JAC-Antimicrobial Resistance最新文献

{"title":"Aetiology, susceptibility and outcomes of fever in patients receiving chemotherapy in Malawi: a prospective study.","authors":"Kaushik Puranam, Meagan Harrington, Edwards Kasonkanji, Gerald Tegha, Maria J Chikasema, Mena L Chawinga, Maganizo B Chagomerana, Robert Krysiak, Satish Gopal, David van Duin, Melissa B Miller, Matthew S Painschab","doi":"10.1093/jacamr/dlae173","DOIUrl":"https://doi.org/10.1093/jacamr/dlae173","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi.</p><p><strong>Methods: </strong>In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever workup, and antibiotics. All patients were followed through 90 days post-fever event or completion of chemotherapy.</p><p><strong>Results: </strong>One hundred and five patients were screened and 50 were enrolled. Of the enrollees, 26 (52%) were men and 26 (52%) were HIV positive, with a mean ART duration of 7 years and CD4 count of 293 cells/µL. The most common diagnoses were aggressive non-Hodgkin lymphoma (40%) and Hodgkin lymphoma (22%). Twenty-three febrile events were recorded from 15 patients. Of the 23 events, a causative agent was isolated in 13 cases: <i>Escherichia coli</i> (6), <i>Plasmodium falciparum</i> (3), <i>Streptococcus pneumoniae</i> (2), <i>Pseudomonas aeruginosa</i> (1) and <i>Citrobacter freundii</i> (1). Of the six <i>E. coli</i> isolates, all were found to be resistant to fluoroquinolones and 4/6 (66%) were resistant to cephalosporins. All patients but one survived; the death was attributed to <i>Pseudomonas</i> bacteraemia.</p><p><strong>Conclusions: </strong>This study describes laboratory-confirmed causes of neutropenic fever (NF) in cancer patients in Malawi. Gram-negative rods, followed by malaria, were the most common source of infection. Gram-negative rods were associated with high rates of antimicrobial resistance. Malaria and resistant bacterial infections should be considered for NF treatment and prevention in sub-Saharan Africa.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae173"},"PeriodicalIF":3.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545478","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":"Evaluating the costs of <i>Escherichia coli</i> bloodstream infections: a population-based cohort study in a large metropolitan Canadian region.","authors":"Teagan L King, Elissa Rennert-May, Ranjani Somayaji, Jenine Leal, Jason E Black, John M Conly, Daniel Gregson","doi":"10.1093/jacamr/dlae157","DOIUrl":"10.1093/jacamr/dlae157","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the costs of susceptible and resistant <i>Escherichia coli</i> bloodstream infections (BSIs) in adults. Secondary outcomes were the impact of BSI on length of stay (LOS), readmissions and death.</p><p><strong>Methods: </strong>We examined a population-based retrospective cohort of blood cultures from 2011 to 2018 in Calgary, Canada, linked to microcosting and gross costing data. Propensity score matching was completed, and costs were compared between no BSI and <i>E. coli</i> BSI over 90 days using linear regression.</p><p><strong>Results: </strong>A total of 4581 BSIs in 89 673 adults experienced <i>E. coli</i> bacteraemia during the study period. The mean cost of an <i>E. coli</i> BSI at 90 days was $39 072 (SD: $95 747) in adults. Ceftriaxone-resistant (CRO-R) <i>E. coli</i>, resistant to fluoroquinolones (FQ) and trimethoprim/sulfamethoxazole, compared with susceptible <i>E. coli</i> BSI resulted in the greatest mean cost at $53 899 and the highest odds of readmission, increased LOS, and death.</p><p><strong>Conclusions: </strong><i>E. coli</i> BSI is associated with substantial costs. Total cost differences were highest in those with CRO-R <i>E. coli</i> with resistance to FQ and trimethoprim/sulfamethoxazole. Over the study period, bacteraemia secondary to these strains alone, added over $9 million to costs for healthcare in the Calgary Zone.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae157"},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545481","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":"Influences on use of antibiotics without prescription by the public in low- and middle-income countries: a systematic review and synthesis of qualitative evidence.","authors":"Christie Cabral, Tingting Zhang, Isabel Oliver, Paul Little, Lucy Yardley, Helen Lambert","doi":"10.1093/jacamr/dlae165","DOIUrl":"10.1093/jacamr/dlae165","url":null,"abstract":"<p><strong>Objectives: </strong>Self-medication with antibiotics is common practice in many low- and middle-income countries (LMIC). This review synthesizes the qualitative evidence on influences on perceptions and practices in relation to self-medication by the public with antibiotics in LMIC.</p><p><strong>Methods: </strong>A systematic search was conducted of relevant medical, international and social science databases. Searching, screening, data extraction and quality appraisal followed standard methods. A meta-ethnographic approach was used for synthesis, starting with translation of studies and using a line-of-argument approach to develop the final themes.</p><p><strong>Results: </strong>The search identified 78 eligible studies. Antibiotics were understood as a powerful, potentially dangerous but effective medicine for treating infections. This perception was strongly influenced by the common experience of being prescribed antibiotics for infections, both individually and collectively. This contributed to an understanding of antibiotics as a rational treatment for infection symptoms that was sanctioned by medical authorities. Accessing antibiotics from medical professionals was often difficult logistically and financially. In contrast, antibiotics were readily available over the counter from local outlets. People viewed treating infection symptoms with antibiotics as rational practice, although they were concerned about the risks to the individual and only took them when they believed they were needed.</p><p><strong>Conclusions: </strong>A new model to explain self-medication with antibiotics is presented. This uses the socio-ecological model to integrate influences that operate at individual, community and wider socioeconomic levels, drawing on theories of medical authority and the medicalization and commercialization of health. Interventions to reduce overuse of antibiotics in LMIC need to address both clinical practice and community self-medication practices together.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae165"},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500597","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":"<i>Elizabethkingia</i> bloodstream infections in severely immunocompromised patients: persistent, relapsing and associated with high mortality.","authors":"Mark Fahmy, Adam Stewart, Siok-Keen Tey, Krispin Hajkowicz","doi":"10.1093/jacamr/dlae161","DOIUrl":"10.1093/jacamr/dlae161","url":null,"abstract":"<p><strong>Objectives: </strong><i>Elizabethkingia</i> species are uncommon causes of bloodstream infections, representing a true opportunistic and multi-drug-resistant pathogen to immunocompromised or vulnerable hosts. Despite this, data are lacking regarding optimal management strategy for infections with this organism, which is associated with significant mortality and morbidity. We describe patient characteristics, management and outcomes in this case series.</p><p><strong>Patients and methods: </strong>All inpatients at the Royal Brisbane and Women's Hospital with a positive blood culture for <i>Elizabethkingia</i> spp. were identified by database query. Clinical information including medical history, source of infection, attempts at source control and outcome were collected. Laboratory data including duration of bacteraemia and antimicrobial susceptibility testing were also collected.</p><p><strong>Results: </strong>All patients had severe defects of innate and adaptive immunity. Targeted therapy was started promptly and efforts at source identification and control were appropriately pursued. Despite this, outcomes were generally poor. A previously unrecognized presentation of relapsing infection was described in one case, requiring long-term suppressive antimicrobials to control. One case died as a result of infection and one case was cured, but died soon after due to complications of immunosuppression.</p><p><strong>Conclusions: </strong>Treatment of these organisms is challenging due to limited effective therapy, development of on treatment resistance and profound host immunocompromise. Up-front use of multiple, optimally dosed antimicrobials, attempting source control and attempting to restore host immune function all appear to be key to achieving good outcomes.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae161"},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545477","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 use and adherence to the WHO AWaRe guidelines across 16 hospitals in Zambia: a point prevalence survey.","authors":"Joseph Yamweka Chizimu, Steward Mudenda, Kaunda Yamba, Chileshe Lukwesa, Raphael Chanda, Ruth Nakazwe, Misheck Shawa, Herman Chambaro, Harvey K Kamboyi, Aubrey Chichonyi Kalungia, Duncan Chanda, Sombo Fwoloshi, Elimas Jere, Tiza Mufune, Derick Munkombwe, Peter Lisulo, Tebuho Mateele, Jeewan Thapa, Kenneth Kapolowe, Nyambe Sinyange, Cephas Sialubanje, Nathan Kapata, Mirfin Mpundu, Freddie Masaninga, Khalid Azam, Chie Nakajima, Makomani Siyanga, Nathan Nsubuga Bakyaita, Evelyn Wesangula, Martin Matu, Yasuhiko Suzuki, Roma Chilengi","doi":"10.1093/jacamr/dlae170","DOIUrl":"10.1093/jacamr/dlae170","url":null,"abstract":"<p><strong>Background: </strong>The inappropriate use of antibiotics in hospitals contributes to the development and spread of antimicrobial resistance (AMR). This study evaluated the prevalence of antibiotic use and adherence to the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification of antibiotics across 16 hospitals in Zambia.</p><p><strong>Methods: </strong>A descriptive, cross-sectional study employing the WHO Point Prevalence Survey (PPS) methodology and WHO AWaRe classification of antibiotics was conducted among inpatients across 16 hospitals in December 2023, Zambia. Data analysis was performed using STATA version 17.0.</p><p><strong>Results: </strong>Of the 1296 inpatients surveyed in the 16 hospitals, 56% were female, and 54% were aged between 16 and 50 years. The overall prevalence of antibiotic use was 70%. Additionally, 52% of the inpatients received Watch group antibiotics, with ceftriaxone being the most prescribed antibiotic. Slightly below half (48%) of the inpatients received Access group antibiotics. Compliance with the local treatment guidelines was 53%.</p><p><strong>Conclusions: </strong>This study found a high prevalence of prescribing and use of antibiotics in hospitalized patients across the surveyed hospitals in Zambia. The high use of Watch group antibiotics was above the recommended threshold indicating non-adherence to the WHO AWaRe guidelines for antibiotic use. Hence, there is a need to establish and strengthen antimicrobial stewardship programmes that promote the rational use of antibiotics in hospitals in Zambia.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae170"},"PeriodicalIF":3.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500595","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":"Evaluation of antibiotics returned for safe disposal during and after a community pharmacy antibiotic amnesty campaign.","authors":"Ryan A Hamilton, Marco G Ercolani, Rakhi Aggarwal, Donna Cooper, Sam Kelly, Helen Root, Kunjal Pabari, Conor Jamieson","doi":"10.1093/jacamr/dlae172","DOIUrl":"10.1093/jacamr/dlae172","url":null,"abstract":"<p><strong>Background: </strong>Community pharmacies in England offer convenient and safe disposal of unwanted medicines, including antimicrobials, and better uptake of this service could limit environmental antimicrobial resistance. However, there is limited information on the extent and nature of antibiotic returns to community pharmacies. The impact of an antibiotic amnesty campaign promoting antibiotic disposal through community pharmacies was evaluated with the intention of collecting detailed information on the antibiotics returned.</p><p><strong>Methods: </strong>An antibiotic amnesty campaign was delivered by community pharmacies in the Midlands (England) with an audit of returned antibiotics conducted in 19 community pharmacies in Leicestershire. Detailed information on antibiotics returned for disposal was gathered during the month-long amnesty campaign and again 3 months later in the same pharmacies.</p><p><strong>Results: </strong>Antibiotics accounted for 3.12%-3.35% of all returned medicines. The amnesty campaign led to a significant increase in defined daily doses of returned antibiotics compared to the post-amnesty period (<i>P </i>= 0.0165), but there was no difference in the overall number of returned medicines. Penicillins were the most commonly returned antibiotics in both periods (29.3% and 42.5% of packs, respectively), while solid oral dose formulations predominated. A total of 36.6% of antibiotics returned during the amnesty period were expired, increasing to 53.4% in the post-amnesty period. Amnesty conversations had a significant impact on the number of antibiotic returns but campaign posters did not.</p><p><strong>Conclusions: </strong>Antibiotic conversations can increase the amount of antibiotics returned to community pharmacies for safe disposal, and passive campaign materials had limited impact. More research is needed to identify the most effective interventions to increase returns.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae172"},"PeriodicalIF":3.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500596","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":"Outpatient parenteral antimicrobial therapy for patients with <i>Enterococcus faecalis</i> endocarditis using continuous infusion IV benzylpenicillin plus IV ceftriaxone.","authors":"Simon Briggs, Eamon Duffy, Hasan Bhally, Matthew Broom, Patrick Campbell, Rebekah Lane, Stephen McBride, Genevieve Walls, Simon Dalton","doi":"10.1093/jacamr/dlae168","DOIUrl":"10.1093/jacamr/dlae168","url":null,"abstract":"<p><strong>Background: </strong>Many patients with <i>Enterococcus faecalis</i> endocarditis are clinically stable and able to leave hospital before completing antibiotic treatment, but data are lacking regarding some outpatient treatment options.</p><p><strong>Objectives: </strong>To assess the outcomes for adults with <i>E. faecalis</i> endocarditis receiving outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed adults who received at least 2 weeks duration of OPAT for <i>E. faecalis</i> endocarditis with the above treatment regimen in the Auckland and Christchurch regions between July 2019 and September 2022.</p><p><strong>Results: </strong>Forty-four patients met inclusion criteria. Fifteen were female (34%). The median age was 80 (IQR 71.5 to 84) years. Twenty-two (50%) had prosthetic valve (PV), 15 (34%) native valve (NV), 3 (7%) NV and/or cardiac implantable electronic device (CIED) infection, 3 (7%) PV and/or CIED infection, and 1 (2%) repaired valve endocarditis. Patients received a median of 16.5 days inpatient and 28 days OPAT antibiotic treatment. The 12 month outcome was cure (<i>n</i> = 25; 57%), antibiotic suppression (<i>n</i> = 9; 20%), relapse (<i>n</i> = 2; 5%; both possible) or death (<i>n</i> = 8; 18%). Compared with a historical cohort treated with OPAT continuous infusion IV benzylpenicillin plus bolus IV gentamicin, there was no difference in the relapse rate.</p><p><strong>Conclusions: </strong>This study adds to the accumulating evidence supporting the treatment of <i>E. faecalis</i> endocarditis with OPAT continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone. This is an option for patients requiring further antibiotic treatment at the time of hospital discharge.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae168"},"PeriodicalIF":3.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500598","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":"Real-world performance of susceptibility testing for cefiderocol: insights from a prospective multicentre study on Gram-negative bacteria.","authors":"Alvaro Irigoyen-von-Sierakowski, Azahara Ocaña, Rosa Sánchez-Mayoral, Emilia Cercenado","doi":"10.1093/jacamr/dlae169","DOIUrl":"10.1093/jacamr/dlae169","url":null,"abstract":"<p><strong>Objectives: </strong>Cefiderocol is a novel siderophore-conjugated cephalosporin developed for the treatment of multidrug-resistant Gram-negative bacterial (GNB) infections. However, the current gold standard for cefiderocol susceptibility testing, broth microdilution (BMD) using iron-depleted cation-adjusted Mueller-Hinton broth, presents challenges for many microbiology laboratories. In this study, we evaluate the real-world performance of disc diffusion (DD) and a commercial BMD method (ComASP^®) to test cefiderocol susceptibility in a series of isolates collected prospectively from severely ill patients in a multicentre study.</p><p><strong>Methods: </strong>The susceptibilities of 1472 isolates (632 Enterobacterales, 532 <i>Pseudomonas aeruginosa</i>, 84 <i>Acinetobacter</i> spp. and 224 <i>Stenotrophomonas maltophilia</i>) collected in 60 Spanish hospitals were analysed following the EUCAST 2023 and 2024 criteria. We assessed the performance of DD (cefiderocol 30 μg disc, Liofilchem) and a commercial BMD method (ComASP^® Cefiderocol, Liofilchem).</p><p><strong>Results: </strong>A total of 1408 and 1450 isolates were susceptible by DD and ComASP^® BMD, respectively. Overall, the agreement between both methods was 96.9%. Forty-four isolates were resistant by DD but susceptible by ComASP^® BMD, and two were susceptible by DD but resistant by ComASP^® BMD (<i>Acinetobacter baumannii</i> isolates). Adoption of the updated 2024 EUCAST DD breakpoints and areas of technical uncertainty (ATUs) led to a decrease in susceptibility among Enterobacterales (95.3% versus 92.6%).</p><p><strong>Conclusions: </strong>DD is a straightforward, rapid and accessible method for routine determination of cefiderocol susceptibility in real-world practice. ComASP^® BMD shows a high agreement with DD in susceptible isolates and may help to resolve DD interpretability concerns in isolates with susceptibility results within the ATU, but caution is warranted when testing resistant isolates.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae169"},"PeriodicalIF":3.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500599","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":"Dalbavancin-resistant <i>Staphylococcus epidermidis in vivo</i> selection following a prosthetic joint infection: phenotypic and genomic characterization.","authors":"L Ruffier d'Epenoux, P Barbier, E Fayoux, A Guillouzouic, R Lecomte, C Deschanvres, C Nich, P Bémer, M Grégoire, S Corvec","doi":"10.1093/jacamr/dlae163","DOIUrl":"10.1093/jacamr/dlae163","url":null,"abstract":"<p><strong>Background: </strong>Dalbavancin is a lipoglycopeptide antibiotic with a wide spectrum of activity against Gram-positive bacteria, including MDR isolates. Its pharmacokinetic properties and administration patterns could be useful for the treatment of bone and joint infections, especially prosthetic joint infections (PJIs).</p><p><strong>Introduction: </strong>We report the case of an 80-year-old man who experienced an acute periprosthetic joint infection of his right total knee arthroplasty (TKA). A DAIR procedure was done with tissue sampling, which allowed identification of a linezolid-resistant MDR <i>S. epidermidis</i> (LR-MDRSE) strain. The patient was then treated with dalbavancin (four injections).</p><p><strong>Methods: </strong>We studied the phenotypic and genomic evolution of the strains and plasma through concentrations of dalbavancin at different points in time.</p><p><strong>Results: </strong>After four injections (1500 mg IV) of dalbavancin over a 6 month period, the dalbavancin MIC increased 4-fold. Calculated <i>f</i>AUC_0-24/MIC ratios were 945, 1239 and 766.5, respectively, at Days 49, 71 and 106, assuming an MIC of 0.032 mg/L. The PFGE dendrogram revealed 97% similarity among all the isolates. These results suggest acquisition by the <i>S. epidermidis</i> strain of dalbavancin resistance when the patient underwent dalbavancin treatment. A 4-amino-acid deletion in the <i>walK</i> gene coinciding with the emergence of phenotypic resistance was revealed by WGS without any other relevant indels.</p><p><strong>Conclusions: </strong>Despite dalbavancin treatment with pharmacokinetic management, emerging dalbavancin resistance in <i>S. epidermidis</i> was observed, resulting in treatment failure. This outcome led to a prosthesis revision and long-term suppressive antibiotic therapy, with no recurrence of PJI after an 18 month follow-up.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae163"},"PeriodicalIF":3.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465634","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 MRSA recovered from people with cystic fibrosis during two Spanish multicentre studies (2013 and 2021).","authors":"Ainhize Maruri-Aransolo, Marta Hernandez-García, Raquel Barbero, Malkoa Michelena, María Dolores Pastor-Vivero, Pedro Mondejar-Lopez, Amparo Solé, Rafael Cantón, Juan de Dios Caballero-Pérez","doi":"10.1093/jacamr/dlae160","DOIUrl":"10.1093/jacamr/dlae160","url":null,"abstract":"<p><strong>Background: </strong>Chronic bronchopulmonary infection due to MRSA in people with cystic fibrosis (pwCF) has been associated with accelerated decline in lung function, increased hospitalizations and increased mortality.</p><p><strong>Material and methods: </strong>We studied microbiological and genomic characteristics of MRSA isolates recovered from pwCF in two Spanish multicentre studies (2013, 2021). Antimicrobial susceptibility was performed. WGS was carried out to determine population structure [MLST, <i>spa</i>-typing, staphylococcal cassette chromosome <i>mec</i> (SCC<i>mec</i>)], resistome and virulome. Clinical charts of MRSA-infected and MRSA-non-infected pwCF were also reviewed.</p><p><strong>Results: </strong>MRSA infection prevalence decreased between 2013 (29/341, 8.5%) and 2021 (21/326, 6.4%) (<i>P</i> = 0.378). Differences in lung function were observed between infected and non-infected patients (<i>P</i> < 0.005). A higher prevalence of hospital-acquired (HA) clones was found compared with community-acquired (CA) clones (2013: 67% versus 33%; and 2021: 71% versus 29%). Overall, we noted clustering of isolates based on year of sampling, type of acquisition and clonal complex (CC). HA-MRSA population was dominated by CC5, with ST125-MRSA-IVc-t067 the most prevalent lineage (37%). A higher clonal diversity was detected among CA-MRSA. One Panton-Valentine leucocidin (PVL)-positive strain (ST8-MRSA-IV) and three strains of porcine origin (two ST398-MRSA-V-t011, one ST398-MRSA-V-t8567) were found. Additionally, acquired resistance genes (<i>n</i> = 24) were detected, including the <i>cfr</i> gene conferring linezolid resistance. A higher gentamicin resistance was found in 2021 (42%) compared with 2013 (7%) (<i>P</i> = 0.046), associated with the <i>aac(6')-aph(2″)</i> gene.</p><p><strong>Conclusions: </strong>Despite a decrease in MRSA prevalence, we showed its potential impact on CF severity and progression. Moreover, we observed great genotypic and phenotypic diversity in MRSA isolates from pwCF as well as an MDR trait.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae160"},"PeriodicalIF":3.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465636","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}