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10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 July 2021) | Viewed by 24545

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Special Issue Editor

Prof. Dr. Albert Figueras

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Guest Editor

1. Consultant (Medicines Use, Safety and Policies), Barcelona, Spain
2. Former Professor at Universitat Autònoma de Barcelona, Barcelona, Spain
Interests: antimicrobial use; rational use of medicines; pharmacovigilance; drug utilization studies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The inappropriate use of antimicrobials is one important factor underlying the present resistance thread that is urging researchers to discover new medicines to kill these germs. Within this panorama, different actions could add value to the preservation of the currently available antibiotics. Those designed to identify and describe failures in the value chain and share successful experiences to improve the therapeutic use of these medicines at all healthcare system levels, involving all actors, from health authorities to all healthcare professionals and patients or caregivers, are of high interest.

To improve the ways in which antimicrobials are being prescribed and used, classical and innovative approaches should be combined with an adaptation to each clinical setting's local characteristics in the respective country. Which are the innovative advances needed in to promote the more appropriate use of antibiotics?

This Special Issue seeks manuscript submissions that further our understanding of innovative stewardship experiences at all levels in hospitals and primary healthcare. Submissions describing successful activities aimed at improving the use of antimicrobials are especially encouraged.

Dr. Albert Figueras
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (7 papers)

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Research

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9 pages, 269 KiB

Open AccessArticle

Prevalence and Antimicrobial Resistance of Enterococcus Species: A Retrospective Cohort Study in Italy

by Mariarosaria Boccella, Biagio Santella, Pasquale Pagliano, Anna De Filippis, Vincenzo Casolaro, Massimiliano Galdiero, Anna Borrelli, Mario Capunzo, Giovanni Boccia and Gianluigi Franci

Antibiotics 2021, 10(12), 1552; https://doi.org/10.3390/antibiotics10121552 - 19 Dec 2021

Cited by 25 | Viewed by 4773

Abstract

Antimicrobial resistance represents one of the main threats to healthy ecosystems. In recent years, among the multidrug-resistant microorganisms responsible for nosocomial infections, the Enterococcus species have received much attention. Indeed, Enterococcus have peculiar skills in their ability to acquire resistance genes and to cause severe diseases, such as endocarditis. This study showed the prevalence and antimicrobial resistance rate of Enterococcus spp. isolated from clinical samples, from January 2015 to December 2019 at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy. A total of 3236 isolates of Enterococcus faecalis (82.2%) and Enterococcus faecium (17.8%) were collected from urine cultures, blood cultures, catheters, respiratory tract, and other samples. Bacterial identification and antibiotic susceptibility were performed with VITEK 2. E. faecium showed a high resistance rate against ampicillin (84.5%), ampicillin/sulbactam (82.7%), and imipenem (86.7%), while E. faecalis showed the highest resistance rate against gentamicin and streptomycin high level, but both were highly sensitive to such antibiotics as tigecycline and vancomycin. Studies of surveillance are an important tool to detect changes in the resistance profiles of the main pathogens. These antimicrobial susceptibility patterns are necessary to improve the empirical treatment guideline of infections. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

9 pages, 452 KiB

Open AccessArticle

Pharmacovigilance Data as a Trigger to Identify Antimicrobial Resistance and Inappropriate Use of Antibiotics: A Study Using Reports from The Netherlands Pharmacovigilance Centre

by Jean Marie Vianney Habarugira, Linda Härmark and Albert Figueras

Antibiotics 2021, 10(12), 1512; https://doi.org/10.3390/antibiotics10121512 - 09 Dec 2021

Cited by 3 | Viewed by 4424

Abstract

(1) Background: Antimicrobial resistance (AMR) requires urgent multidisciplinary solutions, and pharmacovigilance has the potential to strengthen current antimicrobial stewardship strategies. This study aimed to characterize AMR-relevant adverse drug reaction (ADR) reports submitted to The Netherlands Pharmacovigilance Centre; (2) Methods: We carried out a descriptive analysis of ADR reports submitted to Lareb, coded with AMR-relevant MedDRA Preferred Terms (PTs); (3) Results: Between 1998 and January 2019, 252 AMR-relevant ADR reports were submitted to Lareb. The most frequent antibiotics were tobramycin (n = 89; 35%), colistin (n = 30; 11.9%), cipro-floxacin (n = 16; 6.3%), doxycycline (n = 14; 5.5%), and aztreonam (n = 12; 4.8%). The PTs used included off label use (n = 91; 36.1%), drug ineffective (n = 71; 28.2%), product use in unapproved indication (n = 28; 11.1%), pathogen resistance (n = 14; 5.6%), and drug resistance (n = 13; 5.2%). 54% of the reports were on Watch antibiotics and 19% were involved in the Reserve group. In the Watch group, “off label use” and “product use in unapproved indication” were the most frequent PTs and the majority of reports on Reserve antibiotics were coded as “Off label”. A sharp increase in the number of reports was observed in the three consecutive years with 21 in 2013, 54 in 2014, and 83 in 2015; (4) Conclusions: In addition to existing AMR monitoring strategies, pharmacovigilance databases can serve as a source of data on suspected resistance and inappropriate use. Future research should explore how these AMR-relevant MedDRA Terms are used in resource-limited settings with less capacity to generate laboratory-confirmed resistance data. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

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12 pages, 279 KiB

Open AccessArticle

Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive Cocci Infections: Effectiveness, Hospital Stay and Mortality

by Mar de Pablo-Miró, Sergi Pujol-Ruiz, Simona Iftimie, María del Mar Arenas-Miras, Inmaculada López-Montesinos, Xavier Duran-Jordà, Albert Anglès, Santiago Grau and Juan P. Horcajada

Antibiotics 2021, 10(11), 1296; https://doi.org/10.3390/antibiotics10111296 - 24 Oct 2021

Cited by 6 | Viewed by 2102

Abstract

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

11 pages, 259 KiB

Open AccessArticle

Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia

by Sanjiv Rampal, Thanusha Ganesan, Narresh Sisubalasingam, Vasantha Kumari Neela, Mehmet Ali Tokgöz, Arun Arunasalam, Mohd Asyraf Hafizuddin Ab Halim, Zulfahrizzat Bin Shamsudin, Suresh Kumar and Ajantha Sinniah

Antibiotics 2021, 10(9), 1120; https://doi.org/10.3390/antibiotics10091120 - 17 Sep 2021

Cited by 3 | Viewed by 2622

Abstract

Background: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the soft tissue (also known as the fascia) with a secondary necrosis of the subcutaneous tissues, leading to a systemic inflammatory response syndrome (SIRS), shock and eventually death despite the availability of current medical interventions. The clinical management of this condition is associated with a significant amount of morbidity with a high rate of mortality. The prognosis of the disease is affected by multiple factors, which include the virulence of the causative pathogen, local host immunity, local wound factors and empirical antibiotics used. The local trends in the prescription of empirical antibiotics are often based on clinical practice guidelines (CPG), the distribution of the causative microorganism and the cost-effectiveness of the drug. However, there appears to be a paucity of literature on the empirical antibiotic of choice when dealing with necrotizing fasciitis in the clinical setting. This paper will outline common causative microorganisms and current trends of prescription in two tertiary centres in Central Malaysia. Methods: This was a cross-sectional study using retrospective data of patients treated for NF collected from two tertiary care hospitals (Hospital Seremban and Hospital Ampang) in Central Malaysia. A total of 420 NF patients were identified from the five years of retrospective data obtained from the two hospitals. Results: The top three empirical antibiotics prescribed are ampicillin + sulbactam (n = 258; 61.4%), clindamycin (n = 55; 13.1%) and ceftazidime (n = 41; 9.8%). The selection of the antibiotic significantly impacts the outcome of NF. The top three causative pathogens for NF are Streptococcus spp. (n = 79; 18.8%), Pseudomonas aeruginosa (n = 61; 14.5%) and Staphylococcus spp. (n = 49; 11.7%). The patients who received antibiotics had 0.779 times lower chances of being amputated. Patients with a lower laboratory risk indicator for necrotizing fasciitis (LRINEC) score had 0.934 times lower chances of being amputated. Conclusions: In this study, the most common empirical antibiotic prescribed was ampicillin + sulbactam followed by clindamycin and ceftazidime. The antibiotics prescribed lower the risk of having an amputation and, hence, a better prognosis of the disease. Broad-spectrum empirical antibiotics following surgical debridement reduce the mortality rate of NF. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

8 pages, 943 KiB

Open AccessArticle

Antibiotic Prescriptions for Respiratory Tract Viral Infections in the Colombian Population

by Manuel E. Machado-Duque, Diego Arturo García, Melissa Hiromi Emura-Velez, Andrés Gaviria-Mendoza, Claudia Giraldo-Giraldo and Jorge E. Machado-Alba

Antibiotics 2021, 10(7), 864; https://doi.org/10.3390/antibiotics10070864 - 16 Jul 2021

Cited by 2 | Viewed by 2287

Abstract

Antimicrobials are frequently inappropriately prescribed for the management of upper respiratory tract infections (URTIs); therefore, the frequency of antibiotic prescriptions for patients with viral URTIs was assessed in this study. A cross-sectional study, including ambulatory patients diagnosed with viral URTI, was conducted, and records of antimicrobial prescriptions were obtained. Sociodemographic, clinical (diagnostic), and pharmacological (antimicrobial) variables were assessed. Through multivariate analysis, variables associated with the use of antibiotics for viral infections were identified. A total of 341,182 patients with viral URTIs were identified. The patients, who were from 26 different departments of Colombia, had a mean age of 29.7 ± 23.5 years and a female predominance of 58.7% (n = 200,195). The most frequent viral infections were as follows: acute rhinopharyngitis (common cold) (n = 206,211; 60.4%); unspecified acute tonsillitis (n = 27,432; 8.0%); and acute pharyngitis (n = 26,411; 7.7%). A total of 24.8% of the patients (n = 84,453) received a prescription for antibiotics, predominantly penicillins (n = 61,871; 18.1%) and cephalosporins (n = 10,926; 3.2%). Patients treated in Atlántico, Valle, and Risaralda departments, along with those older than 5 years, were more likely to receive antibiotics for the treatment of viral infections. Antibiotics are frequently prescribed for the management of URTIs, which is considered an inappropriate practice due to a lack of clinical benefits, increased generation of antimicrobial resistance, and a risk of adverse reactions due to the use of medications that patients do not require. Drug utilization studies are a great tool for monitoring how antibiotics are being used and planning interventions to improve their use. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

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13 pages, 758 KiB

Open AccessArticle

Barriers and Facilitators in Perioperative Antibiotic Prophylaxis: A Mixed-Methods Study in a Small Island Setting

by Liza A. M. van Mun, Sabien J. E. Bosman, Jessica de Vocht, Jaclyn de Kort and Jeroen Schouten

Antibiotics 2021, 10(4), 462; https://doi.org/10.3390/antibiotics10040462 - 19 Apr 2021

Viewed by 2197

Abstract

Few studies have addressed antibiotic guideline adherence in small island settings, such as Aruba. This study aimed to evaluate the appropriateness of perioperative antibiotic prophylaxis (PAP) and identify barriers for PAP guideline adherence. A mixed-methods study was carried out at the operating theatre (OT) in the Dr. Horacio E. Oduber Hospital (HOH) in Aruba. First, a prospective audit was performed on the appropriateness of guideline-derived quality indicators (QIs). Then, interviews based on the Flottorp framework were conducted to identify barriers for guideline adherence. Finally, a survey was distributed to verify the outcomes of the interviews. The appropriateness of QIs was measured: correct indication (50.6%); antimicrobial agent (30.8%); dose (94.4%); timing (55.0%); route of administration (100%); duration (89.5%); and redosing (95.7%). The overall appropriateness was 34.9%. The main barriers discovered were poor knowledge about PAP and the guidelines and professional interactions regarding PAP, specifically poor communication and lack of clarity about responsibilities regarding PAP. This study was the first to evaluate the appropriateness and to identify barriers for PAP guideline adherence in a small island hospital. The overall appropriateness of PAP was poor with just 34.9%. Future interventions should be focused on communication, education and awareness of the possibility to consult an ID physician or microbiologist. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

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Review

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13 pages, 15800 KiB

Open AccessReview

Is Penicillin Allergy a Risk Factor for Early Dental Implant Failure? A Systematic Review

by Angel-Orión Salgado-Peralvo, Juan-Francisco Peña-Cardelles, Naresh Kewalramani, Iván Ortiz-García, Álvaro Jiménez-Guerra, Andrea Uribarri, Eugenio Velasco-Ortega, Jesús Moreno-Muñoz, Enrique Núñez-Márquez and Loreto Monsalve-Guil

Antibiotics 2021, 10(10), 1227; https://doi.org/10.3390/antibiotics10101227 - 09 Oct 2021

Cited by 7 | Viewed by 4769

Abstract

The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients. The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients. An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA^® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin. With the limitations of this study, it is not possible to state that penicillin allergy per se constitutes a risk factor for early dental implant failure as most of the studies included self-reported allergic patients. Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure. Full article

(This article belongs to the Special Issue 10th Anniversary of Antibiotics — Recent Advances in Rational Antimicrobial Use)

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