分析显示，在ltcf（3.74% ~ 6.18%）和社区环境中，大肠杆菌对磷霉素的耐药性均呈上升趋势（2.75% ~ 3.74%），对头孢曲松的耐药性呈上升趋势（13.32% ~ 17.60%）。结论：LTCF驻留与几种常见泌尿系统病原菌较高的AMR独立相关。这些发现表明，通常用于社区居住的老年人的经验性尿路感染方案可能不适合LTCF居民。需要设置特定的抗生素图，改进诊断管理和加强辅助医疗系统干预，以支持适当的处方。进一步的研究纳入患者水平的临床因素是必要的，以完善经验治疗建议的老年人跨护理设置。

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引用次数: 0

Barriers and facilitators to the implementation of antimicrobial stewardship in veterinary education: A scoping review 兽医教育中抗菌剂管理（AMS）实施的障碍和促进因素：范围审查。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jgar.2026.01.015

Rekhashree Raveendran , Navya Vyas , Yashna Bharath Salian , Edlin Glane Mathias , Nagappa Karabasanavar

Objective

To identify the barriers and facilitators to implement antimicrobial stewardship (AMS) in veterinary education globally.

Methods

Following PRISMA-Scoping review guidelines and Arksey and O’Malley’s framework, this review analysed studies published between 2015 and 2025 from databases: PubMed (NCBI), Cochrane Library, Scopus (Elsevier), Embase (Elsevier), ProQuest, Web of Science (Clarivate), and CINAHL (EBSCO) to systematically identify relevant studies.

Results

Twenty studies were included in this review; barriers identified included inadequate AMS content integration within veterinary curricula and limited teaching hours dedicated to pharmacological training for students. Other barriers include gaps between theoretical and clinical practice, lack of electronic record systems enabling real-time monitoring of antimicrobial-use patterns in teaching hospitals, and weak policy enforcement in low- and middle-income countries (LMICs). Facilitators included student and faculty engagement, educational interventions such as workshops, symposiums, and online learnings modules. Institutional leadership and multidisciplinary collaboration have also been found effective in AMS implementation. However, the integration of One Health and AMS programs has remained limited and inconsistent in veterinary education.

Conclusions

The findings emphasise the need for AMS education reforms as curricula lack structured components of responsible antimicrobial usage. Future efforts must involve veterinary stakeholder collaboration to improve curricula, infrastructure, capacity, faculty development, and promote interdisciplinary and One Health education models.

抗菌素耐药性（AMR）是一种全球健康威胁，强调需要跨部门（包括兽医部门）进行抗菌素管理（AMS）。畜牧业中不适当使用抗菌素导致了抗生素耐药性的蔓延。一个关键的挑战是医疗辅助队在兽医教育中的整合不足，突出了弥合意识差距和加强未来兽医准备的重要性。目的：确定在全球兽医教育中实施抗菌药物管理的障碍和促进因素。方法：遵循PRISMA-ScR指南和Arksey和O'Malley的框架，本综述分析了PubMed （NCBI）、Cochrane Library、Scopus（爱思唯尔）、Embase（爱思唯尔）ProQuest、Web of Science （Clarivate）和CINAHL （Ebsco）数据库中2015年至2025年间发表的研究，进行了系统探索。结果：本综述纳入了20项研究，发现的障碍包括兽医课程中AMS内容整合不足，用于学生药理学培训的教学时间有限。其他障碍包括理论和临床实践之间的差距，缺乏能够实时监测教学医院抗微生物药物使用模式的电子记录系统，以及低收入和中等收入国家政策执行不力。促进者包括学生和教师的参与，教育干预，如研讨会，专题讨论会和在线学习。机构领导和多学科合作在辅助医疗系统的实施中也很有效。然而，在兽医教育中，One Health和AMS项目的整合仍然有限且不一致。结论：研究结果强调了AMS教育改革的必要性，因为许多课程没有包括负责任的抗菌药物使用的组成部分。未来的努力必须涉及兽医利益相关者的合作，以改进课程、基础设施、能力、教师发展，并促进跨学科和单一健康教育模式。

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引用次数: 0

The alarming rise of antimicrobial resistance in ICUs in Bangladesh: A silent emergency and the urgent need for national action 孟加拉国icu中抗菌素耐药性的惊人上升：无声的紧急情况和国家行动的迫切需要。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.jgar.2026.02.005

Md Saiful Islam , Be-Nazir Ahmed , Md Tanvir Rahman

引用次数: 0

Genomic analysis of coexisting β-lactamase plasmids in Klebsiella pneumoniae from an immunocompromised patient 免疫功能低下患者肺炎克雷伯菌中共存β-内酰胺酶质粒的基因组分析

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-02-08 DOI: 10.1016/j.jgar.2026.02.002

Thamer M. Brek , Hanan A. Alshafie , Musa A. Ayashi , Othman I. Aljurayyad , Hatim Almutairi , Elaf M. Alattas , Ibrahim A. Al-Zaharani

Objective

Infection significantly increases morbidity and mortality in hematologic malignancies due to immunosuppression, multiple risk factors, and greater susceptibility to healthcare-associated infections. We conducted a comprehensive genomic analysis of ESBL and carbapenemase co-producing K. pneumoniae (KP-JZ177) isolate recovered from a vulnerable patient with acute myeloblastic leukemia (AML) in Jazan region, Saudi Arabia.

Methods

A clinical K. pneumoniae (KP-JZ177) isolate was obtained from a wound swab of a female patient with AML in the Hematology–Oncology unit of a tertiary hospital in Jazan region. Identification and AST were performed using the MicroScan WalkAway system. Whole-genome sequencing enabled comprehensive characterization of the strain’s genetic profile, resistance determinants, virulence factors, and plasmid replicons.

Results

KP-JZ177 isolate displayed resistance to all tested antimicrobials except amikacin, gentamicin, tigecycline, and colistin. The genomic features of KP-JZ177 indicate substantial adaptability and pathogenic potential. KP-JZ177 belongs to sequence type ST147, a globally recognized high-risk clone associated with carbapenem resistance and recurrent hospital outbreaks. Its extensive drug-resistant (XDR) profile is driven by the co-occurrence of carbapenemase genes bla_OXA-48 and bla_NDM-1, which together confer high-level β-lactam resistance. Serotyping classified the isolate as KL64 with an O1/O2v1 O-antigen. Genomic analysis also revealed eight plasmids, many carried β-lactamase determinants and several mobile genetic elements (MGEs).

Conclusions

Genomic profiling of KP-JZ177 reveals high-risk K. pneumoniae clone carrying extensive resistance and virulence determinants on multiple plasmids, including bla_OXA-48 and bla_NDM-1. Its plasmids similarity to geographically distant strains underscore global AMR circulation, emphasizing the need for enhanced surveillance of ST147 CRKP isolates in high-risk populations.

目的：由于免疫抑制、多种危险因素以及对医疗保健相关感染的易感性，感染显著增加血液病恶性肿瘤的发病率和死亡率。我们对从沙特阿拉伯Jazan地区一名易感急性髓母细胞白血病（AML）患者中分离出的ESBL和产碳青霉烯酶的肺炎克雷伯菌（KP-JZ177）进行了全面的基因组分析。方法：从吉赞地区某三级医院血液肿瘤科1例女性急性髓系白血病患者伤口拭子中分离出一株临床肺炎克雷伯菌（KP-JZ177）。使用MicroScan WalkAway系统进行鉴定和AST。全基因组测序能够全面表征菌株的遗传谱、抗性决定因素、毒力因子和质粒复制子。结果：分离株KP-JZ177对除amikacin、庆大霉素、替加环素和粘菌素外的所有抗菌素均有耐药性。KP-JZ177的基因组特征表明其具有很强的适应性和致病潜力。KP-JZ177属于ST147序列型，这是一个全球公认的与碳青霉烯耐药和复发性医院暴发相关的高风险克隆。其广泛的耐药（XDR）特征是由碳青霉烯酶基因blaOXA-48和blaNDM-1的共同出现驱动的，这两个基因共同赋予了高水平的β-内酰胺耐药性。血清分型鉴定该分离物为KL64，具有O1/O2v1 o抗原。基因组分析还发现了8个质粒，许多质粒携带β-内酰胺酶决定因子和几个移动遗传元件（MGEs）。结论：KP-JZ177的基因组分析显示，高风险肺炎克雷伯菌克隆在多种质粒上携带广泛的耐药性和毒力决定因素，包括blaOXA-48和blaNDM-1。其质粒与地理上遥远菌株的相似性强调了全球AMR流行，强调需要加强对高危人群中ST147 CRKP分离株的监测。

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引用次数: 0

Evolution of carbapenem-resistant Klebsiella pneumoniae after ceftolozane–tazobactam exposure in a patient after cord blood transplantation: A case report 脐带血移植后患者接触头孢唑嗪-他唑巴坦后碳青霉烯耐药肺炎克雷伯菌的演变：一例报告。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jgar.2026.01.008

Shuhei Kurosawa , Sohei Harada , Kohji Komori , Kaworu Takatsuna , Hitomi Ike , Yukihiro Yoshimura , Yuki Iketani , Yoko Tateishi , Hiroyuki Hayashi , Tomonori Nakazato

Objective

Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have a poor prognosis, particularly in immunocompromised patients. While carbapenemase production is the primary resistance mechanism in carbapenem-resistant K. pneumoniae (CRKP), other mechanisms may contribute synergistically to carbapenem resistance. Here, we describe a case in which extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae, initially susceptible to carbapenems, acquired carbapenem resistance without carbapenemase production following ceftolozane–tazobactam exposure.

Methods

Whole-genome sequencing was performed on ESBL-producing K. pneumoniae strains detected during the clinical course to investigate the relationship between the genetic characteristics and antimicrobial susceptibility, particularly to ceftolozane–tazobactam and carbapenems. Changes in the transcription levels of the beta-lactamase genes were also analysed using reverse transcription quantitative PCR (RT-qPCR).

Results

Active surveillance stool culture before cord blood transplantation (CBT) identified colonisation with an ESBL-producing K. pneumoniae strain. Febrile neutropenia occurred on day 7 after CBT and was treated empirically with ceftolozane–tazobactam. Fatal bacteraemia developed on day 30 after CBT due to a carbapenemase-negative isolate resistant to both ceftolozane–tazobactam and carbapenems. Whole-genome sequencing analysis revealed that K. pneumoniae ST307 strains harbouring bla_CTX−M-15, bla_SHV-28 and bla_TEM-1B acquired a nonsense mutation in ompK36 following ceftolozane–tazobactam exposure. RT-qPCR analysis documented a significant increase in bla_SHV-28 transcription after ceftolozane–tazobactam exposure.

Conclusions

This case demonstrates that K. pneumoniae without carbapenemase production can acquire carbapenem resistance through a combined resistance mechanisms following exposure to non-carbapenem antibiotics. Antimicrobial stewardship must be implemented comprehensively, not focused solely on specific antibiotics.

目的：耐碳青霉烯肺炎克雷伯菌（CRKP）引起的感染预后较差，特别是在免疫功能低下的患者中。虽然碳青霉烯酶的产生是CRKP的主要耐药机制，但其他机制可能协同促进碳青霉烯类耐药。在这里，我们描述了一个产广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌，最初对碳青霉烯类药物敏感，在暴露于头孢唑嗪-他唑巴坦后，在不产碳青霉烯酶的情况下获得了碳青霉烯类药物耐药性。方法：对临床过程中检测到的产esbl肺炎克雷伯菌进行全基因组测序，研究遗传特征与抗菌药物敏感性的关系，特别是对头孢唑烷-他唑巴坦和碳青霉烯类药物的敏感性。利用反转录定量PCR （RT-qPCR）分析β -内酰胺酶基因转录水平的变化。结果：脐带血移植（CBT）前的主动监测粪便培养确定了产生esbl的肺炎克雷伯菌菌株的定植。认知行为治疗后第7天出现发热性中性粒细胞减少症，经经验应用头孢唑氮-他唑巴坦治疗。由于碳青霉烯酶阴性分离株对头孢唑烷-他唑巴坦和碳青霉烯类均耐药，在CBT后第30天发生致死性菌血症。全基因组测序分析显示，携带blaCTX-M-15、blaSHV-28和blaTEM-1B的肺炎克雷伯菌ST307菌株在暴露于头孢唑氮-他唑巴坦后获得了ompK36的无意义突变。RT-qPCR分析显示，暴露于头孢唑氮-他唑巴坦后，blaSHV-28转录显著增加。结论：本病例表明，不产生碳青霉烯酶的肺炎克雷伯菌在暴露于非碳青霉烯类抗生素后可通过联合耐药机制获得碳青霉烯类耐药性。抗菌药物管理必须全面实施，而不是仅仅集中在特定抗生素上。

{"title":"Evolution of carbapenem-resistant Klebsiella pneumoniae after ceftolozane–tazobactam exposure in a patient after cord blood transplantation: A case report","authors":"Shuhei Kurosawa , Sohei Harada , Kohji Komori , Kaworu Takatsuna , Hitomi Ike , Yukihiro Yoshimura , Yuki Iketani , Yoko Tateishi , Hiroyuki Hayashi , Tomonori Nakazato","doi":"10.1016/j.jgar.2026.01.008","DOIUrl":"10.1016/j.jgar.2026.01.008","url":null,"abstract":"<div><h3>Objective</h3><div>Infections caused by carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) have a poor prognosis, particularly in immunocompromised patients. While carbapenemase production is the primary resistance mechanism in carbapenem-resistant <em>K. pneumoniae</em> (CRKP), other mechanisms may contribute synergistically to carbapenem resistance. Here, we describe a case in which extended-spectrum β-lactamase (ESBL)-producing <em>K. pneumoniae</em>, initially susceptible to carbapenems, acquired carbapenem resistance without carbapenemase production following ceftolozane–tazobactam exposure.</div></div><div><h3>Methods</h3><div>Whole-genome sequencing was performed on ESBL-producing <em>K. pneumoniae</em> strains detected during the clinical course to investigate the relationship between the genetic characteristics and antimicrobial susceptibility, particularly to ceftolozane–tazobactam and carbapenems. Changes in the transcription levels of the beta-lactamase genes were also analysed using reverse transcription quantitative PCR (RT-qPCR).</div></div><div><h3>Results</h3><div>Active surveillance stool culture before cord blood transplantation (CBT) identified colonisation with an ESBL-producing <em>K. pneumoniae</em> strain. Febrile neutropenia occurred on day 7 after CBT and was treated empirically with ceftolozane–tazobactam. Fatal bacteraemia developed on day 30 after CBT due to a carbapenemase-negative isolate resistant to both ceftolozane–tazobactam and carbapenems. Whole-genome sequencing analysis revealed that <em>K. pneumoniae</em> ST307 strains harbouring <em>bla</em><sub>CTX−M-15</sub>, <em>bla</em><sub>SHV-28</sub> and <em>bla</em><sub>TEM-1B</sub> acquired a nonsense mutation in <em>ompK36</em> following ceftolozane–tazobactam exposure. RT-qPCR analysis documented a significant increase in <em>bla</em><sub>SHV-28</sub> transcription after ceftolozane–tazobactam exposure.</div></div><div><h3>Conclusions</h3><div>This case demonstrates that <em>K. pneumoniae</em> without carbapenemase production can acquire carbapenem resistance through a combined resistance mechanisms following exposure to non-carbapenem antibiotics. Antimicrobial stewardship must be implemented comprehensively, not focused solely on specific antibiotics.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"47 ","pages":"Pages 27-32"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacist-led multidisciplinary review of carbapenem use in inpatients: A quasi-experimental study 药师主导的住院患者碳青霉烯使用的多学科综述：一项准实验研究。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.jgar.2026.02.001

Xiaohong Wu, Tingting Nan, Xianni Wei, Yonglong Su, Yumei Cai, Siheng Lian, Xiaoyun Ye, Jinbao Wei

Objective

To evaluate the effect of a clinical pharmacist-led multidisciplinary team (MDT) review model on the appropriateness of carbapenem use amongst inpatients.

Methods

This study employed a quasi-experimental, pre-post design. We retrospectively analysed 1086 inpatient cases receiving carbapenem therapy between 2020 and 2024. From 2023 onward, an MDT comprising clinical pharmacists, infectious disease specialists, and microbiologists systematically reviewed medical orders against standardised criteria and provided evidence-based recommendations.

Results

Post-intervention, the appropriateness of initial carbapenem prescriptions increased from 77.08% to 83.79%, whereas re-evaluation appropriateness improved from 78.94% to 87.00% (P < .05). Pharmacist intervention acceptance rates rose significantly from 56.04% to 82.35% (P < .05). Additionally, median hospital length of stay decreased (19 vs. 15 days), with notable reductions in ICU admission (59.95% vs. 31.50%) and mortality rates (15.51% vs. 4.28%) (P < .001). Multivariable regression identified hepatic/renal dysfunction and hypoalbuminemia as independent risk factors for ICU admission, whereas ICU admission itself strongly predicted mortality. Notably, the detection rates of carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa increased during the intervention period.

Conclusions

The clinical pharmacist-led MDT model enhances carbapenem-prescribing appropriateness and fosters interprofessional collaboration. Its implementation was associated with shorter hospital stays and improvements in key clinical indicators, including reduced ICU admission and mortality. However, the observed shifts in resistant pathogen epidemiology underscore that antimicrobial stewardship strategies must be integrated with rigorous infection prevention and control measures to simultaneously optimise therapeutic outcomes and mitigate resistance.

目的：评价临床药师主导的多学科团队（MDT）评审模式对住院患者碳青霉烯类药物使用适宜性的影响。方法：本研究采用准实验、前后设计。我们回顾性分析了2020年至2024年间接受碳青霉烯治疗的1086例住院患者。从2023年起，由临床药剂师、传染病专家和微生物学家组成的MDT系统地根据标准化标准审查医嘱，并提供基于证据的建议。结果：干预后，碳青霉烯类初始处方的适宜性由77.08%提高到83.79%，再评价的适宜性由78.94%提高到87.00% （P < 0.05）。药师干预满意率由56.04%提高至82.35%，差异有统计学意义（P < 0.05）。此外，中位住院时间缩短（19天比15天），ICU住院率（59.95%比31.50%）和死亡率（15.51%比4.28%）显著降低（P < 0.001）。多变量回归发现肝肾功能障碍和低白蛋白血症是ICU入院的独立危险因素，而ICU入院本身对死亡率有很强的预测作用。值得注意的是，在干预期间，耐碳青霉烯肺炎克雷伯菌和铜绿假单胞菌的检出率有所上升。结论：临床药师主导的MDT模式提高了碳青霉烯类药物处方的适宜性，促进了跨专业合作。该方案的实施缩短了住院时间，改善了关键临床指标，包括降低了ICU住院率和死亡率。然而，观察到的耐药病原体流行病学的变化强调，抗菌药物管理策略必须与严格的感染预防和控制措施相结合，以同时优化治疗结果并减轻耐药性。

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引用次数: 0

Panton-Valentine leukocidin-positive sequence type 88 methicillin-resistant Staphylococcus aureus emerging as nosocomial pathogen in Brazil. 潘通-瓦伦丁白细胞素阳性序列88型耐甲氧西林金黄色葡萄球菌在巴西作为医院病原体出现。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 DOI: 10.1016/j.jgar.2026.02.009

Luisa Rodrigues Benfatti, Gregory Batista Melocco, Marlon do Valle Barroso, Matheus de Silvo Cobucci Cirino, Caroline Rodrigues da-Silva, Letícia Kellen de-Andrade, Cássia Fernanda Estofolete, Fernanda Esposito, Bruna Fuga, Taiana Tainá Silva-Pereira, Nilton Lincopan, Fernanda Zani Manieri, Ilana Lopes Baratella da Cunha Camargo, Tiago Casella, Mara Corrêa Lelles Nogueira

Objectives: This study describes the genomic and phenotypic characteristics of a Panton-Valentine Leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA)-ST88, causing ventilator-associated pneumonia (VAP) in Brazil.

Methods: The MRSA-ST88 isolate (SQ684) was recovered from a tracheal aspirate of a patient with VAP. Identification and antimicrobial susceptibility testing were performed using the BD Phoenix automated system, with vancomycin susceptibility and MICs for daptomycin and tigecycline confirmed by broth microdilution. Whole-genome sequencing (WGS) was conducted on the Illumina NextSeq 550 platform, followed by genomic analyses including MLST, SCCmec typing, resistome and virulome profiling, and core-genome SNP phylogeny incorporating international MRSA isolates.

Results: WGS classified SQ684 as ST88 carrying SCCmec IVc (2B). Phenotypically, the isolate was resistant to oxacillin and azithromycin, and harboured multiple resistance genes, including mecA, blaZ, aminoglycoside and macrolide resistance determinants, as well as genes linked to efflux pumps, plasmid replication, and virulence factors such as PVL. Core-genome phylogeny revealed substantial divergence from 169 international MRSA-ST88 isolates (243-293 SNPs), consistent with long-term, geographically independent evolution within the ST88 lineage.

Conclusion: With only one previous clinical report of MRSA-ST88 in Brazil, the identification of an SCCmec IVc- and PVL-positive ST88 strain underscores the potential for CA-MRSA clones to infiltrate hospital settings. Continued genomic surveillance is critical to clarify its epidemiological dynamics and assess public health implications in Brazil.

目的：本研究描述了在巴西引起呼吸机相关性肺炎（VAP）的ppanton - valentine Leukocidin （PVL）阳性耐甲氧西林金黄色葡萄球菌(MRSA)-ST88的基因组和表型特征。方法：从1例VAP患者气管抽吸中分离出MRSA-ST88分离株（SQ684）。使用BD Phoenix™自动化系统进行鉴定和药敏试验，用微量肉汤稀释法确定万古霉素的敏感性和对达托霉素和替加环素的mic。在Illumina NextSeq 550平台上进行全基因组测序（WGS），随后进行基因组分析，包括MLST， SCCmec分型，抗性组和病毒组分析，以及包含国际MRSA分离株的核心基因组SNP系统发育。结果：WGS将SQ684归类为携带SCCmec IVc （2B）的ST88。从表型上看，该分离物对oxacillin和阿奇霉素耐药，并携带多种耐药基因，包括mecA、blaZ、氨基糖苷和大环内酯类耐药决定因素，以及与外排泵、质粒复制和毒力因子（如PVL）相关的基因。核心基因组系统发育显示，来自169个国际MRSA-ST88分离株（243-293个snp）存在实质性差异，这与ST88谱系内长期的、地理独立的进化一致。结论：在巴西只有一份MRSA-ST88的临床报告，SCCmec IVc和pvl阳性ST88菌株的鉴定强调了CA-MRSA克隆渗透医院环境的潜力。持续的基因组监测对于澄清其流行病学动态和评估巴西的公共卫生影响至关重要。

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引用次数: 0

Antimicrobial resistance in the Bacteroides fragilis group: National multicenter survey and Bayesian modelling study, France, 2022–2023 脆弱拟杆菌群的抗菌素耐药性：国家多中心调查和贝叶斯模型研究，法国，2022-2023。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-03-01 Epub Date: 2026-01-12 DOI: 10.1016/j.jgar.2026.01.003

Gauthier Delvallez , Pascal Campagne , Corentine Alauzet , Laure Diancourt , Frédéric Barbut , Hélène Marchandin , Bruno Dupuy , BFG AMR Collaborative Study group

Objectives

Epidemiological studies on Bacteroides fragilis group (BFG) species and their antimicrobial resistance (AMR) profiles remain scarce worldwide and are lacking in France. The aim of this study was to provide comprehensive national data on the distribution of BFG species, isolation sites, AMR and its potential regional disparity.

Methods

A retrospective multicenter study was conducted from January 2022 to December 2023 using routine data from 45 French hospitals. A total of 9458 BFG isolates identified to the species level by MALDI-ToF were included. Antimicrobial susceptibility testing (AST) was performed according to French guidelines using either disc diffusion or gradient diffusion methods. AST results were collected for ten antibiotics: amoxicillin-clavulanate (AMC), piperacillin-tazobactam (PIT), imipenem (IMI), clindamycin (CLI), metronidazole (MET), moxifloxacin, tigecycline, linezolid, rifampicin, and chloramphenicol. A Bayesian statistical model was applied to estimate regional resistance frequencies with corresponding credible intervals.

Results

Bacteroides fragilis sensu stricto (B. fragilis) was the most prevalent species (62.4%), followed by Bacteroides thetaiotaomicron (14.2%). Resistance to IMI and MET remained low, while AMC, PIT, and CLI resistance varied markedly across species: 5.2%, 3.6%, and 34.4% for B. fragilis; 18.0%, 50.1%, and 72.9% for B. thetaiotaomicron; and 32.1%, 19.5%, and 75.2% for Parabacteroides distasonis, respectively. Bayesian modelling produced robust regional estimates for B. fragilis, revealing noticeable regional disparities, particularly for AMC, PIT, and MET.

Conclusion

Bayesian modeling revealed substantial interspecies and interregional differences in BFG resistance, highlighting the importance of species-level identification and localized surveillance to inform empirical antibiotic therapy.

目的：脆弱拟杆菌群（BFG）物种及其抗菌素耐药性（AMR）谱的流行病学研究在世界范围内仍然稀缺，在法国缺乏。本研究的目的是提供有关BFG种类分布、分离点、AMR及其潜在区域差异的综合数据。方法：采用法国45家医院的常规数据，于2022年1月至2023年12月进行回顾性多中心研究。通过MALDI-ToF鉴定到种水平的BFG菌株共9458株。抗菌药敏试验（AST）按照法国指南采用碟扩散法或梯度扩散法进行。收集阿莫西林-克拉维酸酯（AMC）、哌拉西林-他唑巴坦（PIT）、亚胺培南（IMI）、克林霉素（CLI）、甲硝唑（MET）、莫西沙星、替加环素、利奈唑胺、利福平、氯霉素等10种抗生素的AST检测结果。采用贝叶斯统计模型估计具有相应可信区间的区域电阻频率。结果：严感脆弱拟杆菌（B. fragilis）最多，占62.4%，其次是太古微拟杆菌（Bacteroides thetaiotaomicron），占14.2%。对IMI和MET的抗性较低，而对AMC、PIT和CLI的抗性在不同物种间差异显著：脆弱芽孢杆菌为5.2%、3.6%和34.4%；大肠杆菌为18.0%、50.1%、72.9%；副芽孢杆菌的感染率分别为32.1%、19.5%和75.2%。贝叶斯模型对脆弱芽孢杆菌进行了可靠的区域估计，揭示了明显的区域差异，特别是对AMC、PIT和MET。结论：贝叶斯模型揭示了BFG耐药性的物种间和地区间差异，强调了物种水平鉴定和局部监测对经验性抗生素治疗的重要性。

{"title":"Antimicrobial resistance in the Bacteroides fragilis group: National multicenter survey and Bayesian modelling study, France, 2022–2023","authors":"Gauthier Delvallez , Pascal Campagne , Corentine Alauzet , Laure Diancourt , Frédéric Barbut , Hélène Marchandin , Bruno Dupuy , BFG AMR Collaborative Study group","doi":"10.1016/j.jgar.2026.01.003","DOIUrl":"10.1016/j.jgar.2026.01.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Epidemiological studies on <em>Bacteroides fragilis</em> group (BFG) species and their antimicrobial resistance (AMR) profiles remain scarce worldwide and are lacking in France. The aim of this study was to provide comprehensive national data on the distribution of BFG species, isolation sites, AMR and its potential regional disparity.</div></div><div><h3>Methods</h3><div>A retrospective multicenter study was conducted from January 2022 to December 2023 using routine data from 45 French hospitals. A total of 9458 BFG isolates identified to the species level by MALDI-ToF were included. Antimicrobial susceptibility testing (AST) was performed according to French guidelines using either disc diffusion or gradient diffusion methods. AST results were collected for ten antibiotics: amoxicillin-clavulanate (AMC), piperacillin-tazobactam (PIT), imipenem (IMI), clindamycin (CLI), metronidazole (MET), moxifloxacin, tigecycline, linezolid, rifampicin, and chloramphenicol. A Bayesian statistical model was applied to estimate regional resistance frequencies with corresponding credible intervals.</div></div><div><h3>Results</h3><div><em>Bacteroides fragilis sensu stricto</em> (<em>B. fragilis</em>) was the most prevalent species (62.4%), followed by <em>Bacteroides thetaiotaomicron</em> (14.2%). Resistance to IMI and MET remained low, while AMC, PIT, and CLI resistance varied markedly across species: 5.2%, 3.6%, and 34.4% for <em>B. fragilis</em>; 18.0%, 50.1%, and 72.9% for <em>B. thetaiotaomicron</em>; and 32.1%, 19.5%, and 75.2% for <em>Parabacteroides distasonis</em>, respectively. Bayesian modelling produced robust regional estimates for <em>B. fragilis</em>, revealing noticeable regional disparities, particularly for AMC, PIT, and MET.</div></div><div><h3>Conclusion</h3><div>Bayesian modeling revealed substantial interspecies and interregional differences in BFG resistance, highlighting the importance of species-level identification and localized surveillance to inform empirical antibiotic therapy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"47 ","pages":"Pages 9-19"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genomic insights into antimicrobial resistance and cytotoxin production in Klebsiella oxytoca complex isolates from a nationwide Japanese surveillance program. 从日本全国监测计划中获得的克雷伯菌复合菌株的抗菌素耐药性和细胞毒素产生的基因组见解。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-02-26 DOI: 10.1016/j.jgar.2026.02.011

Yo Sugawara, Wataru Hayashi, Ikue Hayashi, Shaheem Elahi, Hui Zuo, Liansheng Yu, Kohei Kondo, Yukari Sato, Natsumi Kawahara, Sayoko Kawakami, Koji Yahara, Shizuo Kayama, Motoyuki Sugai

Objectives: The Klebsiella oxytoca complex inhabits diverse environments, including the human gut, and frequently causes opportunistic infections. This species complex carries the intrinsic β-lactamase gene bla_OXY, which confers resistance to ampicillin, and may acquire resistance to other antimicrobials, such as carbapenems, through mobile antimicrobial resistance genes or chromosomal mutations. A subset of the K. oxytoca complex produces cytotoxins associated with antibiotic-associated hemorrhagic colitis. However, the epidemiological and genomic data from Japan are limited. In this study, we aimed to characterize the genomic and phenotypic features of K. oxytoca complex collected nationwide in Japan within the scope of a national antimicrobial resistance surveillance (JARBS) program.

Methods: A total of 46 K. oxytoca complex isolates were obtained through the JARBS program targeting third-generation cephalosporin-resistant and carbapenem-non-susceptible Enterobacterales in Japan. Whole-genome sequencing, antimicrobial susceptibility testing, plasmid analysis, and cell culture- and mass spectrometry-based cytotoxin detection were performed to investigate antimicrobial resistance and toxin production.

Results: Our analyses of clinical isolates revealed diverse genotypes and potential plasmid-mediated mechanisms for bla_IMP acquisition. Phenotypic assays revealed multidrug resistance and cytotoxin production in a subset of isolates, and the corresponding genomic determinants were identified. Notably, we identified a multidrug-resistant, cytotoxin-producing lineage belonging to sequence type (ST) 176 that has disseminated across multiple regions of Japan.

Conclusions: This study provides the first nationwide integrated genomic and phenotypic analysis of the K. oxytoca complex in Japan. The spread of the multidrug-resistant, cytotoxin-producing ST176 lineage represents a previously unrecognized high-risk linage in Japan, underscoring the need for continued genomic surveillance.

目的：产氧克雷伯菌复合体存在于多种环境中，包括人类肠道，并经常引起机会性感染。该物种复合体携带内源性β-内酰胺酶基因blaOXY，该基因赋予氨苄西林耐药性，并可能通过移动抗微生物药物抗性基因或染色体突变获得对其他抗微生物药物（如碳青霉烯类）的耐药性。氧梭菌复合体的一个亚群产生与抗生素相关性出血性结肠炎相关的细胞毒素。然而，来自日本的流行病学和基因组数据有限。在这项研究中，我们旨在描述在日本全国范围内收集的K. oxytoca复合体的基因组和表型特征，该复合体是在国家抗菌素耐药性监测（JARBS）计划的范围内收集的。方法：利用日本第三代头孢菌素耐药和碳青霉烯不敏感肠杆菌的JARBS项目，获得46株oxytoca复合菌株。采用全基因组测序、抗菌素敏感性测试、质粒分析、细胞培养和质谱为基础的细胞毒素检测来研究抗菌素耐药性和毒素产生。结果：我们对临床分离株的分析揭示了不同的基因型和潜在的质粒介导的blaIMP获得机制。表型分析显示，在一部分分离株中存在多药耐药性和细胞毒素产生，并确定了相应的基因组决定因素。值得注意的是，我们发现了一种多药耐药的细胞毒素产生谱系，属于序列型（ST） 176，已在日本多个地区传播。结论：这项研究提供了日本第一个全国范围内的综合基因组和表型分析。多药耐药、产生细胞毒素的ST176谱系在日本的传播是一种以前未被认识到的高风险谱系，强调了继续进行基因组监测的必要性。

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引用次数: 0

Vancomycin-Resistant Enterococcus Colonization in Newborns Transferred After Earthquake-Related Trauma: A Retrospective Analysis. 地震相关创伤后转移新生儿万古霉素耐药肠球菌定植：回顾性分析

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2026-02-23 DOI: 10.1016/j.jgar.2026.02.010

Berfin Özgökçe Özmen, Şefika Aldaş, Mustafa Akçalı, Hüseyin Şimşek, Mehtap Durukan Tosun

Objective: This study investigated vancomycin-resistant Enterococcus (VRE) colonization among neonates admitted to a tertiary neonatal intensive care unit (NICU) following the February 2023 Kahramanmaraş earthquake, focusing on post-disaster interhospital transfers, clinical interventions, and feeding practices.

Methods: This retrospective study included neonates with documented VRE colonization hospitalized between February 2023 and July 2024. Demographic and birth-related variables, admission diagnoses, antimicrobial exposure including vancomycin, mechanical ventilation, length of hospitalization, and feeding practices were recorded. Statistical analyses included correlation analyses and multivariate logistic regression. A p value <0.05 was considered statistically significant.

Results: The cohort consisted of 49.7% male neonates, with a median hospital stay of 46 days (range: 2-161). Cesarean delivery was observed in 73.8% of cases, and 62.1% of neonates were premature. The most common admission diagnoses were prematurity (44.8%), transient tachypnea of the newborn (17.9%), and intrauterine growth restriction (6.2%). Antibiotic therapy for ≥7 days was administered to 79.3% of neonates, and 35.1% received vancomycin. VRE colonization was more frequent in 2023 than in 2024, particularly among neonates requiring mechanical ventilation or interhospital transfer. Prolonged hospitalization was significantly associated with mechanical ventilation. Breastfeeding rates were higher in 2024 compared with 2023 (91.9% vs. 70.4%). In multivariate analysis, mechanical ventilation was independently associated with hospitalization in 2024, whereas interhospital transfer showed a marginal inverse association.

Conclusion: Neonates transferred under emergency post-disaster conditions represent a vulnerable population at increased risk of VRE colonization. Consideration of mechanical ventilation, transfer status, feeding practices support targeted infection control strategies in NICUs during post-disaster periods.

目的：本研究调查了2023年2月kahramanmaraki地震后入住三级新生儿重症监护病房（NICU）的新生儿万古霉素耐药肠球菌（VRE）定植情况，重点研究了灾后医院间转院、临床干预和喂养方法。方法：这项回顾性研究纳入了2023年2月至2024年7月期间住院的有记录的VRE定植的新生儿。记录人口统计学和出生相关变量、入院诊断、抗菌药物暴露（包括万古霉素）、机械通气、住院时间和喂养方法。统计分析包括相关分析和多元逻辑回归。结果：该队列包括49.7%的男性新生儿，中位住院时间为46天（范围：2-161）。剖宫产占73.8%，早产占62.1%。最常见的入院诊断为早产（44.8%）、新生儿短暂性呼吸急促（17.9%）和宫内生长受限（6.2%）。79.3%的新生儿接受抗生素治疗≥7天，35.1%的新生儿接受万古霉素治疗。2023年VRE定植比2024年更频繁，特别是在需要机械通气或医院间转院的新生儿中。延长住院时间与机械通气显著相关。2024年母乳喂养率高于2023年（91.9%对70.4%）。在多因素分析中，机械通气与2024年住院独立相关，而院间转院呈边际负相关。结论：在灾后紧急情况下转移的新生儿是VRE定植风险增加的弱势群体。考虑到机械通气、转移状态、喂养方法支持在灾后期间对新生儿重症监护室采取有针对性的感染控制策略。

{"title":"Vancomycin-Resistant Enterococcus Colonization in Newborns Transferred After Earthquake-Related Trauma: A Retrospective Analysis.","authors":"Berfin Özgökçe Özmen, Şefika Aldaş, Mustafa Akçalı, Hüseyin Şimşek, Mehtap Durukan Tosun","doi":"10.1016/j.jgar.2026.02.010","DOIUrl":"https://doi.org/10.1016/j.jgar.2026.02.010","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated vancomycin-resistant Enterococcus (VRE) colonization among neonates admitted to a tertiary neonatal intensive care unit (NICU) following the February 2023 Kahramanmaraş earthquake, focusing on post-disaster interhospital transfers, clinical interventions, and feeding practices.</p><p><strong>Methods: </strong>This retrospective study included neonates with documented VRE colonization hospitalized between February 2023 and July 2024. Demographic and birth-related variables, admission diagnoses, antimicrobial exposure including vancomycin, mechanical ventilation, length of hospitalization, and feeding practices were recorded. Statistical analyses included correlation analyses and multivariate logistic regression. A p value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>The cohort consisted of 49.7% male neonates, with a median hospital stay of 46 days (range: 2-161). Cesarean delivery was observed in 73.8% of cases, and 62.1% of neonates were premature. The most common admission diagnoses were prematurity (44.8%), transient tachypnea of the newborn (17.9%), and intrauterine growth restriction (6.2%). Antibiotic therapy for ≥7 days was administered to 79.3% of neonates, and 35.1% received vancomycin. VRE colonization was more frequent in 2023 than in 2024, particularly among neonates requiring mechanical ventilation or interhospital transfer. Prolonged hospitalization was significantly associated with mechanical ventilation. Breastfeeding rates were higher in 2024 compared with 2023 (91.9% vs. 70.4%). In multivariate analysis, mechanical ventilation was independently associated with hospitalization in 2024, whereas interhospital transfer showed a marginal inverse association.</p><p><strong>Conclusion: </strong>Neonates transferred under emergency post-disaster conditions represent a vulnerable population at increased risk of VRE colonization. Consideration of mechanical ventilation, transfer status, feeding practices support targeted infection control strategies in NICUs during post-disaster periods.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0