JAC-Antimicrobial Resistance最新文献

{"title":"Effectiveness of temocillin in treatment of non-urinary tract infections caused by ESBL-producing Enterobacterales and risk factors for failure.","authors":"Christel Mamona Kilu, Camille Menvielle, Anne Cataldi, Antoine Hamon, Clara Duran, Cedric Mwanba, Chloé Tesmoingt, Laura Bouabdallah-Perrin, Pauline Touche, Aurélie Chanh Hew Wai, Clément Ourghanlian, Marie Antignac, Marc-Antoine Bildan, Alexandre Bleibtreu, Hugues Michelon, Sylvain Diamantis, Benoit Pilmis, Antoine Citerne, Eric Farfour, Aurélien Dinh","doi":"10.1093/jacamr/dlae164","DOIUrl":"https://doi.org/10.1093/jacamr/dlae164","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the real-life use of temocillin for non-urinary tract infections, to assess its effectiveness in infections caused by ESBL-producing Enterobacterales, and to identify risk factors for treatment failure.</p><p><strong>Method: </strong>Retrospective multicentric study in 14 tertiary care hospitals, including all patients who received at least one dose of temocillin for ESBL infections from 1 January 2016 to 31 December 2021 for non-urinary tract infections. Failure was a composite criterion defined within 28 day follow-up by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. Logistic regression with univariable and multivariable analysis was performed to identify risks associated with failure.</p><p><strong>Results: </strong>Data on 163 infection episodes were collected; 133 were due to ESBL-producing Enterobacterales and 128 were included in the effectiveness analysis. Median (IQR) age was 61 (53-70) years and 61.7% of patients were male. Main indications were lower respiratory tract infection (LRTI; 28.9%), intra-abdominal infections (IAI; 28.1%) and cutaneous infections (12.5%). The main bacteria involved were <i>Klebsiella pneumoniae</i> (48.4%), <i>Escherichia coli</i> (25.0%) and <i>Enterobacter cloacae</i> (24.2%). Polymicrobial infections occurred in 45.3% of cases. Temocillin was used as monotherapy in 86/128 (67.2%). Failure was found in 36/128 (28.1%) cases. In multivariable analysis, the only factor associated with failure was initial severity of the episode [adjusted OR 3.0 (95% CI: 1.06-8.69)].</p><p><strong>Conclusions: </strong>During non-urinary tract infections, the main use of temocillin was for LRTIs and IAIs due to ESBL-producing <i>E. coli</i> and <i>K. pneumoniae</i>. The main risk factor for failure was initial severity of the disease.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae164"},"PeriodicalIF":3.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465635","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":"To assess the availability of antibiotics for online sale and comparison of e-pharmacies on key characteristics influencing safe and rational use of antibiotics: an exploratory analysis.","authors":"Puneet Kaur, Navjot Kaur, Jasbir Singh, Jasmeen Kaur","doi":"10.1093/jacamr/dlae158","DOIUrl":"https://doi.org/10.1093/jacamr/dlae158","url":null,"abstract":"<p><strong>Background: </strong>Growing antimicrobial resistance represents serious public health threat. With the increasing presence of online/e-pharmacies in India, public access to medicines has increased. Easy access coupled with lack of adequate and authentic drug information can undermine rational antibiotic use.</p><p><strong>Objectives: </strong>The present study aimed at exploring the availability of antibiotics for online sale and comparing the e-pharmacies on key characteristics influencing safe and rational use of antibiotics.</p><p><strong>Methods: </strong>A cross-sectional study was conducted over a period of 3 months using the websites of 10 popular e-pharmacies in India. Availability of antibiotics for online sale was assessed in context of the National List of Essential Medicines, 2022 and WHO-AWaRe (Access, Watch, Reserve) categories. Three separate questionnaires were developed to extract and compare relevant information from e-pharmacies pertaining to their safety and authenticity (in light of the expected standards laid down in draft e-pharmacy rules, 2018), availability of drug product and consumer awareness information for promoting prudent antibiotic use. Data were summarized using descriptive statistics.</p><p><strong>Results: </strong>Out of the 17 antibiotics studied; antibiotics belonging to all WHO-AWaRe categories i.e. Access (83.33%), Watch (88.33%) and Reserve (78%) groups were available through e-pharmacies. Wide variation exists among the e-pharmacies regarding compliance to studied parameters under three questionnaires.</p><p><strong>Conclusions: </strong>Increased access to Watch and Reserve groups of antibiotics can translate into antibiotic misuse. It is therefore crucial that the regulatory gaps concerning e-pharmacies are addressed urgently and consumers are educated regarding safe and rational use of antibiotics.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae158"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465638","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 (OPAT) using a continuous ambulatory delivery device (CADD) allowing treatment with multiple daily doses: a brief report of a Norwegian experience.","authors":"Vegard Skogen, Rita Helleren, Marianne Giske Jacobsen, Anne Opsal, Frode Gallefoss","doi":"10.1093/jacamr/dlae155","DOIUrl":"https://doi.org/10.1093/jacamr/dlae155","url":null,"abstract":"<p><strong>Background: </strong>Outpatient parenteral antimicrobial therapy (OPAT) is safe, effective and increasingly available. While OPAT in Norwegian healthcare has been rare, a new continuous ambulatory delivery device (CADD) allowing multiple daily dosing treatments has been innovated making OPAT more accessible.</p><p><strong>Objectives: </strong>To describe the clinical outcome and safety using CADD in an OPAT setting.</p><p><strong>Methods: </strong>Adult patients in need of parenteral antibiotic treatment were offered OPAT and discharged with a programmable digital infusion pump allowing multiple daily dosings.</p><p><strong>Results: </strong>Altogether, 170 patients were included in the study, among which 21% of all patients (36 of 170) were readmitted to hospital while receiving OPAT or within 30 days after end of intravenous antibiotics. None of the 170 patients died due to OPAT and allergies were not noticeable as a problem.</p><p><strong>Conclusions: </strong>We have developed a safe and clinically effective programme offering OPAT in accordance with Norwegian antibiotic treatment guidelines.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae155"},"PeriodicalIF":3.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465637","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>In vitro</i> performance of cost differentiated ceftriaxone brands against <i>Escherichia coli</i>: insights from a tertiary referral hospital in Mbeya, Tanzania.","authors":"Anthony Nsojo, Christopher Mbotwa, Linus Rweyemamu, Godlove Mbwanji, Frank Wilson, Lutengano George, Davance Mwasomola, Clement N Mweya, Issakwisa Mwakyula","doi":"10.1093/jacamr/dlae162","DOIUrl":"https://doi.org/10.1093/jacamr/dlae162","url":null,"abstract":"<p><strong>Background: </strong>In Tanzania, ceftriaxone is one of the most commonly prescribed antibiotics. However, there is quite a significant variation in cost for numerous ceftriaxone brands, leading to the perception that pricier options are more effective. Yet, limited empirical data support this perception.</p><p><strong>Methods: </strong>Five ceftriaxone brands with a wide price range were tested <i>in vitro</i> against a ceftriaxone-sensitive <i>Escherichia coli</i> clinical isolate using microdilution and spectrophotometry. Brands were evaluated across a spectrum of concentrations. Bacterial growth inhibition was measured using optical density. Analysis of variance was used to compare the bacterial optical densities among the brands.</p><p><strong>Results: </strong>All brands were comparable at all tested concentrations, with peak inhibition above 1.95 mg/L.</p><p><strong>Conclusions: </strong>Despite significant price disparities, low-cost and high-cost ceftriaxone brands demonstrated similar <i>in vitro</i> performance against <i>E. coli</i>. This challenges the notion that higher-priced options offer better performance. Further, <i>in vivo</i> studies are recommended to validate these findings.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae162"},"PeriodicalIF":3.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465633","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":"Carriage and antimicrobial susceptibility patterns of rectal ESBL <i>E. coli</i> in surgical patients at the University Teaching Hospitals in Lusaka, Zambia.","authors":"Amon Siame, Kaunda Yamba, Mulemba Samutela, Andrew Mukubesa, Gina Mulundu","doi":"10.1093/jacamr/dlae159","DOIUrl":"10.1093/jacamr/dlae159","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are on the rise and are a global concern as they complicate the recovery of patients postoperatively. Bacterial colonization of the patient's skin and alimentary tract are known to be major contributing sources to SSIs. However, Zambia lacks data relating to carriage rates of antibiotic-resistant rectal <i>Escherichia coli</i> among surgical patients.</p><p><strong>Methods: </strong>This was a cross-sectional study aimed at determining the preoperative (preop) and postoperative (postop) carriage and antimicrobial susceptibility patterns of rectal ESBL-producing <i>E. coli</i> (ESBL-Ec) in elective surgery patients at the highest tertiary hospital in Lusaka, Zambia. Phenotypic methods were used in the identification of <i>E. coli.</i> Antibiotic susceptibility patterns and identification of ESBL-Ec was determined by Kirby-Bauer disc diffusion.</p><p><strong>Results: </strong>A total of 120 study participants were recruited, of which 75 were followed up at least 72 h after surgery. From 195 rectal swabs cultured, 177 (90.8%) were positive for <i>E. coli</i>, of which 53 (29.9%) were ESBL-Ec, with a significantly (<i>P</i> < 0.0001) higher proportion in postop (47.9%) than preop (17.3%) participants. Overall, ESBL-Ec isolates showed higher resistance in postop than preop to cefotaxime (100% versus 88.9%, respectively), ampicillin (100% versus 94.4%), ciprofloxacin (88.3% versus 83.3%), amoxicillin/clavulanic acid (80% versus 66.7%) and cefepime (80% versus 77.8%). MDR ESBL-Ec strains were more frequent in postop than in preop participants (91.4% versus 88.9%).</p><p><strong>Conclusions: </strong>The study showed a significantly higher rate of antimicrobial-resistant rectal <i>E. coli</i> in postop than preop participants. There is a need to ascertain the source of the resistance and to institute robust infection control measures, preop screening of surgical patients for ESBL-Ec, and to raise awareness on prudent use of antibiotics.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae159"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390577","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":"Multidrug-resistant organism bloodstream infections in solid organ transplant recipients and impact on mortality: a systematic review.","authors":"Alice J Liu, Adelaide S M Dennis, Zarin Fariha, Rekha Pai Mangalore, Nenad Macesic","doi":"10.1093/jacamr/dlae152","DOIUrl":"10.1093/jacamr/dlae152","url":null,"abstract":"<p><strong>Background: </strong>Bloodstream infections (BSIs) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. There are few data regarding the contribution of MDR organisms (MDROs) to these infections. We evaluated the resistance percentage of MDRO BSIs in SOT recipients and the associated mortality.</p><p><strong>Methods: </strong>A systematic review of MEDLINE and Embase databases up to January 2024, for studies of adult SOT recipients that quantified MDRO BSI resistance percentage and/or associated crude mortality. MDROs studied were carbapenem-resistant Enterobacterales (CRE), <i>Acinetobacter baumannii</i> (CRAB) and <i>Pseudomonas aeruginosa</i> (CRPA), third-generation cephalosporin-resistant Enterobacterales (3GCR-E), MRSA and VRE. Resistance percentage and mortality outcomes were reported as median (IQR) and crude mortality (%), respectively.</p><p><strong>Results: </strong>Of 945 studies identified, 52 were included. Most were retrospective (41/52) and/or single centre (37/52), and liver transplantation was the most frequently studied SOT type (22/52). High resistance percentages of BSIs were noted, ranging from 13.6% CRE for Enterobacterales to 59.2% CRAB for <i>A. baumannii</i>. Resistance percentage trends decreased over time, but these changes were not statistically significant. Asia had the highest resistance percentages for MRSA [86.2% (IQR 77.3%-94.6%)], 3GCR-E [59.5% (IQR 40.5%-66.7%)] and CRE [35.7% (IQR 8.3%-63.1%)]. North America had the highest VRE resistance percentages [77.7% (IQR 54.6%-94.7%)]. Crude mortality was 15.4%-82.4% and was consistently higher than for non-MDRO BSIs.</p><p><strong>Conclusions: </strong>MDRO BSI resistance percentages were high for all pathogens studied (IQR 24.6%-69.4%) but there was geographical and temporal heterogeneity. MDRO BSIs were associated with high mortality in SOT recipients. Microbiological and clinical data in this vulnerable population were incomplete, highlighting the need for robust international multicentre studies.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae152"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390578","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":"Resistance is reality: findings from the first Ukrainian cumulative antibiogram.","authors":"Arkadii Vodianyk, Oksana Holovnia, Eugene Diomin, Alyssa R Letourneau, Mark C Poznansky, Erica S Shenoy, Sarah E Turbett","doi":"10.1093/jacamr/dlae156","DOIUrl":"10.1093/jacamr/dlae156","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance is a global health threat resulting in significant morbidity and mortality worldwide. Until recently, in Ukraine, cumulative antibiograms (CuAbgms) have never been available.</p><p><strong>Objectives: </strong>To describe the first CuAbgm developed in Ukraine.</p><p><strong>Methods: </strong>We developed a CuAbgm for the Okhmatdyt National Specialized Children's Hospital using data from WHONET. Antimicrobial susceptibility testing was performed per EUCAST guidelines. The CuAbgm was developed using guidance from CLSI.</p><p><strong>Results: </strong>For <i>Escherichia coli</i>, 66% and 69% of isolates were susceptible to ceftazidime and ceftriaxone, respectively, and 99% were susceptible to meropenem. For <i>Klebsiella pneumoniae</i>, 26% and 27% of isolates were susceptible to ceftazidime and ceftriaxone, respectively, and only 59% were susceptible to meropenem. Of the carbapenem-resistant <i>K. pneumoniae</i> isolates that underwent additional susceptibility testing, only 38% were susceptible to ceftazidime/avibactam. For <i>Pseudomonas aeruginosa</i>, only 53% were susceptible to meropenem. Of those that were resistant to meropenem and underwent additional susceptibility testing, only 12% were susceptible to ceftazidime/avibactam. Similarly, for <i>Acinetobacter</i> spp., only 37% of isolates were susceptible to meropenem. Susceptibility to ampicillin/sulbactam was also low at 45%. The oxacillin susceptibility rate for <i>Staphylococcus aureus</i> was 99%.</p><p><strong>Conclusions: </strong>In this first-ever CuAbgm developed in Ukraine, high levels of resistance were demonstrated among Gram-negative bacteria. CuAbgms should be prioritized in laboratories in Ukraine to guide empirical antimicrobial therapy, infection control and antimicrobial stewardship policies. This is of heightened relevance during wartime, when there is a need for healthcare systems to treat complex and infected penetrating and blast-related injuries.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae156"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390579","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":"Molecular diversity in fusidic acid-resistant Methicillin Susceptible <i>Staphylococcus</i> <i>aureus</i>.","authors":"Dalida Bivona, Emanuele Nicitra, Carmelo Bonomo, Maddalena Calvo, Giuseppe Migliorisi, Marianna Perez, Grete Francesca Privitera, Nicolò Musso, Stefania Stefani, Dafne Bongiorno","doi":"10.1093/jacamr/dlae154","DOIUrl":"10.1093/jacamr/dlae154","url":null,"abstract":"<p><strong>Objectives: </strong>The recent emergence of fusidic acid (FA)-resistant <i>Staphylococcus aureus</i> has underscored the importance of active surveillance in isolating these strains. The molecular basis of fusidic acid resistance and the carriage of virulence factors in four borderline oxacillin-resistant <i>Staphylococcus aureus</i> (BORSA) clinical strains was assessed through phenotypical and genotypical methods.</p><p><strong>Methods: </strong>All <i>S. aureus</i> clinical strains were obtained from various hospital units in Sicily<i>. In vitro</i> antibiotic susceptibility testing was conducted. WGS was performed using the Illumina MiSeq Platform, and data analysis was carried out to determine ST, resistome and virulome profiles.</p><p><strong>Results: </strong>Genotypic characterization revealed that the strains belong to four STs: ST630, ST8, ST15, and ST1. FA resistance was associated with mutations in the <i>fusA</i> gene or <i>fusB</i> and <i>fusC</i> genes. Additionally, one case exhibited resistance to mupirocin, related to the presence of the <i>mupA</i> gene. Borderline MIC values were observed for cefoxitin in three out of four cases, leading to their categorization as BORSA. Virulence gene content was complex and diversified, with one testing positive for the <i>lukS/F</i> genes, coding for PVL toxin.</p><p><strong>Conclusions: </strong>Resistance to FA is multifactorial, involving point mutations in chromosomal genes or association with mobile genetic elements. Monitoring the resistance to these antibiotics might help to manage and eradicate mupirocin- and FA-resistant <i>S. aureus</i> strains, which are also known to be important carriers of virulence determinants.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae154"},"PeriodicalIF":3.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380863","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":"Wild-type MIC distributions and epidemiological cutoff values for 5-flucytosine and <i>Candida</i> species as determined by EUCAST broth microdilution.","authors":"Fatima Zohra Delma, Willem J G Melchers, Paul E Verweij, Jochem B Buil","doi":"10.1093/jacamr/dlae153","DOIUrl":"10.1093/jacamr/dlae153","url":null,"abstract":"<p><strong>Objectives: </strong>EUCAST has established clinical breakpoints and epidemiological cutoff values (ECOFFs) for <i>Candida</i> spp. However, limited data are available for 5-flucytosine (5-FC). We assessed the <i>in vitro</i> susceptibility of 5-FC against a large collection of clinical <i>Candida</i> species using EUCAST methodology and determined the associated ECOFFs.</p><p><strong>Methods: </strong>A total of 5622 <i>Candida</i> isolates were collected from patients across the Netherlands between 2008 and 2024. 5-FC MICs were determined using the EUCAST microbroth dilution reference method. Furthermore, MICs were extracted from the EUCAST website. The MICs from this study and those extracted were used to determine ECOFFs and local ECOFFs (L-ECOFFs).</p><p><strong>Results: </strong>5-FC exhibited potent <i>in vitro</i> activity against <i>C. albicans</i>, <i>N. glabratus</i> and <i>C. parapsilosis,</i> while decreased susceptibility was observed for <i>C. tropicalis, Pichia species, K. marxianus, Y. lipolytica,</i> and <i>C. auris.</i> The ECOFFs (mg/L) and the percentages of WT isolates for 5-FC were: <i>C. albicans</i>: 0.5 (97.2%), <i>N. glabratus</i>: 0.5 (96.6%), <i>C. parapsilosis</i>: 0.5 (99.5%) and <i>P. kudriavzevii</i>: 8 (99.4%). The L-ECOFF (mg/L) and the percentages of WT isolates for 5-FC were: <i>C. dubliniensis</i>: 0.25 (96.8%), <i>C. tropicalis</i>: 0.25 (67.2%), <i>K. marxianus</i>: 0.25 (48.0%), <i>C. lusitaniae</i>: 0.25 (86.5%), <i>M. guillermondii</i>: 0.125 (95.9%) and <i>P. norvegiensis</i>: 8 (94.2%).</p><p><strong>Conclusions: </strong>5-FC remains a valuable drug to manage difficult-to-treat invasive <i>Candida</i> infections. <i>In vitro</i> susceptibility cannot be predicted based on species identification for most <i>Candida</i> species, but requires MIC-testing. ECOFFs will help to interpret the MICs to support treatment decisions.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae153"},"PeriodicalIF":3.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380864","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":"Adopting prospective antimicrobial stewardship (AMS) practice in high-risk immunosuppressed groups: an urgent call to action in the era of antimicrobial resistance (AMR).","authors":"S Agrawal, A Bapat, J Amos, E Howes, T Ashfield","doi":"10.1093/jacamr/dlae145","DOIUrl":"https://doi.org/10.1093/jacamr/dlae145","url":null,"abstract":"<p><p>Life-saving immunosuppressive treatments including intensive chemotherapy and bone marrow transplantation expose patients to a considerable risk of death from infection globally. With evolving AMR and transmission, this could spell disaster for patients across the world and society at large. Antimicrobial stewardship (AMS) and prompt appropriate management of potentially fatal, emergent infections are essential. It is now apparent that antibacterial prophylaxis in patients with haematological cancer may not provide survival benefit while simultaneously increasing risks for AMR carriage. With evolving AMR and increasing immunosuppressed populations across the world, we must institute robust AMS practices. Significant resources are used to combat the impact of AMR on immunosuppressed patients. For lower-middle income countries (LMICs) these resources may not be available and as such the impact caused by AMR is greater. By considering the patient journey holistically we consider risk of infection presented to patients temporally and geographically. A short-term and easy to implement approach of multi-disciplinary team (MDT)-style advance care planning for infection is advocated. Antimicrobials, when used appropriately, enable healthcare procedures to occur and exist. Indeed, the very future of clinical medicine will rely on this yet to be realized value of enablement. Proactive effort and change must occur across all sectors with holism; hence our impetus for convening a joint industry and clinical working group. With at-risk immunosuppressed groups being a sentinel for change, awareness and implementation of patient-centric actions for infection are essential and our recommendations serve as an urgent call to action.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 5","pages":"dlae145"},"PeriodicalIF":3.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346844","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}