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Antibiotics
Special Issues
Antimicrobial Stewardship in the Management of Bloodstream Infections
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Antimicrobial Stewardship in the Management of Bloodstream Infections

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

Deadline for manuscript submissions: 28 February 2026 | Viewed by 870

Special Issue Editors

Prof. Dr. Zoran Todorovic

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Guest Editor
1. Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
2. University Clinical Hospital Center "Bezanijska Kosa", Belgrade, Serbia
Interests: antibiotics; ischemia-reperfusion injury; lipidomics; pharmacovigilance; bioethics
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Gordana Dragović

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Guest Editor
Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Interests: antiviral drugs; antiretroviral drugs; HIV; COVID-19; pharmacokinetics; pharmacogenomics; TDM
Prof. Dr. Saša Trailović

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Guest Editor
Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
Interests: anthelmintic drugs; anthelmintic resistance and its mechanism drug-drug interaction; side effects of drugs

Special Issue Information

Dear Colleagues,

We cordially invite you to contribute to this Special Issue, entitled "Antimicrobial Stewardship in the Management of Bloodstream Infections". Antimicrobial drugs are the mainstay treatment of infections. Blood infections caused by contamination with different pathogens are called bloodstream infections and include bacteremias, fungemias, viremias, or parasitemias. They should be distinguished from sepsis, which has an exaggerated inflammatory response. Regarding blood-borne viruses, the CDC emphasizes the importance of HIV, hepatitis B, and hepatitis C. The presence of blood-borne microbes is a sign of a pathological process. They enter the blood in different ways, from dental procedures through surgical interventions to pneumonia or the use of foreign devices such as catheters.

An immune reaction to microbes in the blood can lead to sepsis or septic shock, while the transmission of microbes to other tissues can give rise to secondary foci (e.g., endocarditis, meningitis, or osteomyelitis).

A particular challenge is the emergence of bloodstream infections in patients with altered immune responses, including immunodeficient patients with solid tumors, hematological malignancies, congenital immune system disabilities, and chronic non-transmissible diseases or infections, not to mention certain specific cohorts (e.g., premature infants and newborns).

Considering the increasing resistance of bacteria, viruses, parasites, and fungi to antimicrobial drugs, therapeutic approaches in patients with bloodstream infections are becoming increasingly challenging. To optimally treat these infections, a more profound knowledge of the pharmacokinetics and pharmacodynamics of antimicrobial drugs and the relationship between pharmacokinetics and pharmacodynamics (PK/PD) is necessary. Therapeutic drug monitoring in these infections is of essential importance.

Prof. Dr. Zoran Todorovic
Prof. Dr. Gordana Dragović 
Prof. Dr. Saša Trailović
Guest Editors

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.

Keywords

  • bloodstream infections
  • antimicrobial drugs
  • immunodeficiency
  • sepsis
  • antimicrobial resistance
  • therapeutic drug monitoring

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Published Papers (1 paper)

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24 pages, 2071 KB  
Article
Increased Antimicrobial Consumption, Isolation Rate, and Resistance Profiles of Multi-Drug Resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii During the COVID-19 Pandemic in a Tertiary Healthcare Institution
by Predrag Savic, Ljiljana Gojkovic Bukarica, Predrag Stevanovic, Teodora Vitorovic, Zoran Bukumiric, Olivera Vucicevic, Nenad Milanov, Vladimir Zivanovic, Ana Bukarica and Milos Gostimirovic
Antibiotics 2025, 14(9), 871; https://doi.org/10.3390/antibiotics14090871 - 29 Aug 2025
Viewed by 535
Abstract
Background: The aims of this paper are to examine the impact of the COVID-19 pandemic on the non-rational use of antibiotics and potential alterations in the antibiotic resistance profiles of multi-drug resistant (MDR) isolates of Klebsiella pneumoniae (KPN), Pseudomonas aeruginosa (PAE), and Acinetobacter [...] Read more.
Background: The aims of this paper are to examine the impact of the COVID-19 pandemic on the non-rational use of antibiotics and potential alterations in the antibiotic resistance profiles of multi-drug resistant (MDR) isolates of Klebsiella pneumoniae (KPN), Pseudomonas aeruginosa (PAE), and Acinetobacter baumannii (ABA). Material and Methods: This study was conducted at the tertiary University Hospital “Dr Dragisa Misovic-Dedinje” (Belgrade, Serbia) and was divided into three periods: pre-pandemic (1.4.2019–31.3.2020, period I), COVID-19 pandemic (1.4.2020–31.3.2021, period II), and COVID-19 pandemic-second phase (1.4.2021–31.3.2022, period III). Cultures were taken from each patient with clinically suspected infection (symptoms, biochemical markers of infection). All departments of the hospital were included in this study. Based on the source, all microbiological specimens were divided into 1° blood, 2° respiratory tract (tracheal aspirate, bronchoalveolar lavage fluid, throat, sputum), 3° central-line catheter, 4° urine, 5° urinary catheter, 6° skin and soft tissue, and 6° other (peritoneal fluid, drainage sample, bioptate, bile, incisions, fistulas, and abscesses). After the isolation of bacterial strains from the samples, an antibiotic sensitivity test was performed for each individual isolate with the automated Vitek® 2 COMPACT. Antibiotic consumption testing was performed by the WHO guideline equations (ATC/DDD). Results: A total of 2196 strains of KPN, PAE, and ABA from 41,144 hospitalized patients were isolated (23.6% of the number of total isolates). The number of ABA isolates statistically increased (p = 0.021), while the number of PAE isolates statistically decreased (p = 0.003) during the pandemic. An increase in the percentage of MDR strains was observed for KPN (p = 0.028) and PAE (p = 0.027). There has been an increase in the antibiotic resistance of KPN for piperacillin–tazobactam, the third and fourth generations of cephalosporins (ceftriaxone, ceftazidime, and cefepime), all carbapanems (imipenem, meropenem, and ertapenem), and levofloxacin; of PAE for imipenem; and of ABA for amikacin. Total antibiotic consumption increased (from 755 DBD to 1300 DBD, +72%), especially in the watch and reserve group of antibiotics. The highest increases were noted for vancomycin, levofloxacin, azithromycin, and meropenem. MV positively correlated with the increased occurrence of MDR KPN (r = 0.35, p = 0.009) and MDR PAE (r = 0.43, p = 0.009) but not for MDR ABA (r = 0.09, p = 0.614). There has been a statistically significant increase in the Candida sp. isolates, but the prevalence of Clostridium difficile infection remained unchanged. Conclusions: The COVID-19 pandemic has influenced the increase in total and MDR strains of KPN, ABA, and PAE and worsened their antibiotic resistance profiles. An increase in the consumption of both total and specific antibiotics was observed, mostly of fluoroquinolones and carbapenems. A positive correlation between the number of patients on MV and an increase in MDR KPN and MDR PAE strains was noted. It is necessary to adopt and demand the implementation of appropriate antimicrobial stewardship interventions to decrease the resistance of intrahospital pathogens to antibiotics. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in the Management of Bloodstream Infections)
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