Antibiotics in Public Health: Reasonable Application and Stewardship

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 (30 September 2022) | Viewed by 8644

Special Issue Editor

Department of Pharmacy, University of Split School of Medicine, Split, Croatia
Interests: adverse drug reaction; drug-drug interaction; patient adherence; antimicrobial resistance; clinical guidelines
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well established that excessive and inappropriate use of antimicrobials promotes antimicrobial resistance. Antimicrobial resistance contributes to 700,000 deaths worldwide each year. Moreover, the OECD estimates that the lack of action to face antimicrobial resistance may generate an expense of EUR 1.1 billion annually by 2050 in the EU alone. Antimicrobial resistance may be perceived as a feature of urban social change. In an ever-changing world, expected to face climate change, food insecurity and emerging pandemics, society needs readily available antimicrobial stewardship programs in order to be able to respond to health threats. Inappropriate response, as seen at the beginning of the COVID-19 pandemic, may drive antimicrobial resistance further. Greater public awareness, education and self-responsibility may assist healthcare workers in the appropriate use of antimicrobials. This Special Issue focuses on the prudent use of antimicrobials in public health and will consist of 10–15 manuscripts, which may include original research, review articles, case series and opinion papers. We are interested in both qualitative research and quantitative research that provide tools for professionals and individuals to responsibly use antimicrobials.

Prof. Dr. Darko Modun
Guest Editor

Manuscript Submission Information

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Keywords

  • antimicrobial resistance
  • antimicrobial stewardship
  • rational prescribing
  • public health
  • antimicrobial surveillance
  • responsible antimicrobial use

Published Papers (4 papers)

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Research

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10 pages, 616 KiB  
Article
Current Practices and Opportunities for Outpatient Parenteral Antimicrobial Therapy in Hospitals: A National Cross-Sectional Survey
Antibiotics 2022, 11(10), 1343; https://doi.org/10.3390/antibiotics11101343 - 01 Oct 2022
Cited by 2 | Viewed by 2161
Abstract
This nationwide study assessed how outpatient parenteral antimicrobial therapy (OPAT) is organised by Dutch acute care hospitals, the barriers experienced, and how an OPAT program affects the way hospitals organised OPAT care. We systematically developed and administered a survey to all 71 Dutch [...] Read more.
This nationwide study assessed how outpatient parenteral antimicrobial therapy (OPAT) is organised by Dutch acute care hospitals, the barriers experienced, and how an OPAT program affects the way hospitals organised OPAT care. We systematically developed and administered a survey to all 71 Dutch acute care hospitals between November 2021 and February 2022. Analyses were primarily descriptive and included a comparison between hospitals with and without an OPAT program. Sixty of the 71 hospitals (84.5%) responded. Fifty-five (91.7%) performed OPAT, with a median number of 20.8 (interquartile range [IQR] 10.3–29.7) patients per 100 hospital beds per year. Of these 55 hospitals, 31 (56.4%) had selection criteria for OPAT and 34 (61.8%) had a protocol for laboratory follow-up. Sixteen hospitals (29.1%) offered self-administered OPAT (S-OPAT), with a median percentage of 5.0% of patients (IQR: 2.3%–10.0%) actually performing self-administration. Twenty-five hospitals (45.5%) had an OPAT-related outcome registration. The presence of an OPAT program (22 hospitals, 40.0%) was significantly associated with aspects of well-organised OPAT care. The most commonly experienced barriers to OPAT implementation were a lack of financial, administrative, and IT support and insufficient time of healthcare staff. Concluding, hospital-initiated OPAT is widely available in the Netherlands, but various aspects of well-organised OPAT care can be improved. Implementation of a team-based OPAT program can contribute to such improvements. The observed variation provides leads for further scientific research, guidelines, and practical implementation programs. Full article
(This article belongs to the Special Issue Antibiotics in Public Health: Reasonable Application and Stewardship)
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8 pages, 2563 KiB  
Case Report
Syndromic Testing in Infectious Diseases: From Diagnostic Stewardship to Antimicrobial Stewardship
Antibiotics 2023, 12(1), 6; https://doi.org/10.3390/antibiotics12010006 - 21 Dec 2022
Cited by 1 | Viewed by 2253
Abstract
The implementation into clinical practice of syndromic testing by multiplex polymerase chain reaction allows early etiological diagnosis and paves the way towards timely targeted treatment. However, there is stringent need for diagnostic stewardship, as multiplex testing can also come with a high risk [...] Read more.
The implementation into clinical practice of syndromic testing by multiplex polymerase chain reaction allows early etiological diagnosis and paves the way towards timely targeted treatment. However, there is stringent need for diagnostic stewardship, as multiplex testing can also come with a high risk of misdiagnosis if improperly ordered or interpreted. We report two cases that illustrate proper and improper diagnostic stewardship, having important implications for correct patient management and application of antimicrobial stewardship into current clinical practice. Full article
(This article belongs to the Special Issue Antibiotics in Public Health: Reasonable Application and Stewardship)
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33 pages, 4361 KiB  
Systematic Review
Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis
Antibiotics 2022, 11(9), 1192; https://doi.org/10.3390/antibiotics11091192 - 03 Sep 2022
Cited by 6 | Viewed by 2371
Abstract
Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for [...] Read more.
Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings. Full article
(This article belongs to the Special Issue Antibiotics in Public Health: Reasonable Application and Stewardship)
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5 pages, 208 KiB  
Brief Report
Evaluation of a Frozen Micro-Agar Plates of MAPt Antibiotic Susceptibility Test for Enhanced Bioterror Preparedness
Antibiotics 2022, 11(5), 580; https://doi.org/10.3390/antibiotics11050580 - 26 Apr 2022
Cited by 1 | Viewed by 1261
Abstract
There is an urgent need for rapid antibiotic susceptibility tests to improve clinical treatment and to support antibiotic stewardship, especially concerning the emergence of multi-drug-resistant bacteria. Nowadays this need is even more profound due to progress in synthetic biology procedures that may facilitate [...] Read more.
There is an urgent need for rapid antibiotic susceptibility tests to improve clinical treatment and to support antibiotic stewardship, especially concerning the emergence of multi-drug-resistant bacteria. Nowadays this need is even more profound due to progress in synthetic biology procedures that may facilitate the malicious preparation of engineered antibiotic-resistant pathogens. We recently described a novel, rapid, simple, specific, and sensitive method named a Micro-Agar-PCR-test (MAPt) and showed its performance on clinical as well as environmental samples. The method does not require any isolation or purification steps and is applicable to a wide range of bacterial concentrations, thus allowing a short time to respond within a bioterror event (5–7 h for B. anthracis, 10–12 h for Y. pestis, and 16 h for F. tularensis). Ready-to-use reagents for this assay may add a level of preparedness. We examined the option of freezing pre-prepared MAPt agar plates and thawing them upon need. Our results show that adequate minimal inhibitory concentration (MIC) values are obtained with the use of thawed 6- and 12-month frozen agar plates. The ability to store MAPt micro-agar plates at −70 °C for a year, together with all other reagents required for MAPt, holds a great advantage for bioterror preparedness. Full article
(This article belongs to the Special Issue Antibiotics in Public Health: Reasonable Application and Stewardship)
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