Antibiotics-Basel最新文献

Background: Infection is a typical consequence of cancer treatment due to its immunosuppressive nature, where the high use of antimicrobials raises the risk of antimicrobial resistance (AMR). The primary objective of an antimicrobial stewardship program (ASP) is to optimize antimicrobial use, reduce the emergence of AMR, and ensure cost containment. This study sought to assess the difference in cost of resource use with the ASP in the specialized hematology/oncology setting in Qatar, before and after ASP maturity. Methods: From the perspective of the public healthcare hospital, the research investigated the difference in the cost of resource use between the developed ASP and the preliminary ASP at the National Center for Cancer Care and Research (NCCCR), Qatar. The preliminary ASP was defined as the 12 months following the establishment of the ASP (i.e., May 2015 to April 2016), while the developed ASP was defined as the last 12 months of a 5-year ASP implementation (i.e., February 2019 to January 2020). Patient records were retrospectively reviewed. The overall difference in cost of resource use was based on cost savings, cost avoidance, and operational cost measures. Results: A total of 186 patients were included in the study, with 81 in the preliminary ASP and 105 in the developed ASP. While total resource utilization costs rose by 17% in the developed ASP, per-patient analysis revealed lower resource costs of Qatari Riyal (QAR) 1390 (USD 381) compared to QAR 1546 (USD 423) in the preliminary period. The developed ASP achieved reductions in antimicrobial consumption (-55.9%) and costs (-80.9%), along with a total cost avoidance of QAR 11,969,651 (USD 3,288,366). Overall, the program resulted in a net annual reduction of QAR 13,205,840 (USD 3,618,038), which equates to QAR 180,910 (USD 49,564) saved per patient. Conclusions: At the NCCCR, Qatar, it seems that running the ASP for five years, with presumed development in its practices, was associated with reductions in antimicrobial costs, operational expenses, and overall resource spending.

Background: Neurocysticercosis is a parasitic infection of the central nervous system caused by the larval stage of Taenia solium. This disease is endemic in some countries in Central and South America, South and South-East Asia, and sub-Saharan Africa. In North America, Europe, Japan, and Australia, only sporadic cases are documented. Moreover, reports of bacterial superinfection arising within neurocysticercotic lesions remain exceptionally scarce. Methods: We report a clinically severe and diagnostically challenging case of suspected neurocysticercosis with cerebral streptococcal superinfection in a 17-year-old Italian patient with Down syndrome and no history of travel to endemic regions. Results: The patient, with pre-existing epileptic encephalopathy, presented with progressive drowsiness and altered mental status, rapidly deteriorating to cardiorespiratory arrest. Neuroimaging demonstrated multiple ring-enhancing lesions, in conjunction with positive Taenia solium serology. Streptococcus spp. was identified in one neurosurgically drained lesion, consistent with secondary bacterial involvement in association with concurrent pneumonia. Combined antiparasitic therapy and targeted antimicrobial treatment resulted in sustained clinical and radiological improvement. Conclusions: In non-endemic settings, neurocysticercosis should remain within the differential diagnosis of unexplained epilepsy and multifocal CNS lesions. Although rare, bacterial superinfection warrants consideration in atypical presentations, particularly in individuals with concomitant infectious foci and underlying immune dysfunction such as that associated with Down syndrome.

Background: Candidozyma auris has emerged globally as a multidrug-resistant pathogen with high rates of colonization and potential for invasive infection. Understanding the progression from colonization to infection and associated outcomes is limited. This study aimed to describe the characteristics and outcomes of C. auris-colonized patients and identify risk factors for progression to infection.

Methods: We conducted a single-center retrospective case-control study of hospitalized patients with documented C. auris colonization at a tertiary care center (2018-2024). Cases were patients who progressed to a fungal infection (infection group), while controls remained colonized (colonized group). Demographics, comorbidities, device use, prior antimicrobial exposure, microbiologic characteristics, and outcomes were compared.

Results: Among 334 C. auris-colonized patients, 44 (13.2%) progressed to infection. The median age was 66.4 years. Those in the infection group had higher Charlson Comorbidity Index (5.9 ± 3.1 vs. 4.79 ± 2.7, p = 0.0112) and were more likely to have central line (90.9% vs. 71.7%, p = 0.0067), mechanical ventilation (77.3% vs. 60.34%, p = 0.0306), parenteral nutrition (6.82% vs. 1.72%, p = 0.0395), and abdominal surgery (13.64% vs. 4.83%, p = 0.0217). In multivariate analysis, abdominal surgery was the only independent predictor of infection (OR 4.08; 95% CI 1.1-15.1; p = 0.03). In-hospital mortality was significantly higher in the infection group (65.9% vs. 33.1%, p < 0.0001).

Conclusions: Approximately one in eight colonized patients developed C. auris infection. Recent abdominal surgery independently predicted progression, while infection was associated with higher mortality and prolonged hospitalization, underscoring the need for targeted prevention in high-risk patients.

Background: Rifaximin is a non-aminoglycoside antibiotic utilized for the treatment of mastitis in cows, but its milk disposition kinetics, residue, and bacteriological status in lactating cow milk have hardly been reported. This study aimed to assess the milk disposition kinetics and residue of rifaximin in milk and to evaluate the bacteriological status in milk after intramammary treatment with rifaximin. Methods: An ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) approach was developed to assess rifaximin concentrations in milk. Milk disposition kinetics parameters of rifaximin in cow milk were obtained by non-compartment model analysis. Rifaximin residues in milk were analyzed up to 108 h post-administration to estimate the withdrawal period. Clinically, the efficacy of Rifaximin Intramammary Infusion (Lactating Cow) was evaluated in mastitis cases caused by various pathogens and compared with lincomycin as the control drug, including clinical cure rate, bacteriological cure rate, and somatic cell count (SCC) at D21 post-treatment. Results: The C_max of rifaximin in milk was 54,273.3 ± 12,421.32 ng/mL, the area under the curve (AUC) was 340,731.8 ± 43,968.82 h⋅ng/mL, the T_1/2 was 5.57 ± 0.68 h, the mean resident time (MRT) was 7.3927 ± 1.34 h, and the area under the moment curve (AUMC) was 2,475,745 ± 230,305.1 h⋅h⋅ng/mL. Based on rifaximin residues in milk, the withdrawal period for cow milk was calculated to be 95.1 h. Clinically, Rifaximin Intramammary Infusion (Lactating Cow) demonstrated a clinical cure rate of 83.33% and a bacteriological cure rate of 76.67% in mastitis cases caused by various pathogens, with both rates being 10% higher than those of lincomycin. At D21 post-treatment, the rifaximin group had a significantly lower SCC than the lincomycin group (p < 0.05). Conclusions: Rifaximin exhibits favorable milk disposition kinetics, an acceptable withdrawal period of 95.1 h, and good clinical and bacteriological cure rates in bovine mastitis. These findings support rifaximin as a useful intramammary option and contribute to rational antimicrobial use and milk safety in dairy.

Background: Dedicated bundles were proven to reduce CLABSIs in a neonatal intensive care unit (NICU). Methods: We performed an observational pre-post study to evaluate the impact of a bundle for CLABSI prevention in our NICU. All umbilical vein catheters (UVCs) and epicutaneo-caval catheters (ECCs) with dwell time > 2 days were included. The primary outcome was CLABSI rate/1000 central line days. Results: A total of 145 catheters (67 UVCs and 78 ECCs) and 142 catheters (65 UVCs and 77 ECCs) were inserted before and after bundle implementation, respectively. The duration of the UVC was significantly shorter before than after the bundle [4 (3-6) vs. 8 (6-11) days; p < 0.0001], while the duration of the ECC did not differ [10 (6-17) vs. 11 (6-19) days; p = 0.711]. CLABSI were less frequent after than before bundle (3.6 vs. 10.7/1000 CL days; p = 0.042); both UVC-related and ECC-related CLABSI were significantly reduced (0 vs. 7.2/1000 CL days, p = 0.015; and 4.4 vs. 12.3/1000 CL days, p = 0.044, respectively). The Kaplan-Meier curve for ECC-related CLABSIs showed no differences between the two periods (p = 0.255), but higher survival without CLABSIs after vs. before bundle was found if considering only ECC with dwell time < 14 days (p = 0.040). Gestational age (p = 0.004) and bundle (p = 0.026) were predictive factors for CLABSIs. Non-infective complications were significantly less frequent after than before bundle (11 vs. 20%, p = 0.033). Conclusions: Our bundle reduced the overall CLABSI rate, and both UVC- and ECC-related CLABSI occurrence. The efficacy for the reduction in ECC-related CLABSIs seems limited to the first 14 days of dwell time.

The poultry industry plays a major role in the emergence and spread of foodborne zoonotic diseases, particularly those associated with antibiotic-resistant bacteria. These diseases pose substantial global public health challenges, and the increasing development of antimicrobial resistance further intensifies these concerns. In response, scientific efforts have expanded to develop and implement innovative technologies capable of mitigating the rising prevalence of multidrug-resistant (MDR) microorganisms. Therapeutic bacteriophage supplementation has regained significant attention because it can selectively lyse specific bacteria, is cost-effective to produce, offers environmentally favorable characteristics, and provides several advantages over conventional antibiotics. Experimental studies have demonstrated that phage therapy is both safe and effective for controlling poultry-associated enteric pathogens. Phages can be applied at various stages of the poultry production chain, from rearing to processing and distribution, using multiple delivery strategies. Despite certain limitations, the targeted and well-regulated application of phage cocktails offers considerable potential as an alternative to antibiotics for managing MDR infections. The success of bacteriophage therapy depends on several factors, including the timing of administration, dosage, delivery method, and its integration with other therapeutic approaches. Therefore, developing a comprehensive understanding of bacteriophage utilization in poultry production is both timely and necessary. This review examines the applications, constraints, and future opportunities of phage therapy within the commercial poultry industry, with particular emphasis on the mechanisms through which bacteriophages control bacterial infections.

Background/Objectives: This research was conducted to evaluate the antimicrobial activity of four molecules present in essential oils (thymol, terpinen-4-ol, citral, and E-2-dodecenal), complementing the study with the observation of structural damage caused by the contact of these compounds with microorganisms. Methods: The micro dilution in plates method was used to determine the minimum inhibitory concentration, using different concentrations of metabolites in contact with the microorganisms. Optical Microscopy was used to observe structural damage in yeasts, while Scanning Electron Microscopy (SEM) was used for bacteria. Results: In determining the minimum inhibitory concentration, very good activity was observed for all microorganisms at concentrations below 500 µg/mL or 0.05% w/w. In microscopic tests, we can observe three consequences of contact with the molecule to a greater or lesser extent. First, there is a clear decrease in the concentration of microorganisms. Second, we observe damage to the cell membrane. Finally, there are structural changes within the cytoplasm. Conclusions: This study demonstrated that the four metabolites possess good antimicrobial activity, in some of the tests they were even very close to the control antibiotics' activity. Structural observations show that the activity can be explained by several factors. Many essential oils contain some of the molecules used, so their presence in nature could be a marker of antimicrobial activity.

Background: Small-scale food animal production is common worldwide but often underestimated as a source of antimicrobial resistance. This study aimed to determine the prevalence of MRSA and VRE-E. faecium, and ESBL-E. coli bacteria among workers and within the production environment of low-capacity slaughterhouses, as well as to analyze the antimicrobial resistance patterns of these bacteria and their ability to form biofilms. Methods: The measurements were carried out in three low-capacity slaughterhouses in Poland. Bioaerosol samples, swabs from the production environment fomite and carcasses, meat samples, and swabs from workers' hands and nostrils were taken. The strains' susceptibility to antibiotics was assessed using the disk diffusion method, and their biofilm-forming potential was assessed using the microplate method. Isolates were also tested for the presence of genes related to biofilm formation and resistance to antiseptics. Results: In this study, 13.8%, 20.5%, and 14.9% of the samples (n = 268) were positive for MRSA, ESBL-E. coli, and VRE-E. faecium, respectively, with the highest detection rates on pork carcasses and surfaces. MRSA and ESBL-E. coli bacteria were also detected in swabs from workers' hands and nasal swabs, and in bioaerosol samples. Most isolates revealed multidrug resistance, including 89% of MRSA, 76% of ESBL-E. coli, and 83% of VRE-E. faecium. The majority of them were also capable of biofilm formation-81%, 65%, and 75%, respectively-emphasizing their survival capabilities in slaughterhouse environments. Conclusions: The slaughterhouse workers are regularly exposed to antibiotic-resistant bacteria such as MRSA, ESBL-E. coli, and VRE-E. faecium. To reduce these risks, it is essential for small slaughterhouses to strictly follow hygiene protocols, enhance the separation between clean and contaminated areas, improve ventilation, and ensure the use of protective measures.

Background: Carbapenem-resistant Enterobacterales and difficult-to-treat resistance (DTR) Pseudomonas aeruginosa are a growing public health issue. Cefiderocol demonstrated activity against β-lactamase-producing Gram-negative bacteria (GNB). However, bone PharmacoKinetics (PK) data is lacking. Here, we report a case of post-traumatic chronic osteomyelitis caused by extensively drug-resistant (XDR) Pseudomonas aeruginosa which was successfully treated with cefiderocol. Moreover, we conducted a non-systematic review of the available literature. Case Report: We described the case of a 64-year-old man who was admitted to a traumatology ward after a work accident caused crushing of his left foot. Microbiological tests on intraoperative biopsies demonstrated XDR P. aeruginosa and K. oxytoca. Despite the administrations of different antibiotics regimens and multiple surgical revisions, the patient developed chronic osteomyelitis. To prevent amputation, cefiderocol was prescribed for six weeks, resulting in a complete clinical resolution of osteomyelitis. Review of the Literature: We performed a non-systematic review of the literature searching the public databases PubMed and Google Scholar. We identified nine case reports. In most patients (60%) the cause of osteomyelitis was post-surgical, and all the reported cases were healthcare associated. Osteomyelitis treatment required both antimicrobial therapy and surgery in all the cases described. Cefiderocol was often prescribed in association with other antibiotics (70%). Clinical cure was described in all the reported cases. Conclusions: This study highlights that cefiderocol is safe and efficacious to treat osteomyelitis caused by carbapenem-resistant GNB. However, evidence is limited to a few case reports.

Background/Objectives: This study assessed the risk associated with third-generation cephalosporin- and fluoroquinolone-resistant Salmonella from pork consumption by integrating phenotypic resistance profiles with genetic data to characterize the risks and transmission pathways. Methods: Salmonella were isolated from raw pork meat samples (n = 793) collected from fresh markets and hypermarkets across Bangkok during 2021-2022, of which 150 were extended-spectrum β-lactamase (ESBL)-producing and 31 were fluoroquinolone-resistant isolates. Phenotypic and genotypic resistance profiles were characterized. Quantitative antimicrobial resistance risk assessment (AMR RA) was conducted using a dose-response model. Results: Salmonella spp. was detected in 42.75% of pork samples, with a higher prevalence in fresh markets (75.5%) than in hypermarket samples and with concentrations ranging from 1.3 to 180 MPN/g. Twenty-eight percent of isolates were ESBL producers, with ciprofloxacin and levofloxacin resistance observed in 5.3% and 3.0%, respectively. The bla_CTX-M55 genes were located on conjugative plasmids. Whole genome sequencing revealed both vertical and horizontal gene transfer. IncHI2/N and IncC plasmids shared conserved backbones and resistance gene architectures, indicating horizontal dissemination of resistance genes. Phylogenomics suggested possible clonal transmission among pigs, pork, and humans. AMR RA estimated 88,194 annual illness cases per 100,000 people from ESBL-producing Salmonella and 61,877 from ciprofloxacin-resistant strain, compared with 95,328 cases predicted by QMRA from Salmonella contamination. Cooking pork at ≥64 °C for 3 min eliminated the risk in all scenarios. Sensitivity analysis identified initial contamination level and cooking temperature as key determinants. Conclusions: Raw pork meat consumption represents the highest risk, which can be mitigated by thorough cooking (>64 °C, ≥3 min), while integrating genomic data enhances AMR hazard identification, source attribution, and exposure assessment. Therefore, promoting well-cooked meat consumption and safe cooking practices, alongside the use of AMR genetic data to inform targeted interventions, is recommended.