JAC-Antimicrobial Resistance最新文献

{"title":"Quantifying cost savings from outpatient parenteral antimicrobial therapy programme: a systematic review and meta-analysis.","authors":"Solomon Ahmed Mohammed, Jason A Roberts, Manuel Mirón-Rubio, Luis Eduardo López Cortés, Getnet Mengistu Assefa, James Pollard, Kate McCarthy, Mark Gilchrist, Menino Cotta, Fekade B Sime","doi":"10.1093/jacamr/dlaf049","DOIUrl":"10.1093/jacamr/dlaf049","url":null,"abstract":"<p><strong>Background: </strong>The outpatient parenteral antimicrobial therapy (OPAT) programme was introduced to reduce costs and enhance the quality of life for patients requiring prolonged treatment with parenteral antimicrobials. However, given the escalating inflation, the extent of current cost savings achieved through OPAT programmes remains unclear. This systematic review and meta-analysis employ a cost-minimization analysis to quantify the cost savings from OPAT compared to inpatient treatment.</p><p><strong>Methods: </strong>The Cochrane Library, MEDLINE, Embase, PubMed and Web of Science databases were searched for studies comparing the costs of parenteral antimicrobial treatment without restriction on study design and year. Two reviewers conducted eligibility screening and cross-validated the extracted data. The cost data were adjusted and inflated to 2023 US dollars. A random effect model calculated mean differences (MD) with 95% confidence intervals (CI). The review protocol was registered on PROSPERO (CRD42024584201).</p><p><strong>Results: </strong>Twenty studies involving 2790 patients were included in the systematic review, and six studies (three randomized controlled trials and three cohorts) were subject to metanalysis. Collectively, these included 560 patients who received treatment in outpatient settings, and 491 treated as inpatients. The cost of parenteral antimicrobial per episode of care was lower in the outpatient settings MD -$5436.73 (95% CI: -$9589.24 to -$1284.22, I² = 96%; <i>P</i> = 0.01) than in inpatient settings.</p><p><strong>Conclusions: </strong>OPAT significantly saves costs compared to inpatient treatment. We recommend comprehensive analysis of treatment costs from all perspectives, including various cost types.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 2","pages":"dlaf049"},"PeriodicalIF":3.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811130","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":"Case of <i>bla_KPC-12</i> -carrying hypervirulent <i>Klebsiella pneumoniae</i> from bloodstream infection in China.","authors":"Aoxiao Chen, Hanyu Wang, Jing Zhang, Yi Sun, Gongxiang Chen, Hongwei Zhou","doi":"10.1093/jacamr/dlaf048","DOIUrl":"10.1093/jacamr/dlaf048","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 2","pages":"dlaf048"},"PeriodicalIF":3.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795579","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":"Macrolide resistance in <i>Mycobacterium abscessus</i>: current insights and future perspectives.","authors":"Victoria L Nguyen, Kelly L Eick, Mingyu Gan, Taryn A Miner, Anne E Friedland, Allison F Carey, Kenneth N Olivier, Qingyun Liu","doi":"10.1093/jacamr/dlaf047","DOIUrl":"10.1093/jacamr/dlaf047","url":null,"abstract":"<p><p><i>Mycobacterium abscessus</i> (MAB) is a rapidly growing, non-tuberculous mycobacterium that has emerged as a significant pathogen in both pulmonary and extrapulmonary infections. It is rising in prevalence, especially among individuals with underlying lung conditions such as cystic fibrosis and chronic obstructive pulmonary disease, highlighting its growing clinical importance. The treatment of MAB infections is notoriously challenging due to intrinsic resistance to many antibiotics and low cure rates, typically <50%. Macrolides are a cornerstone in the treatment of MAB infections because regimens that include effective macrolide therapy are associated with higher cure rates. However, MAB possesses intrinsic and acquired drug resistance mechanisms against macrolides, complicating drug susceptibility testing and selection of highly effective treatment regimens. This review aims to provide a summary of the current understanding of macrolide resistance mechanisms in MAB. We explored the epidemiology of resistance in different countries and the molecular mechanisms involved. We have highlighted the variability in sensitivity of existing markers to predict phenotypic macrolide drug resistance across different countries, suggesting the involvement of unknown resistance mechanisms. By synthesizing current knowledge and identifying gaps in the literature, this review seeks to inform clinical practice and guide future research efforts in the fight against MAB drug resistance.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 2","pages":"dlaf047"},"PeriodicalIF":3.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772425","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":"Aerosolized delivery resulting in high polymyxin B concentration levels in epithelial lining fluid ensures efficacy in ventilator-associated pneumonia.","authors":"Xiaofen Liu, Lei Yang, Meihua Wang, Yu Wang, Beining Guo, Chuhan Zhang, Xingyi Qu, Chenxue Guo, Yaxin Fan, Hailan Wu, Xin Li, Jin Hu, Jing Zhang","doi":"10.1093/jacamr/dlaf023","DOIUrl":"10.1093/jacamr/dlaf023","url":null,"abstract":"<p><strong>Background: </strong>Aerosolized polymyxin B delivery was a promising approach for the treatment of ventilator-associated pneumonia (VAP). However, there were little data on the concentrations of polymyxin B in epithelial lining fluid (ELF), which impedes the optimal use of aerosolized polymyxin B in clinics.</p><p><strong>Methods: </strong>We present four cases of patients diagnosed with VAP caused by Gram-negative bacteria, who enrolled in a prospective, therapeutic drug monitoring (TDM) study of polymyxin B. The patients were treated with aerosolized and intravenous administration of polymyxin B. Polymyxin B concentrations in both ELF and plasma were determined using validated LC-MS/MS methods.</p><p><strong>Results: </strong>All four patients achieved bacterial eradication, with three of them reaching clinical improvement or cure. Following aerosol administration (25 or 50 mg, q12h) and intravenous infusion (50-100 mg, q12h) of polymyxin B, it was observed that the concentrations of polymyxin B in ELF were significantly higher in ELF (20.6-97.6 mg/L) compared to those in plasma (1.19-5.16 mg/L) during the steady sate. The area under the concentration-time curve for 24 h (AUC_24h,ELF) ranged from 283.6 to 1872.9 mg•h/L.</p><p><strong>Conclusions: </strong>This study presented polymyxin B concentrations in ELF following aerosolized delivery, supporting its clinical use from a PK/PD perspective. Following combined aerosol and intravenous administration, polymyxin B achieved notably higher concentrations in ELF than those observed in plasma.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 2","pages":"dlaf023"},"PeriodicalIF":3.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763949","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":"Do policies that allow access to unregistered antimicrobials address the unmet need? Australia as a case study of a high-income country with universal healthcare.","authors":"Nadine T Hillock, Allen Cheng, Andrew Bowskill","doi":"10.1093/jacamr/dlae216","DOIUrl":"10.1093/jacamr/dlae216","url":null,"abstract":"<p><strong>Background: </strong>Ensuring timely and equitable access to effective and optimal antimicrobials is crucial for optimal patient care, to minimize the use of less appropriate treatment options and reduce the risk of antimicrobial resistance (AMR).</p><p><strong>Objectives: </strong>To determine the average time for new antibacterials to gain registration for use in Australia after obtaining marketing approval internationally, and to quantify the use of 'new' and older unregistered antimicrobials in Australian clinical practice between 2018 and 2023.</p><p><strong>Methods: </strong>Two data sources were utilized to estimate the usage of antimicrobials not registered for use in Australia. Annual hospital inpatient usage data were sourced from the National Antimicrobial Utilisation Surveillance Program (NAUSP) and data on Special Access Scheme (SAS) applications for unregistered antimicrobial was sourced from the Australian Government Department of Health and Aged Care.</p><p><strong>Results: </strong>Between 2018 and 2023 there were 36 131 applications to access unapproved antimicrobials in Australia. In 26.6% of cases, access to an unapproved antimicrobial was for the treatment of a critically ill patient. Levofloxacin, pyrazinamide, tetracycline and pristinamycin were the most frequently accessed unregistered antimicrobials. Applications for 'new' antibacterials increased from 55 in 2018 to 249 in 2023. Inpatient use of nine new antibacterials was reported in Australian hospitals in 2023, two registered and seven unregistered.</p><p><strong>Conclusions: </strong>Unapproved antimicrobials are frequently accessed by clinicians for patients unable to be treated with registered antimicrobials in Australia. Policy reform and economic incentives are required to support the registration of antimicrobials needed for otherwise untreatable infections and to ensure the sustainability of supply.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlae216"},"PeriodicalIF":3.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557083","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":"Duration of antibiotic treatment for respiratory tract infections in primary care.","authors":"Carl Llor, Malene Plejdrup Hansen, Jesper Lykkegaard, Jonas Olsen, Bent Håkan Lindberg, Ingrid Keilegavlen Rebnord, Pia Touboul Lundgren, Pascale Bruno, Anna Kowalczyk, Christos Lionis, Ruta Radzeviciene, Lina Jaruseviciene, Lars Bjerrum, Ana García-Sangenís","doi":"10.1093/jacamr/dlaf028","DOIUrl":"10.1093/jacamr/dlaf028","url":null,"abstract":"<p><strong>Objectives: </strong>The primary driver of antimicrobial resistance is excessive antibiotic use, posing a global threat to public health. Reducing individual exposure to antibiotics is a key to addressing the problem. This study aimed to assess the duration of antibiotic courses administered to patients with acute respiratory tract infections (RTIs) in primary care.</p><p><strong>Methods: </strong>Consecutive patients presenting with RTI symptoms were prospectively included from general practices and out-of-hours services in France, Greece, Lithuania, Poland and Spain for two winter periods (February to April 2022 and 2023). Data were collected using a paper-based Audit Project Odense template, with clinicians recording patient age, gender, RTI diagnosis, type of antibiotic prescribed and treatment duration.</p><p><strong>Results: </strong>A total of 196 doctors (133 in general practice and 63 in out-of-hours services) registered 11 270 cases, with 34.0% (3835) receiving antibiotics. The mean antibiotic course duration was 7.52 days (SD 2.11), which was significantly longer for pneumonia, COVID-19 infection and pharyngotonsillitis (8.01, 8.00 and 7.74 days, respectively), and lowest for predominantly viral infections, such as the common cold and flu infection, laryngitis and acute bronchitis (6.32, 6.48 and 6.98 days, respectively; <i>P</i> < 0.001). A total of 26.7% of the courses were prescribed for 10 days or longer.</p><p><strong>Conclusions: </strong>Antibiotic courses for common RTIs are often prolonged, which does not align with current recommendations for course duration. Antibiotics should be avoided in cases of predominantly viral infections and most mixed infections; however, if deemed necessary, the courses should be substantially reduced to minimize unnecessary exposure.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlaf028"},"PeriodicalIF":3.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501381","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":"Emerging β-lactam non-susceptibility in <i>Group A Streptococcus</i>: implications for Ethiopia's healthcare system.","authors":"Alene Geteneh, Sirak Biset, Melese Abate Reta","doi":"10.1093/jacamr/dlaf020","DOIUrl":"10.1093/jacamr/dlaf020","url":null,"abstract":"<p><p>The emergence of β-lactam non-susceptibility in <i>Group A Streptococcus</i> (GAS) or <i>Streptococcus pyogenes</i> represents a major challenge for the global public health, particularly in resource-limited settings like Ethiopia. GAS, a primary cause of pharyngitis and invasive infections, is conventionally treated with β-lactam antibiotics such as penicillin. However, the recent evidence raises concerns about the treatment efficacy with reduced susceptibility, the diagnostic limitations, and the potential for complications such as acute rheumatic fever. This commentary calls for attention to the antimicrobial resistance trends in Ethiopian GAS isolates, underscoring the need for routine susceptibility testing, advanced molecular diagnostics, and strengthened laboratory capacities to guide effective treatment strategies and mitigate the antibiotic resistance-associated risks.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlaf020"},"PeriodicalIF":3.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483095","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":"Heteroresistance associated with the production of fosfomycin-resistant inner colonies during disk diffusion testing among a geographically diverse collection of <i>Klebsiella pneumoniae</i> clinical isolates.","authors":"Morgan L Bixby, Lindsey B Collins, Ellora C Daley, Jenna M Salay, Sofia Oliver, Alexandra L Bryson, Elizabeth B Hirsch","doi":"10.1093/jacamr/dlaf013","DOIUrl":"10.1093/jacamr/dlaf013","url":null,"abstract":"<p><strong>Background: </strong>Fosfomycin susceptibility breakpoints apply only to <i>Escherichia coli</i> despite clinical use against <i>Klebsiella pneumoniae.</i> EUCAST and CLSI have different breakpoints and guidelines for disk diffusion (DD) interpretation that are frequently extrapolated to <i>K. pneumoniae.</i> Guidelines differ in interpreting inner colonies (IC) that grow within the zone of inhibition, but specificity to <i>E. coli</i> leaves knowledge gaps when extrapolating to other uropathogens.</p><p><strong>Objectives: </strong>To examine the frequency and MIC of <i>K. pneumoniae</i> IC during fosfomycin DD testing and to determine potential relationships between IC production, heteroresistance and <i>fosA</i> presence.</p><p><strong>Methods: </strong>A collection of <i>K. pneumoniae</i> clinical isolates (<i>n</i> = 262) and their IC (<i>n</i> = 116) underwent broth microdilution testing. Heteroresistance screening and PCR for <i>fosA</i> was performed on susceptible isolates that either never produced (NP) IC (<i>n</i> = 14) or produced ≥5 resistant IC (<i>n</i> = 43).</p><p><strong>Results: </strong>The MIC range (≤2 to >256 mg/L) of clinical isolates increased to 32 to >1024 mg/L for the IC collection with a median MIC increase of three, 2-fold dilutions. IC producers had 1.71 greater odds (<i>P</i> < 0.01) of a positive heteroresistance screen compared to NP isolates. No relationship was found between <i>fosA</i> presence and either IC production or heteroresistance.</p><p><strong>Conclusions: </strong>Production of ≥5 IC among clinical <i>K. pneumoniae</i> isolates was frequent and often resulted in an increased IC isolate MIC. Significantly greater odds of heteroresistance among IC producers were found when compared to NP isolates. Thus, presence of IC during fosfomycin DD testing should prompt avoidance of fosfomycin treatment.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlaf013"},"PeriodicalIF":3.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467867","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":"AMRrounds: presumed mechanisms of resistance in a case of XDR <i>Klebsiella pneumoniae</i> empyema.","authors":"Michael Casias, Madison Salam","doi":"10.1093/jacamr/dlaf019","DOIUrl":"10.1093/jacamr/dlaf019","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlaf019"},"PeriodicalIF":3.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467866","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":"Host-response testing with MeMed BV in community-acquired pneumonia: an economic evaluation from the UK NHS perspective.","authors":"Emily Gregg, Sara Graziadio, William Green, Daniela Afonso, Monica Garrett, Karina Watts, Deborah Watkins, Enitan D Carrol, Jonathan Cooke, Tim Felton","doi":"10.1093/jacamr/dlaf016","DOIUrl":"10.1093/jacamr/dlaf016","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) remains a leading cause of hospital admissions and mortality. A novel host-response test, MeMed BV (MMBV), has been developed for discriminating between bacterial and viral infection that could improve the clinical management of CAP.</p><p><strong>Objectives: </strong>To evaluate the cost-effectiveness of using MMBV to guide antibiotic decisions in the clinical management of CAP in the UK.</p><p><strong>Methods: </strong>An economic model was developed to understand the incremental cost per person associated with the implementation of MMBV from the UK NHS perspective. A qualitative care pathway analysis was performed to inform the standard of care (SOC) and SOC plus MMBV (SOC + MMBV) clinical pathways captured in the model.</p><p><strong>Results: </strong>In the base case analysis, the SOC + MMBV strategy for a hypothetical cohort of 1000 patients (adults and children modelled independently) presenting to the emergency department with suspected CAP was estimated to provide total cost savings of £134 018 and £105 750 for adults and children, respectively. Cost savings were associated with reductions in total antibiotic treatment, the number of patients receiving additional diagnostic tests, and hospital admissions. Deterministic sensitivity analysis revealed that the specificity of SOC + MMBV and sensitivity of the SOC were primary drivers of the cost model for adults, whereas the specificity of SOC and SOC + MMBV were primary drivers for paediatrics.</p><p><strong>Conclusions: </strong>Overall, the model predicts that the introduction of SOC + MMBV has the potential to be cost-saving and promote antimicrobial stewardship for both adult and paediatric CAP patients.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 1","pages":"dlaf016"},"PeriodicalIF":3.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458011","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}