JAC-Antimicrobial Resistance最新文献

{"title":"AMRrounds: Metallo-β-lactamase-producing <i>Klebsiella pneumoniae</i> complex-everything and the kitchen zinc.","authors":"Drew T Dickinson, Dan Ilges, Emir Kobic, Andrew Bryan","doi":"10.1093/jacamr/dlaf187","DOIUrl":"https://doi.org/10.1093/jacamr/dlaf187","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf187"},"PeriodicalIF":3.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatio-temporal distribution of extended spectrum β-lactamase producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> blood stream infections in Laos.","authors":"Tamalee Roberts, Vilada Chansamouth, Sayaphet Rattanavong, Viengmon Davong, Manivanh Vongsouvath, Mayfong Mayxay, Rene Neihus, David A B Dance, Ben S Cooper, Paul N Newton","doi":"10.1093/jacamr/dlaf180","DOIUrl":"10.1093/jacamr/dlaf180","url":null,"abstract":"<p><strong>Objectives: </strong>ESBLs are an important cause of third generation cephalosporin resistance in Enterobacterales. However, there is a paucity of data on ESBLs in blood stream infections (BSI) in Laos. The aim of this study was to investigate the presence of ESBL-producing <i>Escherichia coli</i> (ESBLEC) and ESBL-producing <i>Klebsiella pneumoniae</i> (ESBLKP) in blood cultures submitted to Mahosot Hospital, Laos and how these have changed over 18 years.</p><p><strong>Methods and materials: </strong>This retrospective observational study included blood cultures from patients presenting with fever to Mahosot Hospital between 2000 and 2018. Full identification and antibiotic susceptibility testing was carried out on positive bottles. ESBL production was determined using the double-disc method. Patient clinical and residence data were included in univariable and multivariable analyses to identify risk factors for having an ESBL.</p><p><strong>Results: </strong>From 52 249 blood culture sets collected over the 18-year period, 222 (0.42%) were positive for an ESBLEC or ESBLKP. The proportion of <i>E. coli</i> and <i>K. pneumoniae</i> isolates that were ESBL positive increased from 3.2% in 2000 to 35.4% in 2018. While there was a steady increase seen in ESBLEC over the 18-year period, ESBLKP have remained at ∼7% of <i>K. pneumoniae</i> isolates. Most ESBLs were community acquired. From univariable analysis, factors positively associated with an ESBL isolate included chronic renal failure, renal stones and having taken an antibiotic in the week before the blood sample.</p><p><strong>Conclusion: </strong>With a rising trend of ESBLEC in Laos, controlling unregulated antibiotic usage in the community will be pivotal to stopping further increases.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf180"},"PeriodicalIF":3.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proactive antimicrobial stewardship with real-time microbiological alerts improves management of bloodstream infections.","authors":"Arianna Di Marcello, Antonella Santoro, Vera Todisco, Erica Franceschini, Gabriella Orlando, Stefania Casolari, Adriana Cervo, Marianna Menozzi, Andrea Bedini, Davide Chemello, Mario Sarti, Jacopo Vecchiet, Katia Falasca, Cristina Mussini, Marianna Meschiari","doi":"10.1093/jacamr/dlaf182","DOIUrl":"10.1093/jacamr/dlaf182","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to assess the impact of proactive Infectious Disease Specialist (IDS) interventions, in addition to standard antimicrobial stewardship (AMS) practices, triggered by real-time microbiological alerts, on improving the appropriateness and timeliness of antimicrobial prescriptions in hospitalized patients with bloodstream infections (BSIs).</p><p><strong>Methods: </strong>We conducted a prospective, single-center, pre-post interventional study at the University Hospital of Modena, Italy. Adult inpatients with monomicrobial BSIs between June 2022 and March 2023 were included. During the intervention phase (November 2022-March 2023), real-time microbiological alerts were automatically delivered to IDS consultants, who proactively reviewed therapy. Primary outcomes included the time to effective therapy (TTE) and the time to appropriate therapy (TTA). Secondary outcomes encompassed the duration of antimicrobial therapy, 14 and 30-day mortality from BSI, and hospital length of stay.</p><p><strong>Results: </strong>A total of 446 BSI episodes were analyzed (211 pre-intervention, 235 post-intervention). Post-intervention, the rate of appropriate therapy significantly increased (97.4% versus 76.2%, <i>P</i> < 0.001), and TTE was significantly shorter (0.63 versus 0.87 days, <i>P</i> = 0.022). No statistically significant reduction in TTA was observed (1.97 versus 2.37 days, <i>P</i> = 0.081). Early IDS intervention (<48 h) was associated with the shortest TTE and TTA. No significant differences were observed in mortality or hospital stay. Kaplan-Meier analysis showed a higher probability of receiving effective and appropriate therapy earlier in the post-intervention phase (log-rank test <i>P</i> = 0.014; 0.072, respectively). Subgroup analysis showed TTE improvements across MDR pathogens.</p><p><strong>Conclusions: </strong>A proactive intervention of IDS, based on automatic microbiological alert, in addition to routine AMS activities, is significantly associated with improved prescription appropriateness, reducing TTE.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf182"},"PeriodicalIF":3.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding dentists' antibiotic prescribing behaviour in Spain: a focus group study.","authors":"Olalla Vázquez-Cancela, Maruxa Zapata-Cachafeiro, Adolfo Figueiras, Almudena Rodríguez-Fernández","doi":"10.1093/jacamr/dlaf185","DOIUrl":"10.1093/jacamr/dlaf185","url":null,"abstract":"<p><strong>Background: </strong>Dentists are responsible for 10% of all antibiotic prescriptions. It is estimated that, in certain situations, up to 80% of antibiotic prescriptions in dentistry may be inappropriate. The aim of this study was to explore Spanish dentists' attitudes, perceptions, and contextual factors influencing antibiotic use and misuse in clinical practice.</p><p><strong>Methods: </strong>From July to December 2022, we conducted focus groups with 31 dentists from Spain Data were analysed using thematic analysis with a pragmatic orientation to address the research objectives. Inclusion criteria required participants to be dentistry graduates or oral medicine specialists (stomatologists) and actively working as dentists. The sample was selected through key informants and the snowball method. We ensured methodological quality by adhering to the COREQ checklist.</p><p><strong>Results: </strong>We formed seven synchronous online focus groups with 31 participants. Dentists acknowledged the problem of antibiotic resistance, identifying fear, working conditions and burnout and patient trust as factors contributing to inappropriate prescribing. Despite this awareness, dentists did not see themselves as key agents of change in combating antibiotic resistance. However, they expressed interest in further education on the topic.</p><p><strong>Conclusions: </strong>These findings underscore the need for educational interventions that highlight dentists' role in antimicrobial stewardship. By situating these interventions within the One Health framework, dentists can be empowered to translate their leadership in oral health into active participation in the prudent use of antibiotics. Strengthening this role has practical implications for multidisciplinary strategies to combat antimicrobial resistance.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf185"},"PeriodicalIF":3.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between daptomycin dosing and in-hospital mortality in patients with vancomycin-resistant <i>Enterococcus faecium</i> bloodstream infection.","authors":"Kelly A Cairns, Iain J Abbott, Andrew A Udy, Trisha N Peel, Sue J Lee, Michael J Dooley, Anton Y Peleg","doi":"10.1093/jacamr/dlaf172","DOIUrl":"10.1093/jacamr/dlaf172","url":null,"abstract":"<p><strong>Background: </strong>Vancomycin-resistant <i>Enterococcus faecium</i> (VRE<i>fm</i>) bloodstream infections (BSIs) pose significant management challenges with uncertainties relating to the optimal daptomycin dose for treatment.</p><p><strong>Methods: </strong>A retrospective cohort study of adult patients receiving ≥3 days of definitive treatment for a first episode VRE<i>fm</i> BSI between 2015 and 2022 was undertaken. Daptomycin doses were classified as low (≤7.9 mg/kg), medium (8.0 to 9.9 mg/kg) or high (≥10 mg/kg). We aimed to assess the association between daptomycin dose and in-hospital 30-day all-cause mortality in addition to other clinical outcomes (hospital length of stay, transfer to the ICU within 48 hours and microbiological failure). In addition, we undertook a comparative analysis of mortality and other outcomes in <i>vanB</i> VRE<i>fm</i> BSIs receiving definitive daptomycin and teicoplanin treatment.</p><p><strong>Results: </strong>A total of 191 patients received definitive daptomycin (<i>n</i> = 111) or teicoplanin (<i>n</i> = 80) therapy and were included in two separate analyses. Of the 111 daptomycin patients, most received high-dose daptomycin (59.5%), with 29.7% and 10.8% receiving medium and low doses, respectively. All-cause 30-day in-hospital mortality was 17.1% and there was no association between daptomycin dose groups and in-hospital 30-day mortality (log rank <i>P</i> = 0.369). Microbiological failure was associated with dose (<i>P</i> = 0.036): 33.3% in the low dose group, 12.1% for medium and 19.7% for high. No mortality difference was observed between <i>vanB</i> VRE<i>fm</i> BSIs treated with daptomycin or teicoplanin [adjusted cause-specific hazard ratio 0.67 (95% CI: 0.28-1.59)].</p><p><strong>Conclusions: </strong>In this contemporary study of predominantly high daptomycin doses, there was no association between daptomycin dose and 30-day in-hospital mortality but we did observe an association with microbiological failure.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf172"},"PeriodicalIF":3.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance with the national and WHO antibiotic treatment guidelines for respiratory tract infections and their association with clinical and economic outcomes in Vietnam: an observational study.","authors":"Vu Quoc Dat, Tran Tat Dat","doi":"10.1093/jacamr/dlaf168","DOIUrl":"10.1093/jacamr/dlaf168","url":null,"abstract":"<p><strong>Background and objectives: </strong>Antibiotic guidelines are a component of antimicrobial stewardship for optimizing antibiotic use. To evaluate the compliance with the national guidelines and the WHO AWaRe Antibiotic Book for the empirical treatment for community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in critical care units (CCUs) in Vietnam.</p><p><strong>Methods: </strong>In this 7-day observational study, 51 participating CCUs consecutively enrolled patients aged ≥18 years from March to July 2019. We assessed the compliance for empirical antibiotic prescription using the national guidelines and the WHO AWaRe Antibiotic Book.</p><p><strong>Results: </strong>We included 500 patients with CAP and 249 patients with AECOPD. The rates of overall compliance with the national guidelines and the WHO AWaRe Antibiotic Book were 54.4% (272/500) and 43.2% (216/500) for CAP; and 48.2% (120/249) and 7.2% (18/249) for AECOPD, respectively. The overall case fatality at 7 days was 4.0% (20/500) in patients with CAP, and 2.0% (5/249) in patients with AECOPD with no significant difference between those receiving compliant and non-compliant regimens by either guideline. The average cost of empirical antibiotic regimens for CAP was lowest at US$3.10 ($3.02-$3.17) per Defined Daily Dose (DDD) for the full compliant regimens versus US$15.26 ($12.72-$17.81) per DDD for the non-compliant regimen according to the WHO AWaRe Antibiotic Book.</p><p><strong>Conclusions: </strong>Our study indicates that the compliance with the antibiotic guidance was suboptimal in CCUs in Vietnam. Compliance with guidelines for empirical antibiotic therapy could be associated with lower costs.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf168"},"PeriodicalIF":3.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing a penicillin allergy de-labelling implementation intervention in a UK hospital: a process evaluation reporting healthcare workers' experiences.","authors":"Neil Powell, Mathew Upton, Bridie Kent, Jonathan A T Sandoe, Sarah Tonkin-Crine","doi":"10.1093/jacamr/dlaf174","DOIUrl":"10.1093/jacamr/dlaf174","url":null,"abstract":"<p><strong>Background and objectives: </strong>Penicillin allergy (penA) records prevent first-line penicillin antibiotic use, but more than 90% are incorrect after formal testing and can be removed ('de-labelled'). We developed an implementation intervention package that supports a multi-professional non-allergy workforce to deliver penicillin allergy de-labelling (PADL) in a UK hospital. To explore the experiences of doctors, nurses, pharmacists and medicines optimization pharmacy technicians (MOPTs) of the implementation intervention package.</p><p><strong>Methods: </strong>Process evaluation utilizing semi-structured interviews with doctors, nurses, pharmacists and MOPTs with a target sample size of 20. Inductive reflexive thematic analysis was used to analyse the data.</p><p><strong>Results: </strong>Fifteen interviews were conducted between 7 November 2024 and 25 March 2025 with six doctors, five pharmacists and four MOPTs. PADL aligned well with the medicine's reconciliation process, the process of accurately listing a person's current medicines, which meant it better aligned with pharmacists' and MOPTs' roles than doctors' roles. Healthcare worker (HCW) confidence to deliver PADL remained low among some doctors and pharmacists, but all reported that with time and support PADL would embed. Competing priorities in an inadequately resourced healthcare setting made PADL challenging. Professional bodies formally defining PADL as a core role for their HCWs would increase engagement with PADL. The PADL champion role was identified as key to the implementation of PADL.</p><p><strong>Conclusions: </strong>Competing priorities were limiting PADL engagement and as such PADL needs to be a core part of a HCW's role for it to be prioritized. The champion is required to support PADL as a shared responsibility and needs to be available until the process is embedded into ways of working.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf174"},"PeriodicalIF":3.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subpopulations in clinical samples of <i>M. tuberculosis</i> can give rise to rifampicin resistance and shed light on how resistance is acquired.","authors":"Viktoria M Brunner, Philip W Fowler","doi":"10.1093/jacamr/dlaf175","DOIUrl":"10.1093/jacamr/dlaf175","url":null,"abstract":"<p><strong>Objectives: </strong>WGS has become a key tool for diagnosing <i>Mycobacterium tuberculosis</i> infections, but discrepancies between genotypic and phenotypic drug susceptibility testing can hinder effective treatment and surveillance. This study investigated the impact of resistant subpopulations and compensatory mutations in WGS-based rifampicin resistance prediction.</p><p><strong>Methods: </strong>Based on a dataset of 35 538 clinical <i>M. tuberculosis</i> samples, the sensitivity and specificity of resistance classification were evaluated with and without considering subpopulations and compensatory mutations.</p><p><strong>Results: </strong>By lowering the fraction of reads required to identify a resistance-associated variant in a sample from 0.90 to 0.05, the sensitivity increased significantly from 94.3% to 96.4% without a significant impact on specificity. Allowing compensatory mutations to predict resistance further lowered the false negative rate. Finally, we found that samples with resistant subpopulations were less likely to be compensated than homogeneous resistant samples. Further analysis of these samples revealed distinct clusters with differing amounts of within-sample diversity, pointing towards different mechanisms of resistance acquisition, such as within-host evolution and secondary infections.</p><p><strong>Conclusions: </strong>Our results indicate that a substantial fraction of false negative calls in WGS-based rifampicin resistance prediction can be explained by masked resistant subpopulations. The genetic diversity within the heterogeneous samples is consistent with at least 28% of the rifampicin resistance arising from secondary infections.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf175"},"PeriodicalIF":3.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents' perspectives on childhood antibiotic treatment in Ireland-a qualitative study.","authors":"Anthony Maher, Eimear C Morrissey, Andrew W Murphy, Gerard J Molloy","doi":"10.1093/jacamr/dlaf176","DOIUrl":"10.1093/jacamr/dlaf176","url":null,"abstract":"<p><strong>Background and objectives: </strong>Paediatric respiratory tract infections can be a common reason for antibiotic prescribing in primary healthcare. Despite stewardship efforts, prescribing patterns often diverge from evidence-based guidelines. There are limited explorations of how parental beliefs and behaviours shape clinical decision-making. This qualitative study explored parental perspectives on antibiotic treatment-seeking behaviour in Ireland.</p><p><strong>Methods: </strong>We carried out semi-structured interviews with 20 parents who had children under 8 years old in Ireland. The interviews were guided by the COM-B (Capability, Opportunity, Motivation - Behaviour) model. The interview data was analysed inductively, using reflexive thematic analysis. Following this, relevant themes and subthemes were mapped to the domains of the COM-B.</p><p><strong>Results: </strong>The study identified three key themes: (i) experiencing perceived knowledge gaps in antimicrobial resistance (AMR) and antibiotic use captured how participants described negotiating AMR as a personal health risk while also experiencing AMR as a distant policy; (ii) navigating professional gatekeepers described the role of consulting with the general practitioner (GP), the out-of-hours doctor paradox, trusting the pharmacist and seeing receptionists as hidden gatekeepers who all shaped access to care; and (iii) deciding when to act reflected how people sought pragmatic reassurance and managed illness escalation anxiety in making decisions about seeking treatment.</p><p><strong>Conclusions: </strong>The study underscores the need for socio-culturally tailored antimicrobial resistance messaging and interventions that address both parental concerns and systemic barriers. By centring parental voices, this research highlights opportunities to strengthen antimicrobial stewardship through improved communication, recognition and expanded roles for the primary healthcare team.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf176"},"PeriodicalIF":3.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of isavuconazole in critically ill patients in intensive care units: a prospective, observational, multicentre, cohort study.","authors":"Daniele Roberto Giacobbe, Claudia Bartalucci, Martina Bavastro, Riccardo Schiavoni, Vincenzo Di Pilato, Marco Muccio, Alessio Signori, Chiara Aldieri, Jacopo Angelini, Erika Asperges, Elisabetta Blasi Vacca, Nicoletta Boffa, Enrica Bono, Bruno Cacopardo, Alessandra Calabresi, Martina Casarini, Annamaria Cattelan, Silvia Corcione, Federica Cosentino, Gennaro De Pascale, Francesco Giuseppe De Rosa, Valerio Del Bono, Filippo Del Puente, Chiara Fanelli, Fiorenza Fava, Erica Franceschini, Nicholas Geremia, Maddalena Giannella, Simone Giuliano, Ivana Maida, Andrea Marino, Maria Mazzitelli, Maria Chiara Meloni, Marco Merli, Marianna Meschiari, Chiara Moreal, Chiara Oltolini, Rita Pallone, Sandro Panese, Emanuele Pontali, Martina Ricciardetto, Matteo Rinaldi, Alessandro Russo, Maurizio Sanguinetti, Vincenzo Scaglione, Francesca Serapide, Francesco Saverio Serino, Nour Shbaklo, Carlo Torti, Giovanna Travi, Laura Magnasco, Federica Portunato, Federica Briano, Malgorzata Mikulska, Lorenzo Ball, Chiara Robba, Nicolò Patroniti, Denise Battaglini, Mauro Giacomini, Erika Coppo, Anna Marchese, Antonio Vena, Matteo Bassetti","doi":"10.1093/jacamr/dlaf177","DOIUrl":"10.1093/jacamr/dlaf177","url":null,"abstract":"<p><strong>Objectives: </strong>In this multicentre, prospective study, we aimed to describe the use of isavuconazole in critically ill adult patients in ICU, in terms of patient characteristics, infection characteristics and outcomes.</p><p><strong>Methods: </strong>Prospective, observational study of ICU patients treated with isavuconazole from January 2023 to 30 April 2025 in 17 centres (ISA-SITA study within the MULTI-SITA project).</p><p><strong>Results: </strong>A total of 177 ICU patients treated with isavuconazole were included in the study. Most patients showed at least one European Organisation for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) or FUNgal Diseases in adult patients in Intensive Care Unit (FUNDICU) host factor (141/177, 79.7%). Overall, 82/177 patients (46.3%) had either proven or probable invasive mould disease (6 and 76, respectively, mostly invasive pulmonary aspergillosis). In patients with proven or probable disease, 30-day mortality was 44.0%, and 90-day mortality was 62.2%. In multivariable analyses, SOFA score (HR 1.14 per one point increase, 95% CI 1.03-1.26, <i>P</i> = 0.010) and concomitant bacterial pneumonia (HR 2.32, 95% CI 1.17-4.59, <i>P</i> = 0.016) were associated with 30-day mortality, whereas prior hospitalization (HR 2.26, 95% CI 1.19-4.27, <i>P</i> = 0.013) and SOFA score (HR 1.17 per one point increase, 95% CI 1.07-1.28, <i>P</i> < 0.001) were associated with 90-day mortality.</p><p><strong>Conclusions: </strong>Diverse patterns of isavuconazole use were observed in a large cohort of critically ill adult patients, and the drug was well tolerated. Mortality was lower than many previous estimates in critically ill patients and could serve as a basis for future standardized comparisons.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf177"},"PeriodicalIF":3.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}