JAC-Antimicrobial Resistance最新文献

{"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"Pharmacist roles in antimicrobial stewardship: a qualitative study from India, South Africa and the United Kingdom.","authors":"Vrinda Nampoothiri, Oluchi Mbamalu, Marc Mendelson, Sanjeev Singh, Esmita Charani","doi":"10.1093/jacamr/dlae047","DOIUrl":"10.1093/jacamr/dlae047","url":null,"abstract":"<p><strong>Objective: </strong>To explore pharmacist roles in antimicrobial stewardship (AMS) in India, South Africa (SA), United Kingdom (UK) and the factors that contribute to their participation in the programme in these countries.</p><p><strong>Methods: </strong>Data were collected between April 2019 and March 2022 through semi-structured interviews with key AMS stakeholders from India (Kerala); SA (Western Cape province) and the UK (England). Interviews were conducted face to face or via Zoom and Skype platforms, audio recordings were transcribed verbatim and thematically analysed using a grounded theory approach aided by NVivo 12 software.</p><p><strong>Results: </strong>We interviewed 38 key AMS stakeholders (pharmacists and doctors). India and the UK have dedicated AMS pharmacists (Doctor of Pharmacy and Master of Pharmacy graduates with opportunities for additional post-graduate qualifications respectively). Pharmacists in the UK lead AMS programmes, while in India, predominantly in the private sector, pharmacists drive AMS in collaboration with clinicians. In SA, pharmacists (Bachelor of Pharmacy graduates) participate in AMS out of their own commitment in addition to their pharmacy responsibilities. Private sector pharmacists drive AMS while public sector pharmacists participate in clinician-led AMS programmes. Current pharmacy curricula do not provide adequate training in AMS, and this limitation shapes pharmacist roles and acceptance in AMS among clinicians in India and SA. Support of mentors (doctors/senior pharmacists) and self-motivated learning are key factors for effective pharmacist involvement in AMS.</p><p><strong>Conclusions: </strong>A contextually developed, standardized and accessible AMS training programme along with pharmacy curricula modification to include AMS, may facilitate prominent pharmacist roles in AMS.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876454","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":"Intravenous cefuroxime as a first-line treatment for women hospitalized for pyelonephritis.","authors":"Céline Everard, Axelle Schampaert, Louise Doyen, Valérie Verbelen, Jean-Christophe Marot, Grégoire Wieërs","doi":"10.1093/jacamr/dlae071","DOIUrl":"10.1093/jacamr/dlae071","url":null,"abstract":"<p><strong>Background: </strong>Empirical treatment of pyelonephritis in the emergency ward includes broad-spectrum antibiotics. Such a strategy favours broad-spectrum antibiotic overuse. Local antibiotic stewardship teams can propose local recommendations to adapt empirical antibiotic treatment devoted to spare precious molecules that remain active on MDR bacteria, such as fluoroquinolones or other broad-spectrum antibiotics.</p><p><strong>Objectives: </strong>We aimed to evaluate the incidence of urinary tract infection recurrence within 3 months after hospital discharge following empirical antibiotic therapy with cefuroxime in women with pyelonephritis in the emergency room.</p><p><strong>Patients and methods: </strong>We conducted a retrospective, single-centre study. We identified 109 women treated for pyelonephritis, 95 with cefuroxime at any time, and 14 with only other antibiotics, and divided them into subgroups based on antibiotic switch to other molecules. We compared the incidence of urinary tract infection recurrence in the subgroups.</p><p><strong>Results: </strong>In the group of patients treated with cefuroxime only, we identified five cases of recurrence (9.4%) in a total of 53 patients, but only 1 (1.9%) case of recurrence associated with the same uropathogen. No significant difference in clinical outcome, length of antibiotic treatment, or urinary tract infection recurrence was observed between the subgroups.</p><p><strong>Conclusions: </strong>Our study supports that a strategy elaborated by an antibiotic stewardship team based on local ecology and aimed at proposing the narrowest-spectrum antibiotic upon treatment initiation in the emergency room is safe.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876453","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":"Antimicrobial resistance and ESBL production in uropathogenic <i>Escherichia coli</i>: a systematic review and meta-analysis in Ethiopia.","authors":"Zelalem Asmare, Mulat Erkihun, Wagaw Abebe, Ephrem Tamrat","doi":"10.1093/jacamr/dlae068","DOIUrl":"10.1093/jacamr/dlae068","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a serious threat to global health systems. <i>Escherichia coli</i> is a major cause of urinary tract infections (UTIs). Understanding the AMR patterns of uropathogenic <i>E. coli</i> (UPEC) is crucial for effective public health interventions worldwide.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis aimed to consolidate existing research and provide a comprehensive information on AMR UPEC in Ethiopia.</p><p><strong>Methods: </strong>We systematically searched databases such as PubMed, Web of Science, and Science Direct, along with including articles from Google Scholar. Data were extracted into Microsoft Excel and analysed using STATA 17.0. Cohen's kappa was computed to assess reviewer agreement, while the I² statistic evaluated heterogeneity. Egger's tests were conducted to detect publication bias, and random-effects models were utilized to estimate the pooled resistance, with AMR rates for each antibiotic pooled separately.</p><p><strong>Results: </strong>UPEC showed resistance rates, ranging from 3.64% (95% CI: -4.38% to 11.67%) for amikacin to 85.32% (95% CI: 78.6%-92.04%) for ampicillin. Highest resistance was to ampicillin (85.32%), followed by amoxicillin at 82.52% (95% CI: 74.3%-90.74%), tetracycline at 60.67% (95% CI: 51.53%-69.81%) and trimethoprim/sulfamethoxazole at 57.17% (95% CI: 49.93%-64.42%). Conversely, resistance rates were lower for amikacin at 3.64% and meropenem at 5.26% (95% CI: 2.64%-7.88%). UPEC demonstrated a pooled MDR rate of 79.17% (95% CI: 70.32%-88.01%) and a pooled ESBL production rate of 29.16% (95% CI: 22.36%-38.55%).</p><p><strong>Conclusions: </strong>High levels of AMR were observed in UPEC strains, highlighting a critical public health issue requiring urgent action through robust antimicrobial stewardship and surveillance to preserve effective UTI treatment options.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876450","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":"Three-years of dalbavancin use at a UK tertiary referral hospital serving a population with high numbers of people who inject drugs.","authors":"Carolin Bresges, Kristina Bresges, Claudette Hewitt, Sunil Sharma, Bethany Davies","doi":"10.1093/jacamr/dlae066","DOIUrl":"10.1093/jacamr/dlae066","url":null,"abstract":"<p><strong>Background: </strong>Dalbavancin's unique properties have led to an increase in its off-licence use in complex infection and in vulnerable populations including people who inject drugs (PWID), but data remain limited. In this retrospective cohort study, we describe the characteristics, treatment rationale and outcomes for all adult inpatients treated with dalbavancin at a UK tertiary hospital.</p><p><strong>Results: </strong>Fifty-eight inpatients were treated with dalbavancin between 1 January 2018 and 1 January 2021, 98.3% for off-licence diagnoses. Acute bacterial skin and skin structure infection, infective endocarditis and endovascular infections were each diagnosed in 22.4% of patients. Bone and joint infections were diagnosed in 18.9%, discitis in 12.1% and central line-associated bloodstream infections in 5.2%. Sixty-nine percent of patients were bacteraemic; 52.5% <i>Staphylococcus aureus</i>, 5.0% MRSA. Two mild adverse reactions were attributed to dalbavancin. Treatment was successful in 43 (75.4%) patients, and failed in seven (12.3%). Seven (12.3%) were lost to follow-up.Thirty-five patients (60.3%) were PWID, with low median age (41.0 years) and Charlson Comorbidity scores (0). Self-discharge was taken by 17.1% of PWID, and 20.6% were lost to follow-up. At 90 days, three (8.6%) PWID were deceased.</p><p><strong>Conclusions: </strong>In this first UK cohort, dalbavancin was used off licence and in persons facing barriers to conventional therapies. Where data is available, it was safe and effective. Dalbavancin appears a potentially valuable tool in improving outcomes for PWID.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876455","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":"Influencing attitudes towards antimicrobial use and resistance in companion animals-the impact on pet owners of a short animation in a randomized controlled trial.","authors":"Emma Wright, Lisbeth Rem Jessen, Alice Tompson, Catherine Rutland, David Singleton, Ian Battersby, Isuru Gajanayake, Margo Mosher, Sharon Pfleger, Toby Gemmill, Tim Sparks, Tina M Sørensen, Fergus Allerton","doi":"10.1093/jacamr/dlae065","DOIUrl":"10.1093/jacamr/dlae065","url":null,"abstract":"<p><strong>Objectives: </strong>Antimicrobial resistance (AMR) is a vital One Health issue; the rational use of antimicrobials is essential to preserve their efficacy. Veterinarians cite pressure from pet owners as a contributor to antimicrobial prescription. Engaging pet owners in antimicrobial stewardship could reduce this pressure. A short educational animation could facilitate communication of this message. The impact of the animation on participant's opinions relating to antimicrobial prescribing and awareness of AMR was assessed via a randomized controlled trial.</p><p><strong>Methods: </strong>A survey was created based on the health belief model. Owners attending six UK veterinary centres were randomized to the intervention or control group (ratio 1:1). All owners completed an agreement level survey of two questions followed by 18 statements scored using a Likert agreement scale. The control group responded without interruption, whereas the animation group was shown the animation after answering the first two questions and five statements.</p><p><strong>Results: </strong>In total, 647 owners participated in the study; 350 complete responses were analysed. Responses to 10 of 13 statements asked after the animation were significantly different (all <i>P</i> < 0.050) between groups, whereas there was no significant difference between groups in response to any of the statements asked before the animation. The animation group were more likely to agree that lower antimicrobial use would help maintain future efficacy (<i>P</i> < 0.001) and that requesting antimicrobials from their vet could increase unnecessary use (<i>P</i> < 0.001). The animation group were more likely to disagree that they would expect antimicrobials if their pet had diarrhoea (<i>P</i> = 0.048).</p><p><strong>Conclusions: </strong>Pet owners that watched a short AMR engagement animation displayed greater awareness of the impact of AMR and were more likely to support measures in line with antimicrobial stewardship. This behavioural-nudge resource could support owners towards contributing to a multi-faceted approach to AMR.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876452","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":"Activity of ceftolozane/tazobactam and imipenem/relebactam against Gram-negative clinical isolates collected in Mexico—SMART 2017–2021","authors":"J. Karlowsky, S. Lob, F. Siddiqui, T. Polis, Jose L Vallejo, K. Young, M. Motyl, Daniel F Sahm","doi":"10.1093/jacamr/dlae077","DOIUrl":"https://doi.org/10.1093/jacamr/dlae077","url":null,"abstract":"Abstract Objectives To investigate the activities of ceftolozane/tazobactam and imipenem/relebactam against Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from hospitalized patients in Mexico in 2017–2021. Methods MICs were determined by CLSI broth microdilution and interpreted using CLSI M100 breakpoints. β-Lactamase genes were identified in ceftolozane/tazobactam-, imipenem/relebactam-, and/or imipenem-non-susceptible isolates. Results Ceftolozane/tazobactam and imipenem/relebactam inhibited 89% and 99% of E. coli isolates (n = 2337), and 87% and 94% of K. pneumoniae isolates (n = 1127). Sixty-four percent of E. coli and 47% of K. pneumoniae had an ESBL non-carbapenem-resistant Enterobacterales (ESBL non-CRE) phenotype. Eighty-six percent and 91% of ESBL non-CRE E. coli and K. pneumoniae were ceftolozane/tazobactam susceptible, and 99.9% and 99.8% were imipenem/relebactam susceptible. Ceftolozane/tazobactam was the most active agent studied against P. aeruginosa (n = 1068; 83% susceptible), 9–28 percentage points higher than carbapenems and comparator β-lactams excluding imipenem/relebactam (78% susceptible). Ceftolozane/tazobactam remained active against 35%–58%, and imipenem/relebactam against 32%–42%, of P. aeruginosa in meropenem-, piperacillin/tazobactam-, and cefepime-non-susceptible subsets. The majority of isolates of ceftolozane/tazobactam-non-susceptible E. coli carried an ESBL, whereas among ceftolozane/tazobactam-non-susceptible K. pneumoniae and P. aeruginosa, the majority carried carbapenemases. The most prevalent carbapenemase observed among E. coli (estimated at 0.7% of all isolates), K. pneumoniae (4.8%) and P. aeruginosa (10.0%) was an MBL. Almost all imipenem/relebactam-non-susceptible E. coli and K. pneumoniae carried MBL or OXA-48-like carbapenemases, whereas among imipenem/relebactam-non-susceptible P. aeruginosa, 56% carried MBL or GES carbapenemases. Conclusions Ceftolozane/tazobactam and imipenem/relebactam may provide treatment options for patients infected with β-lactam-non-susceptible Gram-negative bacilli, excluding isolates carrying an MBL- or OXA-48-like carbapenemase.","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141129486","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":"Antimicrobial resistance profiles of <i>Escherichia coli</i> isolated from clinical and environmental samples: findings and implications.","authors":"Maisa Kasanga, Doreen Mainza Shempela, Victor Daka, Mark J Mwikisa, Jay Sikalima, Duncan Chanda, Steward Mudenda","doi":"10.1093/jacamr/dlae061","DOIUrl":"https://doi.org/10.1093/jacamr/dlae061","url":null,"abstract":"<p><strong>Background: </strong>The overuse and misuse of antimicrobials has worsened the problem of antimicrobial resistance (AMR) globally. This study investigated the AMR profiles of <i>Escherichia coli</i> isolated from clinical and environmental samples in Lusaka, Zambia.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted from February 2023 to June 2023 using 450 samples. VITEK^® 2 Compact was used to identify <i>E. coli</i> and perform antimicrobial susceptibility testing. Data analysis was done using WHONET 2022 and SPSS version 25.0.</p><p><strong>Results: </strong>Of the 450 samples, 66.7% (<i>n</i> = 300) were clinical samples, whereas 33.3% (<i>n</i> = 150) were environmental samples. Overall, 47.8% (<i>n</i> = 215) (37.8% clinical and 10% environmental) tested positive for <i>E. coli</i>. Of the 215 <i>E. coli</i> isolates, 66.5% were MDR and 42.8% were ESBL-producers. Most isolates were resistant to ampicillin (81.4%), sulfamethoxazole/trimethoprim (70.7%), ciprofloxacin (67.9%), levofloxacin (64.6%), ceftriaxone (62.3%) and cefuroxime (62%). Intriguingly, <i>E. coli</i> isolates were highly susceptible to amikacin (100%), imipenem (99.5%), nitrofurantoin (89.3%), ceftolozane/tazobactam (82%) and gentamicin (72.1%).</p><p><strong>Conclusions: </strong>This study found a high resistance of <i>E. coli</i> to some antibiotics that are commonly used in humans. The isolation of MDR and ESBL-producing <i>E. coli</i> is a public health concern and requires urgent action. Therefore, there is a need to instigate and strengthen interventional strategies including antimicrobial stewardship programmes to combat AMR in Zambia.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11055401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849408","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":"Comparing indicators of disease severity among patients presenting to hospital for urinary tract infections before and during the COVID-19 pandemic.","authors":"Selina Patel, Martin Gill, Andrew Hayward, Susan Hopkins, Andrew Copas, Laura Shallcross","doi":"10.1093/jacamr/dlae067","DOIUrl":"https://doi.org/10.1093/jacamr/dlae067","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, patients may have delayed seeking healthcare for urinary tract infections (UTIs). This could have resulted in more severe presentation to hospital and different antibiotic usage.</p><p><strong>Objectives: </strong>We explored evidence for such changes through existing national indicators of prescribing, and routine clinical data collected in the electronic health record (EHR).</p><p><strong>Methods: </strong>We carried out a retrospective cohort study of patients presenting to two UK hospitals for UTIs, comparing two indicators of disease severity on admission before and during the pandemic: intravenous (IV) antibiotic use, and National Early Warning Score 2 (NEWS2). We developed regression models to estimate the effect of the pandemic on each outcome, adjusting for age, sex, ethnicity and index of multiple deprivation.</p><p><strong>Results: </strong>During the pandemic, patients were less likely to present to hospital for UTI with NEWS2 of 0 or 1 [adjusted odds ratio (aOR): 0.66; 95% confidence interval (CI): 0.52-0.85] compared with before, more likely to present with score 2 (aOR: 1.52; 95% CI: 1.18-1.94), whereas the likelihood of presenting with a NEWS2 of >2 remained the same (aOR: 1.06; 95% CI: 0.87-1.29). We did not find evidence that this limited increase in disease severity resulted in changes to IV antibiotic use on admission (adjusted risk ratio: 1.02; 95% CI: 0.91-1.15).</p><p><strong>Conclusions: </strong>There may have been a small increase in disease severity at hospital presentation for UTI during the pandemic, which can be detected using routine data and not through national indicators of prescribing. Further research is required to validate these findings and understand whether routine data could support a more nuanced understanding of local antimicrobial prescribing practices.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855004","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}