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Antibiotics
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Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions
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Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions

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 (15 November 2023) | Viewed by 14681

Special Issue Editor

Prof. Dr. Svetlana Rachina

E-Mail Website
Guest Editor
Internal Medicine Department #2, Sechenov First Moscow State Medical University, Moscow, Russia
Interests: respiratory tract infections; antimicrobial consumption; quality indicators; patterns of antibiotic use; antimicrobial stewardship

Special Issue Information

Dear Colleagues,

This Special Issue of Antibiotics addresses variable aspects of antimicrobial usage in hospital settings and strategies to optimize it. Although most antibiotics are prescribed in the community, hospital settings are characterized by a high incidence of their excessive and inappropriate use. To date, there is little doubt that antibiotic overuse and misuse is associated with the spread of antibiotic-resistant pathogens. Antimicrobial resistance has become one of the greatest public health challenges of our time, as it threatens the effective treatment for a wide range of infections. Various approaches are being taken to improve the use of antibiotics in hospitals. Antimicrobial stewardship is widely accepted as the most comprehensive and important strategy for combating antimicrobial resistance. However, its implementation around the world is constantly facing obstacles due to insufficient funding, lack of human resources and challenges such as the COVID-19 pandemic.

Thus, in this Special Issue, the editors would like to focus on original studies and reviews of current trends in antibiotic consumption in hospitals, quantitative and qualitative aspects of their use, and the best practices for implementing antimicrobial stewardship.

Prof. Dr. Svetlana Rachina
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.

Keywords

  • antimicrobial consumption
  • quality indicators
  • patterns of antibiotic use
  • antimicrobial stewardship
  • healthcare-associated infections
  • information campaign
  • decision support systems for antibiotic prescribing

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Published Papers (5 papers)

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Research

18 pages, 1559 KiB  
Article
Improving Clostridioides difficile Infectious Disease Treatment Response via Adherence to Clinical Practice Guidelines
by Dalia Adukauskienė, Rytis Mickus, Asta Dambrauskienė, Tomas Vanagas and Agnė Adukauskaitė
Antibiotics 2024, 13(1), 51; https://doi.org/10.3390/antibiotics13010051 - 4 Jan 2024
Cited by 1 | Viewed by 2138
Abstract
Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral [...] Read more.
Clostridioides difficile (C. difficile) is a predominant nosocomial infection, and guidelines for improving diagnosis and treatment were published in 2017. We conducted a single-center, retrospective 10-year cohort study of patients with primary C. difficile infectious disease (CDID) at the largest referral Lithuanian university hospital, aiming to evaluate the clinical and laboratory characteristics of CDID and their association with the outcomes, as well as implication of concordance with current Clinical Practice Guidelines. The study enrolled a total of 370 patients. Cases with non-concordant CDID treatment resulted in more CDID-related Intensive Care Unit (ICU) admissions (7.5 vs. 1.8%) and higher CDID-related mortality (13.0 vs. 1.8%) as well as 30-day all-cause mortality (61.0 vs. 36.1%) and a lower 30-day survival compared with CDID cases with concordant treatment (p < 0.05). Among cases defined by two criteria for severe CDID, only patients with non-concordant metronidazole treatment had refractory CDID (68.8 vs. 0.0%) compared with concordant vancomycin treatment. In the presence of non-concordant metronidazole treatment for severe CDID, only cases defined by two severity criteria had more CDID-related ICU admissions (18.8 vs. 0.0%) and higher CDID-related mortality (25.0 vs. 2.0%, p < 0.05) compared with cases defined by one criterion. Severe comorbidities and the continuation of concomitant antibiotics administered at CDID onset reduced (p < 0.05) the 30-day survival and increased (p = 0.053) 30-day all-cause mortality, with 57.6 vs. 10.7% and 52.0 vs. 25.0%, respectively. Conclusions: CDID treatment non-concordant with the guidelines was associated with various adverse outcomes. In CDID with leukocytes ≥ 15 × 109/L and serum creatinine level > 133 µmol/L (>1.5 mg/dL), enteral vancomycin should be used to avoid refractory response, as metronidazole use was associated with CDID-related ICU admission and CDID-related mortality. Severe comorbidities worsened the outcomes as they were associated with reduced 30-day survival. The continuation of concomitant antibiotic therapy increased 30-day all-cause mortality; thus, it needs to be reasonably justified, deescalated or stopped. Full article
(This article belongs to the Special Issue Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions)
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12 pages, 760 KiB  
Article
Microfoundations of Data-Driven Antimicrobial Stewardship Policy (ASP)
by Yogita Thakral, Sundeep Sahay and Arunima Mukherjee
Antibiotics 2024, 13(1), 24; https://doi.org/10.3390/antibiotics13010024 - 26 Dec 2023
Viewed by 1842
Abstract
This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, [...] Read more.
This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments. Full article
(This article belongs to the Special Issue Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions)
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14 pages, 7278 KiB  
Article
Development of a Polymicrobial Checkerboard Assay as a Tool for Determining Combinatorial Antibiotic Effectiveness in Polymicrobial Communities
by Caroline Black, Hafij Al Mahmud, Victoria Howle, Sabrina Wilson, Allie C. Smith and Catherine A. Wakeman
Antibiotics 2023, 12(7), 1207; https://doi.org/10.3390/antibiotics12071207 - 20 Jul 2023
Cited by 5 | Viewed by 5613
Abstract
The checkerboard assay is a well-established tool used to determine the antimicrobial effects of two compounds in combination. Usually, data collected from the checkerboard assay use visible turbidity and optical density as a readout. While helpful in traditional checkerboard assays, these measurements become [...] Read more.
The checkerboard assay is a well-established tool used to determine the antimicrobial effects of two compounds in combination. Usually, data collected from the checkerboard assay use visible turbidity and optical density as a readout. While helpful in traditional checkerboard assays, these measurements become less useful in a polymicrobial context as they do not enable assessment of the drug effects on the individual members of the community. The methodology described herein allows for the determination of cell viability through selective and differential plating of each individual species in a community while retaining much of the high-throughput nature of a turbidity-based analysis and requiring no specialized equipment. This methodology further improves turbidity-based measurements by providing a distinction between bacteriostatic versus bactericidal concentrations of antibiotics. Herein, we use this method to demonstrate that the clinically used antibiotic combination of ceftazidime and gentamicin works synergistically against Pseudomonas aeruginosa in monoculture but antagonistically in a polymicrobial culture also containing Acinetobacter baumannii, Staphylococcus aureus, and Enterococcus faecalis, highlighting the fundamental importance of this methodology in improving clinical practices. We propose that this method could be implemented in clinical microbiology laboratories with minimal impact on the overall time for diagnosis. Full article
(This article belongs to the Special Issue Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions)
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13 pages, 1448 KiB  
Article
Assessment of Antimicrobial Consumption in Multi-Field Hospitals with Pediatric Inpatients: Conventional vs. Novel Pediatric-Adjusted Methodologies
by Svetlana Rachina, Yuliya Belkova, Roman Kozlov, Vladimir Mladov, Vladimir Mishchenko, Alla Andreeva, Olga Domanskaya, Ulyana Portnjagina, Anastasiia Dushina and Khadizhat Zainalabidova
Antibiotics 2023, 12(7), 1162; https://doi.org/10.3390/antibiotics12071162 - 7 Jul 2023
Viewed by 1280
Abstract
Background: the objective of this study was to propose a methodology for the assessment of antimicrobial consumption (AMC) in pediatric inpatients and to estimate variances in consumption levels in multi-field hospitals with pediatric inpatients, calculated by means of the pediatric-adjusted methodology vs. the [...] Read more.
Background: the objective of this study was to propose a methodology for the assessment of antimicrobial consumption (AMC) in pediatric inpatients and to estimate variances in consumption levels in multi-field hospitals with pediatric inpatients, calculated by means of the pediatric-adjusted methodology vs. the conventional methodology. Methods: the pediatric-adjusted methodology based on the conventional ATC/DDD method and children’s DDDs (cDDD) for antimicrobials were proposed and validated in a series of probabilistic sensitivity analyses of real clinical data extracted from the receipt notes of three multi-field hospitals. Differences in AMC in multi-field hospitals with pediatric inpatients, calculated by means of the proposed methodology vs. the conventional methodology, were assessed for a virtual cohort of inpatients, with the pediatric share increasing by 1%. Results: in children ≤12 years old, assessment by the standard methodology resulted in a 59% underestimation of AMC from the levels based on prescribed doses, vs. a 25% underestimation for the proposed methodology. In a mixed-age virtual population of inpatients, the underestimation of consumption levels rose to 321% for the ATC/DDD methodology compared to the proposed one. Conclusions: the proposed methodology demonstrated a higher accuracy of AMC estimates compared to the conventional one and can be considered for the quantification of antimicrobial utilization in pediatric institutions and multi-field hospitals with a substantial share of pediatric inpatients. Full article
(This article belongs to the Special Issue Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions)
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9 pages, 254 KiB  
Article
Comparison of the NG-Test Carba 5, Colloidal Gold Immunoassay (CGI) Test, and Xpert Carba-R for the Rapid Detection of Carbapenemases in Carbapenemase-Producing Organisms
by Danxia Gu, Zelin Yan, Chang Cai, Jiaping Li, Yanyan Zhang, Yuchen Wu, Jiaxing Yang, Yonglu Huang, Rong Zhang and Yongning Wu
Antibiotics 2023, 12(2), 300; https://doi.org/10.3390/antibiotics12020300 - 2 Feb 2023
Cited by 10 | Viewed by 2923
Abstract
Carbapenem-resistant Enterobacterales (CRE) are increasingly recognized as an urgent public health concern. The rapid and accurate identification of carbapenemases could provide insights into antimicrobial therapy and infection control. In this study, we evaluated the efficacy of three different methods, including the NG-test Carba [...] Read more.
Carbapenem-resistant Enterobacterales (CRE) are increasingly recognized as an urgent public health concern. The rapid and accurate identification of carbapenemases could provide insights into antimicrobial therapy and infection control. In this study, we evaluated the efficacy of three different methods, including the NG-test Carba 5, colloidal gold immunoassay (CGI) test, and Xpert Carba-R assay, for the rapid detection of five carbapenemases (KPC, NDM, IMP, OXA-48, and VIM). A total of 207 Gram-negative strains collected from patients and hospital sewages were tested. The presence or absence of carbapenemase genes in the whole-genome sequences was used as the gold standard for evaluating the accuracy of the above-mentioned three methods. Among the 192 strains carrying only one carbapenemase gene, the accuracies of the NG-Test Carba 5, CGI test, and Xpert Carba-R were 96.88% (95% CI, 93.01–98.72%), 96.88% (95% CI, 93.01–98.72%), and 97.92% (95% CI, 94.41–99.33%), respectively. Xpert Carba-R was able to detect all 13 types of KPC variants, including KPC-2, KPC-3, KPC-25, KPC-33, KPC-35, KPC-51, KPC-52, KPC-71, KPC-76, KPC-77, KPC-78, KPC-93, and KPC-123, with a detection sensitivity of 100.00% (95% CI, 96.50–100.00%), a specificity of 100.00% (95% CI, 92.38–100.00%), and a κ index of 1.00. For IMP, Carba 5 was superior to the other two methods, with a sensitivity of 100% (95% CI, 71.66–100.00%), a specificity of 100% (95% CI, 97.38–100.00%), and a κ index of 1.00. For the remaining 15 strains carrying two or three kinds of carbapenemase genes, Carba 5 performed the best, which accurately identified all the target genes, followed by Xpert Carba-R (12/15, 80.00%) and the CGI test (10/15, 66.67%). Therefore, all three assays demonstrated reliable performances in carbapenemase detection, and Xpert Carba-R should be recommended for the detection of KPC variants, especially for patients at a high risk of infections caused by ceftazidime/avibactam-resistant strains. IMPORTANCE: CRE was listed as one of the top three pathogens that are in critical need of new antibiotics by the WHO. The rapid and accurate identification of carbapenemases is important for antimicrobial therapy and infection control. In recent years, new beta-lactam/beta-lactamase inhibitor combinations such as ceftazidime/avibactam (CZA) have been approved by the Food and Drug Administration (FDA) to cope with CRE challenges. CZA was effective against class A, class C, and some class D enzymes such as OXA-48-like. However, CZA-resistant KPC variants emerged at an alarming speed, which posed a new challenge for the accurate identification of KPC variants. In this study, we evaluated the performance of two lateral flow immunochromatographic assays, namely, NG-test Carba 5 and the CGI test, and the automated real-time quantitative PCR Xpert Carba-R in the rapid detection of carbapenemases. Notably, 13 types of KPC variants were enrolled in this study, which covered most KPC variants discovered in China. Carba-R was superior to NG-teat Carba 5 and the CGI test; it was able to detect all of the included KPC variants, including KPC-2, KPC-3, KPC-25, KPC-33, KPC-35, KPC-51, KPC-52, KPC-71, KPC-76, KPC-77, KPC-78, KPC-93, and KPC-123. Full article
(This article belongs to the Special Issue Improving Antimicrobial Use in the Hospital: Challenges and Possible Solutions)
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