JAC-Antimicrobial Resistance最新文献

{"title":"Phenotypic susceptibility profiles of AmpC- and/or extended-spectrum beta-lactamase-(co)producing <i>Escherichia coli</i> strains.","authors":"Joan E Totté, Chantal Quiblier, Oliver Nolte, Vladimira Hinic, Herman F Wunderink, Adrian Egli, Stefano Mancini","doi":"10.1093/jacamr/dlaf091","DOIUrl":"10.1093/jacamr/dlaf091","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf091"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158838","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":"Current practices in outpatient parenteral antimicrobial therapy programmes: an international multi-centre survey.","authors":"Zenaw T Wolie, Jason A Roberts, Luis Eduardo López-Cortés, Manuel Mirón-Rubio, James Pollard, Afra Nahdia Marizan Nor, Mohd H Abdul-Aziz, Conor Jamieson, R Andrew Seaton, Mark Gilchrist, Fekade B Sime","doi":"10.1093/jacamr/dlaf075","DOIUrl":"10.1093/jacamr/dlaf075","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the current international practices of outpatient parenteral antimicrobial therapy (OPAT).</p><p><strong>Methods: </strong>A multi-site cross-sectional study was conducted, using REDCap platform for survey distribution and data collection. Data analysis was performed in SPSS version 29.</p><p><strong>Results: </strong>Of the 146 OPAT responding centres serving adults, paediatrics or both, 82% have been operating for over 10 years. OPAT teams were multidisciplinary, with nurses comprising the largest proportion in 89% of centres, followed by infectious disease (ID) pharmacists (83%) and ID physicians (80%). Service activity varied widely, with 92% centres treating fewer than 100-5000 patients annually (median = 300). Home-based models of care were used by more than 85% of facilities in Australia, the UK and Spain, while 82% of Malaysian and 75% of UK centres used infusion centres. Common OPAT indications include skin and soft tissue, bone and joint, urinary tract and respiratory tract infections, with ceftriaxone and ertapenem used by over 80% of the centres. Peripherally inserted central and midline catheters were common except in Malaysia. Among enrolled centres, complex oral antimicrobial therapy supervision was higher in the UK (82%) than in Spain (77%), Australia (42%) and Malaysia (24%). Inconsistencies in guidelines supporting antimicrobial stability and dosing information were noted, with a call for more stability data on certain antimicrobials.</p><p><strong>Conclusions: </strong>This study revealed significant variation in OPAT practice. Further study is needed to understand the reasons for these differences and whether better alignment of practice could improve patient outcomes, antimicrobial stewardship practice and resource utilization.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf075"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158710","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":"Magnitude, predictors, and trends of multidrug-resistant tuberculosis among tuberculosis patients at Debre Markos, Northwest, Ethiopia: a five-year retrospective study.","authors":"Aytenew Atnaf, Mekuanenit Kibret, Bekele Tesfaye, Desalegn Abebaw","doi":"10.1093/jacamr/dlaf086","DOIUrl":"10.1093/jacamr/dlaf086","url":null,"abstract":"<p><strong>Background: </strong>The emergence of multidrug-resistant tuberculosis (MDR-TB) is a threat to the people of resource-limited countries, such as Ethiopia. This study aimed to assess the magnitude, predictors and trends of multidrug-resistant tuberculosis among patients with pulmonary tuberculosis (TB) at Debre Markos Comprehensive and Specialized Hospital (DMCSH), Northwest Ethiopia.</p><p><strong>Materials and methods: </strong>A retrospective cross-sectional study was conducted among patients with TB treated at the directly observed treatment short course (DOTS) clinic at DMCSH from 1 June 2016 to 1 June 2020. Data from 1509 patients with TB registered in the clinic were retrieved from medical records. Statistical analysis was performed using SPSS v.24. The frequency of variables is presented via tables and figures. Logistic regression was fitted to predictors of MDR-TB, and a <i>P</i> value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Overall, data from 1509 patients with pulmonary TB were retrieved during the study. The overall prevalence of MDR-TB was 4.1%. Variables such as sex, human immunodeficiency virus (HIV) status, lesion on chest X-ray, and a history of anti-TB treatment were significantly associated with MDR-TB. The trend of MDR-TB decreased by 40% in 2017, 29% in 2018, and 10% in 2019, but increased by 21% in 2020.</p><p><strong>Conclusions and recommendations: </strong>The prevalence of MDR-TB among patients with pulmonary TB was comparable to the national rate. Key risk factors for MDR-TB included male sex, prior TB treatment, HIV infection, and chest X-ray abnormalities. The increasing trend in 2020 highlights the need for strengthened TB treatment adherence counselling and further prospective studies to explore additional predictors of MDR-TB.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf086"},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158837","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":"Associations between antibiotic consumption intensity and extended-spectrum cephalosporin resistance in nursing homes: a retrospective ecological study.","authors":"Emmanouil Glampedakis, Anne Niquille, Patricia Cuiña Iglesias, Alessandro Cassini, Catherine Plüss-Suard, Andreas Kronenberg, Marie Immaculée Nahimana Tessemo, Tom R Brewer, Thomas Rawson","doi":"10.1093/jacamr/dlaf088","DOIUrl":"10.1093/jacamr/dlaf088","url":null,"abstract":"<p><strong>Background: </strong>Studies relating the usage of antibiotics with extended-spectrum cephalosporin resistance (ESC-R) rates from clinical isolates in nursing homes (NHs) are rare. We investigated associations between the intensity of NH-level antibiotic consumption (ABC) and the frequency of ESC-R expressing urinary <i>Escherichia coli</i>, <i>Klebsiella</i> spp. and <i>Proteus</i> spp. isolates from NH residents.</p><p><strong>Materials and methods: </strong>We used retrospective data on ABC and ESC-R counts aggregated by NH and year between 2017 and 2022 from NHs of canton Vaud in Switzerland. Negative binomial regression was used to relate ABC intensity, expressed as DDDs per 1000 resident days, with counts of ESC-R expressing bacteria.</p><p><strong>Results: </strong>Fifty-four NHs were included cumulatively accounting for 6601 urinary isolates, of which 5028 <i>E. coli</i>, 999 <i>Klebsiella</i> spp. and 574 <i>Proteus</i> spp. Among these, the 6-year ESC-R cumulative incidence was 10.3% (<i>E. coli</i> 12.6%, <i>Klebsiella</i> spp. 3.8% and <i>Proteus</i> spp. 1.2%). Median annual overall ABC varied between 31.3 and 44.2 DDDs per 1000 resident days. There was no association between overall ABC, most antibiotic categories and ESC-R cumulative incidence. The consumption of cephalosporins [adjusted incidence rate ratio (aIRR): 1.023, 95% CI: 1-1.047] and carbapenems (aIRR: 1.542, 95% CI: 1.018-2.336) was independently associated with increased incidence.</p><p><strong>Conclusion: </strong>No association was found between overall ABC and ESC-R rates. Cephalosporin consumption showed a modest association, while for carbapenems this could reflect therapeutic use. These findings highlight the need for enhanced surveillance and resident-level data to better understand antibiotic resistance drivers in this setting.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf088"},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The magnitude of MDR carbapenemase-producing Enterobacteriaceae isolates and associated factors among hospitalized patients of Northeast Ethiopia.","authors":"Assefa Sisay, Chalie Mulugeta","doi":"10.1093/jacamr/dlaf080","DOIUrl":"10.1093/jacamr/dlaf080","url":null,"abstract":"<p><strong>Background: </strong>Currently, carbapenemase-producing Enterobacteriaceae (CPE) are becoming a global public health threat. Infections caused by these bacteria limit treatment options and are associated with high morbidity and mortality. This study aimed to assess the prevalence of CPE and identify associated risk factors.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted from June to August 2023. Clinical samples were cultured, and species identification was performed using standard biochemical tests. Antimicrobial susceptibility testing was done, and a modified carbapenem inactivation method was employed to confirm carbapenemase production. Data were entered using Epi Data and analysed with SPSS.</p><p><strong>Results: </strong>From a total of 143 isolates, the most commonly identified species were <i>Escherichia coli</i> (62 isolates, 43.4%) and <i>Klebsiella pneumoniae</i> (39 isolates, 27.3%). The highest level of resistance was against ampicillin (138 isolates, 96.5%), whereas the lowest was observed with meropenem (19 isolates, 13.3%). Overall, 123 isolates (86.0%) were classified as MDR. The prevalence of CPE and carbapenem-resistant Enterobacteriaceae (CRE) was 5.7% and 8.1%, respectively. <i>K. pneumoniae</i> and <i>E. coli</i> were the most common carbapenemase producers. Chronic underlying disease, consuming raw vegetables, and lack of regular hand-washing habits before meals showed adjusted odds ratios of 7.9 (95% CI 1.9-31.5), 11 (95% CI 3.4-40) and 8.0 (95% CI 1.7-85), respectively, showing a significant association.</p><p><strong>Conclusions: </strong>The high prevalence of CPE underscores the need for urgent infection control measures. Implementing antimicrobial stewardship, strengthening infection control measures, and further molecular studies are vital to combating this problem.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf080"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127568","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":"High-dose isoniazid for TB with low-to-moderate isoniazid resistance after 1 week of treatment.","authors":"U D Ranganathan, S E Smith-Jeffcoat, S Balaji, K Devika, D Nair, B Devaleenal Daniel, R Srinivasan, M Baskaran, D RaviKumar, D Sangamithirai, G Radhika, G Mangalambal, J Lavanya, K Maheswaran, S Kumar, R Sridhar, S Tripathy, S Swaminathan, K D Eisenach, J P Cegielski","doi":"10.1093/jacamr/dlaf072","DOIUrl":"10.1093/jacamr/dlaf072","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of high-dose isoniazid in patients with isoniazid-resistant TB by its bactericidal activity after 1 or more weeks of treatment.</p><p><strong>Subjects and methods: </strong>Using the rapid direct method of phenotypic drug susceptibility testing, we screened persons with positive sputum microscopy results and genotypic drug resistance for isoniazid resistance. Those with no growth at a critical concentration of 2.0 mg/L were invited to participate in a trial of high-dose isoniazid monotherapy lasting 6 days. After 3 days of no treatment, patients received isoniazid 15 mg/kg and were followed with serial quantitative sputum cultures from Days 0 to 6.</p><p><strong>Results: </strong>We enrolled 15 patients after a median of 2 weeks standard first-line treatment. Their median bacillary count on Day 0 was 4.9 log₁₀ cfu/mL on solid agar, and the time to detection (TTD) was 200 h in liquid medium. Neither metric showed meaningful change in bacillary burden over 6 days, declining by a non-significant 0.08 log₁₀ cfu/mL/d on solid media and slowing TTD by 23 h. These effects did not differ by degree of isoniazid resistance or specific <i>Inhibin Subunit Alpha</i> (<i>inhA)</i> gene mutations.</p><p><strong>Conclusions: </strong>The utility of high-dose isoniazid against low-level isoniazid resistance beyond the first 2 weeks of chemotherapy should be reconsidered.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf072"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127566","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> activity of cefiderocol against ESBL-producing and carbapenem-resistant <i>Pseudomonas aeruginosa</i>.","authors":"Rocío Egoávil-Espejo, Barbara Ymaña, Rosario Oporto-Llerena, Dafne Navarro, Rosario Huerto-Huánuco, Gina Salvador-Luján, Tamin Ortiz-Gómez, Maria Pinedo-Bardales, Luciano A Palomino-Kobayashi, Andrea C Gómez, Angie K Castillo, Patricia Gonzales, Carmen Valera-Krumdieck, Gabriela Soza, Cristhian Zapata-Cachay, Maribel Riveros, Maria J Pons, Joaquim Ruiz","doi":"10.1093/jacamr/dlaf082","DOIUrl":"10.1093/jacamr/dlaf082","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the activity of cefiderocol against 101 Peruvian <i>Pseudomonas aeruginosa</i> isolates.</p><p><strong>Methods: </strong>Carbapenem- and/or third- and fourth-generation cephalosporin-resistant <i>P. aeruginosa</i> clinical isolates were isolated in nine Peruvian health centres. Antibiotic susceptibility was established by automated methods and/or disc diffusion (10 antimicrobial agents), colistin agar test (colistin) and microdilution (cefiderocol). The presence of <i>bla</i> _PER, <i>bla</i> _CTX-M, <i>bla</i> _GES, <i>bla</i> _KPC, <i>bla</i> _IMI, <i>bla</i> _IMP, <i>bla</i> _NDM, <i>bla</i> _OXA-23, <i>bla</i> _OXA-24, <i>bla</i> _OXA-48, <i>bla</i> _OXA-58, <i>bla</i> _VIM and <i>oprD</i> was established by PCR; <i>bla</i> _CTX-M and <i>oprD</i> were sequenced. The levels of antimicrobial resistance ranged from 20.8% (colistin) to 97.0% (meropenem).</p><p><strong>Results: </strong>The MIC of cefiderocol ranged from  ≤ 0.06 to 8 mg/L (one isolate). Cefiderocol resistance rates were 1.0% (according to the FDA and EUCAST) and 0% according to CLSI, whereas 14.9% and 1.0% of isolates were classified as cefiderocol-intermediate according to FDA and CLSI, respectively. CTX-M-131 and GES, and IMP and VIM were the most frequent ESBLs and carbapenemases, respectively. The presence of <i>oprD</i> mutations was tested in 47 carbapenem-resistant isolates, 23 with <i>oprD</i>-inactivating mutations as the sole underlying mechanism. Although no specific association was found between the presence of ESBLs and carbapenemases with cefiderocol resistance, carbapenemase-producing isolates tended to present slightly higher cefiderocol MIC values. The cefiderocol-resistant isolate did not present ESBLs or carbapenemases, showing only an <i>oprD</i>-inactivating mutation.</p><p><strong>Conclusions: </strong>Cefiderocol showed excellent activity against <i>P. aeruginosa</i>, irrespective of the presence of ESBLs and/or carbapenemases. The high number of isolates bordering cefiderocol-resistant levels suggests the need for cautious use and continuous surveillance of this antibiotic.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf082"},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The price of WAR: AMR.","authors":"Laura J Rojas, Tracy L Lemonovich, Steven H Marshall, Adam Hirschfeld, Federico Perez, Robert A Bonomo","doi":"10.1093/jacamr/dlaf083","DOIUrl":"10.1093/jacamr/dlaf083","url":null,"abstract":"<p><strong>Background: </strong>The ongoing conflict in Ukraine has exacerbated the risk of MDR bacterial infections in war-injured patients.</p><p><strong>Methods: </strong>We present the case of a Ukrainian soldier who sustained a traumatic explosive injury to the bilateral lower extremities, underwent surgery and subsequently experienced an infection with a carbapenem-resistant <i>Klebsiella pneumoniae</i>. The isolate was subject to genomic WGS.</p><p><strong>Results: </strong>This case study describes the successful management of a traumatic injury in a Ukrainian soldier infected with a carbapenem-resistant <i>K. pneumoniae</i> isolated from surgical wounds. WGS revealed a hypervirulent ST147 strain carrying multiple resistance and virulence factors, including <i>bla</i> _NDM-1. Treatment with ceftazidime/avibactam and aztreonam was effective.</p><p><strong>Conclusions: </strong>Ceftazidime/avibactam and aztreonam is highlighted as a promising regimen for MDR infections in conflict zones.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf083"},"PeriodicalIF":3.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110666","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":"Pitt candidaemia score as an assessment tool for mortality in patients with candidaemia caused by <i>Candida tropicalis</i> and other <i>Candida</i> species: a multicentre study conducted in Japan.","authors":"Takashi Ueda, Hiroshi Kakeya, Koichiro Yoshida, Akihiro Hisato, Akira Ukimura, Taku Ogawa, Kazuhiko Nakajima, Kosuke Iijima, Miki Nagao, Yasuhiro Tsuchido, Hideki Kawamura, Akari Shigemi, Muneki Hotomi, Masamitsu Kono, Kei Kasahara, Natsuko Imakita, Yukihiro Kaneko, Makoto Niki, Koichi Yamada, Shigeki Kakuno, Taiga Miyazaki, Makoto Sumiyoshi, Yasushi Murakami, Miki Doi, Mutsunobu Yoshioka, Yoshitsugu Miyazaki, Yoshio Takesue","doi":"10.1093/jacamr/dlaf078","DOIUrl":"10.1093/jacamr/dlaf078","url":null,"abstract":"<p><strong>Background: </strong>A bedside scoring system to assess the severity of disease is lacking for candidaemia. The Pitt candidaemia score (PCS) was evaluated for its association with mortality.</p><p><strong>Methods: </strong>The PCS consists of five components, namely dialysis, hypotension, mechanical ventilation, cardiac arrest and mental status. Patients were classified into four categories according to their PCS. The correlation between PCS category at blood culture collection and 30 day mortality was studied individually for five <i>Candida</i> species.</p><p><strong>Results: </strong>Leading rates of mortality were observed in <i>Candida tropicalis</i> and <i>Candida krusei</i>. The interval from inoculation to positive culture was 19.4 ± 9.7 h for <i>C. tropicalis</i> and 21.3 ± 5.6 h for <i>C. krusei</i>; these intervals were significantly shorter than those for other <i>Candida</i> species. In a Kaplan-Meier survival curve, a significant risk stratification by PCS category was demonstrated in all <i>Candida</i> species. A high PCS was an independent risk factor for mortality, and source control decreased the risk for <i>C. tropicalis</i> and <i>Candida glabrata</i> infections. Regarding antifungal therapy, the median PCS was 8 for liposomal amphotericin B, 2 for echinocandins and 0 for azoles, and this trend was consistent among four <i>Candida</i> species.</p><p><strong>Conclusions: </strong>The mortality rate was well stratified by the PCS, and the PCS affected the selection of antifungals. A future prospective study is required for the PCS in guiding therapy for candidaemia.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf078"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110662","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":"Current status and future direction of antimicrobial stewardship programs and antibiotic prescribing in primary care hospitals in Zambia.","authors":"Faustina Makiko, Aubrey Chichonyi Kalungia, Martin Kampamba, Steward Mudenda, Natalie Schellack, Johanna Catharina Meyer, Flavien Nsoni Bumbangi, Michael Okorie, David Banda, Derick Munkombwe, Ilunga Mutwale, Joseph Yamweka Chizimu, Maisa Anita Kasanga, Freddie Masaninga, Zoran Muhimba, Chileshe Lukwesa, Duncan Chanda, Raphael Chanda, Mirfin Mpundu, Chiluba Mwila, Anja St Claire-Jones, Melanie Newport, Roma Chilengi, Israel Abebrese Sefah, Brian Godman","doi":"10.1093/jacamr/dlaf085","DOIUrl":"10.1093/jacamr/dlaf085","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial Stewardship Programs (ASPs) intended to optimize antibiotic use will be more effective if informed by the current status and patterns of antibiotic utilisation. In Zambia's primary healthcare (PHC) settings, data on ASPs and antibiotic utilisation were inadequate to guide improvements. As a first step, this study assessed antibiotic prescribing and ASP core elements among PHC first-level hospitals (FLHs) in Zambia.</p><p><strong>Methods: </strong>A point prevalence survey was conducted at the five FLHs in Lusaka using the Global-PPS^® protocol. Hospital ASP core elements evaluated included hospital leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education.</p><p><strong>Results: </strong>Antibiotic use prevalence was 79.8% (146/183). A total of 220 antibiotic prescription encounters were recorded among inpatients, with ceftriaxone (J01DD04, Watch) being the most (50.0%) prescribed. Over 90.0% (202) of the antibiotic prescriptions targeted suspected community-acquired infections, but only 36.8% (81) were compliant with national treatment guidelines. ASP core element implementation was 36.0% (16.2/45), with only two hospitals achieving over 50.0%. The most deficient core elements were accountability, action, tracking, and reporting.</p><p><strong>Conclusions: </strong>ASP implementation in Zambia's FLHs providing PHC was sub-optimal, with high antibiotic prescribing rates, frequent use of broad-spectrum Watch group antibiotics, and low compliance with national treatment guidelines. As key ways forward, ASPs in Zambia's PHC require strengthening by adapting the WHO AWaRe recommendations and improving accountability, actions, tracking, and reporting antibiotic use to improve stewardship practice and reduce AMR.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 3","pages":"dlaf085"},"PeriodicalIF":3.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110658","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}