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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 8567

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Prof. Dr. Egidia Gabriela Miftode

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Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
Interests: systemic infections; antibiotic resistance; CNS infections; viral hepatitis
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Prof. Dr. Gabriel Adrian Popescu

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Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania
Interests: antibiotic resistance; severe infections; rare infections

Dr. Simin-Aysel Florescu

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Special Issue Information

Dear Colleagues,

The antimicrobial resistance (AMR) is inducing an increasingly significant burden on public health, this issue becoming even more pronounced in the context of COVID-19 pandemic. The infection with SARS-CoV 2, until recently an absolutely unknown element in the landscape of infectious pathology, created from the very beginning the premises of fear both in general population and among healthcare personnel, an aspect which led to a further attitude of overprotection. Subsequently, a systematic, early, and often non-judicious administration of antibiotics has been observed, even in the absence of any data attesting to a co-infection. An eventual later development of a true superinfection often necessitated therapy escalation or an extension of the administration period of the initial antibiotic regimen.

Last, but not least, it is worrisome that the dramatic increase in misuse or overuse of reserve antibiotics, with difficult to quantify consequences concerning the resistance patterns of certain germs or the mortality rates associated with these infections.

The main purpose of this Special Issue is to provide an appropriate background for sharing with us your experience gained during the COVID-19 pandemic period, so that the data provided could enhance the therapeutic management and optimize the antibiotic regimens in all services where infectious pathologies are a constant of daily clinical practice. Therefore, original research and reviews from interdisciplinary areas focusing on antibiotic therapy and antibiotic resistance related to COVID-19 will be of great interest.

Prof. Dr. Egidia Gabriela Miftode
Prof. Dr. Gabriel Adrian Popescu
Dr. Simin-Aysel Florescu
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.

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Keywords

Coronavirus disease 2019
COVID-19
antimicrobial resistance
antimicrobial treatment
antimicrobial development
superinfections

Published Papers (5 papers)

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16 pages, 1277 KiB

Open AccessArticle

The Clash of the Titans: COVID-19, Carbapenem-Resistant Enterobacterales, and First mcr-1-Mediated Colistin Resistance in Humans in Romania

by Ionela-Larisa Miftode, Daniela Leca, Radu-Stefan Miftode, Florin Roşu, Claudia Plesca, Isabela Loghin, Amalia Stefana Timpau, Ivona Mitu, Irina Mititiuc, Olivia Dorneanu and Egidia Miftode

Antibiotics 2023, 12(2), 324; https://doi.org/10.3390/antibiotics12020324 - 03 Feb 2023

Cited by 8 | Viewed by 1420

Abstract

(1) Background: Antibiotic resistance and coronavirus disease-19 (COVID-19) represent a dual challenge in daily clinical practice, inducing a high burden on public health systems. Hence, we aimed to dynamically evaluate the impact of COVID-19 on patients with carbapenem-resistant Enterobacterales (CRE) urinary tract infections (UTIs), as well as the antibiotic resistance trends after the onset of the pandemic. (2) Methods: We conducted a prospective study including patients with CRE UTIs who were enrolled both pre- and during the pandemic from 2019 to 2022. We further performed a standardized and comparative clinical, paraclinical, and microbiological assessment between patients with and without COVID-19. (3) Results: A total of 87 patients with CRE UTIs were included in this study (46 pre-pandemic and 41 during the pandemic, of which 21 had associated Severe Acute Respiratory Syndrome Coronavirus-2 infection). Klebsiella pneumoniae was the main etiological agent of the UTIs, with the majority of strains (82.7%) being carbapenemase producers (mainly OXA-48 producers), while five of the 34 colistin-resistant isolates were harboring the mobile colistin resistance-1 (mcr-1) gene. COVID-19 patients presented a significantly worse outcome with higher rates of intensive care unit (ICU) admissions (66.7% for COVID patients vs. 18.2% for non-COVID patients, p < 0.001), while the fatality rates were also considerably higher among patients with concomitant viral infection (33.3% vs. 12.1%, p < 0.001). Besides COVID-19, additional risk factors associated with increased mortality were urinary catheterization, sepsis with K. pneumoniae, impaired liver and kidney function, and an inappropriate initial empiric antibiotic therapy. (4) Conclusions: COVID-19 showed a pronounced negative impact on patients with CRE UTIs, with significantly longer hospitalizations and higher ICU admissions and mortality rates. Full article

(This article belongs to the Special Issue United in the Prevention of Bacterial Resistance during the COVID-19 Era)

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10 pages, 1173 KiB

Open AccessArticle

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward

by Felicia Sturza, Ștefan-Decebal Guță and Gabriel-Adrian Popescu

Antibiotics 2023, 12(1), 150; https://doi.org/10.3390/antibiotics12010150 - 11 Jan 2023

Cited by 1 | Viewed by 1524

Abstract

Background: although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. Methods: in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. Results: from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54–76) vs. 65 (52.5–71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2–5) vs. 2 (1–4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X² = 39.563] and required more oxygen [3 (0–6) vs. 0 (0–2), p < 0.001, r = 0.328]. Conclusion: empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment. Full article

(This article belongs to the Special Issue United in the Prevention of Bacterial Resistance during the COVID-19 Era)

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18 pages, 1103 KiB

Open AccessArticle

An Overview of the Impact of Bacterial Infections and the Associated Mortality Predictors in Patients with COVID-19 Admitted to a Tertiary Center from Eastern Europe

by Amalia-Stefana Timpau, Radu-Stefan Miftode, Irina-Iuliana Costache, Antoniu Octavian Petris, Ionela-Larisa Miftode, Liliana Gheorghe, Razvan Timpau, Ioana Diandra Miftode, Cristian Sorin Prepeliuc, Ioana Coman, Dana-Teodora Anton-Paduraru, Cristina Tuchilus and Egidia Gabriela Miftode

Antibiotics 2023, 12(1), 144; https://doi.org/10.3390/antibiotics12010144 - 11 Jan 2023

Cited by 6 | Viewed by 1999

Abstract

1. Background: Literature data on bacterial infections and their impact on the mortality rates of COVID-19 patients from Romania are scarce, while worldwide reports are contrasting. 2. Materials and Methods: We conducted a unicentric retrospective observational study that included 280 patients with SARS-CoV-2 infection, on whom we performed various microbiological determinations. Based on the administration or not of the antibiotic treatment, we divided the patients into two groups. First, we sought to investigate the rates and predictors of bacterial infections, the causative microbial strains, and the prescribed antibiotic treatment. Secondly, the study aimed to identify the risk factors associated with in-hospital death and evaluate the biomarkers’ performance for predicting short-term mortality. 3. Results: Bacterial co-infections or secondary infections were confirmed in 23 (8.2%) patients. Acinetobacter baumannii was the pathogen responsible for most of the confirmed bacterial infections. Almost three quarters of the patients (72.8%) received empiric antibiotic therapy. Multivariate logistic regression has shown leukocytosis and intensive care unit admission as risk factors for bacterial infections and C-reactive protein, together with the length of hospital stay, as mortality predictors. The ROC curves revealed an acceptable performance for the erythrocyte sedimentation rate (AUC: 0.781), and C-reactive protein (AUC: 0.797), but a poor performance for fibrinogen (AUC: 0.664) in predicting fatal events. 4. Conclusions: This study highlighted the somewhat paradoxical association of a low rate of confirmed infections with a high rate of empiric antibiotic therapy. A thorough assessment of the risk factors for bacterial infections, in addition to the acknowledgment of various mortality predictors, is crucial for identifying high-risk patients, thus allowing a timely therapeutic intervention, with a direct impact on improving patients’ prognosis. Full article

(This article belongs to the Special Issue United in the Prevention of Bacterial Resistance during the COVID-19 Era)

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9 pages, 311 KiB

Open AccessArticle

Changes in Use of Blood Cultures in a COVID-19-Dedicated Tertiary Hospital

by Alina-Ioana Andrei, Gabriel-Adrian Popescu, Mona Argentina Popoiu, Alexandru Mihai and Daniela Tălăpan

Antibiotics 2022, 11(12), 1694; https://doi.org/10.3390/antibiotics11121694 - 24 Nov 2022

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Abstract

Blood cultures should be collected within an hour in the setting of sepsis/septic shock. The contamination rate should be below 3%. Worldwide reports have described an increase in blood contamination rates during the COVID-19 pandemic. We performed a retrospective analysis of the blood cultures collected during a 10-month period (March–December 2020) at NIID “Prof. Dr. Matei Balș”. The results were compared with data from the pre-pandemic period (March–December 2016) and with the existing data in the literature. During the pandemic, there was a significant decrease in the number of blood cultures collected (1274 blood cultures in 2020 vs. 5399 in 2016). The contamination rate was higher in 2020 (11.7%) compared to 2016 (8.2%), p < 0.001. The rate of infectious episodes in which the etiological agent was identified was constant: 11% in 2020 versus 11.9% in 2016, p = 0.479, but there were fewer invasive bacterial/fungal infections: 0.95/1000 patient days in 2020 vs. 2.39/1000 patient days in 2016, p < 0.001. We observed a change in the species distribution. The Gram-negative isolate’s proportion increased from 50.6% to 63.1% and the gram-positive isolate’s proportion decreased from 31.8% to 19%. Collection of a low number of blood cultures and a high contamination rate was identified in our clinic. In order to improve the usefulness of blood cultures as a diagnostic method, at least two sets should be collected in aseptic conditions. Full article

(This article belongs to the Special Issue United in the Prevention of Bacterial Resistance during the COVID-19 Era)

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10 pages, 2308 KiB

Open AccessCase Report

Diagnostic and Treatment Challenges of Emergent COVID-Associated-Mucormycosis: A Case Report and Review of the Literature

by Manuela Arbune, Anca-Adriana Arbune, Alexandru Nechifor, Iulia Chiscop and Violeta Sapira

Antibiotics 2023, 12(1), 31; https://doi.org/10.3390/antibiotics12010031 - 25 Dec 2022

Cited by 3 | Viewed by 1497

Abstract

Mucormycosis is a rare fungal infection, with high mortality, commonly associated with diabetes, malignancies, immunosuppressive therapy, and other immunodeficiency conditions. The emergence of mucormycosis cases has been advanced by the COVID-19 pandemic. Clinical presentation is variable, from asymptomatic to persistent fever or localized infections. We present a case of a Romanian old man, without diabetes or other immunodepression, with COVID-19 who developed severe rhino-orbital mucormycosis and bacterial superinfections, with Pseudomonas aeruginosa and Klebsiella pneumoniae. The late diagnostic and antifungal treatment was related to extensive lesions, bone and tissue loss, and required complex reconstruction procedures. We review the relationships between mucormycosis, COVID-19, and bacterial associated infections. The suspicion index of mucormycosis should be increased in medical practice. The diagnostic and treatment of COVID-19-Associated-Mucormycosis is currently challenging, calling for multidisciplinary collaboration. Full article

(This article belongs to the Special Issue United in the Prevention of Bacterial Resistance during the COVID-19 Era)

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