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Antibiotics
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Rational Use of Antibiotics in Bloodstream Infection
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Rational Use of Antibiotics in Bloodstream Infection

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 (20 February 2024) | Viewed by 11344

Special Issue Editor

Dr. Tsung-Yu Huang

E-Mail Website
Guest Editor
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Interests: skin and soft tissue infections; necrotizing fasciitis; extra-pulmonary tuberculosis; antimicrobial stewardship
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial therapy is administered to one-fifth to two-thirds of hospitalized patients. Globally, inappropriate antibiotic use is on the rise in hospital settings, including general wards and intensive care units. Bloodstream infections treated with antibiotics inappropriately can result in increased antimicrobial consumption, expenditures, hospital stays, costs, antimicrobial resistance, and mortality in hospitalization. Nosocomial infections induced by multidrug-resistant organisms, both Gram-positive cocci and Gram-negative bacilli, are increasingly widespread in hospital settings. Microbiologists and new technology can identify pathogen susceptibility patterns and organisms to prevent fatalities. However, clinical doctors typically order antibiotics based on bacterial culture even if there is no evidence of infection despite the pathogens being isolated. We are pleased to invite you to submit articles related to antibiotic stewardship, education, antibiotic resistance, bloodstream infections in intensive care units, different pathogens causing bloodstream infections, indication of antibiotic use, antimicrobial consumption, and expenditure. This Special Issue, “Rational Use of Antibiotics in Bloodstream Infection”, welcomes all submissions from a variety of fields that use any method to reduce inappropriate antibiotic use, antibiotic resistance, and in-hospital mortality through improvement of the use of antibiotics.

Dr. Tsung-Yu Huang
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

  • bloodstream infection
  • bacteremia
  • rational antibiotic usage
  • antibiotic resistance
  • multidrug resistant organism
  • intensive care units
  • infectious disease physician
  • antibiotic stewardship
  • education
  • de-escalation

Related Special Issue

Published Papers (6 papers)

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Research

10 pages, 598 KiB  
Article
Daptomycin Use for Persistent Coagulase-Negative Staphylococcal Bacteremia in a Neonatal Intensive Care Unit
by Eleni Papachatzi, Despoina Gkentzi, Sotiris Tzifas, Theodore Dassios and Gabriel Dimitriou
Antibiotics 2024, 13(3), 254; https://doi.org/10.3390/antibiotics13030254 - 12 Mar 2024
Viewed by 978
Abstract
During the last two decades, the incidence of late-onset sepsis (LOS) has increased due to improved survival of premature neonates. Persistent bacteremia (PB) in LOS is defined as more than two positive blood cultures obtained on different calendar days during the same infectious [...] Read more.
During the last two decades, the incidence of late-onset sepsis (LOS) has increased due to improved survival of premature neonates. Persistent bacteremia (PB) in LOS is defined as more than two positive blood cultures obtained on different calendar days during the same infectious episode. Although rare, PB should be treated aggressively to prevent adverse outcomes. Daptomycin, a lipopeptide antibiotic, has been used in neonates with persistent coagulase-negative staphylococci (CoNS) bacteremia with promising results, but studies reporting on the efficacy and safety of the agent are scarce. The purpose of this study was to evaluate the efficacy and safety of daptomycin use for persistent CoNS bacteremia in a neonatal cohort. This is a retrospective, observational, single-center study of neonates treated with daptomycin during 2011–2022 in the Tertiary Neonatal Intensive Care Unit (NICU) of the University General Hospital of Patras, Greece. For the years 2011–2022, there were 3.413 admissions to the NICU. During the last 3 years (2020–2022)—the active epidemiological surveillance period—123 infants (out of 851 admissions, 14.4%) developed CoNS bacteremia (LOS). During the study period, twelve infants with PB were treated with daptomycin. They had a median gestational age of 32 weeks (IQR 31–34) and mean (SD) birth weight of 1.840 (867) grams. CoNS bacteremia isolates were s. epidermidis (50%), s. haemolyticus (20%), s. hominis (20%) and s. warneri (10%). The decision to start daptomycin (6 mg/kg/dose twice daily) was taken on median day 10 (ΙQR 7–15) of infection. None of the infants had focal complications or meningitis. Daptomycin therapy caused no renal, hepatic, muscular or gastrointestinal adverse events. One neonate developed seizures, and one death occurred due to multiple complications of prematurity. Most infants (11/12) were successfully treated and eventually had negative blood culture. Daptomycin monotherapy showed an adequate cure rate in premature neonates with persistent CoNS bacteremia in a tertiary NICU. In our study, daptomycin was effective and well tolerated; the safety profile, however, needs to be confirmed in larger studies and randomized controlled trials. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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11 pages, 955 KiB  
Article
High Incidence of Metastatic Infections in Panton-Valentine Leucocidin-Negative, Community-Acquired Methicillin-Resistant Staphylococcus aureus Bacteremia: An 11-Year Retrospective Study in Japan
by Hitoshi Kawasuji, Yoshihiro Ikezawa, Mika Morita, Kazushige Sugie, Mayu Somekawa, Masayoshi Ezaki, Yuki Koshiyama, Yusuke Takegoshi, Yushi Murai, Makito Kaneda, Kou Kimoto, Kentaro Nagaoka, Hideki Niimi, Yoshitomo Morinaga and Yoshihiro Yamamoto
Antibiotics 2023, 12(10), 1516; https://doi.org/10.3390/antibiotics12101516 - 06 Oct 2023
Viewed by 1166
Abstract
Panton-Valentine leucocidin (PVL)-negative community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was originally disseminated in Japan and has since replaced healthcare-associated MRSA (HA-MRSA). However, the clinical characteristics of CA-MRSA bacteremia (CA-MRSAB) compared with those of HA-MRSA bacteremia (HA-MRSAB) are unknown. We aim to clarify differences and [...] Read more.
Panton-Valentine leucocidin (PVL)-negative community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was originally disseminated in Japan and has since replaced healthcare-associated MRSA (HA-MRSA). However, the clinical characteristics of CA-MRSA bacteremia (CA-MRSAB) compared with those of HA-MRSA bacteremia (HA-MRSAB) are unknown. We aim to clarify differences and investigate associations between the clinical manifestations and virulence genes associated with plasma-biofilm formation in PVL-negative CA-MRSA. From 2011 to 2021, when CA-MRSA dramatically replaced HA-MRSA, 79 MRSA strains were collected from blood cultures and analyzed via SCCmec typing and targeted virulence gene (lukSF-PV, cna, and fnbB) detection. The incidence of metastatic infection was significantly higher in CA-MRSAB than in HA-MRSAB. PVL genes were all negative, although cna and fnbB were positive in 55.6% (20/36) and 50% (18/36) of CA-MRSA strains and 3.7% (1/27) and 7.4% (2/27) of HA-MRSA strains, respectively. cna and fnbB carriage were not associated with the development of metastatic infections in MRSAB; however, the bacteremia duration was significantly longer in CA-MRSAB harboring cna. CA-MRSAB may be more likely to cause metastatic infections than HA-MRSAB. Since CA-MRSA is dominant in Japan, suspected metastatic infection foci should be identified by computed tomography, magnetic resonance imaging, and echocardiography when treating MRSAB. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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10 pages, 582 KiB  
Article
Microbiological Assessment of the FilmArray Blood Culture Identification 2 Panel: Potential Impact in Critically Ill Patients
by Carola Mauri, Alessandra Consonni, Elena Briozzo, Chiara Giubbi, Elisa Meroni, Silvia Tonolo and Francesco Luzzaro
Antibiotics 2023, 12(8), 1247; https://doi.org/10.3390/antibiotics12081247 - 29 Jul 2023
Viewed by 1178
Abstract
Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with bloodstream infections (BSI) and in achieving their improved outcomes. In this context, the FilmArray Blood Culture Identification (BCID2) panel is an FDA approved molecular test, which [...] Read more.
Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with bloodstream infections (BSI) and in achieving their improved outcomes. In this context, the FilmArray Blood Culture Identification (BCID2) panel is an FDA approved molecular test, which can quickly identify different species and resistance determinants, thus making an impact in antimicrobial practice. In this study, we analyzed 136 positive blood cultures collected from septic critically ill patients from April 2021 to March 2023 by using the FilmArray BCID2 panel, and results obtained by fast molecular analysis were compared to those obtained by routine protocols. Overall, the BCID2 panel showed a strong concordance with conventional methods, particularly in the case of monomicrobial samples, whereas some discrepancies were found in 10/32 polymicrobial samples. Of note, this technique allowed us to identify a significant number of yeasts (37/94 samples) and to unravel the presence of several resistance markers, including both Gram-positive and Gram-negative organisms. These findings strongly support the potential use of the BCID2 panel as an adjunct to the conventional microbiology methods for the management of critically ill septic patients, thus accelerating blood pathogen and resistance genes identification, focusing antibiotic therapy, and avoiding inappropriate and excessive use of drugs. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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12 pages, 1585 KiB  
Article
Insight into the Clonal Lineage and Antimicrobial Resistance of Staphylococcus aureus from Vascular Access Infections before and during the COVID-19 Pandemic
by Chih-Chen Kao, Chi-Hsiang Lai, Min-Yi Wong, Tsung-Yu Huang, Yuan-Hsi Tseng, Chu-Hsueh Lu, Chien-Chao Lin and Yao-Kuang Huang
Antibiotics 2023, 12(6), 1070; https://doi.org/10.3390/antibiotics12061070 - 18 Jun 2023
Viewed by 1001
Abstract
Patients receiving hemodialysis are at risk of vascular access infections (VAIs) and are particularly vulnerable to the opportunistic pathogen Staphylococcus aureus. Hemodialysis patients were also at increased risk of infection during the COVID-19 pandemic. Therefore, this study determined the change in the [...] Read more.
Patients receiving hemodialysis are at risk of vascular access infections (VAIs) and are particularly vulnerable to the opportunistic pathogen Staphylococcus aureus. Hemodialysis patients were also at increased risk of infection during the COVID-19 pandemic. Therefore, this study determined the change in the molecular and antibiotic resistance profiles of S. aureus isolates from VAIs during the pandemic compared with before. A total of 102 S. aureus isolates were collected from VAIs between November 2013 and December 2021. Before the pandemic, 69 isolates were collected, 58%, 39.1%, and 2.9% from arteriovenous grafts (AVGs), tunneled cuffed catheters (TCCs), and arteriovenous fistulas (AVFs), respectively. The prevalence of AVG and TCC isolates changed to 39.4% and 60.6%, respectively, of the 33 isolates during the pandemic. Sequence type (ST)59 was the predominant clone in TCC methicillin-resistant S. aureus (MRSA) and AVG-MRSA before the pandemic, whereas the predominant clone was ST8 in AVG-MRSA during the pandemic. ST59 carrying the ermB gene was resistant to clindamycin and erythromycin. By contrast, ST8 carrying the msrA gene was exclusively resistant to erythromycin. The ST distribution for different VAIs changed from before to during the pandemic. The change in antibiotic resistance rate for different VAIs was closely related to the distribution of specific STs. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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13 pages, 1893 KiB  
Article
Development and Validation of a Prognostic Model for Multi-Drug-Resistant Non-Hospital-Acquired Bloodstream Infection
by Emanuele Pivetta, Silvia Corcione, Paolo Peasso, Irene Cara, Alberto Capodanno, Andrea Brussino, Paolo Petitti, Eleonora Galli, Maddalena Galmozzi, Valeria Ghisetti, Rossana Cavallo, Franco Aprà, Enrico Lupia, Francesco Giuseppe De Rosa and Giuseppe Montrucchio
Antibiotics 2023, 12(6), 955; https://doi.org/10.3390/antibiotics12060955 - 24 May 2023
Viewed by 1234
Abstract
Bloodstream infections (BSI) are an increasing cause of admissions to hospitals. Non-hospital-acquired BSI are defined by blood cultures that are positive less than 48 hours after admission, but a relevant difference exists between community-acquired and healthcare-associated (HCA) BSI in terms of risk of [...] Read more.
Bloodstream infections (BSI) are an increasing cause of admissions to hospitals. Non-hospital-acquired BSI are defined by blood cultures that are positive less than 48 hours after admission, but a relevant difference exists between community-acquired and healthcare-associated (HCA) BSI in terms of risk of multidrug resistance (MDR). We planned a retrospective study in three different cohorts in order to develop and to temporally and spatially validate an easy and rapid prognostic model for identifying MDR non-hospital-acquired (non-HA) BSI. The pathogens most involved in BSI are Staphylococcus spp. and Escherichia coli, responsible for about 75% of all MDR isolated. The model includes age, gender, long-term care facility admission, immunocompromise, any recent invasive procedures and central line placement, recent intravenous treatment and antibiotic treatment. It shows an acceptable performance, especially for intermediate probabilities of MDR infection, with a C-index of 70%. The model was proposed in a nomogram that could allow better targeting of antibiotic therapy for non-HA BSI admitted in hospital. However, it should be further validated to determine its applicability in other populations. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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13 pages, 1303 KiB  
Article
Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions
by Hung-Yen Chen, Tsung-Yu Huang, Jiun-Liang Chen, Liang-Tseng Kuo, Kuo-Chin Huang and Yao-Hung Tsai
Antibiotics 2022, 11(11), 1454; https://doi.org/10.3390/antibiotics11111454 - 22 Oct 2022
Cited by 2 | Viewed by 4974
Abstract
Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with [...] Read more.
Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with different organisms, to appraise the appropriate use of ceftriaxone, and to compare the clinical and laboratory risk indicators of NF patients with Gram-positive and Gram-negative infections on the initial examination. Methods: From March 2018 to December 2020, there were seventy-four NF patients with positive monomicrobial bacterial cultures enrolled based on surgical confirmation, and were categorized into two groups: the Gram-positive group and the Gram-negative group. Ceftriaxone susceptibility tests were carried out using the standard disk diffusion technique. Data, such as demographics, clinical outcomes, microbiological results, presentations of hemorrhagic bullae, and laboratory findings, were compared among these two groups. Results: The Gram-negative group included 52 patients, of whom 6 patients died, resulting in a mortality rate of 11.5%. The Gram-positive group included 22 patients and none died. Patients with bacteremia, hemorrhagic bullae, shock, fever, higher segmented forms and banded forms, and lower platelet counts constituted higher proportions in the Gram-negative group than in the Gram-positive group. The multivariate analysis identified six variables for the differentiation of Gram-negative and Gram-positive NF: the presentation of bacteremia, hemorrhagic bullae, shock at first consultation, fever with body temperature > 38.5 °C, band forms > 0%, and segmented forms ≦ 74%. A total of 66 isolates (89.2%) was susceptible to ceftriaxone. Conclusions: Gram-negative NF patients were significantly associated with hemorrhagic bullae presentation, blood stream infection, and mortality. Physicians should be alert to NF patients with the appearance of bacteremia, shock, fever, higher WBC banded and segmented forms, and lower platelet counts at the emergency department, with patients revealed to more likely have Gram-negative infections. Ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appeared to be clinically effective for the treatment of NF and blood stream infections. Full article
(This article belongs to the Special Issue Rational Use of Antibiotics in Bloodstream Infection)
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