JAC-Antimicrobial Resistance最新文献

{"title":"Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany.","authors":"Jon Salmanton-García, Michaela Simon, Andreas H Groll, Oliver Kurzai, Tobias Lahmer, Thomas Lehrnbecher, Maria Schroeder, Oliver A Cornely, Jannik Stemler","doi":"10.1093/jacamr/dlae083","DOIUrl":"10.1093/jacamr/dlae083","url":null,"abstract":"<p><strong>Introduction: </strong>In Germany, the growing incidence of invasive fungal infections (IFIs) is a significant health concern, particularly impacting individuals with compromised immune systems due to factors like increasing transplant recipients, an ageing population, and heightened use of immunosuppressive medications. Diagnosing IFI remains challenging, and the integration of biomarker assays into clinical practice is difficult. Antifungal resistance, exemplified by pan-antifungal-resistant <i>Candida auris</i> cases, adds complexity to treatment. This study aims to provide a concise overview of the diagnostic and treatment landscape for IFI in Germany, identifying areas for improvement and paving the way for targeted interventions.</p><p><strong>Methods: </strong>Data were collected using an online electronic case report form from October 2021 to February 2023. The survey included questions about institutional practices related to fungal infection diagnosis and treatment, with invitations extended to researchers nationwide.</p><p><strong>Results: </strong>The study surveyed 58 hospitals across Germany. Notably, 77.6% managed high-risk patients for IFI. While 86% had onsite microbiology labs, a significant difference was noted for high-risk patients (93% in specialized hospitals versus 62% in others). Microscopy services had 96% coverage, while overall access to culture was 96%. Antigen tests had 96% coverage, and antibody access was reported at 98%. PCR testing was available at 98%. Imaging access showed no significant access differences. Variability existed in amphotericin B formulations based on patient profiles. Therapeutic drug monitoring was more common in high-risk patient institutions (89.5% versus 50.0%). All analysed institutions reported access to surgery (100%).</p><p><strong>Conclusions: </strong>Addressing identified disparities in diagnostic and therapeutic resources for IFI is crucial to improving patient outcomes. The study calls for ongoing research and collaboration to optimize strategies for the prevention and treatment of IFI, emphasizing the importance of equitable access to resources, especially in high-risk patient populations.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae083"},"PeriodicalIF":3.7,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175580","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":"Ceftaroline fosamil treatment patterns and outcomes in adults with community-acquired pneumonia: a real-world multinational, retrospective study.","authors":"Alex Soriano, Matteo Bassetti, Charalambos Gogos, Tristan Ferry, Raul de Pablo, Wajeeha Ansari, Michal Kantecki, Bernd Schweikert, Gustavo Luna, Francesco Blasi","doi":"10.1093/jacamr/dlae078","DOIUrl":"10.1093/jacamr/dlae078","url":null,"abstract":"<p><strong>Background: </strong>This multicentre, observational, retrospective chart review study assessed ceftaroline fosamil treatment patterns and outcomes in adults hospitalized with community-acquired pneumonia (CAP) in usual care settings.</p><p><strong>Methods: </strong>Anonymized patient data were extracted from hospital records of adults with CAP who received ≥4 consecutive IV ceftaroline fosamil doses at sites in Brazil, Colombia, France, Greece, Italy, Russia and Spain.</p><p><strong>Results: </strong>The dataset included 185 patients (58.9% male; mean age 62.2 years), of whom 128 (69.2%) had severe CAP defined by CURB-65, PSI/PORT score or physician judgement. <i>Streptococcus pneumoniae</i> (<i>n </i>= 44; 23.8%) and <i>Staphylococcus aureus</i> [MSSA (<i>n </i>= 15) and MRSA (<i>n </i>= 14)] were the most frequently identified pathogens. Clinical response occurred in 151 (81.6%) patients overall, and in 104 (81.3%) severe CAP patients. Response within ≤4 and >4 days occurred in 79 (42.7%) and 62 (33.5%) patients (unknown, <i>n </i>= 10), respectively. Twenty (10.8%) patients required readmission within 30 days. Thirty-day all-cause mortality rates were 9.7% (<i>n </i>= 18) overall and 10.2% (<i>n </i>= 13) in severe CAP. In sensitivity analysis using ICU admission as a more objective marker of severe CAP (<i>n </i>= 75), clinical response and 30 day mortality occurred in 57 (76.0%) and 10 (13.3%) patients, respectively. Overall, clinical response to ceftaroline fosamil was associated with >60% shorter length of ICU stay (3.6 versus 9.2 days), and >30% lower hospital costs ($8449 versus $12 559) versus non-responders.</p><p><strong>Conclusions: </strong>Ceftaroline fosamil was effective in treating adults with CAP, including severe CAP, in Europe and Latin America. Clinical response to ceftaroline fosamil was associated with reductions in healthcare resource use compared with non-responders.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae078"},"PeriodicalIF":3.7,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158010","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 utilization patterns in Tanzania: a retrospective longitudinal study comparing pre- and intra-COVID-19 pandemic era using Tanzania Medicines and Medical Devices Authority data.","authors":"Raphael Z Sangeda, Sahani M William, Faustine C Masatu, Adonis Bitegeko, Yonah H Mwalwisi, Emmanuel A Nkiligi, Pius G Horumpende, Adam M Fimbo","doi":"10.1093/jacamr/dlae081","DOIUrl":"10.1093/jacamr/dlae081","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a growing public health concern globally, and misuse of antibiotics is a major contributor.</p><p><strong>Objective: </strong>This study investigated antibiotic utilization patterns before and during the COVID-19 pandemic in Tanzania using data from the Tanzania Medicines and Medical Devices Authority (TMDA).</p><p><strong>Methods: </strong>This retrospective longitudinal study analysed secondary data. The study compared antibiotics consumption in defined daily doses per 1000 inhabitants per day (DID) in two distinct eras: 2018-2019 as the pre-COVID-19 era and 2020-2021 as the intra-COVID-19 era. A sample <i>t</i>-test was conducted using Statistical Package for the Social Sciences.</p><p><strong>Results: </strong>The study analysed 10 614 records and found an overall increase in antibiotics consumption from 2018 to 2021. We found that the consumption was 61.24 DID in the intra-COVID-19 era and 50.32 DID in the pre-COVID-19 era. Levofloxacin had the highest percentage increase in use, with a 700% increase in DID during the intra-COVID-19 era. Azithromycin had a 163.79% increase, while cefotaxime had a 600% increase. By contrast, some antibiotics exhibited a decrease in usage during the intra-COVID-19 era, such as nalidixic acid, which had a 100% decrease, and cefpodoxime, which had a 66.67% decrease.</p><p><strong>Conclusions: </strong>Increased antibiotic consumption during the COVID-19 pandemic highlights the importance of implementing effective antimicrobial stewardship strategies to prevent AMR, especially during pandemics.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae081"},"PeriodicalIF":3.7,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157995","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":"Long-term outcome in a person with pandrug-resistant HIV: the added value of a multidisciplinary approach.","authors":"Tommaso Clemente, Diana Canetti, Emanuela Messina, Elisabetta Carini, Liviana Della Torre, Rebecka Papaioannu Borjesson, Antonella Castagna, Vincenzo Spagnuolo","doi":"10.1093/jacamr/dlae074","DOIUrl":"10.1093/jacamr/dlae074","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae074"},"PeriodicalIF":3.7,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956625","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":"Time is running out. No excuses to delay implementation of antimicrobial stewardship programmes: impact, sustainability, resilience and efficiency through an interrupted time series analysis (2017-2022).","authors":"Giovanni Del Fabro, Sergio Venturini, Manuela Avolio, Giancarlo Basaglia, Astrid Callegari, Igor Bramuzzo, Barbara Basso, Chiara Zanusso, Anna Rizzo, Giuseppe Tonutti, Michele Chittaro, Eva Fiappo, Maurizio Tonizzo, Massimo Crapis","doi":"10.1093/jacamr/dlae072","DOIUrl":"10.1093/jacamr/dlae072","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO declared antimicrobial resistance (AMR) a significant concern in 2014, sparking initiatives to ensure responsible antibiotic use. In human medicine, Antimicrobial Stewardship Programmes (ASPs) in hospitals play a pivotal role in combating AMR. Although evidence supports the effectiveness of ASPs in optimizing antimicrobial use, often the lack of resources becomes an excuse to limit their dissemination and use. This paper provides a comprehensive report on a 6-year analysis of an ASP implemented in a healthcare region in north-east Italy.</p><p><strong>Methods: </strong>A retrospective data collection was conducted to assess the programme's impact on antibiotic consumption expressed as DDDs/100 patient-days, its sustainability over time, resilience during the COVID-19 pandemic and the efficiency of the ASP (relationship between workload and human resources).</p><p><strong>Results: </strong>A substantial overall reduction in antibiotic consumption (-14%), particularly in fluoroquinolones (-64%) and carbapenems (-68%), was demonstrated, showcasing the programme's impact. Sustainability was confirmed through enduring trends in antibiotic consumption and ecological analysis over time. The ASP demonstrates resilience by maintaining positive trends even amid the challenging COVID-19 pandemic. Efficiency was underscored by an increase in on-site consultations despite consistent human resources until 2021.</p><p><strong>Conclusions: </strong>This study offers insights into the prolonged success of a resource-efficient ASP, emphasizing the crucial role of long-term commitment in fostering responsible antibiotic use in the context of global health challenges such as AMR.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae072"},"PeriodicalIF":3.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944835","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":"Eliciting the barriers and enablers towards anaesthetists giving penicillin-based antibiotic prophylaxis to low-risk patients who have had their penicillin allergy label removed as part of a preoperative delabelling process.","authors":"Neil Roberts, Libby Fontaine, Jonathan Sandoe, Sarah Tonkin-Crine, Neil Powell","doi":"10.1093/jacamr/dlae062","DOIUrl":"10.1093/jacamr/dlae062","url":null,"abstract":"<p><strong>Background: </strong>Some penicillin allergy labels can be removed by non-allergy specialists by direct oral challenge, but there is reluctance amongst anaesthetists to give penicillin to these patients. We aimed to assess anaesthetist beliefs about giving penicillin to patients delabelled by direct oral challenge.</p><p><strong>Methods: </strong>A survey, developed using the Theoretical Domains Framework, was circulated to anaesthetists within a regional research network in England. Domains were rated using 5-point Likert scales. Overall and group medians were used to dichotomize domains rated by group into 'relatively important/unimportant' and 'relative enabler/barrier'.</p><p><strong>Results: </strong>We received 257 responses from six hospitals (response rate 49.7%). Seven domains were rated as important for all stakeholder groups and hospitals: <i>Knowledge</i>, <i>Skills</i>, <i>Belief in Capabilities</i>, <i>Belief in Consequences</i>, <i>Memory/Attention/Decisions</i>, <i>Environmental Context and Resources</i>, and <i>Emotions</i>. <i>Social and Professional Role</i> was also important to all respondents except those in one hospital. <i>Intentions</i> and <i>Optimism</i> were rated as important for some groups/hospitals and unimportant for others. All four other domains were rated as unimportant for all groups/hospitals. All domains rated as important were enablers for all groups/hospitals, with the exception of <i>Memory/Attention/Decisions</i> and <i>Emotions,</i> which were rated as discordant barriers/enablers between groups. This means they were acting as a barrier for some staff groups/hospitals and an enabler for others. Barrier domains (<i>Reinforcement</i>, <i>Goals</i>, <i>Social Influences</i>, <i>Behavioural Regulation</i>) were all rated unimportant.</p><p><strong>Conclusions: </strong>Behavioural influences on giving penicillin prophylaxis to a delabelled patient are complex and nuanced. These findings could inform targeted interventions, both across and within hospitals and staff groups.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae062"},"PeriodicalIF":3.7,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916726","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":"Emergence of an IncX3 plasmid co-harbouring the carbapenemase genes <i>bla</i>_NDM-5 and <i>bla</i>_OXA-181.","authors":"Hui Zuo, Yo Sugawara, Kohei Kondo, Shizuo Kayama, Sayoko Kawakami, Kohei Uechi, Ami Nakano, Koji Yahara, Motoyuki Sugai","doi":"10.1093/jacamr/dlae073","DOIUrl":"10.1093/jacamr/dlae073","url":null,"abstract":"<p><strong>Background: </strong>The spread of transmissible plasmids with carbapenemase genes has contributed to a global increase in carbapenemase-producing Enterobacterales over the past two decades, with <i>bla</i>_NDM and <i>bla</i>_OXA among the most prevalent carbapenemase genes.</p><p><strong>Objectives: </strong>To characterize an <i>Escherichia coli</i> isolate co-carrying <i>bla</i>_NDM-5 and <i>bla</i>_OXA-181 (JBEHAAB-19-0176) that was isolated in the Japan Antimicrobial Resistant Bacterial Surveillance in 2019-20, and to evaluate the functional advantage of carrying both genes as opposed to only one.</p><p><strong>Methods: </strong>The whole-genome sequence of the isolate was determined using long- and short-read sequencing. Growth assay and co-culture experiments were performed for phenotypic characterization in the presence of different β-lactam antibiotics.</p><p><strong>Results: </strong>WGS analysis showed that <i>bla</i>_NDM-5 and <i>bla</i>_OXA-181 were carried by the same IncX3 plasmid, pJBEHAAB-19-0176_NDM-OXA. Genetic characterization of the plasmid suggested that the plasmid emerged through the formation of a co-integrate and resolution of two typical IncX3 plasmids harbouring <i>bla</i>_NDM-5 and <i>bla</i>_OXA-181, which involved two recombination events at the IS<i>3000</i> and IS<i>26</i> sequences. When cultured in the presence of piperacillin or cefpodoxime, the growth rate of the transformant co-harbouring <i>bla</i>_NDM-5 and <i>bla</i>_OXA-181 was significantly higher than the transformant with only <i>bla</i>_NDM-5. Furthermore, in co-culture where the two <i>bla</i>_NDM-5-harbouring transformants were allowed to compete directly, the strain additionally harbouring <i>bla</i>_OXA-181 showed a marked growth advantage.</p><p><strong>Conclusions: </strong>The additional carriage of <i>bla</i>_OXA-181 confers a selective advantage to bacteria in the presence of piperacillin and cefpodoxime. These findings may explain the current epidemiology of carbapenemase-producing Enterobacterales, in which bacteria carrying both <i>bla</i>_NDM-5 and <i>bla</i>_OXA-48-like genes have emerged independently worldwide.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae073"},"PeriodicalIF":3.7,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916730","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> analysis of interactions between <i>Pseudomonas aeruginosa</i> and <i>Candida albicans</i> treated with silver sulfadiazine in wound infections.","authors":"Preetha Kamath, Suchismita Paul, Jose Valdes, Joel Gil, Michael Solis, Alex Higa, Stephen C Davis","doi":"10.1093/jacamr/dlae075","DOIUrl":"10.1093/jacamr/dlae075","url":null,"abstract":"<p><strong>Background: </strong>Microorganisms tend to rely on close relationships with other species to survive. Consequently, biofilms formed by interactions of different species have been shown to delay the wound healing process. Studies suggest these mixed-population infections contribute to the development of drug resistance and inhibition of host immune response. Silver sulfadiazine (SSD) has been shown to effectively decrease the risk of infection in an open wound. Typically, these are bacterial wound infections; however, the role of fungal species needs further attention.</p><p><strong>Objectives: </strong>The purpose of this <i>in vitro</i> study was to determine the effect of SSD on interactions between <i>Pseudomonas aeruginosa</i> 09-009 (PA1) or <i>P. aeruginosa</i> 09-010 (PA2) and <i>Candida albicans</i> ATTC 64550 (CA).</p><p><strong>Methods: </strong>A mixture of 4 mL of tryptic soy broth (TSB) and 100 µL of CA and/or PA1 or PA2 (∼10⁶ log cfu/mL) inoculums were deposited into either wells or vials. The wells or vials were then sonicated (50 W for 10 s) to separate microorganisms attached to the walls. After incubation, cell counts were performed at 24 and 48 h for each microorganism using specific media.</p><p><strong>Results: </strong>Our results show that without SSD treatment, <i>P. aeruginosa</i> exhibits an inhibitory effect on <i>C. albicans</i>. Treatment with SSD demonstrated significant reduction of <i>P. aeruginosa</i>; however, <i>C. albicans</i> persisted. This experiment demonstrates that SSD was effective in reducing the bioburden of both <i>P. aeruginosa</i> strains after 24 and 48 h; however, it was not as effective in reducing <i>C. albicans</i>.</p><p><strong>Conclusions: </strong>The data suggest that for polymicrobial mixed infections containing <i>Pseudomonas</i> spp. and <i>C. albicans</i>, treatment with SSD may be beneficial but does not provide adequate microorganism eradication. As such, added treatments that provide coverage for <i>Candida</i> infection are necessary. Additional <i>in vivo</i> studies are needed to obtain a better understanding of the complex interactions between these organisms.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae075"},"PeriodicalIF":3.7,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11089415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916724","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":"Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021.","authors":"Bénédicte Melot, Elise Launay, Florian Drouet, Julie Salomon, Julie Toubiana, Julien Grosjean, Catherine Duclos, Jérémie F Cohen","doi":"10.1093/jacamr/dlae070","DOIUrl":"10.1093/jacamr/dlae070","url":null,"abstract":"<p><strong>Background: </strong>Recent regulatory and reimbursement changes facilitated the development of teleconsultation within primary care. French guidance advises against antibiotic prescribing in children in teleconsultation. We assessed paediatric antibiotic prescribing on a French teleconsultation platform.</p><p><strong>Methods: </strong>This cross-sectional observational study analysed paediatric (0-14 years) visits on a national direct-to-consumer teleconsultation platform between January 2018 and December 2021. Teleconsultations with complete information regarding diagnosis (ICD-10 coding) and prescriptions were included. We assessed antibiotic prescription rates per 100 visits across diagnoses and used logistic regression to identify factors associated with antibiotic prescribing.</p><p><strong>Results: </strong>In the 37 587 included paediatric teleconsultations (median age 3 years) performed by 713 general practitioners (GPs) and 89 paediatricians, antibiotics were prescribed for 12.1%. Respiratory tract infections (RTIs) accounted for 49.5% of antibiotic prescriptions. Antibiotic prescription rates per 100 visits were: sinusitis, 69.5%; urinary tract infections, 62.2%; pharyngitis, 59.0%; pneumonia, 45.5%; otitis, 46.6%; bronchitis, 19.6%; rhinitis, 11.6%; bronchiolitis 6.6%. Antibiotic prescription rates were higher in GPs than paediatricians [OR 2.21 (IC95% 2.07-2.35)], among physicians aged 45-54 and over 65 [OR 1.66 (1.48-1.85) and 1.48 (1.32-1.66), respectively], in female practitioners [OR 1.13 (1.05-1.21)], in children 3-6 years old [OR 1.41 (1.28-1.56)] and over 6 [OR 1.50 (1.35-1.66)], during winter [OR 1.28 (1.21-1.37)] and for RTIs [OR 1.99 (1.87-2.10)]. Antibiotic prescription rates were lower in doctors with extensive experience in teleconsultation [OR 0.92 (0.86-0.98)].</p><p><strong>Conclusions: </strong>Despite current recommendations, paediatric patients were frequently prescribed antibiotics during acute care teleconsultations. Specific antibiotic stewardship campaigns should target paediatric teleconsultations.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae070"},"PeriodicalIF":3.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892068","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":"Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review.","authors":"Calvin Ka-Fung Lo, Ashwin Sritharan, Jiesi Zhang, Nicole Li, Cindy Zhang, Frank Wang, Mark Loeb, Anthony D Bai","doi":"10.1093/jacamr/dlae069","DOIUrl":"10.1093/jacamr/dlae069","url":null,"abstract":"<p><strong>Background: </strong>The cefazolin inoculum effect (CzIE) is a phenomenon whereby some MSSA isolates demonstrate resistance to cefazolin when a high bacterial inoculum is used for susceptibility testing. The clinical significance of this phenotypic phenomenon remains unclear. We conducted a systematic review to answer the following question: In patients with serious MSSA infection treated with cefazolin, does infection due to CzIE-positive MSSA isolates result in worse clinical outcomes than infection due to CzIE-negative MSSA isolates?</p><p><strong>Methods: </strong>Ovid MEDLINE, Embase, Cochrane CENTRAL, medRxiv and bioRxiv were searched from inception until 12 April 2023. Studies were included if they tested for CzIE in clinical isolates from MSSA infections in humans. Two independent reviewers extracted data and conducted risk-of-bias assessment. Main outcomes were treatment failure and mortality. Pooling of study estimates was not performed given the heterogeneity of patient populations and outcome definitions.</p><p><strong>Results: </strong>Twenty-three observational studies were included. CzIE presence amidst MSSA isolates ranged from 0% to 55%. There was no statistically significant mortality difference in two studies that compared MSSA infections with and without CzIE, with ORs ranging from 0.72 to 19.78. Of four studies comparing treatment failure, ORs ranged from 0.26 to 13.00. One study showed a significantly higher treatment failure for the CzIE group, but it did not adjust for potential confounders.</p><p><strong>Conclusions: </strong>The evidence on CzIE is limited by small observational studies. In these studies, CzIE did not predict higher mortality in MSSA infections treated with cefazolin. Our findings do not support CzIE testing in clinical practice currently.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"6 3","pages":"dlae069"},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876451","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}