JAC-Antimicrobial Resistance最新文献

{"title":"Pharmacokinetic/pharmacodynamic analysis of sulbactam against <i>Acinetobacter baumannii</i> pneumonia: establishing <i>in vivo</i> efficacy targets in the epithelial lining fluid.","authors":"Yasmeen Abouelhassan, Joseph L Kuti, David P Nicolau, Kamilia Abdelraouf","doi":"10.1093/jacamr/dlae203","DOIUrl":"https://doi.org/10.1093/jacamr/dlae203","url":null,"abstract":"<p><strong>Background: </strong>Sulbactam is an effective therapy for <i>Acinetobacter baumannii</i> infections. Previous sulbactam pharmacokinetics/pharmacodynamics (PK/PD) analyses established exposure efficacy targets in plasma against <i>A. baumannii</i> pneumonia. Herein, we established sulbactam efficacy targets in epithelial lining fluid (ELF). The PTA following clinical sulbactam regimens was estimated.</p><p><strong>Methods: </strong>Sulbactam (dosed as ampicillin-sulbactam) bronchopulmonary PK was assessed in the neutropenic murine pneumonia model. The percentage of the dosing interval during which the free drug concentration remained above the MIC (%<i>f</i>T > MIC) required to achieve different efficacy endpoints was estimated in 21 clinical <i>A. baumannii</i> isolates. PTA was assessed using Monte Carlo Simulations and utilizing previously published healthy volunteers sulbactam ELF pharmacokinetics.</p><p><strong>Results: </strong>Median (IQR) %<i>f</i>T > MIC required to achieve 1-log kill in isolates resistant to both sulbactam and meropenem was 47.51 (39.7-54.2). This target was much higher than isolates with other phenotypes (i.e. sulbactam-susceptible/intermediate and sulbactam-resistant but meropenem susceptible) that required 16.62 (5.3-22.0). The PTA following sulbactam 1 g q6h 0.5h infusion regimen was >90% up to MIC of 2 mg/L while the PTA for MIC 4 mg/L (susceptibility breakpoint) was 81%. Conversely, previous assessment in plasma demonstrated the same regimen exceeded 90% PTA up to MIC of 4 mg/L. Sulbactam 3 g q8h 4h infusion provided PTA >90% for MIC 8 mg/L (sulbactam-intermediate), similar to previous assessment in plasma.</p><p><strong>Conclusion: </strong>Based on the ELF assessment, the maximum FDA approved dose of sulbactam (1 g q6h 0.5h infusion) provided >90% PTA for isolates with sulbactam MIC only up to 2 mg/L. Nevertheless, sulbactam 3 g q8h for 4 hours of infusion achieved higher PTA and conferred additional benefit against sulbactam-susceptible/intermediate isolates.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae203"},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876506","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":"Antimicrobial resistance-attributable mortality: a patient-level analysis.","authors":"Ioannis Baltas, Timothy Miles Rawson, Hamish Houston, Louis Grandjean, Gabriele Pollara","doi":"10.1093/jacamr/dlae202","DOIUrl":"https://doi.org/10.1093/jacamr/dlae202","url":null,"abstract":"<p><strong>Background: </strong>The impact of antimicrobial resistance (AMR) on death at the patient level is challenging to estimate. We aimed to characterize AMR-attributable deaths in a large UK teaching hospital.</p><p><strong>Methods: </strong>This retrospective study investigated all deceased patients in 2022. Records of participants were independently reviewed by two investigators for cases of AMR-attributable deaths using a newly proposed patient-level definition.</p><p><strong>Results: </strong>In total, 758 patients met inclusion criteria. Infection was the underlying cause of death for 11.7% (89/758) and was implicated in the pathway that led to death in 41.1% (357/758) of participants. In total, 4.2% (32/758) of all deaths were AMR-attributable. Median time from index sample collection to death was 4.5 days (IQR 2-10.5 days). The majority of AMR-attributable deaths (56.3%, 18/32) were associated with intrinsic resistance mechanisms, primarily by <i>Enterococcus faecium</i> (20.7%), Enterobacterales carrying repressed chromosomal ampicillinase Cs (AmpCs) (14.7%) and <i>Pseudomonas aeruginosa</i> (11.8%<i>)</i>, whereas a minority (43.7%, 14/32) had acquired resistance mechanisms, primarily derepressed chromosomal AmpCs (11.8%) and ESBLs (8.8%). The median time to effective treatment was 32 h 15 min (no difference between subgroups). Only 62.5% (20/32) of AMR-attributable deaths had infection recorded on the death certificate. AMR was not recorded as a cause of death in any of the patients.</p><p><strong>Conclusions: </strong>Infection and AMR were important causes of death in our cohort, yet they were significantly underreported during death certification. In a low-incidence setting for AMR, pathogen-antimicrobial mismatch due to intrinsic resistance was an equally important contributor to AMR-attributable mortality as acquired resistance mechanisms.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae202"},"PeriodicalIF":3.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864185","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":"Leveraging local public health to advance antimicrobial stewardship (AMS) implementation and mitigate antimicrobial resistance (AMR): a scoping review.","authors":"Valerie Leung, Diane Ashiru-Oredope, Lauri Hicks, Sarah Kabbani, Mehdi Aloosh, Irene E Armstrong, Kevin A Brown, Nick Daneman, Kevin Lam, Hamidah Meghani, Mahad Nur, Kevin L Schwartz, Bradley J Langford","doi":"10.1093/jacamr/dlae187","DOIUrl":"https://doi.org/10.1093/jacamr/dlae187","url":null,"abstract":"<p><strong>Objective: </strong>To explore the role of local public health organisations in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) surveillance.</p><p><strong>Methods: </strong>A scoping review was conducted. Peer-reviewed and grey literature from countries within the organisation for economic co-operation and development was searched between 1999 and 2023 using the concepts of local public health, AMR and AMS. Thematic analysis was performed to identify themes.</p><p><strong>Results: </strong>There were 63 citations illustrating 122 examples of AMS and AMR surveillance activities with local public health involvement. Common AMS activities (<i>n</i> = 105) included healthcare worker education (<i>n</i> = 22), antimicrobial use (AMU) evaluation (<i>n</i> = 21), patient/public education (<i>n</i> = 17), clinical practice guidelines (<i>n</i> = 10), and antibiograms (<i>n</i> = 10). Seventeen citations described local public health activities in AMR surveillance; the majority focussed on communicable diseases (<i>n</i> = 11) and/or AMR organisms (<i>n</i> = 6).</p><p><strong>Conclusions: </strong>Local public health capabilities should be leveraged to advance high-impact activities to mitigate AMR, particularly in the areas of knowledge translation/mobilisation, optimising surveillance and establishing strategic collaborations.</p><p><strong>Policy implications: </strong>Future work should focus on better understanding barriers and facilitators, including funding, to local public health participation in these activities.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae187"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854200","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":"'Some patients demand for a prescription of an antibiotic': an assessment of barriers and facilitators to rational antimicrobial use in a private health facility in Uganda.","authors":"Mark Kizito, Rejani Lalitha, Henry Kajumbula, Richard Muhumuza, Moses Grace Kintu, David Muyanja, Pauline Byakika-Kibwika","doi":"10.1093/jacamr/dlae204","DOIUrl":"https://doi.org/10.1093/jacamr/dlae204","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial misuse and overuse propagate antimicrobial resistance, yet data on factors influencing antibiotic prescription decisions in low-resource settings are limited. We describe factors influencing antimicrobial prescription at a large tertiary care private not-for-profit hospital in Uganda.</p><p><strong>Methods: </strong>We conducted a descriptive phenomenology qualitative study involving face-to-face in-depth interviews of 12 purposively selected prescribers (four intern doctors, six medical officers and two Internal Medicine physicians) in a private not-for-profit hospital in Kampala, Uganda. Audio recordings and filed notes were transcribed verbatim and analysed manually by content analysis. Emerging themes and sub-themes were recorded and reported.</p><p><strong>Results: </strong>Three broad themes emerged: experience with antimicrobial use in Uganda, barriers and facilitators to rational antimicrobial prescription and measures to address irrational antimicrobial use. Participants recognized that antibiotics are often used irrationally, prescribed even when there is uncertainty regarding clinical evidence for infection, and influenced by drug promoters, and noted high levels of antibiotic resistance. Patients' symptoms and clinical signs, previous experience using antibiotics, fear of bad outcomes, patient demand and expectations, influence from senior colleagues, the turnaround time of clinical investigations and drug marketers were the barriers and facilitators to antimicrobial prescription. Prescribers also acknowledged the need to update clinical guidelines, set up hospital antibiograms, and provide continuous medical education on rational antimicrobial use.</p><p><strong>Conclusions: </strong>A complex interplay of intrinsic and extrinsic factors influences antibiotic prescribing decisions in this hospital. Targeted interventions through continuous education and training for prescribers, providing local prescription guidelines and antibiograms and implementing regulations on over-the-counter antibiotic sales are needed to implement robust antimicrobial stewardship programmes to curb antimicrobial resistance successfully.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae204"},"PeriodicalIF":3.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854201","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":"Behavioural impact of antibiotic stewardship in children in primary care: interviews with GPs and parents.","authors":"Erinn D'hulster, Marina Digregorio, Tine De Burghgraeve, Jeroen Luyten, Samuel Coenen, Sibyl Anthierens, Jan Y Verbakel","doi":"10.1093/jacamr/dlae207","DOIUrl":"https://doi.org/10.1093/jacamr/dlae207","url":null,"abstract":"<p><strong>Background: </strong>The ARON study, a randomized controlled trial, assesses a behavioural intervention incorporating clinically guided C-reactive protein (CRP) point-of-care testing and a parental information booklet to reduce inappropriate antibiotic prescriptions for acutely ill children in Belgian primary care.</p><p><strong>Objectives: </strong>To explore GP and parent views and experiences regarding the ARON trial intervention.</p><p><strong>Methods: </strong>We conducted a qualitative embedded process evaluation in Belgian general practice. Semi-structured interviews were held with purposively sampled GPs and a convenience sample of mothers of acutely ill children presenting to primary care. Data were analysed using inductive thematic analysis.</p><p><strong>Results: </strong>Thirty-four interviews were conducted with 17 GPs and 17 parents from the intervention arm, and four themes were identified. The first theme centres on the supportive role of CRP point-of-care testing in reducing diagnostic uncertainty and decreasing inappropriate prescriptions. The second theme explores the use of CRP in managing perceived parental expectations of antibiotics. The third theme discusses the use of intermediate CRP levels (above the trial's 5 mg/L cut-off) as an indicator of serious infection, as opposed to its intended role in the trial as a rule-out factor. The final theme delves into the dual functionality of the booklet, enhancing self-management and offering reassurance through safety-netting advice. A logic model depicts the assumptions and (un)anticipated dynamics underlying the relationships between these themes and their subthemes.</p><p><strong>Conclusion: </strong>Both GPs and parents consider the intervention to be a helpful complementary tool during consultations for acutely ill children.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae207"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846479","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":"Impact of renal-adjusted ceftazidime/avibactam in patients with KPC-producing <i>Klebsiella pneumoniae</i> bloodstream infection: a retrospective cohort study.","authors":"A Oliva, L Volpicelli, A Gigante, M Di Nillo, S Trapani, A Viscido, F Sacco, C M Mastroianni","doi":"10.1093/jacamr/dlae201","DOIUrl":"https://doi.org/10.1093/jacamr/dlae201","url":null,"abstract":"<p><strong>Background: </strong>Bloodstream infections (BSIs) caused by KPC-producing <i>Klebsiella pneumoniae</i> (KPC-Kp) are still associated with high mortality, and the game-changing drug ceftazidime/avibactam has shown suboptimal pharmacokinetics in some clinical settings. Ceftazidime/avibactam renal dose adjustment has recently been identified as an independent risk factor for mortality.</p><p><strong>Objectives: </strong>To investigate the effect of ceftazidime/avibactam renal dose adjustment on mortality.</p><p><strong>Methods: </strong>Patients with KPC-Kp BSI treated with a ceftazidime/avibactam-based regimen were retrospectively collected and analysed. The primary outcome was mortality at 7, 14 and 30 days after the start of definitive ceftazidime/avibactam antibiotic therapy. Renal function was estimated using the CKD-EPI equation.</p><p><strong>Results: </strong>One hundred and ten patients with KPC-Kp BSI treated with a ceftazidime/avibactam-based regimen were included. Full-dose ceftazidime/avibactam (7.5 g daily) was prescribed to 82 patients (74.5%), while 28 patients (25.5%) received a renal-adjusted dose (17 patients due to chronic renal disease or haemodialysis, 11 patients due to infection-related acute kidney injury), with a median of 1.9 g daily. At multivariable analysis, receiving a reduced dose of ceftazidime/avibactam was independently associated with mortality (HR 4.47, 95% CI 1.09-18.03, <i>P</i> = 0.037), along with intra-abdominal or lower respiratory tract infections as source of BSI (HR 5.42, 95% CI 1.77-16.55, <i>P</i> = 0.003), septic shock (HR 6.99, 95% CI 1.36-35.87, <i>P</i> = 0.020) and SARS-CoV-2 coinfection (HR 10.23, 95% CI 2.69-38.85, <i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>Dose reduction of ceftazidime/avibactam according to renal function in patients with KPC-Kp BSI seems to be independently associated with higher mortality. This may be possibly due to inadequate exposure provided by the recommended doses for renal impairment.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae201"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846544","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":"The impact of the COVID-19 pandemic on the antimicrobial stewardship workforce in Scottish acute care hospitals-a qualitative study.","authors":"Ayodeji Matuluko, Valerie Ness, Jennifer Macdonald, Jacqueline Sneddon, Ronald Andrew Seaton, Kay Currie","doi":"10.1093/jacamr/dlae199","DOIUrl":"10.1093/jacamr/dlae199","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) programmes seek to reduce the risk of antimicrobial resistance by minimizing inappropriate antimicrobial use. The SARS-CoV-2 coronavirus (COVID-19) pandemic was characterized by initial widespread use of antimicrobials in patients with COVID-19, with potential negative effects on AMS efforts.</p><p><strong>Objective: </strong>To explore the impact of the pandemic on the AMS workforce in Scottish acute care hospitals.</p><p><strong>Method: </strong>Individual, semi-structured online interviews were conducted with a purposive sample of clinical staff who had an AMS focused role in Scottish Health Boards. Interviews explored staff experiences of facilitating AMS during the pandemic. Data were analysed using inductive content analysis.</p><p><strong>Results: </strong>Thirteen staff from seven of 15 Scotland Health Boards participated. The data revealed negative (including staff redeployment and shortages) and positive effects (including improved working relationships and use of technology) on the AMS workforce. Notably, greater appreciation of the work of the AMS team was a positive outcome.</p><p><strong>Conclusions: </strong>The robust qualitative methods applied in this original study have generated greater understanding of factors that impeded AMS services in Scotland during the pandemic. These findings may resonate internationally. Adaptation to technology and investment in the workforce are recommended to improve the resilience of AMS services in future crises.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae199"},"PeriodicalIF":3.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818175","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":"A nationwide survey of antimicrobial resistance of <i>Escherichia coli</i> isolated from broiler chickens in Malawi.","authors":"Pilirani Chisembe, Masato Suzuki, Duc Trung Dao, Gilson Njunga, Joseph Nkhoma, Lecollins Mthilakuwili, Ryo Kinoshita-Daitoku, Eisuke Kuroda, Kouji Kimura, Keigo Shibayama","doi":"10.1093/jacamr/dlae200","DOIUrl":"10.1093/jacamr/dlae200","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance is a global health challenge with profound implications across sectors. Livestock, a significant field at the One Health interface, lacks sufficient information, particularly in low-resource settings such as Malawi.</p><p><strong>Objectives: </strong>We determined the antimicrobial resistance rates of <i>Escherichia coli</i> isolated from broiler chickens in Malawi and explored the relationship between resistance genes across sectors using genomic analysis.</p><p><strong>Methods: </strong>In 2023, we isolated 115 <i>E. coli</i> strains from 116 faecal and caecal samples from broiler chickens across Malawi. Antimicrobial susceptibility tests were performed using agar dilution method according to the Clinical Laboratory Standard Institute guidelines. Whole-genome sequencing was performed using Illumina sequencing.</p><p><strong>Results: </strong>Notably, 50 isolates (44%) were resistant to cefotaxime. We detected ESBL <i>bla</i> _CTX-M genes (<i>bla</i> _CTX-M-55, <i>bla</i> _CTX-M-14, <i>bla</i> _CTX-M-65, <i>bla</i> _CTX-M-27, <i>bla</i> _CTX-M-15, <i>bla</i> _CTX-M-1, and <i>bla</i> _CTX-M-3) in 48 cefotaxime-resistant isolates, which exhibited higher resistance rates to levofloxacin than non-ESBL-encoding isolates (29/48; 60% versus 20/67; 30%). All isolates were susceptible to colistin and carbapenems. High resistance rates were observed for tetracycline and co-trimoxazole commonly used in broiler chickens (90% and 70%, respectively). Sequence type 206 and phylogroup A were predominant (14% and 65%, respectively). In the genetic context of <i>bla</i> _CTX-M genes, whole-genome alignment of the ESBL-producing isolates with reference plasmids from <i>E. coli</i> of various origins indicated significant similarity.</p><p><strong>Conclusions: </strong>Antimicrobial resistance is highly prevalent among <i>E. coli</i> from broiler chickens in Malawi. Genomic analysis suggests potential transmission pathways for ESBL genes across sectors, necessitating further studies from One Health perspective.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae200"},"PeriodicalIF":3.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818171","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":"Antibiotic resistance and molecular characterization of non-invasive clinical <i>Haemophilus influenzae</i> isolates in Germany 2019 and 2020.","authors":"Thiemo Frank, Esther Wohlfarth, Heike Claus, Manuel Krone, Thiên-Trí Lâm, Michael Kresken","doi":"10.1093/jacamr/dlae197","DOIUrl":"10.1093/jacamr/dlae197","url":null,"abstract":"<p><strong>Background: </strong><i>Haemophilus influenzae</i> (Hi) is known as a cause of invasive and non-invasive diseases. Especially ear, nose and throat (ENT) infections are common reasons for antibiotic prescriptions in outpatient settings in Germany. Therefore, antibiotic resistance surveillance is important to provide the basis of recommendations for the empirical usage of antibiotic agents.</p><p><strong>Objectives: </strong>To provide data on susceptibility rates of oral antibiotics for non-invasive clinical Hi isolates in Germany and to investigate molecular resistance patterns of β-lactams, ciprofloxacin, doxycycline and trimethoprim/sulfamethoxazole.</p><p><strong>Methods: </strong>Isolates were collected from a sentinel network of diagnostic laboratories in a prospective multicentre prevalence study. Antibiotic susceptibility testing was done with a commercial broth microdilution kit. MICs were interpreted according to EUCAST guidelines. Resistance gene sequencing and WGS were performed to analyze molecular antibiotic resistance patterns and genetic relationships between the isolates.</p><p><strong>Results: </strong>In total, 215 Hi isolates were collected from 23 laboratories across Germany. The highest resistance rates were found for amoxicillin (<i>n</i> = 30; 14%), cefuroxime (<i>n</i> = 40; 18.6%) and trimethoprim/sulfamethoxazole (co-trimoxazole) (<i>n</i> = 34; 15.8%). Resistance to amoxicillin was mainly due to <i>bla_TEM-1</i> (<i>n</i> = 29; 96.7%). PBP3 alterations were found in 39 of 40 cefuroxime-resistant isolates (97.5%). Two of the cefuroxime-resistant isolates harboured PBP3 mutation patterns that have not yet been associated with cefuroxime resistance; in one of them, a known <i>lpoA</i> mutation was found. One isolate showed no mutations in PBP3 or <i>lpoA.</i> All co-trimoxazole-resistant isolates (15.8%) showed known mutations in <i>folA</i> and its promoter region. Additionally, point mutations in <i>folP</i> were identified in a subset of these isolates. The most frequent sequence types (STs) were ST57 (<i>n</i> = 10) and ST103 (<i>n</i> = 10). Genetic cluster analysis identified six clusters, but no epidemiological link could be confirmed.</p><p><strong>Conclusion: </strong>Resistance to oral antibiotics in non-invasive clinical Hi isolates in Germany was generally low. Amoxicillin is estimated to cover 86% of infections involving non-invasive Hi and, therefore, is still effective for the first-line empirical treatment for ENT infections in Germany. Further surveillance of antimicrobial susceptibility in non-invasive Hi isolates is important to ensure the data basis for guidelines of antibiotic usage.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae197"},"PeriodicalIF":3.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806975","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":"Effectiveness of work-based educational interventions for antimicrobial stewardship: a systematic review.","authors":"Darren Langdridge, Jennika Virhia, Rachel McMullan, Duncan Banks, Olivier Biard, Koula Charitonos, Jimmy Patrick Alunyo, Enid Kawala Kagoya, Peter Olupot-Olupot","doi":"10.1093/jacamr/dlae192","DOIUrl":"10.1093/jacamr/dlae192","url":null,"abstract":"<p><strong>Background: </strong>The pressing need for better antimicrobial stewardship (AMS) is invariably reliant on educational interventions in some form.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of post-qualification educational interventions for AMS behaviour change among health professionals.</p><p><strong>Methods: </strong>Seven databases were searched for articles published between 2013 and 2024 for post-qualification educational interventions aimed at health professionals to improve AMS. Randomised controlled trials (RCTs) and quasi-experimental designs such as non-randomised trials, controlled and non-controlled before and after studies, and qualitative studies were considered eligible. The quality of studies was assessed using Cochrane Effective Practice and Organization of Care (EPOC) criteria for RCTs and interrupted time series designs, and the Mixed Methods Appraisal Tool (MMAT) for all other studies. Data were extracted, analysed for effectiveness, and synthesised narratively. Registration: PROSPERO international prospective register of systematic reviews (PROSPERO 2023 CRD42023447115).</p><p><strong>Results: </strong>Forty-six studies were included in the review, with six meeting the EPOC criteria. The remaining forty were assessed using the MMAT. The overall risk of bias for the six studies meeting the EPOC criteria was low, but risk of bias was high for studies assessed using the MMAT. Overall, there was some evidence that formal education alone was effective in this context, but only limited evidence about what type of educational intervention, for which profession, is most effective.</p><p><strong>Conclusions: </strong>Our review provided an in-depth examination of post-qualification AMS interventions. We found studies were heterogeneous and quality of evidence relatively poor. High quality studies focused on establishing key components of effective educational interventions are required.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 6","pages":"dlae192"},"PeriodicalIF":3.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806978","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}