Journal of Antimicrobial Chemotherapy最新文献_第9页

GP or ChatGPT? Ability of large language models (LLMs) to support general practitioners when prescribing antibiotics. 全科医生还是 ChatGPT？大型语言模型 (LLM) 在为全科医生开抗生素处方时提供支持的能力。

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-13 DOI: 10.1093/jac/dkaf077

Oanh Ngoc Nguyen, Doaa Amin, James Bennett, Øystein Hetlevik, Sara Malik, Andrew Tout, Heike Vornhagen, Akke Vellinga

{"title":"GP or ChatGPT? Ability of large language models (LLMs) to support general practitioners when prescribing antibiotics.","authors":"Oanh Ngoc Nguyen, Doaa Amin, James Bennett, Øystein Hetlevik, Sara Malik, Andrew Tout, Heike Vornhagen, Akke Vellinga","doi":"10.1093/jac/dkaf077","DOIUrl":"https://doi.org/10.1093/jac/dkaf077","url":null,"abstract":"Introduction: Large language models (LLMs) are becoming ubiquitous and widely implemented. LLMs could also be used for diagnosis and treatment. National antibiotic prescribing guidelines are customized and informed by local laboratory data on antimicrobial resistance.Methods: Based on 24 vignettes with information on type of infection, gender, age group and comorbidities, GPs and LLMs were prompted to provide a treatment. Four countries (Ireland, UK, USA and Norway) were included and a GP from each country and six LLMs (ChatGPT, Gemini, Copilot, Mistral AI, Claude and Llama 3.1) were provided with the vignettes, including their location (country). Responses were compared with the country's national prescribing guidelines. In addition, limitations of LLMs such as hallucination, toxicity and data leakage were assessed.Results: GPs' answers to the vignettes showed high accuracy in relation to diagnosis (96%-100%) and yes/no antibiotic prescribing (83%-92%). GPs referenced (100%) and prescribed (58%-92%) according to national guidelines, but dose/duration of treatment was less accurate (50%-75%). Overall, the GPs' accuracy had a mean of 74%. LLMs scored high in relation to diagnosis (92%-100%), antibiotic prescribing (88%-100%) and the choice of antibiotic (59%-100%) but correct referencing often failed (38%-96%), in particular for the Norwegian guidelines (0%-13%). Data leakage was shown to be an issue as personal information was repeated in the models' responses to the vignettes.Conclusions: LLMs may be safe to guide antibiotic prescribing in general practice. However, to interpret vignettes, apply national guidelines and prescribe the right dose and duration, GPs remain best placed.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

In vitro and in vivo antibacterial activity, resistance analysis and molecular docking study of pleuromutilin derivatives against Streptococcus suis. 胸腺嘧啶衍生物对猪链球菌的体内外抗菌活性、耐药性分析和分子对接研究。

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-13 DOI: 10.1093/jac/dkaf064

Sujuan Wu, Lu Zhang, Xinyue Luo, Changcheng Lin, Peng Wan, Honghao Huang, Yixing Lu, Youzhi Tang, Zhenling Zeng

{"title":"In vitro and in vivo antibacterial activity, resistance analysis and molecular docking study of pleuromutilin derivatives against Streptococcus suis.","authors":"Sujuan Wu, Lu Zhang, Xinyue Luo, Changcheng Lin, Peng Wan, Honghao Huang, Yixing Lu, Youzhi Tang, Zhenling Zeng","doi":"10.1093/jac/dkaf064","DOIUrl":"https://doi.org/10.1093/jac/dkaf064","url":null,"abstract":"Objectives: To evaluate the in vitro and in vivo antimicrobial activity of pleuromutilin derivatives modified with C14 side-chain against Streptococcus suis.Methods: To determine the minimum inhibitory concentrations (MICs) of 268 pleuromutilin derivatives with C14 side-chain modifications against S. suis ATCC 43 765 using the broth dilution method. Derivative B43, B49, B52, B53 and B54, which exhibited better antimicrobial activity, were selected for further investigation of their in vitro antibacterial effect, cytotoxicity, and in vivo antibacterial effect.Results: Determination activity of five derivatives against clinical strains (n = 37), as well as growth and time-killing curves. Those experiments showed that all the five derivatives had good activity against S. suis in vitro. Resistance-inducing assays demonstrated that, except for B43, the derivatives had similar abilities to induce resistance to tiamulin. In addition, the five derivatives did not have erythrocyte haemolytic toxicity (0.25-16 mg/L) and cytotoxicity (1.25-80 mg/L). In the mouse thigh infection model, the derivative of B49 exhibited superior antibacterial efficacy. About 40 mg/kg B49 had good activity and improved the survival rate of mice by 33.3% in the S. suis mouse peritonitis model. Molecular docking study and scanning electron microscopy revealed that B49 can effectively bind to the active site of the 50S ribosome and disrupt cell membranes.Conclusions: A total of 68.66% of the 268 C14 side-chain modified pleuromutilin derivatives showed potent activity against S. suis. Among them, B49 showed good in vitro and in vivo antimicrobial effects against S. suis, indicating that B49 can be intensively studied as an antimicrobial candidate compound.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of antibiotic provision associated with acute sore throat symptom management in community pharmacies in Wales and England: a natural policy experiment.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-12 DOI: 10.1093/jac/dkaf057

Ayodeji Matuluko, Efi Mantzourani, Haroon Ahmed, Rebecca Cannings-John, Andrew Evans, Mirza Lalani, Nicholas Mays, Rebecca E Glover

{"title":"Comparison of antibiotic provision associated with acute sore throat symptom management in community pharmacies in Wales and England: a natural policy experiment.","authors":"Ayodeji Matuluko, Efi Mantzourani, Haroon Ahmed, Rebecca Cannings-John, Andrew Evans, Mirza Lalani, Nicholas Mays, Rebecca E Glover","doi":"10.1093/jac/dkaf057","DOIUrl":"https://doi.org/10.1093/jac/dkaf057","url":null,"abstract":"Background: Acute sore throat is managed in community pharmacies in England and Wales under different clinical pathways: Acute Sore Throat Pharmacy First (ASTPF) and Sore Throat Test and Treat (STTT), respectively. ASTPF launched in 2024 and allows antibiotic supply with FeverPAIN scores 4 and 5. STTT launched in 2018 and allows antibiotic supply with FeverPAIN ≥2 or Centor ≥3, if point-of-care testing confirms presence of group A Streptococcus (GAS).Objectives: To compare antibiotic supply rates of ASTPF and STTT, between 1 February 2024 and 30 July 2024, covering the first 6 months of ASTPF.Methods: A descriptive study using anonymized individual-level data from electronic pharmacy records of STTT and anonymized population-level aggregate data from electronic records of ASTPF consultations meeting the gateway criteria for reimbursement.Results: During the study period, 317 864 ASTPF and 27 684 STTT consultations were recorded across participating pharmacies, representing 551.0 and 874.9 consultations per 100 000 population in England (57 690 300) and Wales (3 164 400), respectively. The antibiotic supply rate was 72.7% (95% CI: 72.5% to 72.8%) for ASTPF and 29.9% (95% CI: 29.4% to 30.5%) for STTT.Conclusions: In this natural experiment in two similar healthcare systems with pharmacy-led sore throat services, we found different rates of antibiotic supply. Differences could be attributable to service implementation, pharmacists' initial training, engagement with GPs, pathway differences (e.g. gateway criteria and use of point-of-care tests), symptom severity, or most likely a combination of multiple factors. This early analysis suggests adapting the ASTPF pathway, to include point-of-care testing, could lead to reductions in unnecessary antibiotic supply.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: are we already losing cefiderocol?-authors' response.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-12 DOI: 10.1093/jac/dkaf075

Ioannis Baltas, Trupti Patel, Ana Lima Soares

引用次数: 0

Comment on: Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: are we already losing cefiderocol?

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-12 DOI: 10.1093/jac/dkaf074

Christopher M Longshaw, Boudewijn L M Dejonge, Yoshinori Yamano

引用次数: 0

Comment on: Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: are we already losing cefiderocol?

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-12 DOI: 10.1093/jac/dkaf060

Timothy M Rawson, Maxwell Al-Hassan, Ilona Brzeska-Trafny, Anna Morkowska, Elita Jauneikaite, Razan Saman, Hugo Donaldson, Frances Davies

引用次数: 0

Intraventricular injection of eravacycline in the treatment of carbapenem-resistant Acinetobacter baumannii meningitis: a case report.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-11 DOI: 10.1093/jac/dkaf069

Qihui Liu, Xian Zhou, Zhuoying Du, Xuan Wang, Ning Li

引用次数: 0

Antibiotic-induced stress responses in Gram-negative bacteria and their role in antibiotic resistance.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-07 DOI: 10.1093/jac/dkaf068

Chanté Brand, Mae Newton-Foot, Melanie Grobbelaar, Andrew Whitelaw

{"title":"Antibiotic-induced stress responses in Gram-negative bacteria and their role in antibiotic resistance.","authors":"Chanté Brand, Mae Newton-Foot, Melanie Grobbelaar, Andrew Whitelaw","doi":"10.1093/jac/dkaf068","DOIUrl":"https://doi.org/10.1093/jac/dkaf068","url":null,"abstract":"Bacteria adapt to changes in their natural environment through a network of stress responses that enable them to alter their gene expression to survive in the presence of stressors, including antibiotics. These stress responses can be specific to the type of stress and the general stress response can be induced in parallel as a backup mechanism. In Gram-negative bacteria, various envelope stress responses are induced upon exposure to antibiotics that cause damage to the cell envelope or result in accumulation of toxic metabolic by-products, while the heat shock response is induced by antibiotics that cause misfolding or accumulation of protein aggregates. Antibiotics that result in the production of reactive oxygen species (ROS) induce the oxidative stress response and those that cause DNA damage, directly and through ROS production, induce the SOS response. These responses regulate the expression of various proteins that work to repair the damage that has been caused by antibiotic exposure. They can contribute to antibiotic resistance by refolding, degrading or removing misfolded proteins and other toxic metabolic by-products, including removal of the antibiotics themselves, or by mutagenic DNA repair. This review summarizes the stress responses induced by exposure to various antibiotics, highlighting their interconnected nature, as well the roles they play in antibiotic resistance, most commonly through the upregulation of efflux pumps. This can be useful for future investigations targeting these responses to combat antibiotic-resistant Gram-negative bacterial infections.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

In vivo evaluation of cefazolin inoculum effect in the treatment of experimental Staphylococcus aureus pneumonia with cefazolin.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-04 DOI: 10.1093/jac/dkaf065

Soon Ok Lee, Shinwon Lee, Sohee Park, Jeong Eun Lee, Sun Hee Lee

{"title":"In vivo evaluation of cefazolin inoculum effect in the treatment of experimental Staphylococcus aureus pneumonia with cefazolin.","authors":"Soon Ok Lee, Shinwon Lee, Sohee Park, Jeong Eun Lee, Sun Hee Lee","doi":"10.1093/jac/dkaf065","DOIUrl":"https://doi.org/10.1093/jac/dkaf065","url":null,"abstract":"Objectives: This study compared the efficacy of cefazolin in a mouse pneumonia model caused by a methicillin-susceptible Staphylococcus aureus (MSSA) strain with cefazolin inoculum effect (CIE) and its blaZ-eliminated derivative.Methods: An isogenic blaZ gene-eliminated strain was derived from type A blaZ-positive MSSA blood isolates exhibiting CIE: PNIDSA230 (parental strain, CIE+) and PNIDSA230c (blaZ-eliminated strain, CIE-). Mice were inoculated with 2 × 10⁶ to 2 × 10⁷ cfu of MSSA via endotracheal tubes and treated with intraperitoneal cefazolin or oxacillin 5 h post-inoculation. Bacterial loads in the lungs (primary sites), liver, and kidneys (metastatic foci) were measured 24 h later.Results: Cefazolin reduced bacterial densities in the lungs of CIE-positive MSSA-infected mice (n = 11) compared with untreated controls (n = 11) (mean log10 cfu/g ± SD, 6.0 ± 1.6 versus 9.4 ± 2.7; P = 0.006). However, the efficacy of cefazolin was significantly lower in CIE+ infections than in CIE- infections (mean log10 cfu/g ± SD, 6.0 ± 1.6 versus 4.4 ± 0.8, P = 0.0258). Cefazolin-treated CIE- MSSA-infected mice showed no metastatic infections, while 7 of the 11 CIE+ MSSA-infected mice developed liver or kidney infections despite cefazolin treatment. Oxacillin treatment significantly reduced bacterial densities of the lungs, liver, and kidney in CIE-positive (n = 4) and CIE-negative (n = 4) MSSA-infected mice, with no significant differences between CIE-positive and CIE-negative MSSA infections.Conclusions: CIE may diminish cefazolin's efficacy in severe MSSA infections and contribute to the development of metastatic infection foci. Oxacillin remains effective regardless of CIE status.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cellular pharmacology of tenofovir alafenamide and emtricitabine in neutrophils and platelets in people with and without HIV.

IF 3.9 2区医学

Journal of Antimicrobial Chemotherapy Pub Date : 2025-03-04 DOI: 10.1093/jac/dkaf052

Vincent A Mainella, Brian Branchford, Travis Nemkov, Seth Hosford, Ryan P Coyle, Bethany Johnson, Ye Ji Choi, Martin Williams, Jia-Hua Zheng, Lane Bushman, Jennifer J Kiser, Peter L Anderson, Kristina M Brooks

{"title":"Cellular pharmacology of tenofovir alafenamide and emtricitabine in neutrophils and platelets in people with and without HIV.","authors":"Vincent A Mainella, Brian Branchford, Travis Nemkov, Seth Hosford, Ryan P Coyle, Bethany Johnson, Ye Ji Choi, Martin Williams, Jia-Hua Zheng, Lane Bushman, Jennifer J Kiser, Peter L Anderson, Kristina M Brooks","doi":"10.1093/jac/dkaf052","DOIUrl":"https://doi.org/10.1093/jac/dkaf052","url":null,"abstract":"Background: Previous studies have primarily focused on nucleos(t)ide reverse transcriptase inhibitor pharmacology in peripheral blood mononuclear cells (PBMCs) and erythrocytes via dried blood spots (DBS), but not other major blood cells.Objectives: Our objectives were to describe and compare the concentrations of tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in DBS, PBMCs, neutrophils, and platelets in people with HIV (PWH) and people without HIV (PWOH).Methods: DBS, PBMCs, neutrophils, and platelets were isolated from whole blood drawn from PWH and PWOH receiving tenofovir alafenamide and emtricitabine. TFV-DP and FTC-TP concentrations were quantified using LC-MS/MS in each cell type. Linear regression models controlled for time on drug, adherence, and time since last dose, where applicable, to determine geometric mean percent differences (95% confidence interval) by HIV status and estimated half-lives.Results: Data were available in 13 PWH (96% male) and 30 PWOH (53% male). Compared with PWOH, TFV-DP in DBS was 48.9% (15.6%, 91.9%) higher and FTC-TP in platelets was 36.3% (4.5%, 77.7%) higher; TFV-DP in platelets also trended higher [43.5% (-3.24%, 113%)]. No other cell types significantly differed by HIV status. TFV-DP and FTC-TP demonstrated the longest half-lives in neutrophils, followed by PBMCs and then platelets. After normalizing to cell volume, both drugs accumulated from greatest to least in PBMCs, neutrophils, platelets, and erythrocytes across both PWH and PWOH.Conclusions: Our findings highlight differential drug disposition across cell types that also vary by serostatus in DBS and platelets. The mechanisms and implications of these findings require additional research.","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0