Antibiotics

14 pages, 518 KB

Open AccessFeature PaperArticle

Changes in Antibiotic Resistance Patterns in Diabetic Foot Infections Requiring Toe Amputation: A Long-Term Single-Center Retrospective Study

by Alaaddin Levent Özgözen and Enes Altunay

Antibiotics 2026, 15(7), 681; https://doi.org/10.3390/antibiotics15070681 - 10 Jul 2026

Abstract

Objectives: Diabetic foot infections are a major cause of morbidity and amputation, and increasing antibiotic resistance complicates their management. This study aimed to evaluate longitudinal changes in antibiotic resistance among bacterial pathogens isolated from patients undergoing toe amputation due to diabetic foot infections. [...] Read more.

Objectives: Diabetic foot infections are a major cause of morbidity and amputation, and increasing antibiotic resistance complicates their management. This study aimed to evaluate longitudinal changes in antibiotic resistance among bacterial pathogens isolated from patients undergoing toe amputation due to diabetic foot infections. Methods: This retrospective, single-center study included patients who underwent toe amputation for diabetic foot infections between 2013 and 2024. Microbiological culture results and antimicrobial susceptibility data were analyzed across three consecutive time periods: 2013–2016, 2017–2020, and 2021–2024. Results: A total of 351 patients were included (mean age, 64.1 years; 64% male). A history of dialysis was present in 30% of patients, and 54% had a history of prior hospitalization. A total of 351 patients were included in the study. A total of 378 bacterial isolates recovered from positive microbiological cultures were included in the antimicrobial susceptibility analysis. The most frequently isolated microorganisms were Escherichia coli, Enterococcus spp., coagulase-negative Staphylococcus, and Staphylococcus aureus. Among Enterobacterales isolates, statistically significant increases in resistance across the three consecutive time periods were observed for amoxicillin–clavulanate (p = 0.009), piperacillin–tazobactam (p = 0.002), trimethoprim–sulfamethoxazole (p = 0.012), and meropenem (p = 0.027), whereas the increase in imipenem resistance did not reach statistical significance (p = 0.054). Within Staphylococcus spp., a statistically significant increase in resistance across the three consecutive time periods was observed only for ciprofloxacin (p = 0.047). Conclusions: Changes in antimicrobial resistance rates were observed among bacterial isolates recovered from diabetic foot infections across the three consecutive time periods, highlighting the importance of regional surveillance and up-to-date local resistance data for guiding empirical antibiotic therapy. Full article

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23 pages, 1825 KB

Open AccessArticle

Knowledge, Attitudes, and Practices Related to Antibiotic Use and Antibiotic Resistance Among Adults in Communities of Montserrado County, Liberia: A Household-Based Cross-Sectional Study

by Bode Ireti Shobayo, Cecilia Stålsby Lundborg, Helena Nordenstedt, Tamba Fayiah, Mosoka Papa Fallah and Megha Sharma

Antibiotics 2026, 15(7), 680; https://doi.org/10.3390/antibiotics15070680 - 10 Jul 2026

Abstract

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration [...] Read more.

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration of awareness of antibiotic resistance, in Montserrado County, Liberia. Methods: A community-based cross-sectional survey was conducted among 1160 adults in Montserrado County, Liberia, using a structured questionnaire to assess knowledge, attitudes, and practices (KAP) related to antibiotic use and antibiotic resistance. Composite KAP scores were calculated from Likert-scale items and subsequently categorized into ordered levels (poor, moderate, and good) based on percentile thresholds. Ordinal logistic regression was used to examine associations between sociodemographic characteristics and KAP outcomes. Results are presented as crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05. Results: Participants demonstrated moderate knowledge, with correct identification of antibiotic use for bacterial infections (skin infections: 78.8%; ear infections: 76.8%), but widespread misconceptions were observed, including use for colds and flu (73.6%) and diarrhea (80.7%). Attitudes were mixed, with many recognizing inappropriate use, yet expectation-driven demand remained common (62.7% dissatisfied when antibiotics were not prescribed; 80.9% willing to suggest antibiotics to clinicians). Practices were inconsistent, with both appropriate and inappropriate behaviors reported. While 46.2% of participants always completed antibiotic courses, inappropriate practices were frequent, including antibiotic use for common symptoms (38.6%), preventive use (37.2%), and self-medication without prescription (20.1% always). In multivariable analysis, older age was associated with higher knowledge (AOR = 3.82, 95% CI: 1.26–11.1), while lower education predicted poorer knowledge and practices (e.g., AOR = 0.25, 95% CI: 0.07–1.00). Urban residence was associated with poorer practices (AOR = 0.42, 95% CI: 0.29–0.61). Conclusions: While overall knowledge of antibiotic use in Montserrado County is moderate, critical misconceptions remain, and appropriate practices are inconsistent. Weak relationships between knowledge, attitudes, and practices highlight the limitations of knowledge-based interventions alone. Efforts to improve antibiotic use should address structural drivers, including access to antibiotics, healthcare-seeking behavior, and regulatory enforcement, through targeted and context-specific strategies. Full article

(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)

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14 pages, 257 KB

Open AccessArticle

Multicenter Point-Prevalence Study of Carbapenem-Resistant Klebsiella spp. in Türkiye: Epidemiology, Antimicrobial Resistance, and Infection Control Practices

by Esra Erdem Kıvrak, Deniz Özer, Sinan Mermer, Ahmet Sertçelik, Hasip Kahraman, Müge Toygar Deniz, Damla Ertürk, Arzu Nazlı, Hüseyin Aytaç Erdem, Ongun Yeniçeri and Meltem Taşbakan

Antibiotics 2026, 15(7), 679; https://doi.org/10.3390/antibiotics15070679 - 10 Jul 2026

Abstract

Background: Carbapenem-resistant Klebsiella spp. have emerged as major healthcare-associated pathogens worldwide, posing significant therapeutic and infection control challenges. Despite the growing burden of antimicrobial resistance, contemporary multicenter epidemiological data regarding carbapenem-resistant Klebsiella spp. in Türkiye remain limited. This study aimed to determine the [...] Read more.

Background: Carbapenem-resistant Klebsiella spp. have emerged as major healthcare-associated pathogens worldwide, posing significant therapeutic and infection control challenges. Despite the growing burden of antimicrobial resistance, contemporary multicenter epidemiological data regarding carbapenem-resistant Klebsiella spp. in Türkiye remain limited. This study aimed to determine the culture-based prevalence of carbapenem-resistant Klebsiella spp. and to describe the clinical, microbiological, and institutional characteristics associated with these organisms. Materials and Methods: This multicenter cross-sectional point-prevalence study was conducted in seven tertiary-care hospitals located in different regions of Türkiye. On 19 February 2026, all hospitalized adult patients and microbiological cultures obtained on the study day were evaluated. Demographic, clinical, microbiological, antimicrobial treatment, infection control, and hospital-level data were collected using a standardized case report form. Culture-based prevalence estimates were calculated with 95% confidence intervals (CIs). Results: A total of 26 patients with carbapenem-resistant Klebsiella spp. colonization and/or infection were included. The mean age was 68.5 ± 14.1 years, and 61.5% were male. Most patients had at least one comorbidity (84.6%), and recent antibiotic exposure was common (88.5%). Urinary tract infection was the most frequently identified infection type (53.8%), followed by pneumonia (19.5%) and bloodstream infection (19.2%). Urinary catheterization was present in 73.1% of patients, while central venous catheters and mechanical ventilation were present in 46.2% and 34.6%, respectively. Ceftazidime–avibactam susceptibility results were available for 20 isolates, of which 12 (60.0%; 95% CI, 38.66–78.12) were resistant. Colistin susceptibility results were available for 17 isolates, of which four (23.5%; 95% CI, 9.56–47.26) were resistant. The culture-based prevalence of carbapenem-resistant Klebsiella spp. was 1.69% (95% CI, 1.16–2.46) among all cultures obtained on the study day and 8.94% (95% CI, 6.17–12.77) among culture-positive specimens. Conclusions: Carbapenem-resistant Klebsiella spp. remain important healthcare-associated pathogens in Türkiye, particularly among patients with substantial healthcare exposure, invasive device use, and recent antibiotic treatment. Continued surveillance, strengthened infection prevention measures, and expanded molecular characterization are essential for improving the understanding and control of antimicrobial resistance in the country. Full article

16 pages, 1766 KB

Open AccessArticle

Evolution and Antimicrobial Resistance Profiles of Klebsiella spp. Infections in Companion Animals in the Iberian Peninsula

by María Jiménez-Serrano, Anna Vidal, Inma Duran, Chiara Seminati and Laila Darwich

Antibiotics 2026, 15(7), 678; https://doi.org/10.3390/antibiotics15070678 - 10 Jul 2026

Abstract

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an increasing concern within the One Health framework, particularly regarding opportunistic pathogens such as Klebsiella spp. This retrospective study evaluated the epidemiology, antimicrobial susceptibility profiles, and temporal resistance trends of Klebsiella spp. infections in dogs [...] Read more.

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an increasing concern within the One Health framework, particularly regarding opportunistic pathogens such as Klebsiella spp. This retrospective study evaluated the epidemiology, antimicrobial susceptibility profiles, and temporal resistance trends of Klebsiella spp. infections in dogs and cats across the Iberian Peninsula. Methods: A total of 809 clinical isolates collected between 2016 and 2024 and submitted to a private diagnostic laboratory in Barcelona were analysed. Results: Klebsiella pneumoniae was the predominant species (70%), more frequently identified in cats (76%) than in dogs (68%). Dermatological and respiratory samples exhibited the highest prevalence of multidrug-resistant (MDR) isolates. Overall MDR prevalence was high, particularly in cats (51.1%; 95% CI 41.1–60.9%) compared with dogs (38.4%; 95% CI 34.1–42.8%) although it was not statistically significant. K. pneumoniae generally exhibited higher resistance rates than K. oxytoca, particularly to amoxicillin/clavulanic acid, first-/second-generation cephalosporins, third-/fourth-generation cephalosporins (3/4th GC), fluoroquinolones, and tetracyclines. In both bacterial species, resistance rates were consistently higher among feline isolates. In contrast, aminoglycosides and phenicols retained high activity against most isolates. Temporal analysis revealed a significant increasing resistance trend to amoxicillin/clavulanic acid, which is particularly concerning given the widespread use of this antimicrobial as a first-line treatment in small animal practice. However, resistance trend to aminoglycosides showed a significant decline. No significant temporal changes were detected for 3/4th GC and fluoroquinolones, suggesting the persistence of resistant populations within companion animals. Resistance to aminoglycosides and phenicols remained comparatively low in this study. Whereas critically important category B antimicrobials, such as 3/4th GC and fluoroquinolones, exhibited low to moderate effectiveness, raising concerns about their empirical use. Conclusions: These findings highlight the substantial AMR and MDR burden of K. pneumoniae in companion animals in the Iberian Peninsula and reinforce the need for prudent antimicrobial use, routine susceptibility testing, and integrated One Health surveillance strategies. Full article

(This article belongs to the Special Issue Antibiotic Susceptibility Testing and Rapid Diagnostics of Antimicrobial Resistance)

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31 pages, 1323 KB

Open AccessReview

Beyond Antibiotics: One Health Education for Tackling Antimicrobial Resistance

by Beatriz Robredo

Antibiotics 2026, 15(7), 677; https://doi.org/10.3390/antibiotics15070677 - 10 Jul 2026

Abstract

Antimicrobial resistance (AMR) is recognized as one of the most urgent global health threats, demanding coordinated, multisectoral responses under the OH framework. Among the multidisciplinary tasks aimed at collectively tackling the AMR crisis, surveillance, research and education stand as major priorities. Education is [...] Read more.

Antimicrobial resistance (AMR) is recognized as one of the most urgent global health threats, demanding coordinated, multisectoral responses under the OH framework. Among the multidisciplinary tasks aimed at collectively tackling the AMR crisis, surveillance, research and education stand as major priorities. Education is a strategic pillar of the World Health Organization Global Action Plan, yet a comprehensive synthesis of educational initiatives explicitly grounded in One Health (OH) remains limited. Previous reviews have examined AMR educational interventions focusing on specific strategies, regions, professional groups, or pedagogical tools, but without an OH perspective. This review is the first to comprehensively synthesize educational programmes that explicitly integrate OH principles across different educational levels, target audiences, and learning settings. It also examines the pedagogical strategies used to promote AMR awareness, prevention, and responsible antimicrobial use. A structured literature search (2015–2025) was conducted in Scopus and complemented by institutional sources and citation tracking. Educational initiatives incorporating OH principles, addressing multiple sectors, or promoting interdisciplinary AMR education were narratively synthesized. School-based programmes (e.g., e-Bug, ISGlobal initiatives, Ambientech); public awareness and community education via national strategies such as PRAN; programmes for university students; professional training, and continuing education (e.g., ESCMID, AMR EDUCare); and international online platforms including FAO e-learning programmes and the OH Workforce Academy were examined. Programmes were analysed according to target population, pedagogical approach, sectoral integration, and evaluation methods. Active and experiential methodologies, such as service-learning (e.g., Tiny Earth, MicroMundo) game-based learning, gamification, and interdisciplinary and systems thinking-based learning, consistently enhance knowledge acquisition, systems thinking skills, and awareness of cross-sectoral AMR transmission pathways. Despite all these initiatives, studies on knowledge, perceptions and attitudes about AMR point to clear errors and deficiencies. Key gaps, such as inconsistent curriculum integration, limited integration of environmental dimension and scarce rigorous impact evaluations, persist. Strengthening OH-oriented AMR education requires policy-level curriculum inclusion, cross-sector collaboration, standardized competencies, and robust evaluation frameworks. Embedding education within national AMR strategies is essential to fostering sustained behavioural change and preserving antimicrobial effectiveness across human, animal, and environmental systems. Full article

(This article belongs to the Special Issue A One Health Approach to Antimicrobial Resistance, 2nd Edition)

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17 pages, 3265 KB

Open AccessArticle

Prevalence and Genomic Characterization of ESBL-Producing Escherichia coli in Livestock and Farmers in Catalonia, Spain

by Marina Serras-Pujol, Noemí Párraga-Niño, Marian Navarro, Anna Vilamala, Emma Puigoriol, Elisenda Arqué, Judit Serra-Pladevall, Luisa Pedro-Botet and Esteban Reynaga

Antibiotics 2026, 15(7), 676; https://doi.org/10.3390/antibiotics15070676 - 9 Jul 2026

Abstract

Background and objectives: Extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae represent an increasing One Health concern because food-producing animals may act as reservoirs of antimicrobial-resistant bacteria with potential transmission to humans. Therefore, this study aimed to assess the prevalence and genomic characteristics of ESBL- [...] Read more.

Background and objectives: Extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae represent an increasing One Health concern because food-producing animals may act as reservoirs of antimicrobial-resistant bacteria with potential transmission to humans. Therefore, this study aimed to assess the prevalence and genomic characteristics of ESBL- and carbapenemase-producing Enterobacteriaceae in livestock and farmers, and to evaluate genomic overlap between animal and human ESBL-producing Escherichia coli to explore potential shared origins and interspecies transmission. Methods: We conducted a cross-sectional study in Osona (Catalonia, Spain), sampling livestock (swine, cattle, poultry, and horses) and farmers. ESBL-, AmpC-, and carbapenemase-producing Enterobacteriaceae were identified and characterized using whole genome sequencing (WGS). Genomic analyses included sequence typing (ST), serotyping, virulence-associated genes, antimicrobial resistance determinants, and plasmid replicon profiling. Results: A total of 945 animals were analysed. ESBL-producing Enterobacteriaceae were predominantly detected in swine, with 63.5% (127/200) of animals testing positive, including four ESBL + AmpC-producing isolates and two carbapenem-resistant Enterobacteriaceae. No ESBL-, AmpC- or carbapenemase-producing isolates were identified in cattle (0/360) or poultry (0/171), and a low prevalence was observed in horses (7.0%, 15/214). A total of 64 farm workers were analysed. ESBL-producing E. coli were detected in 46.7% (7/15) of swine farmers and 8.3% (2/24) of cattle farmers, while no ESBL-producing isolates were found among poultry farmers (0/8) or equine caretakers (0/17). A total of 162 isolates were analyzed by WGS, showing high genetic diversity. Among the 127 Escherichia coli isolates, the most prevalent were ST10 (18/127, 14.2%), followed by ST453 (7/127, 5.5%), ST515 (7/127, 5.5%), and ST10562 (7/127, 5.5%). Virulence-associated gene profiles were heterogeneous, although genes related to stress tolerance and intestinal colonization predominated among ESBL-producing E. coli isolates from swine, including terC (54/127, 42.5%), csgA (41/127, 32.3%), nlpI (41/127, 32.3%), and fimH (39/127, 30.7%). ESBL production among E. coli isolates from swine was primarily mediated by blaCTX-M genes (89/127, 70.1%), with additional contributions from blaSHV (34/127, 26.8%) and blaTEM (40/127, 31.5%). Among swine isolates, IncX1 (100/127, 78.7%), IncFIB(AP001918) (82/127, 64.6%), IncI1-I(Alpha) (69/127, 54.3%), and IncFII (54/127, 42.5%) were the most frequently detected plasmid replicons. Two carbapenem-resistant isolates carrying blaOXA-48 were identified in swine, including E. coli ST58 and K. oxytoca ST145, both associated with IncL plasmids. Conclusions: Swine appear to constitute the primary reservoir of ESBL-producing E. coli. The genomic relatedness observed between animal and human isolates supports shared exposure to a common ecological pool of multidrug-resistant bacteria. The identification of blaOXA-48-producing Enterobacterales associated with IncL plasmids further highlights the public health relevance of livestock-associated antimicrobial resistance. However, the cross-sectional design precludes inference of transmission pathways or transmission directionality. Longitudinal studies are needed to elucidate the dynamics of interspecies transmission. Full article

(This article belongs to the Special Issue Epidemiology of Antimicrobial-Resistant Pathogens in Animals: A One Health Perspective)

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20 pages, 1369 KB

Open AccessArticle

Activity Against ESKAPE Bacterial Pathogens of Pyrazole-Indol-Ruthenium(II) Complexes

by Yahaira Cuenú-Ibargüen, Andrés Restrepo-Acevedo, Juan Felipe Zambrano-Bedoya, Isabel Murillo-Rodriguez, Carlos Felipe Mejía, Sandra Fabiola Alzate-Walteros, Gladymar Guadalupe Valenzuela-Ramirez, Gilmar López-Armenta, Federico del Rio-Portilla, Jesús Ricardo Parra-Unda, Fernando Cuenú-Cabezas and Ronan Le Lagadec

Antibiotics 2026, 15(7), 675; https://doi.org/10.3390/antibiotics15070675 - 9 Jul 2026

Abstract

This paper presents the synthesis and characterization of Schiff base ligands (L) derived from NH-pyrazole-indole and their ruthenium(II) complexes of the general formula [Ru(p-cymene)(L)Cl₂]. The structural characterization of the ligands and ruthenium complexes was performed using a range of analytical methods, [...] Read more.

This paper presents the synthesis and characterization of Schiff base ligands (L) derived from NH-pyrazole-indole and their ruthenium(II) complexes of the general formula [Ru(p-cymene)(L)Cl₂]. The structural characterization of the ligands and ruthenium complexes was performed using a range of analytical methods, including infrared spectroscopy (IR), Raman spectroscopy, nuclear magnetic resonance (NMR) spectroscopy, ultraviolet-visible (UV-Vis) spectroscopy, elemental analysis, mass spectrometry(ESI-MS), density functional theory (DFT) calculations, and single-crystal X-ray diffraction crystallography for two of the four synthesized compounds. Schiff base ligands (L) derived from NH-pyrazole-indole and their ruthenium(II) complexes were evaluated against antibiotic-resistant bacteria. The effect of substituting the ligand with methoxy groups on biological activity was assessed. The antibacterial activity, Minimal Inhibitory Concentration (MIC), and Minimal Bactericidal Concentration (MBC) of the free ligands and the ruthenium compounds were measured against six bacterial isolates (Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Shigella dysenteriae) and two control strains (Enterococcus faecalis ATCC 29212 and Enterobacter cloacae ATCC 13047) from the ESKAPE group of highly antibiotic-resistant pathogens. The free ligands were inactive, whereas all four ruthenium complexes displayed notable antibacterial activity. In particular, compounds Ru3 and Ru4 exhibited higher activity against Staphylococcus aureus than the Trimethoprim control, with MIC values of 15.60 µg/mL, compared with an MIC > 64 µg/mL for Trimethoprim. The activity of those two complexes was similar to that of Gentamicin against this strain. Molecular docking calculations suggested a possible mechanism of action through binding of the complexes to the active site of S. aureus PBP2a. Full article

(This article belongs to the Special Issue Metal-Based Complexes as Novel Antimicrobial Strategies)

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16 pages, 296 KB

Open AccessArticle

Risk Factors and Outcomes of Early-Onset Sepsis in Very Preterm Infants: Results from the Thai Neonatal Registry (ThaiNy)

by Junya Jirapradittha, Dissajee Lumbiganon, Anucha Thatrimontrichai, Buranee Swatesutipun, Kanmalee Jenjarat, Kullapat Srisomsap, Mananya Sukthong, Manunya Apiwattanaporn, Napas Sripirom, Nawamon Soontaravarapas, Nichanan Sahakaro, Ploypailin Preechawetchakul, Pornpimon Janyoungsak, Pornpimon Rojanakarin, Shanika Kosarat, Sudarat Sirichaipornsak, Sudatip Kositamongkol, Suparat Tipprasert, Tanin Pirunnet, Thaninee Chitsinchayakul, Walaiporn Bowornkitiwong and Chatchay Prempunpong Show full author list Hide full author list

Antibiotics 2026, 15(7), 674; https://doi.org/10.3390/antibiotics15070674 - 9 Jul 2026

Abstract

Objective: To determine the incidence, causative pathogens, risk factors, and clinical outcomes of early-onset sepsis (EOS) in very preterm (gestational age < 32 weeks) and very low birth weight (birth weight < 1500 g) neonates. Methods: This retrospective study analyzed data from the [...] Read more.

Objective: To determine the incidence, causative pathogens, risk factors, and clinical outcomes of early-onset sepsis (EOS) in very preterm (gestational age < 32 weeks) and very low birth weight (birth weight < 1500 g) neonates. Methods: This retrospective study analyzed data from the Thai Neonatal Network registry (2019–2024; total 22 neonatal units). EOS was defined as bacteremia or bacterial meningitis within 72 h of birth. Results: Among 792 neonates (median [interquartile range] gestational age, 28 [26–29] weeks; median [interquartile range] birth weight, 960 [779–1190] g), the incidence of EOS was 4.0% (n = 32). Predominant pathogens were Escherichia coli (n = 10) and Acinetobacter baumannii (n = 9). Antibiograms showed high non-susceptibility for E. coli and A. baumannii to gentamicin (44.4% and 83.3%, respectively) and cefotaxime (37.5% and 75.0%, respectively). Although E. coli remained susceptible to amikacin and meropenem (100%), A. baumannii exhibited extensive resistance (66.7% and 83.3%, respectively). Multivariable analysis identified chorioamnionitis (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI]: 1.07–1.18) and 5 min Apgar score < 7 (aOR 1.05; 95% CI: 1.02–1.18) as significant risk factors. EOS was independently associated with increased early neonatal mortality within 7 days of life (aOR, 1.26; 95% CI: 1.16–1.36). Conclusions: The incidence of EOS is high among very preterm infants in Thailand and significantly increases mortality rates. The prevalence of multidrug-resistant A. baumannii in neonatal EOS is a critical concern that limits the efficacy of empirical treatments. These findings highlight the urgent need for targeted interventions and enhanced antimicrobial stewardship to improve neonatal survival rates. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship in Neonatal Intensive Care)

34 pages, 6615 KB

Open AccessReview

Helicobacter pylori Eradication in the Era of Antibiotic Resistance: From Universal Regimens to Precision-Guided Management

by Ayman Elbehiry and Eman Marzouk

Antibiotics 2026, 15(7), 673; https://doi.org/10.3390/antibiotics15070673 - 9 Jul 2026

Abstract

Helicobacter pylori (H. pylori) infection represents a major global health challenge and a leading cause of peptic ulcer disease and gastric cancer. The increasing prevalence of antimicrobial resistance has progressively reduced the effectiveness of traditional empirical eradication regimens, highlighting the need [...] Read more.

Helicobacter pylori (H. pylori) infection represents a major global health challenge and a leading cause of peptic ulcer disease and gastric cancer. The increasing prevalence of antimicrobial resistance has progressively reduced the effectiveness of traditional empirical eradication regimens, highlighting the need for more individualized treatment approaches. This review evaluates the evolving transition from empirical therapy toward precision-guided H. pylori management by integrating current evidence on resistance epidemiology, determinants of eradication failure, advances in molecular diagnostics, and susceptibility-guided treatment strategies. Contemporary and emerging therapeutic approaches are evaluated in the context of changing resistance patterns, with emphasis on their clinical applicability and potential contributions to treatment optimization. The review also addresses the practical challenges that continue to limit implementation of personalized management, including restricted access to resistance testing, infrastructure limitations, economic constraints, and global disparities in healthcare resources. Furthermore, emerging developments in rapid diagnostics, resistance surveillance, and data-driven treatment selection are considered as components of future management frameworks. Overall, the evidence supports moving away from one-size-fits-all empirical therapy toward targeted treatment based on local resistance patterns and epidemiological trends. Expanding access to effective diagnostics and optimizing treatment selection will be essential for improving eradication outcomes and preserving the long-term effectiveness of available antimicrobial agents. Full article

(This article belongs to the Special Issue Epidemiology of and Antibiotic Therapy for Helicobacter pylori Infection)

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11 pages, 231 KB

Open AccessArticle

Antimicrobial Stewardship in Vancomycin-Resistant Enterococcus faecalis: Clinical Study Evaluating Antimicrobial Susceptibility Patterns and Antibacterial Regimens

by Samantha A. Tolbert, Mollie V. Day, Aline Arif, Preston H. Tolbert, Destyn Dicharry and Alexandre E. Malek

Antibiotics 2026, 15(7), 672; https://doi.org/10.3390/antibiotics15070672 - 9 Jul 2026

Abstract

Background: Vancomycin-resistant enterococci (VRE) Enterococcus faecalis (E. faecalis) remains largely ampicillin-susceptible, yet broad-spectrum agents are frequently used empirically (i.e., daptomycin and linezolid). Despite its frequent susceptibility to ampicillin, VRE E. faecalis is often managed with broad-spectrum antimicrobials, raising concerns about overtreatment and [...] Read more.

Background: Vancomycin-resistant enterococci (VRE) Enterococcus faecalis (E. faecalis) remains largely ampicillin-susceptible, yet broad-spectrum agents are frequently used empirically (i.e., daptomycin and linezolid). Despite its frequent susceptibility to ampicillin, VRE E. faecalis is often managed with broad-spectrum antimicrobials, raising concerns about overtreatment and antimicrobial stewardship. Resistance mechanisms vary, with vancomycin resistance mediated by vanA/vanB operons and beta-lactams by altered penicillin binding proteins. These distinct mechanisms help explain why VRE E. faecalis isolates may remain susceptible to ampicillin, supporting its potential use in clinical isolates. This study aims to describe the antibacterial susceptibility results of Enterococcus faecalis VRE and assess antibiotics use in clinical settings in a tertiary medical center. Methods: This was a single-center, retrospective, descriptive study of hospitalized and outpatient adults with Enterococcus faecalis VRE isolates identified between 1 June 2018 and 15 March 2025. We excluded individuals with concomitant non-Enterococcus faecalis VRE infections and those aged <18 years. Vancomycin resistance was defined by a minimum inhibitory concentration of >32 mcg/mL per the 35th edition of the Clinical and Laboratory Standards Institution breakpoints. Results: A total of 337 patients were screened; 114 met inclusion criteria. The cohort was 54% female, 50% Black, and 48% White, with 54% having hypertension, 36% diabetes, and 19% a history of multidrug-resistant organism carriage. The most common source of infection was urinary (67%), followed by skin and soft tissue infections and bone/joint infections (11% each). All isolates were vancomycin-resistant; 82% were susceptible to ampicillin, 84% to nitrofurantoin, 61% to daptomycin, and 70% to linezolid. Antimicrobial regimens varied, with daptomycin being the most used agent (19%). No patients in the aminopenicillin group experienced 30-day mortality, whereas two patients (3%) in the non-aminopenicillin group died within 30 days. Acute kidney injury occurred in four patients (29%) in the aminopenicillin group compared with four patients (7%) in the non-aminopenicillin group, representing a significantly higher incidence in the aminopenicillin group (p = 0.037). However, myalgia, elevated creatine phosphokinase, and thrombocytopenia were more common in the non-aminopenicillin group. Conclusions: Despite higher susceptibility to ampicillin and nitrofurantoin, daptomycin was the most used agent for VRE E. faecalis infections. These findings highlight a need for improved antimicrobial stewardship and further clinical studies to guide optimal therapy. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Epidemiological Study of Clinically Relevant Pathogens, 2nd Edition)

14 pages, 2795 KB

Open AccessArticle

Identifying Distinct Antibiotic Behavioural Profiles in Singapore’s General Population: A Latent Class Analysis

by Huiling Guo and Angela Chow

Antibiotics 2026, 15(7), 671; https://doi.org/10.3390/antibiotics15070671 - 9 Jul 2026

Abstract

Background: Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is common. However, existing research typically examines single indicators or broad categories of misuse practices, without considering the probabilistic and co-occurring nature of varying behaviours. This study aims to identify and characterise distinct [...] Read more.

Background: Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is common. However, existing research typically examines single indicators or broad categories of misuse practices, without considering the probabilistic and co-occurring nature of varying behaviours. This study aims to identify and characterise distinct antibiotic behavioural profiles within a general population to inform personalised interventions. Methods: This is a broadly representative population-based study of adult Singapore residents between November 2020 and January 2021. Latent class analysis was first performed to identify distinct profiles, followed by multinomial logistic regression to determine individual characteristics associated with each profile, with interaction effects examined. Results: Amongst 2004 respondents, the majority were “antibiotic appropriates” (53.0%), followed by “antibiotic avoiders” (24.9%), and “antibiotic seekers” (22.2%). “Antibiotic seekers” expected antibiotics for cold/flu, hopped between doctors to source antibiotics, used leftover antibiotics, stopped antibiotic courses prematurely and perceived antibiotics as harmless and useful for treating cold/flu. Individuals with poor knowledge of antibiotic use (AOR 3.71, 95% CI 2.89–4.76, p < 0.001) and antimicrobial resistance (AOR 3.51, 95% CI 1.05–11.76, p = 0.042), low eHealth literacy (AOR 1.34, 95% CI 1.02–1.77, p = 0.038), and high trust in doctors (AOR 2.14, 95% CI 1.44–3.17, p < 0.001) were more likely to be “antibiotic seekers”. Older adults with lower education levels were particularly likely to be “antibiotic seekers”. Conclusions: Approximately one-in-five Singapore residents are antibiotic seekers. Targeted education during multiple clinic visits, given the high trust in doctors, can address antibiotic knowledge gaps and misperceptions, reducing antibiotic misuse. Full article

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22 pages, 278 KB

Open AccessArticle

Contextual Determinants of Clinical Pharmacists’ Contributions to Team-Based Antimicrobial Stewardship in Jordanian Hospitals: A Realist-Informed Qualitative Study

by Mona Bustami, Saba Ammar Alabdali, Mohammad Abu Assab, Inas Almazari, Wafa’ A. Al-Haj, Wael Abu Dayyih, Hayam A. Alrasheed, Zainab Zakaraya and Anas Abed

Antibiotics 2026, 15(7), 670; https://doi.org/10.3390/antibiotics15070670 - 8 Jul 2026

Abstract

Background/Objectives: Clinical pharmacists contribute pharmacotherapy expertise to antimicrobial stewardship (AMS), but antimicrobial prescribing remains a multidisciplinary process led by treating clinicians. In physician-centered hospital systems, pharmacists’ contributions may be integrated into prescribing decisions to varying degrees depending on the organizational structures, interprofessional relationships, [...] Read more.

Background/Objectives: Clinical pharmacists contribute pharmacotherapy expertise to antimicrobial stewardship (AMS), but antimicrobial prescribing remains a multidisciplinary process led by treating clinicians. In physician-centered hospital systems, pharmacists’ contributions may be integrated into prescribing decisions to varying degrees depending on the organizational structures, interprofessional relationships, workflow integration, and prescribing cultures. This study aimed to explore how contextual and interprofessional factors shape the integration of clinical pharmacists’ antimicrobial stewardship contributions within multidisciplinary prescribing decisions in Jordanian hospitals. Methods: A multi-site qualitative study was conducted across nine Jordanian hospitals. Semi-structured interviews were conducted with 26 clinical pharmacists involved in antimicrobial reviews in intensive care and general medical units. Interviews incorporated the critical incident technique to elicit examples of accepted and rejected stewardship recommendations. Data were analyzed using a realist-informed approach to develop context–mechanism–outcome configurations explaining variations in pharmacists’ reported AMS contribution. Results: Pharmacotherapy expertise was necessary but not sufficient for pharmacists’ recommendations to shape antimicrobial prescribing. Leadership endorsement, structured multidisciplinary rounds, and formal documentation pathways activated mechanisms of legitimacy, credibility, and workflow visibility, supporting reported uptake of dose optimization, therapeutic drug monitoring, and selected de-escalation recommendations. In contrast, prescriber-led hierarchies, limited documentation pathways, workload pressures, and defensive prescribing cultures activated mechanisms of self-limitation, risk aversion, and limited recommendation uptake, particularly for discontinuation, duration control, and narrowing of broad-spectrum therapy. Conclusions: Strengthening AMS requires not only formal committees and guidelines but also team-based structures that integrate pharmacists’ pharmacotherapy expertise into antimicrobial review while preserving clinicians’ ultimate prescribing responsibility. Full article

(This article belongs to the Special Issue Pharmacist-Led Management of Antimicrobial Treatment)

19 pages, 8976 KB

Open AccessArticle

Antimicrobial Resistance Across the Urban Wastewater Continuum: A One Health Assessment Using High-Throughput qPCR

by Douha Shouqair, Rashed Alghafri, Subham Verma, Mohammed Naji, Abdulla Albastaki, Fatima Al Dhaheri, Mahmood Y. Hachim, Rania Nassar, Ahmed A. Shibl, Jorge Rodríguez, Dean Everett, Richard Goering, Mushtaq Khan and Abiola Senok

Antibiotics 2026, 15(7), 669; https://doi.org/10.3390/antibiotics15070669 - 8 Jul 2026

Abstract

Background: Wastewater systems provide an integrated One Health perspective on antimicrobial resistance but remain uneven globally, with limited data from rapidly urbanizing and highly connected regions such as the Arabian Gulf. Methods: An eight-month prospective study was conducted in Dubai, United [...] Read more.

Background: Wastewater systems provide an integrated One Health perspective on antimicrobial resistance but remain uneven globally, with limited data from rapidly urbanizing and highly connected regions such as the Arabian Gulf. Methods: An eight-month prospective study was conducted in Dubai, United Arab Emirates, with monthly sampling from nine community and two hospital nodes and two wastewater treatment plants (WWTP). Samples were analysed using high-throughput quantitative PCR (HT-qPCR; Resistomap, Finland) with a 72-target One Health gene panel. Results: Across the 120 samples analyzed, the number of detected gene targets ranged from 26 to 68 genes, with the highest diversity in hospital wastewater and the lowest in WWTP effluent. Pathogen-associated markers were detected in all sources, with enterococci, Escherichia coli, and Klebsiella pneumoniae predominant. Hospital wastewater showed broader pathogen-associated gene markers, including those linked to Acinetobacter baumannii and Pseudomonas aeruginosa. Antibiotic resistance genes (ARGs) associated with macrolide–lincosamide–streptogramin B, tetracycline, and aminoglycoside resistance were widespread. Community and influent samples were dominated by msrE, tet(M), and aminoglycoside resistance genes, whereas hospital wastewater showed the highest ARG burden, including enrichment of aac(6′)-Ib, qnrS2, bla_GES, bla_TEM, bla_KPC-2, and bla_IMP-1. Several ARGs, including mcr-1, persisted in WWTP effluent. Mobile genetic elements (MGEs) were ubiquitous, with integron-associated markers prominent in WWTP effluent. ARG–MGE network analysis demonstrated extensive co-occurrence, with MGEs as central hubs linking multiple ARGs. Conclusions: Wastewater captures distinct resistome profiles across urban compartments, supporting its role for AMR surveillance. The persistence of ARGs and MGEs in WWTP effluent highlights the potential for environmental dissemination, through reuse of treated wastewater. Full article

(This article belongs to the Section Mechanism and Evolution of Antibiotic Resistance)

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17 pages, 1345 KB

Open AccessArticle

Molecular Characterization of Multidrug-Resistant Escherichia coli Isolated from Beef and Chicken Meat Products in Samsun, Türkiye

by Goknur Terzi Gulel, Sibel Kanat and Esra Ekizceli

Antibiotics 2026, 15(7), 668; https://doi.org/10.3390/antibiotics15070668 - 8 Jul 2026

Abstract

Background: Foodborne pathogenic Escherichia coli is a major public health concern due to its frequent association with meat and meat products and its potential to harbor virulence factors and antimicrobial resistance (AMR) determinants. Objective: This study aimed to investigate the prevalence, virulence gene [...] Read more.

Background: Foodborne pathogenic Escherichia coli is a major public health concern due to its frequent association with meat and meat products and its potential to harbor virulence factors and antimicrobial resistance (AMR) determinants. Objective: This study aimed to investigate the prevalence, virulence gene profiles, and AMR patterns of E. coli isolates obtained from beef and chicken meat products. Methods: A total of 200 beef and chicken meat product samples were collected from retail markets in Samsun, Türkiye. Isolation of E. coli was performed using conventional culture-based methods, and PCR targeting the uspA gene was used for molecular confirmation. The presence of virulence genes (stx1, stx2, eae, and hlyA) was investigated by PCR. Antimicrobial susceptibility testing was conducted using the disk diffusion method, and multidrug resistance (MDR) and multiple antibiotic resistance (MAR) indices were evaluated. Results: Among the 200 samples analyzed, 80 (40%) were positive for E. coli, including 38 (38%) beef and 42 (42%) chicken meat samples. A total of 185 E. coli isolates were recovered and confirmed by PCR. Virulence gene analysis showed that stx2 was the most prevalent gene (51.4%), followed by eae (37.3%), hlyA (13.0%), and stx1 (6.5%). Antimicrobial susceptibility testing demonstrated high resistance rates to tetracycline (69.7%), ampicillin (58.4%), trimethoprim–sulfamethoxazole (48.1%), streptomycin (40.5%), nalidixic acid (40.0%), chloramphenicol (40.0%), and ciprofloxacin (34.1%). In contrast, the lowest resistance rates were observed for imipenem (2.2%), amoxicillin–clavulanate (4.9%), and amikacin (7.6%). Moreover, 126 isolates (68.1%) were identified as MDR, exhibiting resistance to at least three antimicrobial agents. The MAR index ranged from 0.06 to 1.00. Conclusions: The coexistence of virulence-associated genes and high AMR rates among E. coli isolates from meat products indicates a potential public health risk. These findings highlight the importance of continuous monitoring of pathogenic and antimicrobial-resistant E. coli throughout the food production chain. Full article

(This article belongs to the Special Issue Genomic Characterization of Multidrug-Resistant Bacteria Isolated from Animals and Animal-Derived Foods)

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14 pages, 2614 KB

Open AccessArticle

Cefiderocol Susceptibility in Japanese Clinical Enterobacterales Isolates and the Effect of IMP-Type Carbapenemases on Resistance

by Manke Cai, Go Yamamoto, Shigeto Hamaguchi, Akiko Ueda, Ryuji Kawahara, Daisuke Motooka, Yusuke Takahashi and Satoshi Kutsuna

Antibiotics 2026, 15(7), 667; https://doi.org/10.3390/antibiotics15070667 - 8 Jul 2026

Abstract

Objectives: Carbapenem-resistant Enterobacterales (CRE) limit treatment options, and cefiderocol’s efficacy can be compromised by regional carbapenemases. In this study, we aimed to characterize cefiderocol susceptibility distribution among Enterobacterales in Japan—specifically endemic strains producing IMP-type carbapenemases (IMP)—and explore the effect of IMP in [...] Read more.

Objectives: Carbapenem-resistant Enterobacterales (CRE) limit treatment options, and cefiderocol’s efficacy can be compromised by regional carbapenemases. In this study, we aimed to characterize cefiderocol susceptibility distribution among Enterobacterales in Japan—specifically endemic strains producing IMP-type carbapenemases (IMP)—and explore the effect of IMP in mediating resistance. Methods: The susceptibility of 556 evaluable Enterobacterales isolates (from an initial 560 screened) to cefiderocol was assessed using disk diffusion and broth microdilution methods based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Minimum inhibitory concentration (MIC) distributions across groups were compared using Kruskal–Wallis and Mann–Whitney U tests. Results: A total of 556 isolates yielded evaluable results. The cefiderocol susceptibility rate was 99.5 and 98.7% based on CLSI and European Committee on Antimicrobial Susceptibility Testing breakpoints, respectively. Notably, under both criteria, IMP-producing isolates exhibited a susceptibility rate of 99.6%, whereas non-CRE and non-extended-spectrum β-lactamase (ESBL) exhibited a susceptibility rate of 99.4%. Statistical analysis revealed that the ESBL-only group had higher MICs than the non-CRE/non-ESBL and IMP-only groups (both p < 0.001), whereas no significant difference was observed between the latter two (p = 0.083). Notably, the ESBL-only group exhibited higher MICs than those of isolates harboring both IMP and ESBL. Conclusions: These findings indicate a non-additive effect, in which the coexistence of multiple resistance enzymes does not necessarily increase cefiderocol resistance. The association between IMP and cefiderocol resistance may be limited. In specific enzyme combinations, its presence was even associated with lower MICs. Full article

(This article belongs to the Section Mechanism and Evolution of Antibiotic Resistance)

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19 pages, 7623 KB

Open AccessArticle

A Decision-Oriented Calibrated Screening Workflow for Tylosin Derivatives: Closed-Loop MIC Validation Against Staphylococcus aureus and Streptococcus agalactiae

by Huan Liu, Yiming Liu, Na Yu, Miao An, Yaoxin Tang, Jing Qu and Xiubo Li

Antibiotics 2026, 15(7), 666; https://doi.org/10.3390/antibiotics15070666 - 8 Jul 2026

Abstract

Background: Antimicrobial resistance among Gram-positive veterinary pathogens has increased the need for more rational and experimentally grounded strategies to prioritize tylosin derivatives for antibacterial development. This study aimed to develop and externally a calibrated, decision-oriented screening workflow for tylosin-derived antibacterial analog prioritization against [...] Read more.

Background: Antimicrobial resistance among Gram-positive veterinary pathogens has increased the need for more rational and experimentally grounded strategies to prioritize tylosin derivatives for antibacterial development. This study aimed to develop and externally a calibrated, decision-oriented screening workflow for tylosin-derived antibacterial analog prioritization against Staphylococcus aureus and Streptococcus agalactiae. Methods: Publicly available minimum inhibitory concentration (MIC) data were used to construct organism-specific multilayer perceptron models. Model performance was evaluated using a five-fold out-of-fold framework. Calibrated activity probabilities were then combined with precision-oriented thresholds and similarity-based applicability-domain constraints to define prospective Go/No-Go decisions. To examine external transferability, six synthesized tylosin derivatives (A1–A6) were prospectively predicted and subsequently tested using in vitro MIC assays. Results: Internal validation showed stronger and more stable performance for S. aureus than for S. agalactiae. However, closed-loop external validation revealed distinct organism-specific decision behaviors. For S. aureus, the workflow assigned Go decisions to five compounds and included the only experimentally active analog, A6, but also generated several false Go decisions for inactive analogs. For S. agalactiae, all six compounds were classified as No-Go under the primary decision rule, whereas MIC testing showed that four analogs were experimentally active, indicating conservative under-selection in a low-data extrapolation setting. Conclusions: Calibrated probabilities and applicability-domain analysis can improve the transparency and diagnostic value of antibacterial prioritization, but they do not guarantee robust external activity prediction when training-set coverage, threshold transferability, or chemical-space representation is limited. Overall, this study provides an early-stage, risk-aware closed-loop decision-support framework for tylosin-derived analog prioritization and highlights the need for iterative model updating, probability recalibration, and larger external validation before such workflows are used as high-confidence prospective screening tools in veterinary antibacterial discovery. Full article

(This article belongs to the Special Issue Mastitis: Causative Agents, Drug Resistance, and Treatment Approaches—2nd Edition)

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15 pages, 2132 KB

Open AccessArticle

Activity of Corallopyronin A Against ESKAPEE Pathogens: Potential and Translational Implications

by Jennifer M. Colquhoun, Kara W. Marshall, Miriam Grosse, Birthe Sandargo, Kenneth Pfarr, Andrea Schiefer, Achim Hoerauf, William M. Shafer and Philip N. Rather

Antibiotics 2026, 15(7), 665; https://doi.org/10.3390/antibiotics15070665 - 8 Jul 2026

Abstract

Background: Corallopyronin A (CorA) is a bacterial RNA polymerase inhibitor that binds a site distinct from rifamycins, but its activity across the ESKAPEE pathogen panel and its translational potential remain incompletely defined. Methods: CorA activity was evaluated against representative ESKAPEE pathogens [...] Read more.

Background: Corallopyronin A (CorA) is a bacterial RNA polymerase inhibitor that binds a site distinct from rifamycins, but its activity across the ESKAPEE pathogen panel and its translational potential remain incompletely defined. Methods: CorA activity was evaluated against representative ESKAPEE pathogens using broth microdilution assays ± polymyxin B nonapeptide (PMBN). Activity was benchmarked against rifampin (Rif). Resistance, cross-resistance, serum activity, in vivo efficacy in the Galleria mellonella wax moth larva model, and biofilm disruption were assessed. Results: CorA inhibited Acinetobacter baumannii (minimal inhibitory concentration [MIC] = 16–32 µg/mL), including MDR isolates, with susceptibility enhanced 4–32-fold by efflux disruption or membrane permeabilization. In contrast, most other Gram-negative ESKAPEE pathogens required PMBN for activity, while Gram-positive organisms were intrinsically susceptible. Rif was consistently more potent than CorA across the panel. Rif-resistant A. baumannii and Klebsiella pneumoniae remained fully susceptible to CorA, confirming the absence of cross-resistance. Fractional inhibitory concentration (FIC) index analysis revealed pharmacological indifference between CorA and Rif, with no synergy or antagonism detected. CorA activity was abolished in 50% serum conditions and was not restored by PMBN, consistent with serum sequestration; no efficacy was observed in a G. mellonella infection model at doses up to 20 mg/kg despite Rif demonstrating significant protection. Notably, CorA reduced established A. baumannii biofilms by ∼3–4 log colony-forming units per mL (CFU/mL) across concentrations ≥4× MIC after 24 h of treatment. Conclusions: CorA exhibits selective activity against A. baumannii and retains efficacy against Rif-resistant strains. While high serum binding reduces in vitro activity and efficacy was not observed in the G. mellonella model at a lower dose than in other in vivo models, established in vivo activity against other pathogens demonstrates that serum binding does not preclude therapeutic utility. These findings highlight both the translational considerations for CorA against ESKAPEE pathogens and potential niches for its application, including filarial nematodes, biofilm-associated infections and combination strategies. Full article

(This article belongs to the Section Novel Antimicrobial Agents)

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16 pages, 4178 KB

Open AccessReview

Comparative Trends in Human and Veterinary Antimicrobial Consumption in the European Union, 2019–2024

by Telma de Sousa, Tiago Bugarim, Gilberto Igrejas and Patricia Poeta

Antibiotics 2026, 15(7), 664; https://doi.org/10.3390/antibiotics15070664 - 7 Jul 2026

Abstract

Antimicrobial resistance (AMR) is a global health crisis addressed through a One Health framework. However, recent European Union (EU) surveillance data reveals a marked divergence in progress between the human and animal sectors. This study analyzes the most recent monitoring reports (European Surveillance [...] Read more.

Antimicrobial resistance (AMR) is a global health crisis addressed through a One Health framework. However, recent European Union (EU) surveillance data reveals a marked divergence in progress between the human and animal sectors. This study analyzes the most recent monitoring reports (European Surveillance of Antimicrobial Consumption Network and European Sales and Use of Antimicrobials for Veterinary Medicine, 2024) to compare the effectiveness of mitigation strategies across sectors. The findings expose a clear paradox: while the veterinary sector has achieved a structural 24.3% reduction in antimicrobial sales in the EU since 2018, human medicine has recorded a 2% increase in overall consumption, diverging from established reduction targets. From a qualitative perspective, veterinary medicine has nearly eliminated the use of critically important antimicrobials in the AntiMicrobial Expert Group (AMEG) (category B), including polymyxins and third-generation cephalosporins, which now account for only 0.24% of total sales. In contrast, human medicine continues to struggle to contain antimicrobial resistance in key sentinel pathogens, notably Klebsiella pneumoniae and Escherichia coli. Furthermore, companion animals, representing 97.9% of non-food-producing animal biomass, emerge as a reservoir of antimicrobial-resistant bacteria due to the intensive use of broad-spectrum oral formulations. The results indicate that the veterinary regulatory model, centered on binding volume reduction and preventive strategies, has been more effective in reducing overall antimicrobial consumption compared to the voluntary, guideline-based stewardship approaches currently used in human medicine. Achieving meaningful control of antimicrobial resistance will require human medicine to adopt the same level of structural rigor already implemented in animal production systems. Full article

(This article belongs to the Special Issue Epidemiology of Antimicrobial-Resistant Pathogens in Animals: A One Health Perspective)

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13 pages, 817 KB

Open AccessArticle

Pathogen Spectrum and Antimicrobial Susceptibility Profiles in Culture-Proven Endophthalmitis at a Tertiary Referral Center in China: A Three-Decade Retrospective Study

by Wenfei Zhang, Zhe Yang, Jingjia Zhang, Xinyu Zhao, Chenghui Peng, Yuelin Wang, Youxin Chen and Huan Chen

Antibiotics 2026, 15(7), 663; https://doi.org/10.3390/antibiotics15070663 - 6 Jul 2026

Abstract

Background/Objectives: Endophthalmitis is a devastating, vision-threatening intraocular infectious disease. Given the scarcity of long-term cohort data in Asian populations, appropriate empirical antibiotic therapy is essential to prevent irreversible vision loss. The present study aimed to identify the culture-positive pathogen profiles and antimicrobial [...] Read more.

Background/Objectives: Endophthalmitis is a devastating, vision-threatening intraocular infectious disease. Given the scarcity of long-term cohort data in Asian populations, appropriate empirical antibiotic therapy is essential to prevent irreversible vision loss. The present study aimed to identify the culture-positive pathogen profiles and antimicrobial susceptibility in endophthalmitis. Methods: This retrospective study included 90 culture-positive isolates from patients with endophthalmitis treated between January 1990 and October 2020. The etiology, clinical presentation, and antibiotic susceptibility profiles of the isolates were analyzed. Results: Forty-three isolates were Gram-positive cocci, 23 were Gram-negative bacilli, and 24 were fungi. Postoperative infections were dominated by Gram-positive cocci (72.1%). Furthermore, 47.8% (11/23) of Gram-negative bacilli and 66.7% (16/24) of fungi were recovered from endogenous endophthalmitis isolates. In patients with endophthalmitis caused by Gram-negative bacilli, visual acuity was numerically inferior at both initial presentation and final follow-up visit (p = 0.051 and p = 0.018). All isolates of Gram-positive cocci exhibited full susceptibility to vancomycin and teicoplanin, while linezolid yielded a susceptibility rate of 96.9% (31/32). For Gram-negative bacilli, over 80% of isolates were susceptible to amikacin, aztreonam, and third-generation cephalosporins, whereas carbapenems and fluoroquinolones achieved susceptibility rates exceeding 90%. Among staphylococcal isolates, ciprofloxacin resistance was significantly higher in patients older than 55 years compared with those aged 55 years or younger (71.4% versus 12.5%; exact p = 0.013). Conclusions: Postoperative infection was the leading cause of Gram-positive cocci endophthalmitis. Antimicrobial susceptibility profiles validated intravitreal vancomycin combined with ceftazidime as a rational regimen for empirical antibacterial coverage. Elevated fluoroquinolone resistance among Gram-positive cocci, particularly in elderly patients, underscores the necessity of sustained regional antimicrobial resistance surveillance and periodic reassessment of conventional topical antibiotic prophylatic protocols. Full article

(This article belongs to the Section Antibiotic Therapy in Infectious Diseases)

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