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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 (29 February 2024) | Viewed by 13288

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Dr. Samantha Flores-Treviño

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Department of Infectious Diseases, University Hospital “Dr. José Eleuterio González” and School of Medicine, Autonomous University of Nuevo León, San Nicolás de los Garza, Mexico
Interests: antimicrobial resistance; nosocomial bacterial pathogens; virulence traits; biofilm production; epidemiological surveillance

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is a highly important threat to global human health. The Centers for Disease Control and Prevention (CDC) issued an updated report with the top-18 drug-resistant bacteria and fungi and grouped them into three categories based on the level of health concern in the United States. AMR is most notable in pathogens related to healthcare-associated infections (HAIs), particularly in susceptible populations already burdened by multidrug-resistant (MDR) organisms. However, antimicrobial resistance in community-associated infections is also an ever-present issue. Both antibiotic overuse and reduced prevention and control infection have accelerated the emergence of MDR strains. Furthermore, the Infectious Diseases Society of America (IDSA) emphasizes the importance of specific HAI MDR pathogens, which are designated as ESKAPE. The clinical relevance of this group lays on the resistance it exhibits to critical drugs needed for treatment. This group includes vancomycin-resistant Enterococcus spp. (VRE), methicillin-resistant Staphylococcus spp. (MRS), MDR Acinetobacter baumannii, MDR Pseudomonas aeruginosa, and carbapenemases and/or extended-spectrum betalactamase (ESBL)-producing Enterobacterales (CRE). A pathogen not considered initially within this group is hypervirulent Clostridioides difficile, which is one of the most common pathogens in hospitalized patients receiving antimicrobial therapy and is also associated with severe disease and high mortality rates. Most of these pathogens have either critical or high priority in the global priority pathogens list of antibiotic-resistant bacteria, which urgently require the research and development of new and effective antibiotic treatments. The World Health Organization Global Action Plan on Antimicrobial Resistance exhorts countries to develop national action plans to strengthen knowledge through surveillance and research, reduce the incidence of infection through infection-prevention measures, and optimize the use of antimicrobial medicines in human health.

For this Special Issue, I am pleased to invite you to contribute original research, case reports, and review papers assessing current antimicrobial-resistance trends in the hospital and community settings, including the frequency and transmission of MDR pathogens, particularly those with alarming resistance trends. Reports, including molecular detection, characterization, antimicrobial-resistance determination, and epidemiological surveillance of critical bacterial pathogens, are welcome.

I look forward to receiving your contributions.

Dr. Samantha Flores-Treviño
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

antibiotic resistance
antimicrobial stewardship
community infections
drug-resistant bacteria
genomic epidemiology
healthcare-associated infections
hospital infections
multidrug resistance
molecular epidemiology
nosocomial transmission

Published Papers (8 papers)

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Research

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13 pages, 436 KiB

Open AccessArticle

Characterizing Antibiotic Regimen Modification Behavior, Patient Characteristics, and Outcomes for Patients with Gram-Negative Bacterial Infections, A Retrospective Single-Center Study

by Jason Yamaki, Mirna Mikhail, Richard Beuttler, Philip Robinson, Emre Yücel and Alexandre H. Watanabe

Antibiotics 2024, 13(4), 302; https://doi.org/10.3390/antibiotics13040302 - 27 Mar 2024

Viewed by 701

Abstract

Few studies describe the frequency of antibiotic regimen modification behaviors in the acute care setting. We sought to ascertain patient and treatment characteristics, details of regimen modification, and clinical outcomes with antibiotic modifications. This retrospective study included patients admitted to Hoag Memorial Hospital from 1 January 2019–31 March 2021 with a complicated infection caused by a Gram-negative organism resistant to extended-spectrum cephalosporins or with the potential for resistance (AmpC producers). A total of 400 patients were included. The predominant sources were bloodstream (33%), urine (26%), and respiratory (24%), including patients with multiple sources. The most isolated organisms were Pseudomonas spp. and ESBL-producing organisms, 38% and 34%, respectively. A total of 72% of patients had antibiotic regimen modifications to their inpatient antibiotic regimens. In patients where modifications occurred, the number ranged from one to six modifications. The most common reasons for modifications included a lack of patient response (14%), additional history reviewed (9%), and decompensation (7%). No difference in clinical outcomes was observed based on antibiotic modifications. The numerous changes in therapy observed may reflect the limitations in identifying patients with resistant organisms early on in admission. This highlights the need for more novel antibiotics and the importance of identifying patients at risk for resistant organisms. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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15 pages, 2251 KiB

Open AccessArticle

Outbreak of Pseudomonas aeruginosa High-Risk Clone ST309 Serotype O11 Featuring bla_PER-1 and qnrVC6

by Romina Papa-Ezdra, Matilde Outeda, Nicolás F. Cordeiro, Lucía Araújo, Pilar Gadea, Virginia Garcia-Fulgueiras, Verónica Seija, Inés Bado and Rafael Vignoli

Antibiotics 2024, 13(2), 159; https://doi.org/10.3390/antibiotics13020159 - 06 Feb 2024

Viewed by 1048

Abstract

Pseudomonas aeruginosa is a leading cause of hospital-acquired infections worldwide. Biofilm production, antibiotic resistance, and a wide range of virulence factors contribute to their persistence in nosocomial environments. We describe an outbreak caused by a multidrug-resistant P. aeruginosa strain in an ICU. Antibiotic susceptibility was determined and bla_PER-1 and qnrVC were amplified via PCR. Clonality was determined using PFGE and biofilm formation was studied with a static model. A combination of antibiotics was assessed on both planktonic cells and biofilms. WGS was performed on five isolates. All isolates were clonally related, resistant to ceftazidime, cefepime, amikacin, and ceftolozane-tazobactam, and harbored bla_PER-1; 11/19 possessed qnrVC. Meropenem and ciprofloxacin reduced the biofilm biomass; however, the response to antibiotic combinations with rifampicin was different between planktonic cells and biofilms. WGS revealed that the isolates belonged to ST309 and serotype O11. bla_PER-1 and qnrVC6 were associated with a tandem of ISCR1 as part of a complex class one integron, with aac(6′)-Il and ltrA as gene cassettes. The structure was associated upstream and downstream with Tn4662 and flanked by direct repeats, suggesting its horizontal mobilization capability as a composite transposon. ST309 is considered an emerging high-risk clone that should be monitored in the Americas. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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12 pages, 694 KiB

Open AccessArticle

From Epidemiology of Community-Onset Bloodstream Infections to the Development of Empirical Antimicrobial Treatment-Decision Algorithm in a Region with High Burden of Antimicrobial Resistance

by Darunee Chotiprasitsakul, Akeatit Trirattanapikul, Warunyu Namsiripongpun, Narong Chaihongsa and Pitak Santanirand

Antibiotics 2023, 12(12), 1699; https://doi.org/10.3390/antibiotics12121699 - 05 Dec 2023

Viewed by 1079

Abstract

Antimicrobial-resistant (AMR) infections have increased in community settings. Our objectives were to study the epidemiology of community-onset bloodstream infections (BSIs), identify risk factors for AMR-BSI and mortality-related factors, and develop the empirical antimicrobial treatment-decision algorithm. All adult, positive blood cultures at the emergency room and outpatient clinics were evaluated from 08/2021 to 04/2022. AMR was defined as the resistance of organisms to an antimicrobial to which they were previously sensitive. A total of 1151 positive blood cultures were identified. There were 450 initial episodes of bacterial BSI, and 114 BSIs (25%) were AMR-BSI. Non-susceptibility to ceftriaxone was detected in 40.9% of 195 E. coli isolates and 16.4% among 67 K. pneumoniae isolates. A treatment-decision algorithm was developed using the independent risk factors for AMR-BSI: presence of multidrug-resistant organisms (MDROs) within 90 days (aOR 3.63), prior antimicrobial exposure within 90 days (aOR 1.94), and urinary source (aOR 1.79). The positive and negative predictive values were 53.3% and 83.2%, respectively. The C-statistic was 0.73. Factors significantly associated with 30-day all-cause mortality were Pitt bacteremia score (aHR 1.39), solid malignancy (aHR 2.61), and urinary source (aHR 0.30). In conclusion, one-fourth of community-onset BSI were antimicrobial-resistant, and one-third of Enterobacteriaceae were non-susceptible to ceftriaxone. Treatment-decision algorithms may reduce overly broad antimicrobial treatment. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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16 pages, 1936 KiB

Open AccessArticle

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients Diagnosed with Surgical Site Infection at Four Hospitals in Ethiopia

by Seble Worku, Tamrat Abebe, Berhanu Seyoum, Ashenafi Alemu, Yidenek Shimelash, Marechign Yimer, Alemseged Abdissa, Getachew Tesfaye Beyene, Göte Swedberg and Adane Mihret

Antibiotics 2023, 12(12), 1681; https://doi.org/10.3390/antibiotics12121681 - 29 Nov 2023

Viewed by 1218

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe surgical site infections (SSI). The molecular epidemiology of MRSA is poorly documented in Ethiopia. This study is designed to determine the prevalence of MRSA and associated factors among patients diagnosed with SSI. A multicenter study was conducted at four hospitals in Ethiopia. A wound culture was performed among 752 SSI patients. This study isolated S. aureus and identified MRSA using standard bacteriology, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and cefoxitin disk diffusion test. The genes mecA, femA, vanA, and vanB were detected through PCR tests. S. aureus was identified in 21.6% of participants, with 24.5% of these being methicillin-resistant Staphylococci and 0.6% showing vancomycin resistance. Using MALDI-TOF MS for the 40 methicillin-resistant Staphylococci, we confirmed that 31 (77.5%) were S. aureus, 6 (15%) were Mammaliicoccus sciuri, and the other 3 (2.5%) were Staphylococcus warneri, Staphylococcus epidermidis, and Staphylococcus haemolyticus. The gene mecA was detected from 27.5% (11/40) of Staphylococci through PCR. Only 36.4% (4/11) were detected in S. aureus, and no vanA or vanB genes were identified. Out of 11 mecA-gene-positive Staphylococci, 8 (72.7%) were detected in Debre Tabor Comprehensive Specialized Hospital. Methicillin-resistant staphylococcal infections were associated with the following risk factors: age ≥ 61 years, prolonged duration of hospital stay, and history of previous antibiotic use, p-values < 0.05. Hospitals should strengthen infection prevention and control strategies and start antimicrobial stewardship programs. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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10 pages, 974 KiB

Open AccessArticle

Multi-Model Strategies for Prevention of Infection Caused by Certain Multi-Drug Resistant Organisms in A Rehabilitation Unit: A Semi-Experimental Study

by Shiyu Li, Ji Lin, Siyuan Tao, Linwen Guo, Wenzhi Huang, Jingwen Li, Chunping Du, Zhiting Wang, Liwen Liu, Yi Chen and Fu Qiao

Antibiotics 2023, 12(7), 1199; https://doi.org/10.3390/antibiotics12071199 - 18 Jul 2023

Viewed by 1054

Abstract

Objective: To assess the effectiveness of multi-model strategies on healthcare-associated infections (HAIs) caused by multi-drug resistant organisms (MDROs) in rehabilitation units. Methods: A semi-experimental study was conducted in a rehabilitation unit with 181 beds from January 2021 to December 2022 in a teaching hospital with 4300 beds in China. In 2021, many basic prevention and control measures were conducted routinely. Based on the basic measures, strengthening multi-model strategies for the prevention and control of MDROs was pursued year-round since 1 January 2022. Results: A total of 6206 patients were enrolled during the study period. The incidence density of HAIs caused by MDROs decreased from 1.22 (95% CI, 0.96~1.54) cases/1000 patient-days in the pre-intervention period to 0.70 (95% CI, 0.50~0.95) cases/1000 patient-days (p = 0.004). Similarly, the incidence of HAIs in the intervention period was 50.85% lower than that in the pre-intervention period (2.02 (95% CI, 1.50~2.72) vs. 4.11 (95% CI, 3.45–4.85) cases/100 patients, p < 0.001). The rate of MDROs isolated from the environment decreased by 30.00%, although the difference was not statistically significant (p = 0.259). Conclusion: Multi-model strategies can reduce the incidence of HAIs and HAIs caused by certain MDROs in the rehabilitation unit. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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14 pages, 280 KiB

Open AccessArticle

Teicoplanin-Resistant Coagulase-Negative Staphylococci: Do the Current Susceptibility Testing Methods Reliably Detect This Elusive Phenotype?

by Adriana D. Balasiu and Colin R. MacKenzie

Antibiotics 2023, 12(3), 611; https://doi.org/10.3390/antibiotics12030611 - 19 Mar 2023

Cited by 1 | Viewed by 1686

Abstract

Coagulase-negative staphylococci (CoNS), members of the skin commensal microbiota, are increasingly associated with local or systemic infections due to a shift in patient populations in recent decades. Subsequently, more CoNS strains have been subjected to antibiotic susceptibility testing (AST), thus leading to the increased detection of teicoplanin resistance. However, data concerning teicoplanin resistance among CoNS strains remain limited, heterogeneous, and inconclusive. We collected 162 consecutive CoNS strains identified using Vitek-2 as teicoplanin-resistant and tested them with a range of AST methods. The results of standard and high inoculum broth microdilution (sBMD; hBMD), agar dilution (AD) after 24 h and 48 h incubation, standard and macrogradient diffusion strip (sGDT, MET), screening agar, and disc diffusion were compared to assess their robustness and to establish a diagnostic algorithm to detect teicoplanin resistance. sBMD was used as the reference method, and the lowest number of strains were teicoplanin-resistant using this method. sGDT and disc diffusion generated similar results to sBMD. Compared with sBMD, AD-24 h generated the lowest number of false teicoplanin-resistant strains, followed by hBMD, AD-48 h, and Vitek-2. sGDT, a fast, easy, affordable method in diagnostic settings, generated the highest rate of false teicoplanin-susceptible strains. Vitek-2 testing produced the highest number of teicoplanin-resistant strains. Only in two strains was the initial Vitek-2 teicoplanin resistance confirmed using five other AST methods. In conclusion, the different antibiotic susceptibility testing methods generated inconsistent, inconclusive, and discrepant results, thus making it difficult to establish a diagnostic algorithm for suspected teicoplanin resistance. Teicoplanin testing proved to be challenging and easily influenced by technical factors. This study aimed not only to raise awareness of teicoplanin resistance testing but also of the need for future studies focusing on the clinical efficacy of teicoplanin in relation to its susceptibility results. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

10 pages, 968 KiB

Open AccessArticle

Molecular Characterization of Community- and Hospital- Acquired Methicillin-Resistant Staphylococcus aureus Isolates during COVID-19 Pandemic

by Muhammad Sohail, Moazza Muzzammil, Moaz Ahmad, Sabahat Rehman, Mohammed Garout, Taghreed M. Khojah, Kholoud M. Al-Eisa, Samar A. Breagesh, Rola M. Al Hamdan, Halimah I. Alibrahim, Zainab A. Alsoliabi, Ali A. Rabaan and Naveed Ahmed

Antibiotics 2023, 12(1), 157; https://doi.org/10.3390/antibiotics12010157 - 12 Jan 2023

Cited by 6 | Viewed by 2566

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a drug-resistant superbug that causes various types of community- and hospital-acquired infectious diseases. The current study was aimed to see the genetic characteristics and gene expression of MRSA isolates of nosocomial origin. A total of 221 MRSA isolates were identified from 2965 clinical samples. To identify the bacterial isolates, the clinical samples were inoculated on blood agar media plates first and incubated at 37 °C for 18–24 h. For further identification, the Gram staining and various biochemical tests were performed once the colonies appeared on the inoculated agar plates. The phenotypic identification of antibiotic susceptibility patterns was carried out using Kirby–Bauer disk diffusion method by following the Clinical and Laboratory Standards Institute (CLSI) 2019 guidelines. The biofilm-producing potentials of MRSA were checked quantitatively using a spectrophotometric assay. All strains were characterized genotypically by SCCmec and agr typing using the specific gene primers. Furthermore, a total of twelve adhesion genes were amplified in all MRSA isolates. MRSA was a frequently isolated pathogen (44% community acquired (CA)-MRSA and 56% hospital acquired (HA)-MRSA), respectively. Most of the MRSA isolates were weak biofilm producers (78%), followed by moderate (25%) and strong (7%) biofilm producers, respectively. Prominent adhesion genes were clfB (100%), icaAD (91%), fib (91%), sdrC (91%) followed by eno (89%), fnbA (77%), sdrE (67%), icaBC (65%), clfA (65%), fnbB (57%), sdrD (57%), and cna (48%), respectively. The results of the current study will help to understand and manage the spectrum of biofilm-producing MRSA-associated hospital-acquired infections and to provide potential molecular candidates for the identification of biofilm-producing MRSA. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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Review

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38 pages, 1810 KiB

Open AccessReview

Multidrug-Resistant Sepsis: A Critical Healthcare Challenge

by Nishitha R. Kumar, Tejashree A. Balraj, Swetha N. Kempegowda and Akila Prashant

Antibiotics 2024, 13(1), 46; https://doi.org/10.3390/antibiotics13010046 - 04 Jan 2024

Cited by 3 | Viewed by 3259

Abstract

Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Hospital- and Community-Associated Infections)

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