{"title":"Clinical outcomes in OPAT patients treated with ceftriaxone 4 g and ceftazidime 6 g extended interval dosing regimens.","authors":"David Wareham, Mark Melzer","doi":"10.1093/jacamr/dlae079","DOIUrl":"10.1093/jacamr/dlae079","url":null,"abstract":"<p><strong>Background: </strong>New dosing regimens for ceftriaxone 4 g/24 hours and ceftazidime 3 g/12 hours are convenient for patients receiving OPAT. To date, these have not been clinically validated.</p><p><strong>Aim: </strong>To assess the tolerability, toxicity and effectiveness of once daily ceftriaxone (4 g) and 12 hourly ceftazidime regimens (3 g twice a day) in the OPAT setting.</p><p><strong>Patients and methods: </strong>From April 2018 until March 2023; demographic, clinical, microbiological and outcome data were collected on all adult patients discharged to a community-based OPAT team in East London.</p><p><strong>Results: </strong>There were 487 OPAT episodes. Fifty-three (10.9%) patients received ceftriaxone 4 g once a day and 20 (4.1%) ceftazidime 3 g twice a day. In the ceftriaxone group, the commonest conditions treated were orthopaedic, neurosurgical or diabetic foot infections. OPAT was used to expedite the discharge of 45 (84.9%) patients, the remainder were admission avoidance episodes. The commonest isolate causing infection was MSSA 23 (43.4%). There were no tolerability or toxicity episodes recorded. All patients were cured and bed days saved were 1266.In the smaller twice-daily ceftazidime cohort, seven (35%) patients were treated for necrotizing otitis externa, six (30%) for bronchiectasis and six (30%) for urinary tract infections. The commonest cause of infection was <i>P. aeruginosa</i>, 18 (90%). One case of nephrotoxicity was recorded. All patients were cured and bed days saved were 896.</p><p><strong>Conclusions: </strong>Regimens of ceftriaxone 4 g once a day and ceftazidime 3 g twice a day were well tolerated and highly effective. If widely adopted, these regimens will save OPAT and nursing time and enable more patients to be treated.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179638","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}
Jon Salmanton-García, Michaela Simon, Andreas H Groll, Oliver Kurzai, Tobias Lahmer, Thomas Lehrnbecher, Maria Schroeder, Oliver A Cornely, Jannik Stemler
{"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":null,"pages":null},"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}
Alex Soriano, Matteo Bassetti, Charalambos Gogos, Tristan Ferry, Raul de Pablo, Wajeeha Ansari, Michal Kantecki, Bernd Schweikert, Gustavo Luna, Francesco Blasi
{"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":null,"pages":null},"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}
Raphael Z Sangeda, Sahani M William, Faustine C Masatu, Adonis Bitegeko, Yonah H Mwalwisi, Emmanuel A Nkiligi, Pius G Horumpende, Adam M Fimbo
{"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":null,"pages":null},"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}
S. Mudenda, Billy Chabalenge, V. Daka, Elimas Jere, Isaac Sefah, Evelyn Wesangula, K. Yamba, Julian Nyamupachitu, Nathan Mugenyi, Z. Mustafa, M. Mpundu, Joseph Chizimu, R. Chilengi
{"title":"Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study","authors":"S. Mudenda, Billy Chabalenge, V. Daka, Elimas Jere, Isaac Sefah, Evelyn Wesangula, K. Yamba, Julian Nyamupachitu, Nathan Mugenyi, Z. Mustafa, M. Mpundu, Joseph Chizimu, R. Chilengi","doi":"10.1093/jacamr/dlae076","DOIUrl":"https://doi.org/10.1093/jacamr/dlae076","url":null,"abstract":"Abstract Background Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia. Methods A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0. Results Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics. Conclusion This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140964248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","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":null,"pages":null},"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}
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
{"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":null,"pages":null},"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}
Neil Roberts, Libby Fontaine, Jonathan Sandoe, Sarah Tonkin-Crine, Neil Powell
{"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":null,"pages":null},"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}
Hui Zuo, Yo Sugawara, Kohei Kondo, Shizuo Kayama, Sayoko Kawakami, Kohei Uechi, Ami Nakano, Koji Yahara, Motoyuki Sugai
{"title":"Emergence of an IncX3 plasmid co-harbouring the carbapenemase genes <i>bla</i><sub>NDM-5</sub> and <i>bla</i><sub>OXA-181</sub>.","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><sub>NDM</sub> and <i>bla</i><sub>OXA</sub> among the most prevalent carbapenemase genes.</p><p><strong>Objectives: </strong>To characterize an <i>Escherichia coli</i> isolate co-carrying <i>bla</i><sub>NDM-5</sub> and <i>bla</i><sub>OXA-181</sub> (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><sub>NDM-5</sub> and <i>bla</i><sub>OXA-181</sub> 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><sub>NDM-5</sub> and <i>bla</i><sub>OXA-181</sub>, 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><sub>NDM-5</sub> and <i>bla</i><sub>OXA-181</sub> was significantly higher than the transformant with only <i>bla</i><sub>NDM-5</sub>. Furthermore, in co-culture where the two <i>bla</i><sub>NDM-5</sub>-harbouring transformants were allowed to compete directly, the strain additionally harbouring <i>bla</i><sub>OXA-181</sub> showed a marked growth advantage.</p><p><strong>Conclusions: </strong>The additional carriage of <i>bla</i><sub>OXA-181</sub> 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><sub>NDM-5</sub> and <i>bla</i><sub>OXA-48</sub>-like genes have emerged independently worldwide.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"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}
Preetha Kamath, Suchismita Paul, Jose Valdes, Joel Gil, Michael Solis, Alex Higa, Stephen C Davis
{"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 (∼10<sup>6</sup> 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":null,"pages":null},"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}