Antibiotics

12 pages, 1984 KiB

Open AccessArticle

Primary Healthcare Physicians’ Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study

by Muhtar Kadirhaz, Yushan Zhang, Naveel Atif, Wenchen Liu, Wenjing Ji, Nan Zhao, Jin Peng, Sen Xu, Miaomiao Xu, Chengzhou Tang, Yu Fang and Jie Chang

Antibiotics 2024, 13(10), 923; https://doi.org/10.3390/antibiotics13100923 - 26 Sep 2024

Abstract

Objectives: Overuse of antibiotics in healthcare remains prevalent and requires urgent attention in China, particularly in primary healthcare (PHC) facilities. This study aimed to describe the patterns of antibiotic prescriptions for acute upper respiratory tract infections (URTIs) in PHC facilities in China and [...] Read more.

Objectives: Overuse of antibiotics in healthcare remains prevalent and requires urgent attention in China, particularly in primary healthcare (PHC) facilities. This study aimed to describe the patterns of antibiotic prescriptions for acute upper respiratory tract infections (URTIs) in PHC facilities in China and to investigate how PHC physicians’ knowledge influences their antibiotic prescribing behavior. Methods: A cross-sectional survey linking physician questionnaire responses and their prescription data was conducted in Shaanxi Province, China. The proportions of URTI visits that received at least one antibiotic, combined antibiotics, and broad-spectrum antibiotics were the main outcomes reflecting antibiotic prescribing behavior. Multivariate mixed-effects logistic regressions were applied to analyze the relationship between PHC physicians’ knowledge about antibiotics and their antibiotic prescribing behavior. Results: A total of 108 physicians filled out the questionnaires between February 2021 and July 2021, and a sample of 11,217 URTI visits attended by these physicians from 1 January 2020 to 31 December 2020 were included in the analysis. The overall mean score of our respondents on the knowledge questions was 5.2 (total score of 10). Over sixty percent (61.2%; IQR 50.2–72.1) of the URTI visits received antibiotics. The percentages of URTI visits prescribed with combined and broad-spectrum antibiotics were 7.8% (IQR 2.3–10.2) and 48.3% (IQR 36.7–58.7), respectively. Third-generation cephalosporins were the most frequently used antibiotics. Physicians with lower antibiotic knowledge scores were more inclined to prescribe antibiotics (p < 0.001), combined antibiotics (p = 0.001), and broad-spectrum antibiotics (p < 0.001). Conclusions: Physicians’ insufficient knowledge was significantly associated with antibiotic overprescribing. Professional training targeting physicians’ knowledge of antibiotics is urgently needed to improve the rational use of antibiotics in grassroots healthcare facilities in China. Full article

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

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15 pages, 324 KiB

Open AccessReview

Antimicrobial Resistance in Diverse Escherichia coli Pathotypes from Nigeria

by Kenneth Nnamdi Anueyiagu, Chibuzor Gerald Agu, Uzal Umar and Bruno Silvester Lopes

Antibiotics 2024, 13(10), 922; https://doi.org/10.3390/antibiotics13100922 - 26 Sep 2024

Abstract

Escherichia coli is a gram-negative commensal bacterium living in human and animal intestines. Its pathogenic strains lead to high morbidity and mortality, which can adversely affect people by causing urinary tract infections, food poisoning, septic shock, or meningitis. Humans can contract E. coli [...] Read more.

Escherichia coli is a gram-negative commensal bacterium living in human and animal intestines. Its pathogenic strains lead to high morbidity and mortality, which can adversely affect people by causing urinary tract infections, food poisoning, septic shock, or meningitis. Humans can contract E. coli by eating contaminated food—such as raw or undercooked raw milk, meat products, and fresh produce sold in open markets—as well as by coming into contact with contaminated settings like wastewater, municipal water, soil, and faeces. Some pathogenic strains identified in Nigeria, include Enterohemorrhagic (Verotoxigenic), Enterotoxigenic, Enteropathogenic, Enteroinvasive, and Enteroaggregative E. coli. This causes acute watery or bloody diarrhoea, stomach cramps, and vomiting. Apart from the virulence profile of E. coli, antibiotic resistance mechanisms such as the presence of bla_CTX-M found in humans, animals, and environmental isolates are of great importance and require surveillance and monitoring for emerging threats in resource-limited countries. This review is aimed at understanding the underlying mechanisms of evolution and antibiotic resistance in E. coli in Nigeria and highlights the use of improving One Health approaches to combat the problem of emerging infectious diseases. Full article

11 pages, 240 KiB

Open AccessArticle

Evaluation of the Efficacy of Intravenous Push and Intravenous Piggyback Ceftriaxone in Critically Ill Patients

by Elly R. Sherman, Nha Hue Ta, Trisha N. Branan, Natt Patimavirujh, Luren Ashton Dickinson, Christopher M. Bland and Susan E. Smith

Antibiotics 2024, 13(10), 921; https://doi.org/10.3390/antibiotics13100921 - 26 Sep 2024

Abstract

Background/Objective: Intravenous fluid shortages have led to fluid-sparing measures such as intravenous push (IVP) administration of antibiotics. This study aimed to compare the safety and efficacy of IVP and intravenous piggyback (IVPB) ceftriaxone in critically ill patients. Results: Demographics were similar [...] Read more.

Background/Objective: Intravenous fluid shortages have led to fluid-sparing measures such as intravenous push (IVP) administration of antibiotics. This study aimed to compare the safety and efficacy of IVP and intravenous piggyback (IVPB) ceftriaxone in critically ill patients. Results: Demographics were similar in IVP (n = 201) and IVPB (n = 200) groups. Sequential Organ Failure Assessment (SOFA) score was higher, and sepsis and septic shock were more common in the IVP group. Treatment failure occurred in 37.8% of IVP and 19.5% of IVPB groups (p < 0.001). Hospital mortality was more common with IVP (21.4% vs. 9.5%, p < 0.001). Hospital LOS was longer with IVP while intensive care unit (ICU) LOS was similar between the groups. IVP ceftriaxone (OR 2.33, 95% CI 1.43–3.79) and the SOFA score (OR 1.18, 95% CI 1.1–1.27) were associated with treatment failure. Methods: A single-center, retrospective cohort study included adults admitted to an ICU from 2016 to 2021 who received empiric ceftriaxone for ≥72 h. The primary outcome was treatment failure, defined as a composite of inpatient mortality or escalation of antibiotics. Secondary outcomes included length of stay (LOS) and mortality. Chi-squared and independent-sample t-tests were used. Treatment failure was evaluated using multivariate logistic regression. Conclusions: Compared to IVPB, IVP ceftriaxone was associated with higher treatment failure in critically ill patients. Both safety and efficacy should be considered before implementing novel antibiotic administration strategies in practice based primarily on convenience. Full article

(This article belongs to the Special Issue Antibiotic Use and the Emergence of Antibiotic Resistance in Clinical Settings)

14 pages, 678 KiB

Open AccessArticle

Prevalence and Molecular Epidemiology of Intestinal Colonization by Multidrug-Resistant Bacteria among Hematopoietic Stem-Cell Transplantation Recipients: A Bulgarian Single-Center Study

by Denis Niyazi, Stoyan Vergiev, Rumyana Markovska and Temenuga Stoeva

Antibiotics 2024, 13(10), 920; https://doi.org/10.3390/antibiotics13100920 - 26 Sep 2024

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Abstract

Background/Objectives: Intestinal colonization by multidrug-resistant (MDR) bacteria is considered one of the main risk factors for invasive infections in the hematopoietic stem-cell transplant (HSCT) setting, associated with hard-to-eradicate microorganisms. The aim of this study was to assess the rate of intestinal colonization [...] Read more.

Background/Objectives: Intestinal colonization by multidrug-resistant (MDR) bacteria is considered one of the main risk factors for invasive infections in the hematopoietic stem-cell transplant (HSCT) setting, associated with hard-to-eradicate microorganisms. The aim of this study was to assess the rate of intestinal colonization by MDR bacteria and their microbial spectrum in a group of post-HSCT patients to study the genetic determinants of beta-lactam and glycopeptide resistance in the recovered isolates, as well as to determine the epidemiological relation between them. Methods: The intestinal colonization status of 74 patients admitted to the transplantation center of University Hospital “St. Marina”—Varna in the period January 2019 to December 2021 was investigated. Stool samples/rectal swabs were screened for third-generation cephalosporin and/or carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Stenotrophomonas maltophilia. Identification and antimicrobial susceptibility testing were performed by Phoenix (BD, Sparks, MD, USA) and MALDI Biotyper sirius (Bruker, Bremen, Germany). Molecular genetic methods (PCR, DNA sequencing) were used to study the mechanisms of beta-lactam and glycopeptide resistance in the collected isolates, as well as the epidemiological relationship between them. Results: A total of 28 patients (37.8%) were detected with intestinal colonization by MDR bacteria. Forty-eight non-duplicate MDR bacteria were isolated from their stool samples. Amongst them, the Gram-negative bacteria prevailed (68.8%), dominated by ESBL-producing Escherichia coli (30.3%), and followed by carbapenem-resistant Pseudomonas sp. (24.2%). The Gram-positive bacteria were represented exclusively by Enterococcus faecium (31.2%). The main beta-lactam resistance mechanisms were associated with CTX-M and VIM production. VanA was detected in all vancomycin-resistant enterococci. A clonal relationship was observed among Enterobacter cloacae complex and among E. faecium isolates. Conclusions: To the best of our knowledge, this is the first Bulgarian study that presents detailed information about the prevalence, resistance genetic determinants, and molecular epidemiology of MDR gut-colonizing bacteria in HSCT patients. Full article

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46 pages, 3082 KiB

Open AccessReview

Beyond Antibiotics: What the Future Holds

by Payam Benyamini

Antibiotics 2024, 13(10), 919; https://doi.org/10.3390/antibiotics13100919 - 25 Sep 2024

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Abstract

The prevalence of multidrug resistance (MDR) and stagnant drug-development pipelines have led to the rapid rise of hard-to-treat antibiotic-resistant bacterial infections. These infectious diseases are no longer just nosocomial but are also becoming community-acquired. The spread of MDR has reached a crisis level [...] Read more.

The prevalence of multidrug resistance (MDR) and stagnant drug-development pipelines have led to the rapid rise of hard-to-treat antibiotic-resistant bacterial infections. These infectious diseases are no longer just nosocomial but are also becoming community-acquired. The spread of MDR has reached a crisis level that needs immediate attention. The landmark O’Neill report projects that by 2050, mortality rates associated with MDR bacterial infections will surpass mortality rates associated with individuals afflicted with cancer. Since conventional antimicrobials are no longer very reliable, it is of great importance to investigate different strategies to combat these life-threatening infectious diseases. Here, we provide an overview of recent advances in viable alternative treatment strategies mainly targeting a pathogen’s virulence capability rather than viability. Topics include small molecule and immune inhibition of virulence factors, quorum sensing (QS) quenching, inhibition of biofilm development, bacteriophage-mediated therapy, and manipulation of an individual’s macroflora to combat MDR bacterial infections. Full article

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11 pages, 575 KiB

Open AccessArticle

Surgical Site Infection after Primary Open Surgery for Laryngeal Cancer in a Tertiary Hospital in Belgrade, Serbia: A 10-Year Prospective Cohort Study

by Jelena Sotirović, Nemanja Rančić, Ljubomir Pavićević, Nenad Baletić, Aleksandar Dimić, Ognjen Čukić, Aleksandar Perić, Milanko Milojević, Nenad Ljubenović, Darko Milošević and Vesna Šuljagić

Antibiotics 2024, 13(10), 918; https://doi.org/10.3390/antibiotics13100918 - 25 Sep 2024

Viewed by 208

Abstract

Background: Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. Methods: [...] Read more.

Background: Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. Methods: The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI. Results: SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III–IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159–2.189; p = 0.004) and LOS (RR: 1.074; 95% CI: 1.037–1.112; p < 0.001). Conclusions: Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement. Full article

(This article belongs to the Special Issue Surgical Site Infections: Epidemiology, Microbiology and Prevention)

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15 pages, 2082 KiB

Open AccessArticle

Phenotypic and Genotypic Profiles of Extended-Spectrum Beta-Lactamase-Producing Multidrug-Resistant Klebsiella pneumoniae in Northeastern Thailand

by Sumontha Chaisaeng, Nattamol Phetburom, Pachara Kasemsiri, Nuntiput Putthanachote, Naowarut Wangnadee, Parichart Boueroy, Anusak Kerdsin and Peechanika Chopjitt

Antibiotics 2024, 13(10), 917; https://doi.org/10.3390/antibiotics13100917 - 25 Sep 2024

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Abstract

The global emergence of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae presents a significant public health threat and complicates antibiotic treatment for infections. This study aimed to determine the prevalence of ESBL-producing K. pneumoniae in a clinical setting, analyze their antimicrobial susceptibility profiles, and characterize [...] Read more.

The global emergence of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae presents a significant public health threat and complicates antibiotic treatment for infections. This study aimed to determine the prevalence of ESBL-producing K. pneumoniae in a clinical setting, analyze their antimicrobial susceptibility profiles, and characterize both phenotypic and genetic determinants. A total of 507 non-duplicate clinical isolates of Enterobacterales were collected between 2019 and 2020, and third-generation cephalosporin resistance was screened by disk diffusion. Identification of K. pneumoniae was confirmed using biochemical tests and PCR with species-specific primers. Antimicrobial susceptibility testing was conducted using disk diffusion, and phenotypic ESBL production was confirmed using the combined disk method. Multiplex PCR detected ESBL genes (bla_TEM, bla_SHV, and bla_CTX-M) and identified bla_CTX-M groups. The genetic relatedness of ESBL-producing strains was assessed using the ERIC-PCR approach. Fitty-four isolates were confirmed as ESBL producers, all classified as multidrug-resistant (MDR). All ESBL-producing K. pneumoniae isolates exhibited resistance to ampicillin and cefotaxime, with high resistance rates for ciprofloxacin (98.2%), azithromycin (94.4%), piperacillin–tazobactam (88.9%), and trimethoprim (83.3%). Genotypic analysis revealed bla_CTX-M was present in 94.4% of isolates, bla_SHV in 87%, and bla_TEM in 55.5%. The bla_CTX-M-1 group was the most prevalent, accounting for 96.1% of isolates. Co-harboring of bla_CTX-M, bla_SHV, and bla_TEM occurred in 42.6% of isolates, with co-carrying of bla_CTX-M, and bla_SHV was observed in 23/54 isolates. The ERIC-PCR analysis revealed 15 distinct types, indicating high genetic diversity. These findings highlight the urgent need for ongoing monitoring to control the spread of ESBL among K. pneumoniae and emphasize the importance of early detection and appropriate antibiotic selection for effectively treating infection caused by these pathogens. Full article

(This article belongs to the Special Issue Insights into Antibiotics in Human, Animal, and Agriculture: Resistance, Determinant, and Treatment, 2nd Edition)

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8 pages, 1267 KiB

Open AccessCase Report

Phage–Antibiotic Combination Therapy against Recurrent Pseudomonas Septicaemia in a Patient with an Arterial Stent

by Ulla Elina Otava, Laura Tervo, Riikka Havela, Liisa Vuotari, Matti Ylänne, Annette Asplund, Sheetal Patpatia and Saija Kiljunen

Antibiotics 2024, 13(10), 916; https://doi.org/10.3390/antibiotics13100916 - 24 Sep 2024

Viewed by 552

Abstract

Background: Intravascular stent infections are often associated with high risks of morbidity and mortality. We report here a case of a patient with an arterial stent and recurrent Pseudomonas septicaemias successfully treated with phage–meropenem combination therapy. Methods: A 75-year-old female with arteriosclerosis and [...] Read more.

Background: Intravascular stent infections are often associated with high risks of morbidity and mortality. We report here a case of a patient with an arterial stent and recurrent Pseudomonas septicaemias successfully treated with phage–meropenem combination therapy. Methods: A 75-year-old female with arteriosclerosis and comorbidities went through a femoropopliteal bypass with prosthesis in the right inguinal area. After the bypass, she developed a recurring Pseudomonas aeruginosa infection and also neutropenia during different antibiotics. A rapidly growing pseudoaneurysm in the right inguinal area led to an emergency intra-arterial stent placement during blood stream infection, later suspected to host a P. aeruginosa biofilm. Removing the stent was deemed precarious, and phage therapy was considered as a compassionate treatment option. A three-phage cocktail infecting the P. aeruginosa strain was prepared and administered intravenously together with meropenem for two weeks, after which, a ten-month follow-up was carried out. Results: No adverse reactions occurred during the phage therapy treatment, while infection markers were normalized. In addition, recovery was seen in a PET-CT scan. During the 10-month follow-up, no further P. aeruginosa septicaemias occurred. Conclusions: Phage–meropenem combination therapy was thus found safe and effective in the treatment of recurrent Pseudomonas septicaemia in a patient with an arterial stent. Full article

(This article belongs to the Section Bacteriophages)

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2 pages, 148 KiB

Open AccessEditorial

A Global Call to Action on Antimicrobial Resistance at the UN General Assembly

by Albert Figueras

Antibiotics 2024, 13(10), 915; https://doi.org/10.3390/antibiotics13100915 - 24 Sep 2024

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Abstract

As the United Nations General Assembly prepares to convene its second high-level meeting on antimicrobial resistance (AMR) in September 2024, it is crucial to reflect on the progress made since the first meeting in 2016 and the urgent need for immediate action [...] [...] Read more.

As the United Nations General Assembly prepares to convene its second high-level meeting on antimicrobial resistance (AMR) in September 2024, it is crucial to reflect on the progress made since the first meeting in 2016 and the urgent need for immediate action [...] Full article

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

13 pages, 2168 KiB

Open AccessFeature PaperArticle

Antifungal Susceptibility Data and Epidemiological Distribution of Candida spp.: An In Vitro Five-Year Evaluation at University Hospital Policlinico of Catania and a Comprehensive Literature Review

by Maddalena Calvo, Guido Scalia and Laura Trovato

Antibiotics 2024, 13(10), 914; https://doi.org/10.3390/antibiotics13100914 - 24 Sep 2024

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Abstract

Background: Invasive fungal infections represent a concerning healthcare issue, with Candida spp. reported as the main aetiological agent. Candida spp. bloodstream infections show high mortality rates, indicating increasing antifungal-resistance episodes as a contributing feature. Despite the global prevalence of C. albicans, non- [...] Read more.

Background: Invasive fungal infections represent a concerning healthcare issue, with Candida spp. reported as the main aetiological agent. Candida spp. bloodstream infections show high mortality rates, indicating increasing antifungal-resistance episodes as a contributing feature. Despite the global prevalence of C. albicans, non-albicans species emerged as significant in the last decades. Methods: The present manuscript reports a five-year evaluation on Candida spp. bloodstream isolates and their antifungal susceptibility profiles, aiming to enrich the literature and epidemiological data. Results: According to the gathered data, antifungal-resistance cases remained uncommon. However, the study revealed rare resistance phenotypes such as a single case of pan-echinocandin resistance C. albicans. Conclusions: Finally, a comprehensive review of Candida spp. antifungal resistance integrates the data, emphasizing the extreme species-specific variability and the consequent importance of always providing species identification. Full article

(This article belongs to the Special Issue Emerging Treatment Options for Multidrug-Resistant Bacterial and Fungal Infections, 2nd Edition)

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8 pages, 769 KiB

Open AccessArticle

Attitudes of Dental Students towards the Prescription of Antibiotics during Endodontic Treatment

by Lauzan haj Khalaf, Salma Kabbaj and Babacar Toure

Antibiotics 2024, 13(10), 913; https://doi.org/10.3390/antibiotics13100913 - 24 Sep 2024

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Abstract

Aim: This study aimed to evaluate the antibiotic-prescribing attitudes of dental students during the management of endodontic infections. Materials and methods: This study was conducted in the five faculties of dental medicine in Morocco. A self-administered questionnaire was used and completed online. This [...] Read more.

Aim: This study aimed to evaluate the antibiotic-prescribing attitudes of dental students during the management of endodontic infections. Materials and methods: This study was conducted in the five faculties of dental medicine in Morocco. A self-administered questionnaire was used and completed online. This questionnaire has three parts: the first includes the socio-demographic data, the second is related to the types of antibiotics prescribed, and the final addresses clinical scenarios in which antibiotics are prescribed. Data were analyzed with Jamovi, and X₂ and ANOVA tests were performed. Results: Three hundred and sixty-five students participated in this study. The average duration of antibiotic therapy was 5.87 ± 1.45. Of all the students, 83.8% prescribe amoxicillin first. For patients with penicillin allergy, clindamycin was the most prescribed, amounting to 53.9%. Antibiotics are prescribed for all pulp and periapical pathologies. For acute pulpitis and acute apical periodontitis, a statistically significant difference between the different faculties was noted (p = 0.03). Regarding apical abscesses, antibiotic prescription was more frequent at the public faculty of Casablanca, corresponding to 92.8%. (p = 0.02). Conclusion: It appears from this study that there is a need for faculties to develop innovative teaching models to improve students’ level of knowledge on antibiotics and their indications in endodontics. Full article

(This article belongs to the Special Issue Antibacterial Treatment in Periodontal and Endodontic Therapy, 2nd Edition)

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Antibiotics, Volume 13, Issue 10 (October 2024) – 11 articles

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