Pub Date : 2025-10-11DOI: 10.1016/j.jgar.2025.10.002
Laura Mezzogori , Marco Muccio , Riccardo Schiavoni , Lucia Taramasso , Filippo Giacomini , Bianca Bruzzone , Federica Stefanelli , Nadia Randazzo , Franco Maggiolo , Maurizio Zazzi , Matteo Bassetti , Antonio Di Biagio
Objectives
This study evaluated the impact of pre-existing resistance-associated mutations (RAMs) to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) on treatment outcomes in people living with HIV (PWH) receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in a real-world setting.
Methods
We conducted a single-centre, retrospective review of treatment-experienced adult PWH switched to B/F/TAF, comparing those with and without NRTI RAMs. The primary endpoint was virological success at week 96 (<50 HIV RNA copies/mL). Secondary endpoints were changes in absolute CD4+ counts and CD4+/CD8+ ratio. Continuous variables were analysed using the Wilcoxon rank sum test and categorical variables with the Chi-square or Fisher’s exact test. Longitudinal changes in absolute CD4+ counts and CD4+/CD8+ ratio were assessed using linear mixed-effects models, accounting for repeated measurements over time.
Results
A total of 257 PWH were included, of whom 21 were viraemic at the time of switch; 41 had pre-existing NRTI RAMs, while no RAMs were documented in the remaining 216 participants. At week 96, virological suppression was achieved in 100% of individuals with RAMs and 97.2% of those without NRTI RAMs, respectively (P = ns). Absolute CD4+ counts increased in 44.4% of participants, with no significant impact of NRTI RAMs. The CD4+/CD8+ ratio showed an apparent increase of more than 50% in 73.2% and 62.0% of participants with and without NRTI RAMs, respectively. However, longitudinal trend analysis revealed a significant negative rate of change in both groups, which was less pronounced among participants with RAMs.
Conclusions
B/F/TAF is an effective treatment option for PWH with NRTI RAMs.
{"title":"96-week real-world effectiveness of bictegravir/emtricitabine/tenofovir alafenamide in HIV-infected adults with pre-existing NRTI resistance: A retrospective cohort study","authors":"Laura Mezzogori , Marco Muccio , Riccardo Schiavoni , Lucia Taramasso , Filippo Giacomini , Bianca Bruzzone , Federica Stefanelli , Nadia Randazzo , Franco Maggiolo , Maurizio Zazzi , Matteo Bassetti , Antonio Di Biagio","doi":"10.1016/j.jgar.2025.10.002","DOIUrl":"10.1016/j.jgar.2025.10.002","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluated the impact of pre-existing resistance-associated mutations (RAMs) to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) on treatment outcomes in people living with HIV (PWH) receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in a real-world setting.</div></div><div><h3>Methods</h3><div>We conducted a single-centre, retrospective review of treatment-experienced adult PWH switched to B/F/TAF, comparing those with and without NRTI RAMs. The primary endpoint was virological success at week 96 (<50 HIV RNA copies/mL). Secondary endpoints were changes in absolute CD4+ counts and CD4+/CD8+ ratio. Continuous variables were analysed using the Wilcoxon rank sum test and categorical variables with the Chi-square or Fisher’s exact test. Longitudinal changes in absolute CD4+ counts and CD4+/CD8+ ratio were assessed using linear mixed-effects models, accounting for repeated measurements over time.</div></div><div><h3>Results</h3><div>A total of 257 PWH were included, of whom 21 were viraemic at the time of switch; 41 had pre-existing NRTI RAMs, while no RAMs were documented in the remaining 216 participants. At week 96, virological suppression was achieved in 100% of individuals with RAMs and 97.2% of those without NRTI RAMs, respectively (<em>P</em> = ns). Absolute CD4+ counts increased in 44.4% of participants, with no significant impact of NRTI RAMs. The CD4+/CD8+ ratio showed an apparent increase of more than 50% in 73.2% and 62.0% of participants with and without NRTI RAMs, respectively. However, longitudinal trend analysis revealed a significant negative rate of change in both groups, which was less pronounced among participants with RAMs.</div></div><div><h3>Conclusions</h3><div>B/F/TAF is an effective treatment option for PWH with NRTI RAMs.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 215-219"},"PeriodicalIF":3.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286036","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 : 2025-10-10DOI: 10.1016/j.jgar.2025.09.007
Ling Xin, Jing Wang, Cong Qin, Yi Sun, Hongwei Zhou, Rong Zhang, Gongxiang Chen
Objective
A highly virulent Klebsiella pneumoniae ST23-K1 carrying blaKPC-3, named as Kpn_24-5, was identified in the blood samples of a patient with multiple complications. We investigated the transfer and pathogenic mechanism of this strain, and elucidated the epidemiological situation of the strain.
Methods
A blaKPC-3-positive ST23-K1 K. pneumoniae was isolated. Antimicrobial susceptibility test and whole genome sequencing were used to study the phenotypes and genotypes of the strain. The transmission and pathogenic mechanism were investigated by means of conjugation transfer test, neutrophil killing test, and serum inhibition test.
Results
The Kpn_24-5 strain was ST23 sequence type and K64:O1 capsular serotype, which contains four plasmids. Plasmid 1 carries several virulence genes, belonging to the same clade as K. pneumoniae plasmid isolated from the USA in 2023. Plasmid 2 is an anti-plasmid containing blaKPC-3 carbapenem resistance gene, belonging to the same clade as K. pneumoniae plasmid isolated from China in 2024. The genetic characteristics of plasmids indicated that the genetic environment of blaKPC-3 in plasmid 2 of Kpn_24-5 strain was IS26-ISKpn27-blaKPC-3-Tn21. The resistance plasmid 2 of Kpn_24-5 strain was transferable. The Kpn_24-5 strain has higher tolerance to neutrophils, is not easily inhibited by serum, and has significantly higher infectivity.
Conclusions
The present study corroborates the emergence of hypervirulent CR-hvKP in the Zhejiang region, a phenomenon that is presumably attributable to the acquisition of an IncFIB virulence plasmid and a blaKPC-3 resistance plasmid by the ST23-K1 type K. pneumoniae. Our findings highlight the urgent need to use antibiotics more wisely to limit the emergence of resistance.
{"title":"Emergence of ST23-K1 blaKPC-3-positive hypervirulent carbapenem-resistant Klebsiella pneumoniae from China: A molecular, biological, and epidemiological study","authors":"Ling Xin, Jing Wang, Cong Qin, Yi Sun, Hongwei Zhou, Rong Zhang, Gongxiang Chen","doi":"10.1016/j.jgar.2025.09.007","DOIUrl":"10.1016/j.jgar.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>A highly virulent <em>Klebsiella pneumoniae</em> ST23-K1 carrying <em>bla</em><sub>KPC-3</sub>, named as Kpn_24-5, was identified in the blood samples of a patient with multiple complications. We investigated the transfer and pathogenic mechanism of this strain, and elucidated the epidemiological situation of the strain.</div></div><div><h3>Methods</h3><div>A <em>bla</em><sub>KPC-3-</sub>positive ST23-K1 <em>K. pneumoniae</em> was isolated. Antimicrobial susceptibility test and whole genome sequencing were used to study the phenotypes and genotypes of the strain. The transmission and pathogenic mechanism were investigated by means of conjugation transfer test, neutrophil killing test, and serum inhibition test.</div></div><div><h3>Results</h3><div>The Kpn_24-5 strain was ST23 sequence type and K64:O1 capsular serotype, which contains four plasmids. Plasmid 1 carries several virulence genes, belonging to the same clade as <em>K. pneumoniae</em> plasmid isolated from the USA in 2023. Plasmid 2 is an anti-plasmid containing <em>bla</em><sub>KPC-3</sub> carbapenem resistance gene, belonging to the same clade as <em>K. pneumoniae</em> plasmid isolated from China in 2024. The genetic characteristics of plasmids indicated that the genetic environment of <em>bla</em><sub>KPC-3</sub> in plasmid 2 of Kpn_24-5 strain was IS26-ISKpn27-<em>bla</em><sub>KPC-3</sub>-Tn21. The resistance plasmid 2 of Kpn_24-5 strain was transferable. The Kpn_24-5 strain has higher tolerance to neutrophils, is not easily inhibited by serum, and has significantly higher infectivity.</div></div><div><h3>Conclusions</h3><div>The present study corroborates the emergence of hypervirulent CR-hvKP in the Zhejiang region, a phenomenon that is presumably attributable to the acquisition of an IncFIB virulence plasmid and a <em>bla</em><sub>KPC-3</sub> resistance plasmid by the ST23-K1 type <em>K. pneumoniae</em>. Our findings highlight the urgent need to use antibiotics more wisely to limit the emergence of resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 234-239"},"PeriodicalIF":3.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280415","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}
Data on paediatric bloodstream infection (BSI) in low- and middle-income countries remain scarce. Consequently, this study aims to elucidate the risk factors associated with mortality in paediatric patients with enterobacterial BSIs.
Methods
This was a retrospective analysis of patients with bloodstream infection due to Enterobacterales attended at Hospital Infantil de Mexico during 2013–2019. Factors influencing mortality were assessed. The baseline characteristics of the population, bloodstream infection and antimicrobial treatment were compared between survivors and non-survivors as well.
Results
Of 527 cases of BSIs, 63.6% (n = 335) were caused by Enterobacterales and 307 cases were included. The overall mortality rate was 11.1% (n = 34). In the multivariable regression model, septic shock/multiorgan failure (HR 9.69, 95% CI: 3.28–28.63), and empirical treatment failure (HR 3.4, 95% CI: 1.36–8.45) were associated with an increased mortality risk.
Conclusions
in this study, the mortality in paediatric BSIs was driven by severe clinical presentation and failure to control inflammatory response and infection. Improving outcomes requires proactive measures, including early detection of sepsis by caregivers, education of healthcare providers for timely recognition and treatment, vigilant monitoring of systemic inflammatory response with adaptable therapeutic approaches and reinforcement of antimicrobial stewardship programs.
{"title":"30-d mortality risk factors in paediatric patients with bloodstream infection due to Enterobacterales: A retrospective observational cohort study","authors":"Ojeda-Diezbarroso Karla , Jimenez-Juarez Rodolfo Norberto , Avilés-Robles Martha , Laris-González Almudena , Bonilla-Pellegrini Sergio , Pichardo-Villalón Liliana , Castellanos-Cruz Carmen","doi":"10.1016/j.jgar.2025.09.014","DOIUrl":"10.1016/j.jgar.2025.09.014","url":null,"abstract":"<div><h3>Objective</h3><div>Data on paediatric bloodstream infection (BSI) in low- and middle-income countries remain scarce. Consequently, this study aims to elucidate the risk factors associated with mortality in paediatric patients with enterobacterial BSIs.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients with bloodstream infection due to Enterobacterales attended at Hospital Infantil de Mexico during 2013–2019. Factors influencing mortality were assessed. The baseline characteristics of the population, bloodstream infection and antimicrobial treatment were compared between survivors and non-survivors as well.</div></div><div><h3>Results</h3><div>Of 527 cases of BSIs, 63.6% (n = 335) were caused by Enterobacterales and 307 cases were included. The overall mortality rate was 11.1% (n = 34). In the multivariable regression model, septic shock/multiorgan failure (HR 9.69, 95% CI: 3.28–28.63), and empirical treatment failure (HR 3.4, 95% CI: 1.36–8.45) were associated with an increased mortality risk.</div></div><div><h3>Conclusions</h3><div>in this study, the mortality in paediatric BSIs was driven by severe clinical presentation and failure to control inflammatory response and infection. Improving outcomes requires proactive measures, including early detection of sepsis by caregivers, education of healthcare providers for timely recognition and treatment, vigilant monitoring of systemic inflammatory response with adaptable therapeutic approaches and reinforcement of antimicrobial stewardship programs.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 299-304"},"PeriodicalIF":3.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280354","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 : 2025-10-06DOI: 10.1016/j.jgar.2025.09.015
Hui Wang , Jie Sheng , Ying Zhang , Hao Lan , Xiaofeng Lu , Xi Li , Xiaofei Zhao
Objective
Q (query) fever, caused by Coxiella burnetii, is often linked to negative bacterial cultures, with infective endocarditis with negative cultures difficult to diagnose and treat. Our case demonstrates that metagenomic next-generation sequencing (mNGS) is able to provide a rapid and accurate method for pathogenetic diagnosis in infectious diseases.
Case presentation
A case of infective endocarditis with negative blood cultures is reported in a male patient with a history of sheep farming and previous aortic valve replacement and atrial septal defect atrial septal defect repair. Blood tests showed positive serum immunofluorescent antibodies to Rickettsia, while mNGS of perivalvular abscess tissue suggested C. burnetii. Doxycycline 0.1 g q12h and hydroxychloroquine 0.2 g q12h were used for postoperative antibiotic treatment. The genome of C. burnetii C2245173Z was assembled on the Illumina platform and no known antibiotic resistance genes were detected. Phylogenetic analysis of the C. burnetii genome showed a genetic relationship between animal- and human-derived strains.
Conclusions
mNGS could provide a rapid and accurate assay for clinical diagnosis and play a decisive role in the pathogenetic diagnosis of some infectious diseases. Doxycycline plus hydroxychloroquine remains an effective treatment for chronic Q fever endocarditis. In addition, phylogenetic tree analysis indicates that C. burnetii infection may pose a potential risk to humans working with livestock.
目的：由伯纳氏克希菌引起的发热通常与阴性细菌培养有关。阴性培养的感染性心内膜炎很难诊断和治疗。我们的案例表明，新一代宏基因组测序（mNGS）可以为传染病的病理诊断提供快速准确的方法。病例介绍：我们报告了一例感染性心内膜炎伴阴性血培养的男性患者，有养羊史，有主动脉瓣置换术（AVT）和房间隔缺损（ASD）修复史。血液检查显示血清立克次体免疫荧光抗体阳性，而瓣膜周围脓肿组织的mNGS提示伯氏原体感染。术后应用强力霉素0.1 g q12h、羟氯喹0.2 g q12h给予抗生素治疗。在Illumina平台上组装burnetii C2245173Z基因组，未检测到已知的抗生素耐药基因。伯纳蒂胞杆菌基因组的系统发育分析显示动物源性菌株和人源性菌株之间存在遗传关系。结论：应用mNGS可为临床诊断提供快速、准确的检测方法，在某些感染性疾病的发病诊断中具有决定性作用。强力霉素加羟氯喹仍然是治疗慢性Q热心内膜炎的有效方法。此外，系统发育树分析表明，伯纳蒂胞杆菌感染可能对与牲畜一起工作的人构成潜在风险。
{"title":"Detection of zoonotic Coxiella burnetii causing chronic Q fever endocarditis in a Chinese geriatric patient by mNGS","authors":"Hui Wang , Jie Sheng , Ying Zhang , Hao Lan , Xiaofeng Lu , Xi Li , Xiaofei Zhao","doi":"10.1016/j.jgar.2025.09.015","DOIUrl":"10.1016/j.jgar.2025.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>Q (query) fever, caused by <em>Coxiella burnetii</em>, is often linked to negative bacterial cultures, with infective endocarditis with negative cultures difficult to diagnose and treat. Our case demonstrates that metagenomic next-generation sequencing (mNGS) is able to provide a rapid and accurate method for pathogenetic diagnosis in infectious diseases.</div></div><div><h3>Case presentation</h3><div>A case of infective endocarditis with negative blood cultures is reported in a male patient with a history of sheep farming and previous aortic valve replacement and atrial septal defect atrial septal defect repair. Blood tests showed positive serum immunofluorescent antibodies to <em>Rickettsia</em>, while mNGS of perivalvular abscess tissue suggested <em>C. burnetii</em>. Doxycycline 0.1 g q12h and hydroxychloroquine 0.2 g q12h were used for postoperative antibiotic treatment. The genome of <em>C. burnetii</em> C2245173Z was assembled on the Illumina platform and no known antibiotic resistance genes were detected. Phylogenetic analysis of the <em>C. burnetii</em> genome showed a genetic relationship between animal- and human-derived strains.</div></div><div><h3>Conclusions</h3><div>mNGS could provide a rapid and accurate assay for clinical diagnosis and play a decisive role in the pathogenetic diagnosis of some infectious diseases. Doxycycline plus hydroxychloroquine remains an effective treatment for chronic Q fever endocarditis. In addition, phylogenetic tree analysis indicates that <em>C. burnetii</em> infection may pose a potential risk to humans working with livestock.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 192-195"},"PeriodicalIF":3.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251360","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 : 2025-10-03DOI: 10.1016/j.jgar.2025.09.013
Min Xu , Xiaofen Mo , Yuchao Zhang , Huinan Xia , Huiqiong Jia , Haishen Kong , Qixia Luo , Yiqi Fu
Objective
The emergence of Klebsiella pneumoniae carbapenemase variants (KPCVs), conferring resistance to ceftazidime/avibactam (CAZ/AVI), represents a critical clinical challenge. However, investigations into KPCV-producing K. pneumoniae (KPCV-Kp) are confined to sporadic clinical cases.
Methods
Clinical isolates of KPCV-Kp exhibiting resistance to CAZ/AVI were collected from a Chinese tertiary hospital from February 2015 to March 2024. The clinical characteristics, antimicrobial susceptibility, molecular epidemiology and genetic phylogeny were subjected to analysis.
Results
A total of 25 KPCV-Kp strains displaying high-level resistance to CAZ/AVI were identified, with their initial isolation in 2018 and the majority obtained in 2023 (64.0%, 16/25). All patients except one had prior CAZ/AVI exposure for 3 to 38 days. Twelve KPCVs, including four novel variants (designated as KPC-219 to KPC-222), were identified. KPC-33 predominated (40.0%, 10/25), followed by KPC-71 (12.0%, 3/25), KPC-14, and KPC-90 (8.0%, 2/25 for each). Notably, 50.0% (6/12) of the KPCVs exhibited multiple mutations in the Ω-loop as well as in other regions, which were associated with a significantly longer CAZ/AVI exposure (P = 0.033). Molecular analysis highlighted the circulation of ST11-KL64 clone (72.0%, 18/25), followed by ST11-KL47 and ST11-KL25 clones (12.0%, 3/25 for each). Phylogenetic analysis revealed no epidemiological linkage between cases, and the KPCV-Kp evolved from their individual parental KPC-2-producing strains.
Conclusions
Our study provided a preliminary glimpse into the epidemiology and genetic characteristics of KPCV-Kp in China, underscoring the critical need for continuous monitoring in patients treated with CAZ/AVI, even in short-term therapy, to better grasp the evolving threat posed by these variants.
{"title":"Epidemiological and genetic profiles of ceftazidime/avibactam-resistant Klebsiella pneumoniae conferred by KPC variants in a tertiary hospital in China","authors":"Min Xu , Xiaofen Mo , Yuchao Zhang , Huinan Xia , Huiqiong Jia , Haishen Kong , Qixia Luo , Yiqi Fu","doi":"10.1016/j.jgar.2025.09.013","DOIUrl":"10.1016/j.jgar.2025.09.013","url":null,"abstract":"<div><h3>Objective</h3><div>The emergence of <em>Klebsiella pneumoniae</em> carbapenemase variants (KPCVs), conferring resistance to ceftazidime/avibactam (CAZ/AVI), represents a critical clinical challenge. However, investigations into KPCV-producing <em>K. pneumoniae</em> (KPCV-Kp) are confined to sporadic clinical cases.</div></div><div><h3>Methods</h3><div>Clinical isolates of KPCV-Kp exhibiting resistance to CAZ/AVI were collected from a Chinese tertiary hospital from February 2015 to March 2024. The clinical characteristics, antimicrobial susceptibility, molecular epidemiology and genetic phylogeny were subjected to analysis.</div></div><div><h3>Results</h3><div>A total of 25 KPCV-Kp strains displaying high-level resistance to CAZ/AVI were identified, with their initial isolation in 2018 and the majority obtained in 2023 (64.0%, 16/25). All patients except one had prior CAZ/AVI exposure for 3 to 38 days. Twelve KPCVs, including four novel variants (designated as KPC-219 to KPC-222), were identified. KPC-33 predominated (40.0%, 10/25), followed by KPC-71 (12.0%, 3/25), KPC-14, and KPC-90 (8.0%, 2/25 for each). Notably, 50.0% (6/12) of the KPCVs exhibited multiple mutations in the Ω-loop as well as in other regions, which were associated with a significantly longer CAZ/AVI exposure (<em>P</em> = 0.033). Molecular analysis highlighted the circulation of ST11-KL64 clone (72.0%, 18/25), followed by ST11-KL47 and ST11-KL25 clones (12.0%, 3/25 for each). Phylogenetic analysis revealed no epidemiological linkage between cases, and the KPCV-Kp evolved from their individual parental KPC-2-producing strains.</div></div><div><h3>Conclusions</h3><div>Our study provided a preliminary glimpse into the epidemiology and genetic characteristics of KPCV-Kp in China, underscoring the critical need for continuous monitoring in patients treated with CAZ/AVI, even in short-term therapy, to better grasp the evolving threat posed by these variants.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 176-181"},"PeriodicalIF":3.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232618","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 : 2025-09-29DOI: 10.1016/j.jgar.2025.09.008
Ni Suo , Jing Yu , Haijun Li , Nan Yi , Cailin Liu , Wanhai Wang
Objectives
The emergence of linezolid-resistant enterococci has become a significant global health concern. This study aimed to investigate the molecular characterization and resistance mechanisms in clinical isolates in a tertiary hospital in China.
Methods
The VITEK®2 Compact system, VITEK® MS, and whole-genome sequencing (WGS) were used to identify 59 linezolid-resistant enterococci isolates. Antimicrobial susceptibilities were assessed by broth microdilution. WGS and bioinformatics tools analyzed resistance mechanisms and molecular characteristics. Plasmid-borne linezolid resistance gene transfer was assessed via conjugation and transformation assays.
Results
We collected 59 linezolid-resistant enterococci isolates, including 54 Enterococcus faecalis and 5 Enterococcus faecium strains. One strain carried the poxtA gene, one isolate carried the G2576T mutation in the 23S rRNA gene, and 56 isolates harbored the optrA gene. Notably, one isolate co-harbored the optrA, poxtA, and cfr(D) genes. Twenty-three sequence types (STs) were identified. ST16 (48.1%, 26/54) predominated in E. faecalis. Multilocus sequence typing (MLST) and evolutionary analysis indicated that E. faecalis strains of the same ST were genetically related. Among the seven strains (two E. faecium and five E. faecalis strains) selected for further investigation, IS1216E was detected on plasmids carrying linezolid resistance genes in all five strains. Additionally, transposon Tn554 was detected on the chromosome of an optrA-carrying strain.
Conclusion
This study describes the molecular characteristics and resistance mechanisms of linezolid-resistant enterococci in our hospital, including a novel E. faecium isolate with optrA, poxtA, and cfr(D), highlighting the need for enhanced surveillance to control the dissemination of resistant strains.
{"title":"Molecular characterization and resistance mechanisms of linezolid-resistant enterococci clinical isolates and identification of a clinical Enterococcus faecium strain co-harboring optrA, poxtA, and cfr(D) in a tertiary hospital in China","authors":"Ni Suo , Jing Yu , Haijun Li , Nan Yi , Cailin Liu , Wanhai Wang","doi":"10.1016/j.jgar.2025.09.008","DOIUrl":"10.1016/j.jgar.2025.09.008","url":null,"abstract":"<div><h3>Objectives</h3><div>The emergence of linezolid-resistant enterococci has become a significant global health concern. This study aimed to investigate the molecular characterization and resistance mechanisms in clinical isolates in a tertiary hospital in China.</div></div><div><h3>Methods</h3><div>The VITEK®2 Compact system, VITEK® MS, and whole-genome sequencing (WGS) were used to identify 59 linezolid-resistant enterococci isolates. Antimicrobial susceptibilities were assessed by broth microdilution. WGS and bioinformatics tools analyzed resistance mechanisms and molecular characteristics. Plasmid-borne linezolid resistance gene transfer was assessed via conjugation and transformation assays.</div></div><div><h3>Results</h3><div>We collected 59 linezolid-resistant enterococci isolates, including 54 <em>Enterococcus faecalis</em> and 5 <em>Enterococcus faecium</em> strains. One strain carried the <em>poxtA</em> gene, one isolate carried the G2576T mutation in the 23S rRNA gene, and 56 isolates harbored the <em>optrA</em> gene. Notably, one isolate co-harbored the <em>optrA, poxtA</em>, and <em>cfr</em>(D) genes. Twenty-three sequence types (STs) were identified. ST16 (48.1%, 26/54) predominated in <em>E. faecalis</em>. Multilocus sequence typing (MLST) and evolutionary analysis indicated that <em>E. faecalis</em> strains of the same ST were genetically related. Among the seven strains (two <em>E. faecium</em> and five <em>E. faecalis</em> strains) selected for further investigation, IS<em>1216E</em> was detected on plasmids carrying linezolid resistance genes in all five strains. Additionally, transposon Tn<em>554</em> was detected on the chromosome of an <em>optrA</em>-carrying strain.</div></div><div><h3>Conclusion</h3><div>This study describes the molecular characteristics and resistance mechanisms of linezolid-resistant enterococci in our hospital, including a novel <em>E. faecium</em> isolate with <em>optrA, poxtA,</em> and <em>cfr</em>(D), highlighting the need for enhanced surveillance to control the dissemination of resistant strains.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 182-191"},"PeriodicalIF":3.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206674","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 : 2025-09-27DOI: 10.1016/j.jgar.2025.09.012
Jinhua Zhang , Yi Liu , Lei Fang , Xinrui Wang , Hao Xu , Danfeng Lou
Objectives
This study aims to elucidate the molecular characteristics of a blaVIM-2-carrying Pseudomonas asiatica isolate (L2126) from China and to characterize a ∼44 kb untypable plasmid harboring blaVIM-2. We investigated the genetic context of blaVIM-2, assessed the associated antimicrobial resistance determinants, and explored the role of this plasmid in mediating gene dissemination.
Methods
The isolate L2126 was recovered from an intestinal colonization sample in a patient from Hangzhou, China. Species identification was confirmed by average nucleotide identity (ANI) analysis. Hybrid whole-genome sequencing was performed using Illumina short-read and Oxford Nanopore long-read platforms. Genome assembly was conducted using Unicycler and annotated with Prokka. Antimicrobial resistance genes were identified via ResFinder and CARD. The genetic context of blaVIM-2 was delineated using IntegronFinder. Plasmid profiles were determined by S1-nuclease pulsed-field gel electrophoresis (S1-PFGE) and in silico replicon analysis.
Results
L2126 exhibited a multidrug-resistant profile with high-level resistance to carbapenems, cephalosporins, and fluoroquinolones. Genome analysis revealed 7 resistance genes, including blaVIM-2 and sul1. Notably, blaVIM-2 resides within a class 1 integron (intI1-attI1-blaVIM-2-qacEΔ1-sul1) embedded in a Tn402-like platform on a ∼44 kb untypable plasmid. The adjacent tni module (tniR-tniQ-tniB-tniA) is encoded on the opposite strand, indicating that it is part of the transposition platform rather than the integron cassette array. S1-PFGE confirmed the presence of the ∼44 kb plasmid, and in silico analysis provided a schematic representation of its genetic organization. BLAST analysis demonstrated that this plasmid shares high sequence homology with a plasmid previously identified in Pseudomonas monteilii, despite the two isolates belonging to different species.
Conclusions
Our findings demonstrate that the carriage of blaVIM-2 on a novel ∼44 kb untypable plasmid in P. asiatica L2126 could facilitate horizontal gene transfer of carbapenem resistance. The plasmid’s high homology to one previously identified in P. monteilii suggests that it has the potential for intra-genus dissemination, posing a significant threat to the spread of carbapenem resistance.
{"title":"Molecular characterization of blaVIM-2-carrying Pseudomonas asiatica L2126: identification of a ∼44 kb untypable plasmid with intra-genus dissemination potential","authors":"Jinhua Zhang , Yi Liu , Lei Fang , Xinrui Wang , Hao Xu , Danfeng Lou","doi":"10.1016/j.jgar.2025.09.012","DOIUrl":"10.1016/j.jgar.2025.09.012","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to elucidate the molecular characteristics of a <em>bla</em><sub>VIM-2</sub>-carrying <em>Pseudomonas asiatica</em> isolate (L2126) from China and to characterize a ∼44 kb untypable plasmid harboring <em>bla</em><sub>VIM-2</sub>. We investigated the genetic context of <em>bla</em><sub>VIM-2</sub>, assessed the associated antimicrobial resistance determinants, and explored the role of this plasmid in mediating gene dissemination.</div></div><div><h3>Methods</h3><div>The isolate L2126 was recovered from an intestinal colonization sample in a patient from Hangzhou, China. Species identification was confirmed by average nucleotide identity (ANI) analysis. Hybrid whole-genome sequencing was performed using Illumina short-read and Oxford Nanopore long-read platforms. Genome assembly was conducted using Unicycler and annotated with Prokka. Antimicrobial resistance genes were identified via ResFinder and CARD. The genetic context of <em>bla</em><sub>VIM-2</sub> was delineated using IntegronFinder. Plasmid profiles were determined by S1-nuclease pulsed-field gel electrophoresis (S1-PFGE) and <em>in silico</em> replicon analysis.</div></div><div><h3>Results</h3><div>L2126 exhibited a multidrug-resistant profile with high-level resistance to carbapenems, cephalosporins, and fluoroquinolones. Genome analysis revealed 7 resistance genes, including <em>bla</em><sub>VIM-2</sub> and <em>sul1</em>. Notably, <em>bla</em><sub>VIM-2</sub> resides within a class 1 integron (<em>intI1-attI1-bla</em><sub>VIM-2</sub><em>-qacEΔ1-sul1</em>) embedded in a Tn<em>402</em>-like platform on a ∼44 kb untypable plasmid. The adjacent <em>tni</em> module (<em>tniR-tniQ-tniB-tniA</em>) is encoded on the opposite strand, indicating that it is part of the transposition platform rather than the integron cassette array. S1-PFGE confirmed the presence of the ∼44 kb plasmid, and <em>in silico</em> analysis provided a schematic representation of its genetic organization. BLAST analysis demonstrated that this plasmid shares high sequence homology with a plasmid previously identified in <em>Pseudomonas monteilii</em>, despite the two isolates belonging to different species.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate that the carriage of <em>bla</em><sub>VIM-2</sub> on a novel ∼44 kb untypable plasmid in <em>P. asiatica</em> L2126 could facilitate horizontal gene transfer of carbapenem resistance. The plasmid’s high homology to one previously identified in <em>P. monteilii</em> suggests that it has the potential for intra-genus dissemination, posing a significant threat to the spread of carbapenem resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 173-175"},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191761","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 : 2025-09-27DOI: 10.1016/j.jgar.2025.09.011
Zhengyu Luo , Li Zhang , Zhengyin Liu , Minya Lu , Yingchun Xu , Menglan Zhou
Introduction
Eravacycline (ERV), a novel fluorocycline antibiotic, demonstrates broad-spectrum activity against multidrug-resistant (MDR) pathogens. This multicenter retrospective study evaluates the real-world clinical effectiveness of ERV in treating various infections of the patients hospitalized in the respiratory departments.
Methods
We analyzed 113 adult patients treated with ERV from respiratory departments in China, examining antimicrobial susceptibility profiles and serial laboratory parameters during therapy. Microbiological and clinical outcomes were systematically evaluated at treatment completion and 30-day follow-up. Subgroup analyses focused on Acinetobacter baumannii and Klebsiella pneumoniae infections.
Results
ERV exhibited 87.6% clinical efficacy and 85.8% microbiological eradication rate, accompanied by an 85.0% 30-day survival rate. The antibiotic maintained robust activity against MDR pathogens, particularly A. baumannii (n = 51) and K. pneumoniae (n = 27). Adverse events occurred in only 1.8% (2/113) of cases. Clinical outcomes showed no statistically significant differences between monotherapy (n = 70) and combination regimens (n = 43).
Conclusion
This real-world evidence confirms ERV as an effective and well-tolerated therapeutic option for managing patients in the respiratory departments, particularly those caused by MDR Gram-negative pathogens. The comparable efficacy of monotherapy and combination approaches warrants further investigation.
{"title":"The efficacy and safety of eravacycline in the treatment of patients with pneumonia in respiratory departments: A real-world multicenter retrospective study","authors":"Zhengyu Luo , Li Zhang , Zhengyin Liu , Minya Lu , Yingchun Xu , Menglan Zhou","doi":"10.1016/j.jgar.2025.09.011","DOIUrl":"10.1016/j.jgar.2025.09.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Eravacycline (ERV), a novel fluorocycline antibiotic, demonstrates broad-spectrum activity against multidrug-resistant (MDR) pathogens. This multicenter retrospective study evaluates the real-world clinical effectiveness of ERV in treating various infections of the patients hospitalized in the respiratory departments.</div></div><div><h3>Methods</h3><div>We analyzed 113 adult patients treated with ERV from respiratory departments in China, examining antimicrobial susceptibility profiles and serial laboratory parameters during therapy. Microbiological and clinical outcomes were systematically evaluated at treatment completion and 30-day follow-up. Subgroup analyses focused on <em>Acinetobacter baumannii</em> and <em>Klebsiella pneumoniae</em> infections.</div></div><div><h3>Results</h3><div>ERV exhibited 87.6% clinical efficacy and 85.8% microbiological eradication rate, accompanied by an 85.0% 30-day survival rate. The antibiotic maintained robust activity against MDR pathogens, particularly <em>A. baumannii</em> (<em>n</em> = 51) and <em>K. pneumoniae</em> (<em>n</em> = 27). Adverse events occurred in only 1.8% (2/113) of cases. Clinical outcomes showed no statistically significant differences between monotherapy (<em>n</em> = 70) and combination regimens (<em>n</em> = 43).</div></div><div><h3>Conclusion</h3><div>This real-world evidence confirms ERV as an effective and well-tolerated therapeutic option for managing patients in the respiratory departments, particularly those caused by MDR Gram-negative pathogens. The comparable efficacy of monotherapy and combination approaches warrants further investigation.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 196-201"},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191774","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 : 2025-09-25DOI: 10.1016/j.jgar.2025.09.010
Eva Nohynkova, Aneta Perglerova, Vlasta Korenkova, Pavla Tumova
Objectives
Giardiasis, a worldwide intestinal infection caused by the protozoan parasite Giardia intestinalis, is treatable with metronidazole (MTZ). However, MTZ-refractory giardiasis is common. It remains unclear, however, whether MTZ-resistant pathogens cause treatment failure because the natural resistance of Giardia to MTZ has not yet been demonstrated.
Methods
We developed a simple 24 h viability assay to assess the MTZ sensitivity of Giardia parasites in vitro under two atmospheric conditions, microaerobic and anaerobic. The results of the assay were statistically evaluated.
Results
We tested 18 clinical isolates. Based on the minimum lethal concentration (MLC), hierarchical cluster analysis separated the isolates into three categories: sensitive, intermediate resistant, and resistant. The resistant cluster consisted of two isolates with an MLC of 400 µg/mL MTZ, which exhibited natural MTZ resistance. Interestingly, this resistance was only manifested under microaerobic conditions. The effect of oxygen on the in vitro drug response was evident in the greater variability of MLC values among the other isolates. Two in vitro-resistant isolates originated from patients with MTZ-refractory giardiasis, suggesting that parasite resistance likely contributes to treatment failure. However, two additional isolates from patients with MTZ-refractory giardiasis showed in vitro susceptibility under both test conditions. This indicates that treatment failure in giardiasis likely stems from multiple factors.
Conclusions
Our study highlights the critical importance of oxygen concentration during assessment of Giardia parasite resistance to MTZ. However, it also indicates that MTZ-refractory giardiasis may result from reasons other than parasite resistance.
{"title":"Metronidazole and Giardia: In vitro viability assay under microaerobic conditions indicates a multifactorial basis for metronidazole treatment failure","authors":"Eva Nohynkova, Aneta Perglerova, Vlasta Korenkova, Pavla Tumova","doi":"10.1016/j.jgar.2025.09.010","DOIUrl":"10.1016/j.jgar.2025.09.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Giardiasis, a worldwide intestinal infection caused by the protozoan parasite <em>Giardia intestinalis</em>, is treatable with metronidazole (MTZ). However, MTZ-refractory giardiasis is common. It remains unclear, however, whether MTZ-resistant pathogens cause treatment failure because the natural resistance of <em>Giardia</em> to MTZ has not yet been demonstrated.</div></div><div><h3>Methods</h3><div>We developed a simple 24 h viability assay to assess the MTZ sensitivity of <em>Giardia</em> parasites in vitro under two atmospheric conditions, microaerobic and anaerobic. The results of the assay were statistically evaluated.</div></div><div><h3>Results</h3><div>We tested 18 clinical isolates. Based on the minimum lethal concentration (MLC), hierarchical cluster analysis separated the isolates into three categories: sensitive, intermediate resistant, and resistant. The resistant cluster consisted of two isolates with an MLC of 400 µg/mL MTZ, which exhibited natural MTZ resistance. Interestingly, this resistance was only manifested under microaerobic conditions. The effect of oxygen on the in vitro drug response was evident in the greater variability of MLC values among the other isolates. Two in vitro-resistant isolates originated from patients with MTZ-refractory giardiasis, suggesting that parasite resistance likely contributes to treatment failure. However, two additional isolates from patients with MTZ-refractory giardiasis showed in vitro susceptibility under both test conditions. This indicates that treatment failure in giardiasis likely stems from multiple factors.</div></div><div><h3>Conclusions</h3><div>Our study highlights the critical importance of oxygen concentration during assessment of <em>Giardia</em> parasite resistance to MTZ. However, it also indicates that MTZ-refractory giardiasis may result from reasons other than parasite resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 157-163"},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181886","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 : 2025-09-24DOI: 10.1016/j.jgar.2025.09.009
Nada A. Alsaleh , Abeer AlSmari , Abrar F. Alhameed , Ahmed O. Alenazi , Alaa A. Alsharif , Amal Bin Akresh , Anwar M. Alnakhli , Bashaier Alshehail , Eman A. Alzahrani , Ghadah H. Alshehri , Ghazwa B. Korayem , Hanan A. Bakri , Khalid Eljaaly , Lina I. Alnajjar , Norah S. Aldeghaither , Reem Almahasna , Sara Almuhisen , Yassmin Alsomali , Zikria Saleem
Background
Antimicrobial resistance (AMR) threatens global health by reducing the efficacy of common infection treatments. This study examines antimicrobial use in Saudi Arabian hospitals, identifies influencing factors, and proposes interventions using the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification system.
Methods
A cross-sectional, multicentre point prevalence survey (PPS) of antimicrobial utilization was conducted in 10 hospitals across 6 regions of Saudi Arabia September 2023. All inpatients receiving antimicrobials on the PPS day were included. Data collection utilized the Global PPS tool developed by the University of Antwerp, Belgium.
Results
Among 2890 inpatients, 766 (26.5%) were prescribed at least one antimicrobial, resulting in a total of 982 prescriptions. The primary indications for these antimicrobials were community-acquired infections (37.1%), Healthcare-associated infections (35.9%), surgical prophylaxis (15.4%), unknown reasons (8.7%), medical prophylaxis (2.5%), and other reasons (0.3%). The most common reasons for antimicrobial use included pneumonia or lower respiratory tract infections (16.1%), skin and soft tissue infections (11%) and bacteraemia (8.9%). The most frequently prescribed antimicrobial classes were penicillins with beta-lactamase inhibitors (18.5%), carbapenems (15.7%), and third-generation cephalosporins (11.1%). Most of the antimicrobials (66.3%) were classified as Watch antimicrobials, followed by 23.8% as Access, and 8.9% as Reserve.
Conclusions
The study provides valuable insights into antimicrobial utilization in Saudi Arabia, offering a baseline for assessing prescribing patterns. While findings may reflect certain antimicrobial stewardship efforts, further investigation is needed to evaluate their impact. The study also highlights key areas for improvement, emphasizing the importance of conducting future PPS to guide antimicrobial stewardship strategies and monitor progress in managing AMR.
{"title":"Antimicrobial utilization among hospitalized patients according to WHO AWaRe classification: Results from a multicentre point prevalence survey in Saudi Arabia","authors":"Nada A. Alsaleh , Abeer AlSmari , Abrar F. Alhameed , Ahmed O. Alenazi , Alaa A. Alsharif , Amal Bin Akresh , Anwar M. Alnakhli , Bashaier Alshehail , Eman A. Alzahrani , Ghadah H. Alshehri , Ghazwa B. Korayem , Hanan A. Bakri , Khalid Eljaaly , Lina I. Alnajjar , Norah S. Aldeghaither , Reem Almahasna , Sara Almuhisen , Yassmin Alsomali , Zikria Saleem","doi":"10.1016/j.jgar.2025.09.009","DOIUrl":"10.1016/j.jgar.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) threatens global health by reducing the efficacy of common infection treatments. This study examines antimicrobial use in Saudi Arabian hospitals, identifies influencing factors, and proposes interventions using the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification system.</div></div><div><h3>Methods</h3><div>A cross-sectional, multicentre point prevalence survey (PPS) of antimicrobial utilization was conducted in 10 hospitals across 6 regions of Saudi Arabia September 2023. All inpatients receiving antimicrobials on the PPS day were included. Data collection utilized the Global PPS tool developed by the University of Antwerp, Belgium.</div></div><div><h3>Results</h3><div>Among 2890 inpatients, 766 (26.5%) were prescribed at least one antimicrobial, resulting in a total of 982 prescriptions. The primary indications for these antimicrobials were community-acquired infections (37.1%), Healthcare-associated infections (35.9%), surgical prophylaxis (15.4%), unknown reasons (8.7%), medical prophylaxis (2.5%), and other reasons (0.3%). The most common reasons for antimicrobial use included pneumonia or lower respiratory tract infections (16.1%), skin and soft tissue infections (11%) and bacteraemia (8.9%). The most frequently prescribed antimicrobial classes were penicillins with beta-lactamase inhibitors (18.5%), carbapenems (15.7%), and third-generation cephalosporins (11.1%). Most of the antimicrobials (66.3%) were classified as Watch antimicrobials, followed by 23.8% as Access, and 8.9% as Reserve.</div></div><div><h3>Conclusions</h3><div>The study provides valuable insights into antimicrobial utilization in Saudi Arabia, offering a baseline for assessing prescribing patterns. While findings may reflect certain antimicrobial stewardship efforts, further investigation is needed to evaluate their impact. The study also highlights key areas for improvement, emphasizing the importance of conducting future PPS to guide antimicrobial stewardship strategies and monitor progress in managing AMR.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 147-156"},"PeriodicalIF":3.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176153","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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