Journal of Infection and Chemotherapy最新文献

{"title":"Treatment of Stenotrophomonas malthophilia bloodstream infections from guidance to real life: multicenter retrospective cohort study.","authors":"Renato Pascale, Angelo Maccaro, Mena Gallo, Francesca Giovannenze, Monica Tontodonati, Stefania Chiappetta, Gabriele Pagani, Michele Bartoletti, Francesco Giuseppe De Rosa, Matteo Bassetti, Silvia Corcione, Antonio Vena, Maddalena Giannella","doi":"10.1016/j.jiac.2025.102759","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102759","url":null,"abstract":"<p><strong>Objectives: </strong>Infectious Diseases Society of America guidance recommend the use of combination therapy (CT) for the treatment of Stenotrophomonas maltophilia (SM) infections. The aims of our study are to describe therapeutical management of patients with SM bloodstream infections (SM-BSI) and to evaluate the impact of antibiotic CT compared to monotherapy (MT) on 30-days mortality.</p><p><strong>Methods: </strong>Multicenter, retrospective study of patients with SM-BSI hospitalized in 14 centers between January 2021 - December 2022. Multivariable logistic regression analysis was performed to assess the risk factors for 30-days mortality including CT therapy as main exposure. To address potential confounding, an inverse probability of treatment weighting (IPTW) approach was used.</p><p><strong>Results: </strong>64 patients with SM-BSI analyzed: 32 (50%) male, median age of 65 years (IQR: 55-75). MT was administered in 49 patients (76.6%) and CT in 15 (23.4%). Trimethoprim/sulphamethoxazole was the most frequent drug used in both MT and CT. Levofloxacin was the second preferred MT. Patients receiving CT were more frequently admitted in ICU with septic shock at BSI onset. At multivariable analysis, septic shock (OR: 7.65, 95%CI: 1.32-44.48, p=0.023) and haematological malignancies (OR: 6.82, 95%CI: 1.50-30.88, p= 0.013) were independent risk factors for 30-day mortality. Using an IPTW-based multivariable analysis, CT showed a non-significant trend toward a protective effect on 30-day mortality (OR: 0.88; 95% CI: 0.23-3.42; p = 0.855).</p><p><strong>Conclusions: </strong>CT for SM-BSI is used in a minority of cases in our cohort, representing the worst clinical scenarios. Further evidence is needing to confirm the impact of CT on outcome.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102759"},"PeriodicalIF":1.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiviral Treatment for Influenza in Japan.","authors":"Tadashi Ishida","doi":"10.1016/j.jiac.2025.102760","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102760","url":null,"abstract":"<p><p>Anti-influenza drugs reduce the viral load, which leads to improvement of symptoms, a reduced illness period, suppression of complications, and protection from transmission. It is desirable to administer antiviral drugs within 48 hours of the onset of symptoms. The use of antiviral drugs is limited mainly to individuals who are hospitalized, those who have severe, complicated, or progressive illness, or those who are at high risk for influenza complications in western countries. On the other hand, in Japan, anti-influenza drugs have been widely used from the onset of the disease by general practitioners in order to ease symptoms, that leads to suppressed development of severe complications. Five drugs for influenza are available in Japan at present, which is thought to be that influenza treatment in Japan is the advanced one in the world. Baloxavir, the newest anti-influenza drug which has different mechanism from neuraminidase inhibitors rapidly reduce viral loads. Baloxavir is recommended as oseltamivir for the treatment of influenza.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102760"},"PeriodicalIF":1.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique microbial profiles and severity-associated alterations in the peritoneal fluid of children with acute appendicitis","authors":"Tsubasa Aiyoshi ,&nbsp;Tomo Kakihara ,&nbsp;Eiichiro Watanabe ,&nbsp;Nao Tanaka ,&nbsp;Yusuke Ogata ,&nbsp;Hiroaki Masuoka ,&nbsp;Rina Kurokawa ,&nbsp;Jun Fujishiro ,&nbsp;Wataru Suda ,&nbsp;Kouji Masumoto","doi":"10.1016/j.jiac.2025.102761","DOIUrl":"10.1016/j.jiac.2025.102761","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal abscesses (IAA) after appendectomy for acute appendicitis (AA) result from residual bacteria in the abdominal cavity. However, the microbiota of the peritoneal fluid (PF) in children with AA has not been well-characterized, particularly through culture-independent methods. This study aimed to characterize the PF microbiota using next-generation sequencing.</div></div><div><h3>Methods</h3><div>This observational study prospectively enrolled 21 pediatric AA patients (simple appendicitis [SA], n = 11; complicated appendicitis [CA], n = 10) who underwent appendectomy. PF and appendiceal lumen samples were collected, and their microbiota was analyzed using 16S rRNA amplicon sequencing.</div></div><div><h3>Results</h3><div>The most abundant bacterial genera in the PF microbiota were <em>Bacteroides</em>, <em>Parvimonas</em>, <em>Prevotella</em>, <em>Streptococcus</em>, <em>Blautia</em>, and <em>Fusobacterium</em>, each exhibiting an average relative abundance of ≥5 %. Redundancy analysis revealed a significant correlation between serum C-reactive protein levels and the composition of the PF microbiota (P = 0.011). In addition, nine bacterial genera showed significantly higher relative abundances in SA than in CA. The microbiota of the PF and appendiceal lumen differed regarding alpha- and beta-diversity and the average relative abundance of 19 bacterial genera.</div></div><div><h3>Conclusion</h3><div>The PF microbiota exhibits a unique composition distinct from that of the appendiceal lumen. Furthermore, it demonstrates alterations associated with the severity of AA, reflecting both the degree of inflammatory response, as indicated by serum CRP levels, and pathological severity, as defined by the distinction between SA and CA. These findings provide new insights into the pathogenesis of postoperative IAA.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102761"},"PeriodicalIF":1.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Kawasaki disease in children with a history of COVID-19.","authors":"Hikaru Tabakotani, Masahiro Ishii, Masato Ogawa, Kazuyoshi Mizuki, Takayuki Hoshina","doi":"10.1016/j.jiac.2025.102755","DOIUrl":"https://doi.org/10.1016/j.jiac.2025.102755","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the characteristics of Kawasaki disease (KD) patients with a history of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, including asymptomatic cases.</p><p><strong>Methods: </strong>This retrospective study included 63 patients in whom KD was diagnosed between April 2021 and March 2024. We compared demographic and clinical characteristics of patients with KD who did and did not have a history of COVID-19 (KD-COVID-19 vs. KD-non-COVID-19). We also compared these characteristics in the patients who tested positive for the anti-SARS-CoV-2 spike protein antibody in the two groups (antibody-positive KD-COVID-19 vs. antibody-positive KD-non-COVID-19).</p><p><strong>Results: </strong>Of the 63 patients with KD, 13 had a history of COVID-19. Resistance to initial intravenous immunoglobulin therapy was higher among patients who had had COVID-19 (62%) than among those without COVID-19 (24%; P = 0.017), as were median serum B-type natriuretic peptide (BNP) levels (59.1 vs. 16.0 pg/mL, respectively; P = 0.017). Eight patients (62%) who had had COVID-19 and 16 (32%) who had not had COVID-19 tested positive for the anti-SARS-CoV-2 spike protein antibody. Among patients who were antibody-positive, median serum BNP levels were significantly higher in the patients who had had COVID-19 (76.6 pg/mL) than in those who had not had COVID-19 (14.5 pg/mL; P < 0.001).</p><p><strong>Conclusion: </strong>Patients with KD who had a history of symptomatic SARS-CoV-2 infection are prone to elevated serum BNP levels, which may indicate potential ventricular dysfunction.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"102755"},"PeriodicalIF":1.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of factors affecting fluctuations in urinary oxygen tension and relationship to obligate anaerobic bacterial growth","authors":"Yuki Sato ,&nbsp;Koji Ichihara ,&nbsp;Ryo Kobayashi ,&nbsp;Shinya Nirasawa ,&nbsp;Yuki Katayama ,&nbsp;Ryosei Murai ,&nbsp;Satoshi Takahashi","doi":"10.1016/j.jiac.2025.102757","DOIUrl":"10.1016/j.jiac.2025.102757","url":null,"abstract":"<div><h3>Purpose</h3><div>Obligate anaerobes are infrequently detected in routine urine cultures, potentially due to increased urinary oxygen tension (UpO2) following air exposure, which compromises their viability. This study evaluates time-dependent changes in UpO2 and their impact on the viability of obligate anaerobes in urine to improve diagnostic accuracy in suspected anaerobic urinary tract infections (UTIs).</div></div><div><h3>Methods</h3><div>Urine samples from healthy volunteers were stored in containers and monitored for UpO2 over time. <em>Bacteroides fragilis</em> and <em>Fusobacterium nucleatum</em> were inoculated into urine samples, and bacterial viability was assessed under aerobic and anaerobic conditions at multiple time points.</div></div><div><h3>Results</h3><div>The average UpO2 level immediately after urine collection was 66.9 Torr. No significant correlation was found between UpO2 levels and factors such as age, sex, urine dipstick test results, time of urine collection, or the interval between urinations. UpO2 increased significantly upon air exposure, whereas CO2-filled containers (Kenkiporter II) effectively maintained low oxygen tension. <em>B. fragilis</em> and <em>F. nucleatum</em> did not affect the changes in UpO2. Under aerobic conditions, <em>B. fragilis</em> remained viable for up to 1440 min (24 h), while <em>F. nucleatum</em> showed marked oxygen sensitivity and was undetectable in smear testing after 360 min.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of minimizing oxygen exposure in urine samples. When anaerobic UTIs are suspected, immediate anaerobic culture using appropriate containers should be considered to improve detection rates and avoid false negatives.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102757"},"PeriodicalIF":1.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid and simple detection of extended spectrum β-lactamase, metallo β-lactamase, and AmpC β-lactamase using drug susceptibility testing microfluidic (DSTM) method and its applicability for blood culture specimens","authors":"Ryuji Sakata ,&nbsp;Miho Ogawa ,&nbsp;Sadahiro Ichimura ,&nbsp;Kunihiko Nishino ,&nbsp;Yoshimi Matsumoto","doi":"10.1016/j.jiac.2025.102748","DOIUrl":"10.1016/j.jiac.2025.102748","url":null,"abstract":"<div><h3>Background</h3><div>The recent global increase in the prevalence of antibiotic-resistant bacteria and the lack of development of new antimicrobials emphasize the importance of rapid antimicrobial selection for the treatment of infections. Matsumoto et al. (2016) proposed an innovative rapid method for drug susceptibility testing for <em>Pseudomonas aeruginosa</em> that provides results in 3 h. Subsequently, in a similar Drug Susceptibility Testing Microfluidic device (DSTM), we developed a rapid method to detect extended-spectrum β-lactamase, metallo β-lactamase, and AmpC β-lactamase simultaneously.</div></div><div><h3>Methods</h3><div>When three types of inhibitors (clavulanic acid, EDTA, and cloxacillin) were combined with β-lactamase sensitive substrate, e.g., ceftriaxone together, strains that produce any of these three classes of β-lactamases become susceptible and when one of the three is missing, only strains producing β-lactamase sensitive to the missing inhibitor grow normally. Susceptibilities were microscopically evaluated from elongated cell shapes. Enzyme classes were identified by testing to determine which inhibitors the strains were resistant to when deficient.</div></div><div><h3>Results</h3><div>Multiple enzyme producers were easily identified by this method. Twenty-one genome-sequenced strains of carbapenem-resistant <em>Escherichia coli</em> were tested, and it was confirmed that chromosomal AmpC was not involved in <em>E. coli's</em> carbapenem resistance. Direct blood culture testing was possible by a simple pretreatment of the culture.</div></div><div><h3>Conclusion</h3><div>Rapid detection of β-lactamases via this method could be useful for the infectious treatment approach.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102748"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular versus conventional assay for diagnosis of hospital-acquired pneumonia in critically ill patients: a single center experience","authors":"Angela Quirino ,&nbsp;Claudia Cicino ,&nbsp;Nadia Marascio ,&nbsp;Giorgio Settimo Barreca ,&nbsp;Luigia Gallo ,&nbsp;Brunella Brescia ,&nbsp;Francesca Trimboli ,&nbsp;Marta Pantanella ,&nbsp;Francesca Serapide ,&nbsp;Alessandro Russo ,&nbsp;Giovanni Matera ,&nbsp;Enrico Maria Trecarichi","doi":"10.1016/j.jiac.2025.102754","DOIUrl":"10.1016/j.jiac.2025.102754","url":null,"abstract":"<div><h3>Purpose</h3><div>Lower respiratory tract infections are reported as one of top five causes of mortality and morbidity in the world. A bacterial etiology is often involved in HAP, most frequently from multidrug resistant gram-negative bacteria, and fast accurate diagnosis of etiologic agent(s) of LRTI is essential for an appropriate management. The aim of this retrospective study was to evaluate the analytical performance of Biofire Filmarray Pneumonia Plus for bacteria detection in bronchoalveolar lavage samples and the concordance of bacterial loads between BFPP and cultural gold standard methods.</div></div><div><h3>Methods</h3><div>A total of 111 BAL samples were obtained from 111 consecutive patients admitted to Intensive Care Unit of “Renato Dulbecco” Teaching Hospital of Catanzaro, from March 2023 to March 2024.</div></div><div><h3>Results</h3><div>Compared to conventional methods, BFPP showed a sensitivity of 99 % and a specificity of 64 %. The agreement between the two methods was assessed by calculating PPA and NPA, being 89 % and 95 %, respectively. The most common bacterial species identified at BFPP was <em>Klebsiella pneumoniae</em>, followed by <em>Acinetobacter calcaceuticus-baumanii complex</em>, <em>Staphylococcus aureus</em> and <em>Pseudomonas aeruginosa</em>. Bacterial load (CFU/ml) in relation to copy number detected by molecular analysis showed the best performance for value ≥10⁶ copie/mL. About molecular mechanisms of resistance in comparison to phenotypic profiles, the highest level of performance was observed for presence of KPC genes, all isolates showing resistance to carbapenems, followed by OXA-48 like and NDM.</div></div><div><h3>Conclusion</h3><div>The high concordance reported in this study between the identification of resistance genes and phenotypic indication can lead to an appropriate, fast and tailored antibiotic therapy.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102754"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Tropheryma whipplei pneumonia in an immunocompromised lymphoma patient using metagenomic next generation sequencing: A case report","authors":"Qingming Guo ,&nbsp;Le Wang ,&nbsp;Bin Han ,&nbsp;Xiaofeng Mu ,&nbsp;Weiwei Wu ,&nbsp;Qingqing Bi ,&nbsp;Juan Chen","doi":"10.1016/j.jiac.2025.102752","DOIUrl":"10.1016/j.jiac.2025.102752","url":null,"abstract":"<div><div>Whipple's disease (WD) is a rare chronic infectious illness caused by <em>Tropheryma whipplei</em> (<em>T.whipplei</em>), primarily affecting the gastrointestinal tract and joints, with rare lung involvement. Diagnosis can be challenging due to nonspecific symptoms and the difficulty in isolating the bacterium. This report describes a patient with pneumonia resulting from <em>T.whipplei</em> and <em>Streptococcus pneumoniae</em> infections during lymphoma treatment with chemotherapy and glucocorticoids. Imaging revealed pulmonary infections characterized by diffuse ground glass opacities and small nodules. Metagenomic sequencing of bronchoalveolar lavage fluid confirmed the mixed infection. The patient was treated with moxifloxacin and ceftriaxone, leading to improved inflammation within eight days. After completing chemotherapy, the patient was discharged with significant remission. This case highlights the susceptibility of immunocompromised patients to <em>T.whipplei</em> infection, emphasizing the need for early diagnosis and treatment.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102752"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for mpox infection among MSM with STIs in northern Taiwan, 2022–2024","authors":"Wei-Yen Chen ,&nbsp;Shu-Hsing Cheng ,&nbsp;Cheng-Pin Chen ,&nbsp;Shu-Yuan Lee ,&nbsp;Shin-Yen Ku ,&nbsp;Shu-Ting Gan ,&nbsp;Chen-En Hsieh ,&nbsp;Chien-Yu Cheng","doi":"10.1016/j.jiac.2025.102750","DOIUrl":"10.1016/j.jiac.2025.102750","url":null,"abstract":"<div><h3>Introduction</h3><div>Since 2022, Mpox has emerged among men who have sex with men (MSM) in Taiwan. Data on local risk factors remain limited, particularly the role of sexual behavior and STI history.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case–control study at a regional hospital in Taoyuan from 2022 to 2024. MSM aged ≥18 years with at least one STI were included. Mpox cases were compared to STI-only controls. Data on demographics, HIV status, and behaviors were analyzed using Firth logistic regression.</div></div><div><h3>Results</h3><div>Among 729 MSM, 42 had confirmed Mpox. Having more than two prior STIs was strongly associated with Mpox (aOR = 17.32; 95 % CI: 5.64–53.17). In contrast, HIV viral load &gt;1000 copies/mL (aOR = 0.02) and multiple sexual partners (aOR = 0.22) were linked to lower odds of infection.</div></div><div><h3>Conclusions</h3><div>Multiple STIs were a strong predictor of Mpox. Lower infection rates among viremic or sexually active individuals may reflect behavior change or healthcare engagement. STI history may help guide targeted Mpox prevention.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102750"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global impact of antimicrobial stewardship programs in Healthcare: An umbrella review of effectiveness, cost-efficiency, and implementation strategies","authors":"Yuvaraj Krishnamoorthy ,&nbsp;Dhanajayan Govindan ,&nbsp;Monica Karunakaran ,&nbsp;Muneera Parveen ,&nbsp;Anaswara Manohar ,&nbsp;Jaffar A. Al-Tawfiq","doi":"10.1016/j.jiac.2025.102753","DOIUrl":"10.1016/j.jiac.2025.102753","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial Stewardship Programs (ASPs) are vital in mitigating global threat of antimicrobial resistance (AMR) by optimizing antibiotic use and improving patient outcomes. Despite available evidence from high-income countries, challenges remain in low- and middle-income countries (LMIC) due to resource constraints and heterogeneous implementation. This umbrella review synthesizes evidence from systematic reviews to assess the effectiveness, cost-effectiveness, and implementation barriers and facilitators of ASPs across diverse healthcare settings.</div></div><div><h3>Methods</h3><div>Following PRIOR guidelines and PROSPERO registration (ID: CRD42024541821), we conducted comprehensive search of PubMed, Scopus, Cochrane Library, Epistemonikos, Google Scholar, and ScienceDirect up to July 2024. Data were extracted using standardized form and methodological quality of reviews was assessed with AMSTAR-2 tool. Given heterogeneity in study designs, outcomes, and ASP interventions, narrative synthesis was employed.</div></div><div><h3>Results</h3><div>The included 55 reviews demonstrated that ASPs consistently reduce antibiotic consumption—achieving reductions up to 91 %—and improve adherence to prescribing guidelines. Significant declines in resistance rates for key pathogens, such as MRSA and ESBL-producing organisms, were reported. Although effects on mortality and hospital length of stay were variable, most studies confirmed substantial cost-savings (up to 82 % reduction in antibiotic expenditures). Implementation barriers primarily included limited resources, insufficient data infrastructure, and prescriber resistance, while strong organizational support and multidisciplinary collaboration emerged as key facilitators.</div></div><div><h3>Conclusion</h3><div>ASPs are both clinically effective and economically advantageous in diverse healthcare settings. Tailored strategies that address local barriers and leverage existing infrastructure are essential for sustainable implementation. Future research should focus on standardized evaluation methods and long-term impacts to further optimize ASP adoption globally.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102753"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}