Pub Date : 2025-11-22DOI: 10.1016/j.jgar.2025.11.014
Carla Rivero , Melina M.B. Martínez , Nicole G. Picinin , Eduardo G. Martins , Claudio Paolazzi , Alejandra Capozzo , Denise da Silva Oliveira , Johana Becerra , Benedito M. dos Santos , Lucio H.G. de Freitas-Junior , Andrea Balan , Nilton Lincopan , Rita de Cassia Café Ferreira , Luis Carlos de Souza Ferreira , Leticia Verónica Bentancor
Objective
Bacteriophage-encoded endolysins have emerged as novel antibacterial strategies against antibiotic-resistant bacteria. We identified a bacteriophage-derived conserved sequence encoding an endolysin specific to Staphylococcus aureus. A recombinant endolysin (LysNOVA-I) was then produced, characterised and evaluated against methicillin-resistant Staphylococcus aureus (MRSA).
Methods
The endolysin gene from phage ФvB_SauS-phiIPLA88 was cloned, expressed, and successfully purified using affinity chromatography. The activity of pure recombinant endolysin (rLysNOVA-I) was subsequently evaluated against growing and non-growing planktonic cells and biofilm cultures of international MRSA clones. A computational analysis was conducted to elucidate protein folding and obtain insight into the molecular mechanisms.
Results
rLysNOVA-I exhibited bactericidal activity against both exponential and stationary growth phase S. aureus cells. rLysNOVA-I also prevented biofilm formation and degradation of established S. aureus biofilms. Notably, rLysNOVA-I was active against the MRSA clone ST398, which is of veterinary and clinical relevance.
Conclusions
Our findings highlight the clinical potential of rLysNOVA-I as a therapeutic or complementary alternative to antibiotics against multidrug-resistant S. aureus infections in human and veterinary medicine.
{"title":"Antibacterial activity of recombinant endolysin LysNOVA-I against growing/non-growing and planktonic/biofilm cultures of Staphylococcus aureus strains","authors":"Carla Rivero , Melina M.B. Martínez , Nicole G. Picinin , Eduardo G. Martins , Claudio Paolazzi , Alejandra Capozzo , Denise da Silva Oliveira , Johana Becerra , Benedito M. dos Santos , Lucio H.G. de Freitas-Junior , Andrea Balan , Nilton Lincopan , Rita de Cassia Café Ferreira , Luis Carlos de Souza Ferreira , Leticia Verónica Bentancor","doi":"10.1016/j.jgar.2025.11.014","DOIUrl":"10.1016/j.jgar.2025.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>Bacteriophage-encoded endolysins have emerged as novel antibacterial strategies against antibiotic-resistant bacteria. We identified a bacteriophage-derived conserved sequence encoding an endolysin specific <em>to Staphylococcus aureus.</em> A recombinant endolysin (LysNOVA-I) was then produced, characterised and evaluated against methicillin-resistant <em>Staphylococcus aureus</em> (MRSA).</div></div><div><h3>Methods</h3><div>The endolysin gene from phage ФvB_SauS-phiIPLA88 was cloned, expressed, and successfully purified using affinity chromatography. The activity of pure recombinant endolysin (rLysNOVA-I) was subsequently evaluated against growing and non-growing planktonic cells and biofilm cultures of international MRSA clones. A computational analysis was conducted to elucidate protein folding and obtain insight into the molecular mechanisms.</div></div><div><h3>Results</h3><div>rLysNOVA-I exhibited bactericidal activity against both exponential and stationary growth phase <em>S. aureus</em> cells. rLysNOVA-I also prevented biofilm formation and degradation of established <em>S. aureus</em> biofilms. Notably, rLysNOVA-I was active against the MRSA clone ST398, which is of veterinary and clinical relevance.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the clinical potential of rLysNOVA-I as a therapeutic or complementary alternative to antibiotics against multidrug-resistant <em>S. aureus</em> infections in human and veterinary medicine.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 117-125"},"PeriodicalIF":3.2,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587775","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}
Pub Date : 2025-11-20DOI: 10.1016/j.jgar.2025.11.013
Chahrazed Belhout , Claudia Aldeia , Vincent Perreten , Andrea Endimiani
Objectives
Paenimyroides ceti is a newly defined species belonging to the Flavobacteriaceae family. It was originally isolated from the lung and liver of two beaked whales. Here, we report the first complete circular genome of a P. ceti and provide insights into its antimicrobial resistance determinants.
Methods
P. ceti strain MC-ZM-24 was isolated from homogenized tissues of Zophobas morio larvae. Antimicrobial susceptibility tests were determined by broth microdilution and carbapenemase production was assessed by Blue-Carba test. Whole-genome sequencing (WGS) was obtained using both the Illumina short and Oxford Nanopore long-read technologies. A hybrid genome assembly was generated with Unicycler and subsequently annotated using the NCBI Prokaryotic Genome Annotation Pipeline. Antimicrobial resistance genes were identified using AMRFinder and ResFinder. Known metallo-β-lactamase (MBL) protein sequences deposited in NCBI GenBank and UniProt databases were compared with that of strain MC-ZM-24.
Results
The genome comprised a single circular chromosome of 3,274,043-bp, with 3,053 genes, and exhibited a GC content of 35.56%. Phenotypically, the strain was multidrug-resistant, non-susceptible to carbapenems and produced a carbapenemase. WGS analysis identified a unique chromosomal bla gene encoding a MBL that harbors the conserved subclass B1 motifs, but shares low sequence identity with previously described MBL enzymes.
Conclusions
The complete genome of P. ceti MC-ZM-24 expands our understanding of Paenimyroides ecology and evolution. It also highlights an intrinsic subclass B1 β-lactamase, extending the repertoire of chromosomal MBLs in Flavobacteriaceae. This new MBL will require further detailed characterization.
目的：拟黄杆菌属黄杆菌科新定义种。它最初是从两只喙鲸的肺和肝脏中分离出来的。在这里，我们报告了第一个完整的圆形基因组P. ceti和提供洞察其抗菌素耐药性决定因素。方法：从莫蠓幼虫匀浆组织中分离出ceti P. MC-ZM-24菌株。用微量肉汤稀释法测定其药敏试验，用蓝碳水化合物试验测定其碳青霉烯酶产量。全基因组测序（WGS）采用Illumina短读和Oxford Nanopore长读技术。使用Unicycler生成杂交基因组组装，随后使用NCBI原核基因组注释管道进行注释。采用AMRFinder和ResFinder对耐药基因进行鉴定。将NCBI GenBank和UniProt数据库中已知的金属β-内酰胺酶（MBL）蛋白序列与菌株MC-ZM-24进行比较。结果：该基因组全长3274043 -bp，包含3053个基因，GC含量为35.56%。表型上，该菌株多重耐药，对碳青霉烯类不敏感，并产生碳青霉烯酶。WGS分析发现了一个独特的染色体bla基因编码MBL，该基因包含保守的B1亚类基序，但与先前描述的MBL酶具有低序列同一性。结论：P. ceti MC-ZM-24的全基因组扩展了我们对拟金线虫生态学和进化的认识。它还强调了一个内在的B1 β-内酰胺酶亚类，扩展了黄杆菌科染色体MBLs的库。这种新的MBL需要进一步的详细描述。
{"title":"Full genome of Paenimyroides ceti strain MC-ZM-24 producing a new subclass B1 metallo-β-lactamase","authors":"Chahrazed Belhout , Claudia Aldeia , Vincent Perreten , Andrea Endimiani","doi":"10.1016/j.jgar.2025.11.013","DOIUrl":"10.1016/j.jgar.2025.11.013","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Paenimyroides ceti</em> is a newly defined species belonging to the <em>Flavobacteriaceae</em> family. It was originally isolated from the lung and liver of two beaked whales. Here, we report the first complete circular genome of a <em>P. ceti</em> and provide insights into its antimicrobial resistance determinants.</div></div><div><h3>Methods</h3><div><em>P. ceti</em> strain MC-ZM-24 was isolated from homogenized tissues of <em>Zophobas morio</em> larvae. Antimicrobial susceptibility tests were determined by broth microdilution and carbapenemase production was assessed by Blue-Carba test. Whole-genome sequencing (WGS) was obtained using both the Illumina short and Oxford Nanopore long-read technologies. A hybrid genome assembly was generated with Unicycler and subsequently annotated using the NCBI Prokaryotic Genome Annotation Pipeline. Antimicrobial resistance genes were identified using AMRFinder and ResFinder. Known metallo-β-lactamase (MBL) protein sequences deposited in NCBI GenBank and UniProt databases were compared with that of strain MC-ZM-24.</div></div><div><h3>Results</h3><div>The genome comprised a single circular chromosome of 3,274,043-bp, with 3,053 genes, and exhibited a GC content of 35.56%. Phenotypically, the strain was multidrug-resistant, non-susceptible to carbapenems and produced a carbapenemase. WGS analysis identified a unique chromosomal <em>bla</em> gene encoding a MBL that harbors the conserved subclass B1 motifs, but shares low sequence identity with previously described MBL enzymes.</div></div><div><h3>Conclusions</h3><div>The complete genome of <em>P. ceti</em> MC-ZM-24 expands our understanding of <em>Paenimyroides</em> ecology and evolution. It also highlights an intrinsic subclass B1 β-lactamase, extending the repertoire of chromosomal MBLs in <em>Flavobacteriaceae</em>. This new MBL will require further detailed characterization.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 109-111"},"PeriodicalIF":3.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581683","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}
Pub Date : 2025-11-20DOI: 10.1016/j.jgar.2025.11.007
Vittoria Mattioni Marchetti , Francesca Piscopiello , Assunta Girardi , Stefano Grandesso , Roberta Migliavacca
Objective
Klebsiella pneumoniae ST395 is an internationally disseminated, high-risk clone implicated in OXA-48-producing K. pneumoniae (OXA-48 Kp) outbreaks. In Italy, K. pneumoniae ST395 is sporadically detected and mainly associated with the blaKPC-3 determinant. Here we aimed to explain the increase in cases of OXA-48 Kp ST395 in north-eastern Italy.
Methods
In the period May–July 2024, 57 OXA-48 Kp samples were collected from three different hospitals and related communities within the province of Venice, Italy. Species identification, antimicrobial susceptibility, carbapenemase production, and clonal relatedness were ascertained using MALDI-TOF MS, the Vitek-2 System, CARBA PLUS (MASTGroup), and pulsed-field gel electrophoresis, respectively. Whole-genome sequencing was carried out on seven representative strains using an Illumina (San Diego, CA, USA) NovaSeq.
Results
All 57 OXA-48 Kp strains retained susceptibility to aminoglycosides only, with three pulsotypes (A–C) detected by pulsed-field gel electrophoresis. Pulsotype A included 13 subtypes (A–A12). Subtypes A3 and A9 (n = 8, respectively) had the highest pattern similarity, followed by A12 (n = 4), A5 (n = 3), and A11 (n = 2). ST395 and the K2 capsule were highlighted by whole-genome sequencing. The shared resistome consisted of aminoglycoside (aac(3)-IIa, aac(6′)-Ib-cr), chloramphenicol (catA1, catB4), beta-lactam (blaCTX−M-15), and carbapenem (blaOXA-48) genes. SNP-based phylogeny showed relevant genomic relatedness, although clonal identity was obtained in only two cases.
Conclusions
Here we have highlighted the alarming inter-hospital circulation of OXA-48 Kp ST395 in north-eastern Italy.
{"title":"Emergence and inter-hospital circulation of capsule K2- and OXA-48-producing Klebsiella pneumoniae ST395 in north-eastern Italy","authors":"Vittoria Mattioni Marchetti , Francesca Piscopiello , Assunta Girardi , Stefano Grandesso , Roberta Migliavacca","doi":"10.1016/j.jgar.2025.11.007","DOIUrl":"10.1016/j.jgar.2025.11.007","url":null,"abstract":"<div><h3>Objective</h3><div><em>Klebsiella pneumoniae</em> ST395 is an internationally disseminated, high-risk clone implicated in OXA-48-producing <em>K. pneumoniae</em> (OXA-48 Kp) outbreaks. In Italy, <em>K. pneumoniae</em> ST395 is sporadically detected and mainly associated with the <em>bla</em><sub>KPC-3</sub> determinant. Here we aimed to explain the increase in cases of OXA-48 Kp ST395 in north-eastern Italy.</div></div><div><h3>Methods</h3><div>In the period May–July 2024, 57 OXA-48 Kp samples were collected from three different hospitals and related communities within the province of Venice, Italy. Species identification, antimicrobial susceptibility, carbapenemase production, and clonal relatedness were ascertained using MALDI-TOF MS, the Vitek-2 System, CARBA PLUS (MASTGroup), and pulsed-field gel electrophoresis, respectively. Whole-genome sequencing was carried out on seven representative strains using an Illumina (San Diego, CA, USA) NovaSeq.</div></div><div><h3>Results</h3><div>All 57 OXA-48 Kp strains retained susceptibility to aminoglycosides only, with three pulsotypes (A–C) detected by pulsed-field gel electrophoresis. Pulsotype A included 13 subtypes (A–A12). Subtypes A3 and A9 (<em>n</em> = 8, respectively) had the highest pattern similarity, followed by A12 (<em>n</em> = 4), A5 (<em>n</em> = 3), and A11 (<em>n</em> = 2). ST395 and the K2 capsule were highlighted by whole-genome sequencing. The shared resistome consisted of aminoglycoside (<em>aac(3)-IIa, aac(6′)-Ib-cr</em>), chloramphenicol (<em>catA1, catB4</em>), beta-lactam (<em>bla</em><sub>CTX−M-15</sub>), and carbapenem (<em>bla</em><sub>OXA-48</sub>) genes. SNP-based phylogeny showed relevant genomic relatedness, although clonal identity was obtained in only two cases.</div></div><div><h3>Conclusions</h3><div>Here we have highlighted the alarming inter-hospital circulation of OXA-48 Kp ST395 in north-eastern Italy.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 87-97"},"PeriodicalIF":3.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582246","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}
Pub Date : 2025-11-20DOI: 10.1016/j.jgar.2025.11.010
George Zhanel , Patricia de Rossi , Cosimo Oliva , Truls E. Bjerklund Johansen
During pregnancy, there is increased risk of ascending urinary tract infection (UTI) resulting in pyelonephritis and associated preterm delivery and low birth weight. It is therefore important that pregnant women who are at high risk of pyelonephritis because of the presence of asymptomatic bacteriuria (ASB) or cystitis receive appropriate antibiotic therapy. The aim of this position paper is to propose a risk-factor-based approach for the treatment of ASB and cystitis in pregnancy to help ensure that antibiotic treatment is prescribed only when necessary, and that the benefits of antibiotic treatment outweigh potential harms for pregnant women and neonates. Rather than advocating ASB screen-and-treat for all pregnant women who have ready access to healthcare, this risk-factor-based approach involves selective screening for ASB in pregnant women with other risk factors for UTI (previous UTI, diabetes mellitus, urinary tract abnormalities, or immunosuppression) and/or a history of preterm birth. Antibiotic treatment is indicated for persistent ASB confirmed with two urine cultures during selective high-risk screening, and for all pregnant women with cystitis confirmed by urine culture, with empiric treatment considered for symptoms of dysuria and urinary frequency. Evidence suggests that such a risk-factor-based approach will prevent progression to pyelonephritis in pregnant women with ASB and cystitis while complying with the principles of antimicrobial stewardship.
{"title":"Treatment of asymptomatic bacteriuria during pregnancy: A risk-factor-based approach","authors":"George Zhanel , Patricia de Rossi , Cosimo Oliva , Truls E. Bjerklund Johansen","doi":"10.1016/j.jgar.2025.11.010","DOIUrl":"10.1016/j.jgar.2025.11.010","url":null,"abstract":"<div><div>During pregnancy, there is increased risk of ascending urinary tract infection (UTI) resulting in pyelonephritis and associated preterm delivery and low birth weight. It is therefore important that pregnant women who are at high risk of pyelonephritis because of the presence of asymptomatic bacteriuria (ASB) or cystitis receive appropriate antibiotic therapy. The aim of this position paper is to propose a risk-factor-based approach for the treatment of ASB and cystitis in pregnancy to help ensure that antibiotic treatment is prescribed only when necessary, and that the benefits of antibiotic treatment outweigh potential harms for pregnant women and neonates. Rather than advocating ASB screen-and-treat for all pregnant women who have ready access to healthcare, this risk-factor-based approach involves selective screening for ASB in pregnant women with other risk factors for UTI (previous UTI, diabetes mellitus, urinary tract abnormalities, or immunosuppression) and/or a history of preterm birth. Antibiotic treatment is indicated for persistent ASB confirmed with two urine cultures during selective high-risk screening, and for all pregnant women with cystitis confirmed by urine culture, with empiric treatment considered for symptoms of dysuria and urinary frequency. Evidence suggests that such a risk-factor-based approach will prevent progression to pyelonephritis in pregnant women with ASB and cystitis while complying with the principles of antimicrobial stewardship.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 79-86"},"PeriodicalIF":3.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581633","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}
To evaluate the prevalence of pretreatment HIV-1 resistance to integrase inhibitors in newly diagnosed patients in the general population prior to commencement of the dolutegravir era as the first-line treatment regimen in Benin.
Methods
This retrospective study employed samples described in the 2020 study by Tchiakpe and colleagues. Genotyping was carried out using both Agence nationale de recherches sur le Sida or National AIDS Research Agency (ANRS) and Applied Biosystems (Foster City, California, USA) HIV-1 Genotyping Kit PR/RT with integrase technologies. Sequences were used for viral subtype assignment and identification of resistance mutation positions using the Stanford algorithm.
Results
A total of 161 samples were correctly sequenced. The predominant HIV-1 strain isolated was CRF02_AG (118/161; 73.3%), with 4/161 (2.5%) and 21/161 (13%) patients carrying at least one drug resistance mutation associated with PIs (1/161; 0.6%), NRTIs (1/161; 0.6%), non-nucleoside reverse transcriptase inhibitors (1/161; 0.6%) and NRTIs+NNRTIs (1/161; 0.6%) on the entire protease plus part of the reverse transcriptase and one accessory integrase strand transfer inhibitor (INSTI)-associated resistance mutation, respectively. Resistance mutations associated with the protease plus part of the reverse transcriptase—I85V, K103N, M184V, and M41L—were observed in proportions of 1/161 (0.6%), 2/161 (1.2%), 1/161 (0.6%), and 1/161 (0.6%), respectively. One patient (0.6%) carried both mutations (M41L and K103N). Among the INSTI-associated resistance mutations, E157Q represented 16/161 (9.9%), followed by T97A at 2/161 (1.2%) and 1/161 (0.6%) of each H51Y, D232N, and Q95K mutation. No major INSTI-associated mutations were found.
Conclusions
The prevalence of pretreatment HIV-1 resistance to integrase in this study was zero. This study reinforces the World Health Organization vision of improving patient outcomes by introducing INSTIs as first-line treatment regimens.
{"title":"Prevalence of pretreatment HIV-1 resistance to integrase strand transfer inhibitors in newly diagnosed and antiretroviral therapy-naive adults in Benin, West Africa","authors":"Edmond Tchiakpe , Rene K. Keke , Abou Abdallah Malick Diouara , Nicole Vidal , Halimatou Diop-Ndiaye , Coumba Toure-Kane , Akadiri Yessoufou","doi":"10.1016/j.jgar.2025.11.011","DOIUrl":"10.1016/j.jgar.2025.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the prevalence of pretreatment HIV-1 resistance to integrase inhibitors in newly diagnosed patients in the general population prior to commencement of the dolutegravir era as the first-line treatment regimen in Benin.</div></div><div><h3>Methods</h3><div>This retrospective study employed samples described in the 2020 study by Tchiakpe and colleagues. Genotyping was carried out using both Agence nationale de recherches sur le Sida or National AIDS Research Agency (ANRS) and Applied Biosystems (Foster City, California, USA) HIV-1 Genotyping Kit PR/RT with integrase technologies. Sequences were used for viral subtype assignment and identification of resistance mutation positions using the Stanford algorithm.</div></div><div><h3>Results</h3><div>A total of 161 samples were correctly sequenced. The predominant HIV-1 strain isolated was CRF02_AG (118/161; 73.3%), with 4/161 (2.5%) and 21/161 (13%) patients carrying at least one drug resistance mutation associated with PIs (1/161; 0.6%), NRTIs (1/161; 0.6%), non-nucleoside reverse transcriptase inhibitors (1/161; 0.6%) and NRTIs+NNRTIs (1/161; 0.6%) on the entire protease plus part of the reverse transcriptase and one accessory integrase strand transfer inhibitor (INSTI)-associated resistance mutation, respectively. Resistance mutations associated with the protease plus part of the reverse transcriptase—I85V, K103N, M184V, and M41L—were observed in proportions of 1/161 (0.6%), 2/161 (1.2%), 1/161 (0.6%), and 1/161 (0.6%), respectively. One patient (0.6%) carried both mutations (M41L and K103N). Among the INSTI-associated resistance mutations, E157Q represented 16/161 (9.9%), followed by T97A at 2/161 (1.2%) and 1/161 (0.6%) of each H51Y, D232N, and Q95K mutation. No major INSTI-associated mutations were found.</div></div><div><h3>Conclusions</h3><div>The prevalence of pretreatment HIV-1 resistance to integrase in this study was zero. This study reinforces the World Health Organization vision of improving patient outcomes by introducing INSTIs as first-line treatment regimens.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 112-116"},"PeriodicalIF":3.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564280","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}
Pub Date : 2025-11-17DOI: 10.1016/j.jgar.2025.11.006
Jinjin Zhang , Ruyin Zhou , Jingru Ren , Ziping Wu , Jianzhong Shen , Yang Wang , Shenggen Fan , Xiangming Fang
Background
The resistance rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) resistance rate has risen by 20% over the past 19 y in China. The socioeconomic burden of CRKP infections has rarely been estimated.
Methods
We estimated the number of CRKP-infected inpatients, the disability-adjusted life-years lost, and the socioeconomic burden in China in 2019. Using national surveillance data (China Antimicrobial Surveillance System), published literature, and official statistics, we adapted Cassini’s disease progression model to the Chinese context to quantify the clinical and economic impact. Sensitivity analyses were adjusted for retirement age and age-specific mortality.
Results
In 2019, an estimated 263 000 inpatients had CRKP infections, resulting in 0.72 million disability-adjusted life-years lost (2.73 per patient). Direct medical costs reached $0.61 billion, indirect costs $3.85 billion, totalling $4.46 billion (0.03% of 2019 GDP). Median annual cost per patient was $16 940.
Conclusions
CRKP infections impose significant health and economic burden on China. Enhanced infection control, antimicrobial stewardship, and investment in rapid diagnostics and novel therapeutics are urgently needed. The methodology used in this study can also support burden assessments for other resistant pathogens in similar contexts.
{"title":"Economic burden of carbapenem-resistant Klebsiella pneumoniae infections in Chinese hospitals: A 2019 analysis","authors":"Jinjin Zhang , Ruyin Zhou , Jingru Ren , Ziping Wu , Jianzhong Shen , Yang Wang , Shenggen Fan , Xiangming Fang","doi":"10.1016/j.jgar.2025.11.006","DOIUrl":"10.1016/j.jgar.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>The resistance rate of carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) resistance rate has risen by 20% over the past 19 y in China. The socioeconomic burden of CRKP infections has rarely been estimated.</div></div><div><h3>Methods</h3><div>We estimated the number of CRKP-infected inpatients, the disability-adjusted life-years lost, and the socioeconomic burden in China in 2019. Using national surveillance data (China Antimicrobial Surveillance System), published literature, and official statistics, we adapted Cassini’s disease progression model to the Chinese context to quantify the clinical and economic impact. Sensitivity analyses were adjusted for retirement age and age-specific mortality.</div></div><div><h3>Results</h3><div>In 2019, an estimated 263 000 inpatients had CRKP infections, resulting in 0.72 million disability-adjusted life-years lost (2.73 per patient). Direct medical costs reached $0.61 billion, indirect costs $3.85 billion, totalling $4.46 billion (0.03% of 2019 GDP). Median annual cost per patient was $16 940.</div></div><div><h3>Conclusions</h3><div>CRKP infections impose significant health and economic burden on China. Enhanced infection control, antimicrobial stewardship, and investment in rapid diagnostics and novel therapeutics are urgently needed. The methodology used in this study can also support burden assessments for other resistant pathogens in similar contexts.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 63-70"},"PeriodicalIF":3.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556996","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}
Community-acquired pneumonia (CAP) remains a major global health concern, particularly in regions with rising antimicrobial resistance (AMR). In Lebanon, increasing resistance among respiratory pathogens complicates management, limiting treatment options and worsening clinical and economic outcomes. This expert panel review assessed recent national AMR data to adapt CAP treatment recommendations to the Lebanese context. The 2019 ATS/IDSA guidelines and their 2025 update were reviewed; while most recommendations were retained, empiric antibiotic choices were adjusted for key pathogens based on local resistance patterns. The proposed management algorithm stratifies patients by disease severity, care setting, and AMR risk, integrating pathogen-specific risk factors into clinical decisions. By contextualizing international guidance to local epidemiology and healthcare infrastructure, these recommendations aim to optimize targeted therapy, support antimicrobial stewardship, and preserve antibiotic efficacy in Lebanon’s evolving resistance landscape.
{"title":"Adapting international evidence-based guidelines to local challenges: A Lebanese perspective on the latest American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) community-acquired pneumonia antibacterial therapy recommendations","authors":"Rana Attieh , Joe Nahal , Rola Husni , Jacques E. Mokhbat , Jamil Barhoun , Joumana Kmeid , Mona Youssef , Zahi Helou , Wael Zorkot , Nassab Fakhreddine , Fatima Baalbaki , Nazih Bizri , Hanine Mansour , Dania Abdallah , Rima Moghnieh","doi":"10.1016/j.jgar.2025.11.005","DOIUrl":"10.1016/j.jgar.2025.11.005","url":null,"abstract":"<div><div>Community-acquired pneumonia (CAP) remains a major global health concern, particularly in regions with rising antimicrobial resistance (AMR). In Lebanon, increasing resistance among respiratory pathogens complicates management, limiting treatment options and worsening clinical and economic outcomes. This expert panel review assessed recent national AMR data to adapt CAP treatment recommendations to the Lebanese context. The 2019 ATS/IDSA guidelines and their 2025 update were reviewed; while most recommendations were retained, empiric antibiotic choices were adjusted for key pathogens based on local resistance patterns. The proposed management algorithm stratifies patients by disease severity, care setting, and AMR risk, integrating pathogen-specific risk factors into clinical decisions. By contextualizing international guidance to local epidemiology and healthcare infrastructure, these recommendations aim to optimize targeted therapy, support antimicrobial stewardship, and preserve antibiotic efficacy in Lebanon’s evolving resistance landscape.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 98-108"},"PeriodicalIF":3.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557031","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}
Pub Date : 2025-11-15DOI: 10.1016/j.jgar.2025.11.009
Wei Li , Wenguang Xiong , Junzhuo Guo , Na Sun , Zhenling Zeng
Objective
Animal-derived Staphylococcus aureus frequently exhibits multidrug resistance, with complex and diverse resistance mechanisms that have raised significant public health concerns. The objective of this study was to determine the prevalence of S. aureus in swine farms and evaluate its antimicrobial resistance and distribution of oxazolidinone resistance genes.
Methods
The swine samples were collected on 17 swine farms from four provinces in China. All S. aureus isolates were screened for cfr, optrA, and poxtA. Whole-genome sequencing of cfr-positive strains revealed their molecular characteristics. All cfr-positive isolates were subjected to antimicrobial susceptibility testing.
Results
A total of 302 swine-derived S. aureus were collected from 4973 samples. Seven cfr-positive S. aureus strains, including four ST1-t4792 MSSA, two ST9-t4358 MSSA, and one ST398-t034 MRSA, were identified by whole-genome sequencing. Antimicrobial susceptibility testing against 23 agents from 12 classes revealed that all cfr-positive strains were resistant to penicillin, ampicillin, erythromycin, tetracycline, doxycycline, clindamycin, florfenicol, tiamulin, and valnemulin. Six MSSA strains additionally exhibited resistance to gentamicin, kanamycin, and ciprofloxacin, while three strains showed resistance to tilmicosin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Third-generation sequencing of a strain co-harbouring cfr and fosD demonstrated that both genes were located on a plasmid also carrying fexA and aadD.
Conclusions
This study revealed the presence of the cfr gene across diverse multilocus sequence typing types of S. aureus and highlighted the co-dissemination of cfr with fosD and other resistance genes via plasmids in S. aureus. Based on One Health principles and risk of multidrug resistance spread, continuous surveillance of animal-derived S. aureus was urgently needed.
{"title":"Prevalence of the cfr gene and co-dissemination with the fosD gene in swine-derived Staphylococcus aureus","authors":"Wei Li , Wenguang Xiong , Junzhuo Guo , Na Sun , Zhenling Zeng","doi":"10.1016/j.jgar.2025.11.009","DOIUrl":"10.1016/j.jgar.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>Animal-derived <em>Staphylococcus aureus</em> frequently exhibits multidrug resistance, with complex and diverse resistance mechanisms that have raised significant public health concerns. The objective of this study was to determine the prevalence of <em>S. aureus</em> in swine farms and evaluate its antimicrobial resistance and distribution of oxazolidinone resistance genes.</div></div><div><h3>Methods</h3><div>The swine samples were collected on 17 swine farms from four provinces in China. All <em>S. aureus</em> isolates were screened for <em>cfr, optrA</em>, and <em>poxtA</em>. Whole-genome sequencing of <em>cfr</em>-positive strains revealed their molecular characteristics. All <em>cfr</em>-positive isolates were subjected to antimicrobial susceptibility testing.</div></div><div><h3>Results</h3><div>A total of 302 swine-derived <em>S. aureus</em> were collected from 4973 samples. Seven <em>cfr</em>-positive <em>S. aureus</em> strains, including four ST1-t4792 MSSA, two ST9-t4358 MSSA, and one ST398-t034 MRSA, were identified by whole-genome sequencing. Antimicrobial susceptibility testing against 23 agents from 12 classes revealed that all <em>cfr</em>-positive strains were resistant to penicillin, ampicillin, erythromycin, tetracycline, doxycycline, clindamycin, florfenicol, tiamulin, and valnemulin. Six MSSA strains additionally exhibited resistance to gentamicin, kanamycin, and ciprofloxacin, while three strains showed resistance to tilmicosin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Third-generation sequencing of a strain co-harbouring <em>cfr</em> and <em>fosD</em> demonstrated that both genes were located on a plasmid also carrying <em>fexA</em> and <em>aadD</em>.</div></div><div><h3>Conclusions</h3><div>This study revealed the presence of the <em>cfr</em> gene across diverse multilocus sequence typing types of <em>S. aureus</em> and highlighted the co-dissemination of <em>cfr</em> with <em>fosD</em> and other resistance genes via plasmids in <em>S. aureus</em>. Based on One Health principles and risk of multidrug resistance spread, continuous surveillance of animal-derived <em>S. aureus</em> was urgently needed.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 57-62"},"PeriodicalIF":3.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540978","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}
Pub Date : 2025-11-15DOI: 10.1016/j.jgar.2025.11.004
Eunice Rui Ning Wong , Nicole Tham , Si Hui Low , Jun Cong Goh , Haresh Singaraju , Sky Wei Chee Koh
Objectives
Despite recent developments in national urinary tract infection (UTI) guidelines, primary care physicians have shown limited uptake. This study aims to evaluate the effectiveness of two antimicrobial stewardship interventions in improving antibiotic appropriateness for UTIs in primary care.
Methods
A quasi-experimental study was conducted from March to December 2024 across seven public primary care clinics in Singapore. The study evaluated two interventions: (1) an educational seminar conducted for all clinics, and (2) Epic preference list customization of prescription order sets in one intervention clinic. Segmented regression analysis was used to assess overall changes in antibiotic appropriateness after educational seminar, while difference-in-differences analysis evaluated the specific impacts of preference list customization.
Results
2874 female patients with uncomplicated UTIs (median 59 years) were seen by 301 primary care physicians, with a mean 11.8 years (SD = 9.5) of clinical experience. Educational seminar led to a significant increase in appropriateness rates (66.2% vs. 61.3%, P = 0.036) and reduction in wrong antibiotic selection (10.6% to 7.3%, P = 0.018) across all clinics. Epic preference list customization demonstrated significantly higher appropriateness rates (85.9% vs. 65.5%, P < 0.001) and lower rates of inappropriate antibiotic frequency (9.8% vs. 18.0%, P = 0.01) and duration (0% vs. 9.7%, P < 0.001) in the intervention clinic. There were no significant continued improvement in antibiotic appropriateness demonstrated after the educational seminar or preference list customization.
Conclusion
While preference list customization may be beneficial for maintaining antibiotic appropriateness, multifaceted approaches tailored to site-specific needs are necessary for continued improvements in antibiotic stewardship.
导读：尽管最近国家尿路感染（UTI）指南的发展，初级保健医生已经显示有限的吸收。本研究旨在评估两种抗菌药物管理干预措施在改善初级保健中尿路感染的抗生素适宜性方面的有效性。方法：2024年3月至12月，在新加坡7家公立初级保健诊所进行了一项准实验研究。本研究评估了两种干预措施：(1)在所有诊所开展教育研讨会，(2)在一个干预诊所定制Epic偏好列表处方单集。采用分段回归分析评估教育研讨会后抗生素适宜性的总体变化，而差异中差异分析评估偏好列表定制的具体影响。结果：301名初级保健医生共观察了2874名女性无并发症尿路感染患者（中位年龄59岁），平均临床经验为11.8年（SD 9.5）。教育研讨会显著提高了所有诊所的合适率（66.2%对61.3%,p=0.036），减少了错误的抗生素选择（10.6%对7.3%,p=0.018）。Epic偏好列表定制显示出更高的适宜率（85.9% vs 65.5%）。结论：尽管偏好列表定制可能有利于维持抗生素适宜性，但针对特定地点需求的多方面方法对于持久改善抗生素管理是必要的。
{"title":"Effectiveness of educational seminar and customized prescription order sets on antibiotic appropriateness for urinary tract infections in primary care","authors":"Eunice Rui Ning Wong , Nicole Tham , Si Hui Low , Jun Cong Goh , Haresh Singaraju , Sky Wei Chee Koh","doi":"10.1016/j.jgar.2025.11.004","DOIUrl":"10.1016/j.jgar.2025.11.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite recent developments in national urinary tract infection (UTI) guidelines, primary care physicians have shown limited uptake. This study aims to evaluate the effectiveness of two antimicrobial stewardship interventions in improving antibiotic appropriateness for UTIs in primary care.</div></div><div><h3>Methods</h3><div>A quasi-experimental study was conducted from March to December 2024 across seven public primary care clinics in Singapore. The study evaluated two interventions: (1) an educational seminar conducted for all clinics, and (2) Epic preference list customization of prescription order sets in one intervention clinic. Segmented regression analysis was used to assess overall changes in antibiotic appropriateness after educational seminar, while difference-in-differences analysis evaluated the specific impacts of preference list customization.</div></div><div><h3>Results</h3><div>2874 female patients with uncomplicated UTIs (median 59 years) were seen by 301 primary care physicians, with a mean 11.8 years (SD = 9.5) of clinical experience. Educational seminar led to a significant increase in appropriateness rates (66.2% vs. 61.3%, <em>P</em> = 0.036) and reduction in wrong antibiotic selection (10.6% to 7.3%, <em>P</em> = 0.018) across all clinics. Epic preference list customization demonstrated significantly higher appropriateness rates (85.9% vs. 65.5%, <em>P</em> < 0.001) and lower rates of inappropriate antibiotic frequency (9.8% vs. 18.0%, <em>P</em> = 0.01) and duration (0% vs. 9.7%, <em>P</em> < 0.001) in the intervention clinic. There were no significant continued improvement in antibiotic appropriateness demonstrated after the educational seminar or preference list customization.</div></div><div><h3>Conclusion</h3><div>While preference list customization may be beneficial for maintaining antibiotic appropriateness, multifaceted approaches tailored to site-specific needs are necessary for continued improvements in antibiotic stewardship.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"46 ","pages":"Pages 75-78"},"PeriodicalIF":3.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540815","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}
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