Journal of global antimicrobial resistance最新文献

{"title":"Nasopharyngeal carriage, serotype, antimicrobial susceptibility and genotype of pneumococci in young healthy children attending daycare centres in Klang Valley, Malaysia.","authors":"Norfazlina Mohamad, Maitasha Alia Meor Yahaya, AbdulRahman Muthanna, Mohd Nasir Mohd Desa, Elysha Nur Ismail, Rahmat Dapari, Anita Abd Rahman, Ahmad Najib Hasan, Niazlin Mohd Taib, Siti Norbaya Masri, Chee Hui Yee, Sithra Rengasamy, Norlijah Othman","doi":"10.1016/j.jgar.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.017","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae is a respiratory pathogen that, commonly colonises the nasopharynx in children and the elderly, with 101 serotypes identified. The implementation of pneumococcal conjugate vaccines (PCV) against pneumococcal related diseases has led to a decrease in invasive pneumococcal disease (IPD). In Malaysia, PCV10 was included in national immunisation program in late 2020. Therefore, monitoring serotype distribution and antimicrobial resistance in high-density areas is crucial for vaccine assessment and public health strategies.</p><p><strong>Objective: </strong>This study aimed to investigate the serotype distribution, antimicrobial resistance patterns, and genetic characteristics of pneumococci in healthy children aged five years and below attending daycare centres in Klang Valley, Malaysia, while indirectly assessing transmission dynamics through nasopharyngeal carriage.</p><p><strong>Materials and methods: </strong>168 children across 25 daycare centres provided consent, and their nasopharyngeal swabs collected between January 2023 and May 2024, were analysed for pneumococcal carriage and serotyped by PCR. Antimicrobial susceptibility testing was conducted using the E-test assay. Multilocus sequence typing (MLST) and phylogenetic analysis were performed on isolates with reduced susceptibility.</p><p><strong>Results: </strong>The pneumococcal carriage rate was 22.6%. Serotype 15C was the most prevalent (15.8%), followed by 23A and 11A (13.2% each). In the E-test assay, 47.4% (18/38) of the isolates were resistant to erythromycin, 28.9% to tetracycline, and 5.3% to penicillin. One isolate was resistant to ceftriaxone, whereas none demonstrated resistance to cefotaxime; decreased susceptibility to the two antibiotics was observed in one isolate, while two others with intermediate susceptibility to either ceftriaxone or cefotaxime alone. Sequence Type (ST) distribution was diverse, with ST338 being the most common (n = 3).</p><p><strong>Conclusion: </strong>The notable predominance of non-vaccine serotypes (NVTs), particularly 15C and 23A, alongside significant antibiotic resistance, especially to erythromycin and tetracycline, indicates a potential epidemiological shift in the post-PCV era. These results emphasize the need for continuous surveillance to monitor serotype dynamics and antimicrobial resistance patterns in the community.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin-resistant Enterococcus faecium and its shifting clonal types.","authors":"Ronan F O'Toole","doi":"10.1016/j.jgar.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.020","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-genome sequencing analysis of Staphylococcus aureus isolated from female patients with mastitis in Henan, China.","authors":"Jing Yu, Yanzi Ding, Xue Zhang, Yang Fang, Shuhong Tai, Enwu Yuan, Yitao Duan","doi":"10.1016/j.jgar.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.019","url":null,"abstract":"<p><strong>Objectives: </strong>To study the molecular characteristics, antibiotic resistance profiles and virulence features of Staphylococcus aureus (SA) isolates that cause mastitis.</p><p><strong>Methods: </strong>117 SA isolates were collected from women with mastitis. Strain identification and antimicrobial susceptibility testing were conducted using the Vitek 2 system. All SA isolates were sequenced on the Illumina HiSeq platform. For multilocus sequence typing, ResFinder, spaTyper, and SCCmecFinder were employed to analyse the strains.</p><p><strong>Results: </strong>Thirty-five methicillin-resistant Staphylococcus aureus (MRSA) strains and 82 methicillin-sensitive Staphylococcus aureus (MSSA) strains were isolated from women with acute breast abscesses. The rates of resistance to various antibiotics were significantly higher among MRSA isolates than among MSSA isolates. Twenty-two sequence types (STs), 35 staphylococcal protein A (spa) types, and 4 SCCmec types were identified. ST22, ST59, and ST398 were the major lineages, and t309 and t437 were the most common spa types. SCCmec-IVa was the predominant SCCmec type. Interestingly, toxin gene subtypes A (hlgA, hlgB, hlgC, lukF-PV, lukS-PV, seg, sei, sem, sen, seo, seu, n = 54), B (hlgA, hlgB, hlgC, seb, sek, seq, n = 13), C (hlgA, hlgB, hlgC, lukD, lukE, n = 10), and D (hlgA, hlgB, hlgC, n = 10) accounted for 74.4% (87/117) of all SA isolates, suggesting the high expression of virulence genes.</p><p><strong>Conclusions: </strong>ST22, ST398, and ST59 are the main types that cause mastitis and have different virulence factor profiles. This study provides deeper insights into the molecular epidemiology of SA associated with acute mastitis.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic characterisation of the first case of IMP-13-producing carbapenem-resistant Pseudomonas aeruginosa ST313/ExoU+/O1 isolate in Chile.","authors":"Maximiliano Matus-Köhler, Pablo Araya-Vega, Sergio Mella, Alejandro Aguayo-Reyes, Mario Quezada-Aguiluz, Néstor Herrera-Chávez, Felipe Morales-León, Gerardo González-Rocha, Andrés Opazo-Capurro","doi":"10.1016/j.jgar.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.016","url":null,"abstract":"<p><strong>Objective: </strong>Carbapenemase-resistant Pseudomonas aeruginosa (CR-PA) is a WHO priority pathogen posing a serious public health threat. This study reports the first IMP-13-producing P. aeruginosa isolate (150UDEC/24) in Chile, recovered from a bone infection in April 2024.</p><p><strong>Methods: </strong>Antimicrobial susceptibility was determined using disk diffusion and MIC strip tests. Whole-genome sequencing (WGS) was performed on the Illumina NextSeq platform, and annotation by the NCBI PGAP. Analyses included Staramr, VFDB, MLST, PAst, MOB-Typer, MOB-Recon, and Integron Finder2. Phylogenetic analysis of 150UDEC/24 and 44 ST313 genomes was carried out by IQTree and iTOL for visualization.</p><p><strong>Results: </strong>The 150UDEC/24 isolate exhibited resistance to relevant antibiotics, including cephalosporins and carbapenems (imipenem, meropenem). It belonged to sequence type (ST) ST313 and serotype O1 and harboured multiple resistance genes: aph(6)-Id, aph(3'')-Ib, aph(3')-IIb, aac(6')-Ib4, aph(3')-VI, catB7, dfrB3, sul1, fosA, bla_OXA-488, bla_OXA-2, bla_PDC-37, and bla_IMP-13. The bla_IMP-13 gene was embedded in a class 1 integron alongside dfrB3, aac(6')-Ib4, and bla_OXA-2. Additionally, the virulence gene exoU was detected. Phylogenetic analysis showed 150UDEC/24 diverged from other ST313 strains, with no other isolate carrying bla_IMP-13, suggesting distinct evolution.</p><p><strong>Conclusions: </strong>This study provides the first genomic characterization of an IMP-13-producing ST313 carbapenem-resistant P. aeruginosa isolate (150UDEC/24) in Chile, containing multiple resistance genes and the ExoU virulence factor. Phylogenetic analysis suggests unique evolution, emphasizing the need for continued genomic surveillance to monitor the emergence of highly resistant, virulent strains in clinical settings.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aminoglycoside resistance dynamics and its predictive value for carbapenem resistance in multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae.","authors":"Bence Sajerli, Klára Makai, Lóránt Lakatos, Ágnes Sarkadi-Nagy, Katalin Burián, László Orosz","doi":"10.1016/j.jgar.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.012","url":null,"abstract":"<p><strong>Objectives: </strong>The rise of multidrug-resistant (MDR) bacterial pathogens, including carbapenem-resistant Acinetobacter baumannii (CRAB) and Klebsiella pneumoniae (CRKP), poses a global healthcare challenge. Aminoglycosides remain among the few effective therapeutic options, but increasing resistance threatens their efficacy. This study investigates aminoglycoside consumption and resistance dynamics, focusing on the predictive value of aminoglycoside resistance for future carbapenem resistance.</p><p><strong>Methods: </strong>Data on aminoglycoside use (amikacin, gentamicin, tobramycin) and resistance were retrospectively collected (2010-2024). Resistance patterns were assessed using the Antibiotic Resistance Index and Resistance Instability Index. Correlation analyses examined associations between aminoglycoside consumption and resistance, including delayed effects, and between aminoglycoside and meropenem resistance.</p><p><strong>Results: </strong>We analyzed 4582 A. baumannii and 36,049 K. pneumoniae isolates. Among them, 2462 CRAB and 309 CRKP isolates were identified. Amikacin was the most used aminoglycoside, with stable resistance in CRAB and higher variability in CRKP. Gentamicin showed the most unstable resistance. In CRAB, aminoglycoside resistance - especially amikacin (r = 0.73) - was strongly correlated with meropenem resistance, suggesting predictive potential. In CRKP, predictive correlations were weaker; gentamicin showed the highest (r = 0.62).</p><p><strong>Conclusions: </strong>Aminoglycoside resistance trends, particularly for amikacin in CRAB, may serve as early indicators of emerging carbapenem resistance. Integrating such data into surveillance and stewardship frameworks could improve early detection and response to MDR threats.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of Population Pharmacokinetic Models for Meropenem in Critically Ill Adult Patients.","authors":"Carla Bastida, Alba Escolà-Rodríguez, Sara Fernández, Pedro Castro, Dolors Soy","doi":"10.1016/j.jgar.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.015","url":null,"abstract":"<p><strong>Background: </strong>While several meropenem population pharmacokinetic (popPK) models have been developed, few have undergone external validation, a crucial step to confirm their robustness and applicability in real-world settings.</p><p><strong>Objectives: </strong>This study aimed to conduct an external evaluation of published meropenem popPK models to assess their predictive performance and determine their suitability for implementing Model-Informed Precision Dosing strategies in the Intensive Care Unit (ICU) setting.</p><p><strong>Methods: </strong>The external validation dataset consisted of data retrospectively collected from a tertiary university hospital. Eight published popPK models were selected from the literature and bias and inaccuracy was calculated. Predictive performance was assessed in two subpopulations: CRRT and non-CRRT patients, with further stratification by BMI.</p><p><strong>Results: </strong>Eight popPK models were evaluated with an independent dataset of 30 ICU patients and 48 samples. The Ulldemolins et al. model exhibited the lowest bias for population-level predictions in the overall CRRT cohort. In the overall non-CRRT cohort, the models by Chung et al. and Lan et al. demonstrated excellent population and individual prediction performance. Within the obese subpopulation, the Shekar et al. model showed the lowest bias and inaccuracy in the CRRT cohort, while the models by Li et al., Lan et al., and Chung et al. performed best in the non-CRRT cohort.</p><p><strong>Conclusion: </strong>Published meropenem popPK models exhibit considerable variability in predictive performance when validated in an external dataset of ICU patients failing to generalize across broader patient populations. These findings underscore the need for external validation with independent datasets to ensure reliable performance across diverse populations.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic investigation of NDM-1 producing Enterobacterales transmission in a South Korean hospital.","authors":"Jeong-Ih Shin, Sun Hee Park, Chulmin Park, Seung-Hyun Jung, Dong-Gun Lee","doi":"10.1016/j.jgar.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.010","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged detection of multispecies New Delhi metallo-β-lactamase (NDM)-1-producing Enterobacterales was observed previously in clinical and environmental samples collected from a South Korean hospital. This study aimed to investigate the transmission mechanisms of bla_NDM-1 and assess the role of environmental reservoirs in its persistence.</p><p><strong>Methods: </strong>Epidemiological data were collected, and antibiotic susceptibility testing, carbapenemases detection, and whole-genome sequencing were performed on 42 clinical and 13 environmental isolates collected between November 2018 and February 2021, during the pre-outbreak, outbreak (July-September 2019), and post-outbreak periods. Long-read complete-genome sequencing was performed on four clinical and four environmental isolates to characterize plasmids carrying bla_NDM-1 and associated mobile genetic elements (MGEs). Phylogenetic analyses were also performed.</p><p><strong>Results: </strong>bla_NDM-1 was detected in 15 different species across clinical and environmental isolates. During the 2019 outbreak, clonal spread of Klebsiella pneumoniae and Klebsiella quasipneumoniae in the hospital was the primary mechanism of dissemination. During the post-outbreak period, horizontal gene transfer (HGT), mediated by the IncX3 plasmid carrying bla_NDM-1, was the dominant transmission mechanism. This plasmid, detected in both clinical and environmental isolates, showed high genetic conservation with IncX3 plasmids reported worldwide. These plasmids contained conserved MGEs, including the IS26-dsbD-trpF-ble-bla_NDM-1 structure.</p><p><strong>Conclusion: </strong>This study highlights the dual roles of clonal spread and plasmid-mediated HGT in the dissemination of bla_NDM-1 in hospital settings. The persistence of highly conserved IncX3 plasmids in environmental isolates underscores the complexity of carbapenem resistance control. Comprehensive infection control strategies targeting patient-to-patient transmission and environmental reservoirs are crucial for mitigating the spread of NDM-producing Enterobacterales.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on the correlation between Carbapenem-Resistant Klebsiella pneumoniae infection strains and intestinal colonization strains in Intensive Care Unit of a tertiary hospital in China.","authors":"Li Li, Changlin Yi, Zhenliang Wen, Xiaohong Cai, Peipei Jin","doi":"10.1016/j.jgar.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.004","url":null,"abstract":"<p><strong>Objectives: </strong>Colonization by Carbapenem-Resistant Klebsiella pneumoniae (CRKP) is associated with the risk of developing CRKP infection. Whether infected strains come from colonized strains is not well known.</p><p><strong>Methods: </strong>An observational, prospective cohort study (July 2022 to June 2023) was conducted on ICU patients undergoing rectal CRKP colonization screening. Antibiotic susceptibility testing, modified carbapenem inactivation method (mCIM), serum bactericidal and phagocytic assays, and whole genome sequencing (WGS) were performed on intestinal colonization and infection site isolates from 7 ICU patients.</p><p><strong>Results: </strong>Among 412 ICU patients included, 88 were screened positive. Out of 82 patients who experienced colonization during hospitalization, 41 (50.0%) developed infections. 14 CRKP strains isolated from 7 patients were positive for carbapenemase in mCIM and exhibited similar resistance and virulence phenotype. WGS showed that the 14 CRKP, including 2 ST11, 2 ST15, and 10 ST5422, were bla_KPC-2 producing strains, and the genetic environment surrounding bla_KPC-2 was the same. Comparing the colonized and infected strains of the same patient, they both carried identical virulence genes, but the resistance genes and plasmids were not completely the same, however, the SNPs differed by less than 10.</p><p><strong>Conclusions: </strong>Nosocomial CRKP infection should focus on preventing intestinal colonization in hospitalized patients. Small SNPs differences indicated that the infected strain may have originated from the colonized strain, but some resistance genes or plasmids may have been obtained during this transformation process. bla_KPC-2-carrying K. pneumoniae ST5422 was first reported in our study, and its genetic relationship was closely related to the clone strain ST11.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical imipenem non-susceptible Klebsiella pneumoniae isolates from China: epidemiology, molecular characterization and in vitro activity of imipenem/relebactam.","authors":"Peiyao Jia, Pengcheng Li, Wei Yu, Xiaobing Chu, Hui Zhang, Jingjia Zhang, Wei Kang, Ge Zhang, Qian Zhang, Shiyu Chen, Yingchun Xu, Qiwen Yang","doi":"10.1016/j.jgar.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.011","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the epidemiological and molecular characterization and in vitro activity of imipenem/relebactam against imipenem non-susceptible (IPMNS) Klebsiella pneumoniae isolates in China.</p><p><strong>Methods: </strong>K. pneumoniae isolates were collected from 16 sites in 5 regions across China during 2019. Antimicrobial susceptibility testing was performed. For IPMNS K. pneumoniae isolates, whole genome sequencing was used to screen for drug-resistance and virulence genes.</p><p><strong>Results: </strong>Of 1,011 clinical K. pneumoniae isolates, 277 (27.3%) were IPMNS and were significantly more common in ICU patients (47.5%) and hospital acquired infections (28.9%). Production of carbapenemase was the dominant resistance mechanism, with 228 (89.8%) IPMNS isolates harboring bla_KPC-2, 8 (3.1%) bla_NDM, 2 (0.7%) bla_OXA-232 and 1 (0.4%) bla_OXA-181. The dominant clone was sequence type (ST) 11 (78.7%) followed by ST15 (10.2%). Relebactam restored imipenem's susceptibility in 96.3% isolates harboring a bla_KPC-2 gene.</p><p><strong>Conclusions: </strong>Harboring the bla_KPC-2 gene was the dominant mechanism of IPMNS K. pneumoniae in China. Empirical imipenem/relebactam treatment could be considered when susceptibility or carbapenemase tests are not available.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, microbiological and laboratory predictors of on- and off-label dalbavancin treatment failure.","authors":"Maria Mazzitelli, Daniele Mengato, Vincenzo Scaglione, Elisabetta Maria Vittoria Giunco, Elena Barzizza, Luigi Salmaso, Francesca Venturini, Annamaria Cattelan","doi":"10.1016/j.jgar.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.jgar.2025.05.014","url":null,"abstract":"<p><strong>Background: </strong>Data about risk factors for treatment failure (TF) to dalbavancin are lacking. Our aim was to investigate the clinical, microbiological and laboratory predictors of TF in both on- and off-label dalbavancin treatments.</p><p><strong>Methods: </strong>We included all patients who received at least one dose of dalbavancin at our center from January 2018 to June 2024 and with available data on follow-up, collecting all clinical and laboratory parameters. TF was defined as the need for readmission, emergency department access, or death within 90 days after treatment. Factors correlating with TF and mortality rate were assessed by multivariable analyses and Kaplan Meier curves.</p><p><strong>Results: </strong>Three-hundred-fifty-one patients were included, mostly males (60.9%), median age of 64 years (IQR:49.5-75.5), 55.3% receiving dalbavancin in the emergency department/outpatient setting, and 44.7% for an early discharge, in 54.9% cases as off-label. The main off-label indications were osteomyelitis, prosthetic infections, and endocarditis (17.1%, 8.3%, and 7.7%). In 53.3% cases, a microbiological isolate was available (MRSA in 49.2% cases). Overall, TF rate was 19.4%. Overall, multivariable analysis showed that intravenous drug use (HR:7.99, p<0.001), diabetes (HR:6.1, p<0.001), obesity (HR: 4.5, p<0.001), cancer (HR:5.3, p<0.001), HIV (HR:4.88, p<0.001), levels of CRP at dalbavancin treatment initiation (HR=1.01, p<0.001, and HR=0.72, p=0.02) were associated with TF. Additionally, the duration of intravenous antibiotic therapy before being discharged influenced outcomes in the off-label group (HR=0.52, p=0.02).</p><p><strong>Conclusion: </strong>The observed TF rate was high, particularly in the off-label uses and among individuals with multiple comorbidities or intravenous drug use. More evidences are needed to better define the optimal patient profile for effective dalbavancin treatment.</p>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}