JAC-Antimicrobial Resistance最新文献

{"title":"Prevalence of carbapenem-resistant Enterobacterales with <i>bla</i> _IMP-6 predominance in hospitals from 2018 to 2021 in Nara, Japan.","authors":"Rio Kishi, Ryuichi Nakano, Akiyo Nakano, Takehito Harimoto, Ryusei Taniguchi, Sayaka Ando, Yuki Suzuki, Koichi Yamaguchi, Daisuke Kitagawa, Saori Horiuchi, Kousuke Tsubaki, Ryuichi Morita, Takashi Kawabe, Hisakazu Yano","doi":"10.1093/jacamr/dlae135","DOIUrl":"10.1093/jacamr/dlae135","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the global health risk of carbapenem-resistant Enterobacterales (CRE), especially carbapenemase-producing Enterobacterales (CPE), Japan reports a significantly low frequency of CRE with a predominance of IMP-type carbapenemases. This study aimed to investigate the prevalence and characteristics of CRE isolated from hospitals in the city of Nara, Japan.</p><p><strong>Methods: </strong>We obtained 171 CRE isolates from 16 791 Enterobacterales isolated at 23 hospitals in Nara between January 2018 and December 2021. Isolates of CPE were characterized through antimicrobial susceptibility testing, the carbapenem inactivation method, PCR and DNA sequencing. Genotypic diversity of carbapenemase-producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> was determined via MLST and PFGE.</p><p><strong>Results: </strong>The prevalence of CRE between 2018 and 2021 was 1.02%, gradually decreasing from 1.13% to 0.74%. Ninety-nine isolates were identified as CPE, representing six species. Ninety-seven CPE isolates harboured <i>bla</i> _IMP-6, while the remaining two carried either <i>bla</i> _IMP-1 or <i>bla</i> _IMP-19. Genotype analysis identified ST131 as the dominant genotype for <i>E. coli</i>, but none for <i>K. pneumoniae</i>. PFGE results suggested clonal spread of CPE in Hospital A, where CRE was isolated in high numbers (<i>n</i> = 44).</p><p><strong>Conclusions: </strong>In this study, CRE prevalence was marginally higher than previously reported in Japan, but still low in frequency. A predominance of Enterobacterales harbouring <i>bla</i> _IMP-6 was confirmed in Nara. The spread of CPE at Hospital A suggested the possibility of a nosocomial outbreak due to <i>bla</i> _IMP-6 transmission via plasmids or clonal spread. Continued monitoring is crucial for effective management of CRE prevalence in the region.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae135"},"PeriodicalIF":3.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008853","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":"Oral clindamycin for peritonitis due to <i>Brevibacterium casei</i> and <i>Bacillus cereus</i> in two successive patients undergoing peritoneal dialysis.","authors":"Pierre-Marie Roger, Hélène Sichez-Com, Jacques Ollier, Soraya Boumezber, Stanislas Bataille","doi":"10.1093/jacamr/dlae128","DOIUrl":"10.1093/jacamr/dlae128","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae128"},"PeriodicalIF":3.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004250","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":"Navigating fluoroquinolone resistance in Gram-negative bacteria: a comprehensive evaluation.","authors":"Linda Kherroubi, Joanna Bacon, Khondaker Miraz Rahman","doi":"10.1093/jacamr/dlae127","DOIUrl":"10.1093/jacamr/dlae127","url":null,"abstract":"<p><p>Since the introduction of quinolone and fluoroquinolone antibiotics to treat bacterial infections in the 1960s, there has been a pronounced increase in the number of bacterial species that have developed resistance to fluoroquinolone treatment. In 2017, the World Health Organization established a priority list of the most critical Gram-negative resistant pathogens. These included <i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i>, <i>Pseudomonas aeruginosa</i>, and <i>Escherichia coli</i>. In the last three decades, investigations into the mechanisms of fluoroquinolone resistance have revealed that mutations in the target enzymes of fluoroquinolones, DNA gyrase or topoisomerase IV, are the most prevalent mechanism conferring high levels of resistance. Alterations to porins and efflux pumps that facilitate fluoroquinolone permeation and extrusion across the bacterial cell membrane also contribute to the development of resistance. However, there is a growing observation of novel mutants with newer generations of fluoroquinolones, highlighting the need for novel treatments. Currently, steady progress has been made in the development of novel antimicrobial agents that target DNA gyrase or topoisomerase IV through different avenues than current fluoroquinolones to prevent target-mediated resistance. Therefore, an updated review of the current understanding of fluoroquinolone resistance within the literature is imperative to aid in future investigations.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae127"},"PeriodicalIF":3.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982311","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":"'Cut medicine for me': addressing suboptimal dosing of antimicrobials as a critical issue to combat AMR in Nigeria.","authors":"Kenneth Chukwuebuka Egwu, Maryam Abdulkarim, Shadrach Chinecherem Eze, Oluchi Mbamalu","doi":"10.1093/jacamr/dlae131","DOIUrl":"10.1093/jacamr/dlae131","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) is a critical health challenge in Nigeria as in many other countries in the sub-Saharan region of Africa. Our article describes how the challenges in the regulation and operations of Patent and Proprietary Medicine Vendors (PPMVs) in Nigeria provide a blind spot for the underuse of antimicrobials. This article also sheds light on how patients' antibiotic use and seeking behaviour facilitate this unwholesome practice. In addition, our article looks at the social determinants of this practice, such as poverty and poor education, and proffers solutions towards solving it. While previous research has investigated the knowledge, perceptions and attitudes of PPMVs towards antimicrobial use and AMR, our article is the first to critically raise concerns about the common practice of antimicrobial underdosing in Nigeria.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae131"},"PeriodicalIF":3.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916688","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":"Genomic characterization of carbapenemase-producing Enterobacterales from Dhaka food markets unveils the spread of high-risk antimicrobial-resistant clones and plasmids co-carrying <i>bla</i> _NDM and <i>mcr-1.1</i>.","authors":"Tania Tabassum Nisa, Yo Sugawara, Shigeto Hamaguchi, Dan Takeuchi, Ryuichiro Abe, Eisuke Kuroda, Masatomo Morita, Hui Zuo, Akiko Ueda, Isao Nishi, Nowrin Hossain, Md Mahmudul Hasan, Mahbubul H Siddiqee, Daisaku Nakatani, Ken Nakata, Yukihiro Akeda","doi":"10.1093/jacamr/dlae124","DOIUrl":"10.1093/jacamr/dlae124","url":null,"abstract":"<p><strong>Background: </strong>The transmission of carbapenemase-producing Enterobacterales (CPE) in the external environment, especially through food, presents a significant public health risk.</p><p><strong>Objectives: </strong>To investigate the prevalence and genetic characteristics of CPE in food markets of Dhaka, Bangladesh, using WGS.</p><p><strong>Methods: </strong>CPE isolates were obtained from different food and water samples collected from food markets in the southern part of Dhaka, Bangladesh. The isolates subsequently underwent molecular typing, WGS employing both short- and long-read sequencers, and plasmid analysis.</p><p><strong>Results: </strong>This study unveiled an extensive spread of CPE, with no significant difference in contamination rates observed in samples (<i>N</i> = 136), including meat (<i>n</i> = 8), fish (<i>n</i> = 5), vegetables (<i>n</i> = 36) or various food-washed water (<i>n</i> = 65) from markets near hospitals or residential areas. Thirty-eight Enterobacterales from 33 samples carried carbapenemase genes (<i>bla</i> _{NDM-1, -4, -7}, <i>bla</i> _KPC-2, <i>bla</i> _OXA-181 or <i>bla</i> _IMI-1). Among these, the high-risk <i>Escherichia coli</i> ST410 clone was the most prevalent and distributed across various locations. Furthermore, the identification of IncHI2 plasmids co-harbouring resistance genes like <i>bla</i> _NDM-5 and <i>mcr-1.1</i>, without discernible epidemiological connections, is a unique finding, suggesting their widespread dissemination.</p><p><strong>Conclusions: </strong>The analysis unveils a dynamic landscape of CPE dissemination in food markets, underscored by the proliferation of novel IncHI2 hybrid plasmids carrying both colistin- and carbapenem-resistance genes. This illuminates the ever-evolving landscape of antimicrobial resistance in Dhaka, urging us to confront its emergent challenges.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae124"},"PeriodicalIF":3.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11306930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906660","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":"COVID-19 restrictions limited interactions of people and resulted in lowered <i>E. coli</i> antimicrobial resistance rates.","authors":"Peter Collignon, John Beggs, Jennifer Robson","doi":"10.1093/jacamr/dlae125","DOIUrl":"10.1093/jacamr/dlae125","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic resistance is rising globally and is a major One Health problem. How much person-to-person transmission or 'contagion' contributes to the spread of resistant strains compared with antibiotic usage remains unclear. As part of its COVID-19 response, Australia introduced strict people movement restrictions in early 2020. Along with internal lockdown measures, movement of people into Australia from overseas was severely restricted. These circumstances provided a unique opportunity to examine the association of people movements with changes in resistance rates.</p><p><strong>Methods: </strong>Monthly resistance data on over 646 000 <i>Escherichia coli</i> urine isolates from 2016 till 2023 were modelled for statistical changes in resistance trends during pre-lockdown, lockdown and post-lockdown periods. Data were available for three clinical contexts (community, hospital and aged-care facilities). Data were also available for antibiotic usage volumes and movements of people into Australia.</p><p><strong>Results: </strong>In 2020, arrivals into Australia decreased by >95%. Antibiotic community use fell by >20%. There were sharp falls in trend rates of resistance for all antibiotics examined after restrictions were instituted. This fall in trend rates of resistance persisted during restrictions. Notably, trend rates of resistance fell in all three clinical contexts. After removal of restrictions, an upsurge in trend rates of resistance was seen for nearly all antibiotics but with no matching upsurge in antibiotic use.</p><p><strong>Conclusions: </strong>Restricting the movement of people appeared to have a dramatic effect on resistance rates in <i>E. coli.</i> The resulting reduced person-to-person interactions seems more closely associated with changes in antibiotic resistance than antibiotic usage patterns.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae125"},"PeriodicalIF":3.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11306925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906659","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":"Patient and public understanding of antimicrobial resistance: a systematic review and meta-ethnography.","authors":"Gosha Wojcik, Janyne Afseth, Ross Fagan, Fiona Thomson, Nicola Ring","doi":"10.1093/jacamr/dlae117","DOIUrl":"10.1093/jacamr/dlae117","url":null,"abstract":"<p><strong>Objectives: </strong>To further develop an understanding of laypeople's (adult patients and public) beliefs and attitudes toward antimicrobial resistance (AMR) by developing a conceptual model derived from identifying and synthesizing primary qualitative research.</p><p><strong>Methods: </strong>A systematic search of 12 electronic databases, including CINAHL, MEDLINE, PsycINFO, PubMed and Web of Science to identify qualitative primary studies exploring patient and public understanding of AMR published between 2012 and 2022. Included studies were quality appraised and synthesized using Noblit and Hare's meta-ethnographic approach and reported using eMERGe guidance.</p><p><strong>Results: </strong>Thirteen papers reporting 12 qualitative studies were synthesized. Studies reported data from 466 participants aged 18-90 years. Five themes were identified from these original studies: the responsible patient; when words become meaningless; patient-prescriber relationship; past experience drives antibiotic use; and reframing public perception. These themes supported the development of a conceptual model that illustrates the tension between two different assumptions, that is, how can antibiotics be used for the collective good whilst balancing the immediate needs of individual patients.</p><p><strong>Conclusions: </strong>Findings suggest that AMR is a distinct ethical issue and should not be viewed purely as a prescribing problem. The meta-ethnography-generated conceptual model illustrates many factors affecting the public's perception of AMR. These include laypeople's own knowledge, beliefs and attitudes around antibiotic use, the relationship with the healthcare provider and the wider context, including the overwhelming influence of the media and public health campaigns. Future research is needed to explore effective health messaging strategies to increase laypeople's baseline awareness of AMR as a public threat.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae117"},"PeriodicalIF":3.7,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901743","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":"Predicting antibiotic susceptibility in urinary tract infection with artificial intelligence-model performance in a multi-centre cohort.","authors":"Alfred Lok Hang Lee, Curtis Chun Kit To, Ronald Cheong Kin Chan, Janus Siu Him Wong, Grace Chung Yan Lui, Ingrid Yu Ying Cheung, Viola Chi Ying Chow, Christopher Koon Chi Lai, Margaret Ip, Raymond Wai Man Lai","doi":"10.1093/jacamr/dlae121","DOIUrl":"10.1093/jacamr/dlae121","url":null,"abstract":"<p><strong>Objective: </strong>To develop an artificial intelligence model to predict an antimicrobial susceptibility pattern in patients with urinary tract infection (UTI).</p><p><strong>Materials and methods: </strong>26 087 adult patients with culture-proven UTI during 2015-2020 from a university teaching hospital and three community hospitals in Hong Kong were included. Cases with asymptomatic bacteriuria (absence of diagnosis code of UTI, or absence of leucocytes in urine microscopy) were excluded. Patients from 2015 to 2019 were included in the training set, while patients from the year 2020 were included as the test set.Three first-line antibiotics were chosen for prediction of susceptibility in the bacterial isolates causing UTI: namely nitrofurantoin, ciprofloxacin and amoxicillin-clavulanate. Baseline epidemiological factors, previous antimicrobial consumption, medical history and previous culture results were included as features. Logistic regression and random forest were applied to the dataset. Models were evaluated by F1-score and area under the curve-receiver operating characteristic (AUC-ROC).</p><p><strong>Results: </strong>Random forest was the best algorithm in predicting susceptibility of the three antibiotics (nitrofurantoin, amoxicillin-clavulanate and ciprofloxacin). The AUC-ROC values were 0.941, 0.939 and 0.937, respectively. The F1 scores were 0.938, 0.928 and 0.906 respectively.</p><p><strong>Conclusions: </strong>Random forest model may aid judicious empirical antibiotics use in UTI. Given the reasonable performance and accuracy, these accurate models may aid clinicians in choosing between different first-line antibiotics for UTI.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae121"},"PeriodicalIF":3.7,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901744","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 antimicrobial stewardship governance in Northeast Brazilian hospitals: a survey-based analysis.","authors":"Sylvia Lemos Hinrichsen, Marcela Coelho de Lemos, Juliana Magalhães Bernardino, Juliana Andrade Lima, Genaro Carrazone, Tatiana Vilella, Gabriel Trova, Libia Moura, Reginaldo Gonçalves de Lima-Neto, Adrian John Brink","doi":"10.1093/jacamr/dlae116","DOIUrl":"10.1093/jacamr/dlae116","url":null,"abstract":"<p><strong>Background: </strong>Effective governance of antimicrobial stewardship (AMS) and infection prevention control (IPC) in healthcare facilities is crucial for safeguarding patients against healthcare-associated infections and enhancing patient outcomes by optimizing antibiotic use and curbing the spread of antimicrobial-resistant (AMR) pathogens.</p><p><strong>Objectives: </strong>To assess the current AMS governance in two public hospitals in Northeast of Brazil, specifically focusing on identifying institutional antibiotic policies and operational practices.</p><p><strong>Methods: </strong>A survey was conducted by team leaders of both hospitals from 2020 to 2022 using a questionnaire adapted from the Pan American Health Organization (PAHO) recommendations for implementing AMS programmes (ASP) in Latin America and the Caribbean, alongside criteria from the National Health Surveillance Agency (ANVISA) and CDC.</p><p><strong>Results: </strong>Fifty leaders, from senior management to coordinators, answered the questionnaire. Results indicate a lack of AMS process measures, specialist support, systematic antimicrobial utilization analysis and structured IPC programmes, especially in one hospital where patient records remain in paper format.</p><p><strong>Conclusions: </strong>The empirical use of antimicrobials without local epidemiological or susceptibility data underscores the absence of logistical support for microbiological cultures in the region. These findings emphasize the urgent need for systematic AMS processes and multiprofessional teams to drive AMS and IPC practices, essential for patient care and safety.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae116"},"PeriodicalIF":3.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893411","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":"Promoting antifungal stewardship through an antifungal multidisciplinary team in a paediatric and adult tertiary centre in the UK.","authors":"Shuchita Soni, David Hettle, Stephanie Hutchings, Susan Wade, Kate Forrest-Jones, Iara Sequeiros, Andrew Borman, Elizabeth M Johnson, Irasha Harding","doi":"10.1093/jacamr/dlae119","DOIUrl":"10.1093/jacamr/dlae119","url":null,"abstract":"<p><strong>Background: </strong>Invasive fungal infections (IFIs) present significant challenges, especially among immunocompromised patients, with associated high morbidity, mortality and significant economic impact. Diagnostic difficulties and the emergence of antifungal resistance necessitates enhanced antifungal stewardship (AFS) efforts.</p><p><strong>Methods: </strong>We report outcomes from a review of our multidisciplinary approach to AFS, based in a 1300-bed teaching hospital in the South-West of England. Retrospectively reviewing all adult and paediatric cases over 12 months in 2022, we investigated demographics, diagnosis, antifungal therapy and adherence to AFS advice, including clinical, mycological, financial and teamwork metrics. Data were extracted from our AFS database, supported by pharmacy records.</p><p><strong>Results: </strong>The AFS multidisciplinary team (MDT) reviewed 111 patients, with 30 day and 1 year mortality of 22.7% and 35.4%, respectively. IFIs classified as proven accounted for 26%, with fungal pathogens identified in 36.3% of cases. Antifungal consumption (by 25.1%) and expenditure (by 59.9%) decreased from 2018 to 2022. The AFS MDT issued 324 recommendations, with a 93% acceptance rate.</p><p><strong>Conclusions: </strong>Our approach to AFS, centred around a weekly MDT, demonstrated improvements in IFI management, antifungal consumption and cost-efficiency. This single-centre study highlights the value of a comprehensive, collaborative approach to AFS involving experts in mycology, infection, radiology, antifungal therapies and clinical teams. The programme's success in paediatric and adult populations and the near-universal acceptance of its recommendations show its potential as a model for replication. It represents a model for enhancing patient care and AFS practices, with future directions aimed at expanding service reach and the integration of further rapid diagnostic modalities.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 4","pages":"dlae119"},"PeriodicalIF":3.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893413","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}