Antimicrobial Resistance and Infection Control最新文献

{"title":"Risk factors for detection of Pseudomonas aeruginosa in clinical samples upon hospital admission.","authors":"Romeo Reyle, Frank Schwab, Selin Saydan, Michael Behnke, Rasmus Leistner, Petra Gastmeier, Christine Geffers, Tobias Siegfried Kramer","doi":"10.1186/s13756-025-01527-4","DOIUrl":"10.1186/s13756-025-01527-4","url":null,"abstract":"<p><strong>Background/introduction: </strong>Antipseudomonal antibiotics are frequently used in patients admitted to hospitals. Many of these substances are classified as a reserve or watch status by the WHO. Inappropriate risk assessment of invasive detection of P. aeruginosa (PAE) can be a reason for overuse of antipseudomonal antibiotics. Therefore it is important to define relevant and specific risk factors for invasive PAE detection.</p><p><strong>Objective: </strong>The objective of this study was to identify risk factors for invasive detection of PAE in patients upon hospital admission.</p><p><strong>Methods: </strong>All patients 18 years of age and older with a detection of PAE and/or Enterobacterales in clinical samples taken within 48 h of admission to one of the hospitals of Charité Universitätsmedizin Berlin between 2015 and 2020 were included into this retrospective cohort study.</p><p><strong>Results: </strong>Overall, we included a total of 27,710 patients. In 3,764 (13.6%) patients PAE was detected in clinical samples taken within 48 h after admission. The most frequently detected Enterobacterales was E. coli in 14.142 (51%) patients followed by Klebsiella spp. in 4.432 (16%) patients. Multivariable regression analysis identified that prior colonisation with a multi drug resistant PAE or detection of a PAE in clinical samples during a previous hospitalisation increased the risk for invasive detection of PAE (OR 39.41; 95% CI 28.54-54.39) and OR 7.87 (95% CI 6.60-9.38) respectively. Admission to a specialised ward for patients with cystic fibrosis was associated with an increased risk (OR 26.99; 95% CI 20.48-35.54). Presence of chronic pulmonary disease (OR 2.05; 95% CI 1.85-2.26), hemiplegia (OR 2.16; 95% CI 1.90-2.45) and male gender (OR 1.60; 95% CI 1.46-1.75) were associated with a modest increase in risk for presence of PAE.</p><p><strong>Conclusion: </strong>Patients with a prior detection of P. aeruginosa or admission to a cystic fibrosis ward had the highest risk for invasive detection of P. aeruginosa. Adherence to specific risk scores based on local risk factors could help to optimize prescription of anti-pseudomonal antibiotics that categorized as reserve and watch.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"17"},"PeriodicalIF":4.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling antimicrobial stewardship competence among Italian nurses: results from a nationwide survey.","authors":"Matteo Danielis, Tania Buttiron Webber, Chiara Barchielli, Maria Mongardi, Domenico Regano","doi":"10.1186/s13756-025-01531-8","DOIUrl":"10.1186/s13756-025-01531-8","url":null,"abstract":"<p><strong>Background: </strong>The development of nursing competencies in antimicrobial stewardship (AMS) is influenced by a two-dimensional model, encompassing both internal and environmental factors. In the context of Italian clinical nursing, this study aims to assess and measure these aspects.</p><p><strong>Methods: </strong>Employing a cross-sectional online survey design, nurses from various clinical specialties in Italy were involved. The questionnaire assessed individual variables, knowledge, attitudes, practices, as well as structural and process-related variables influencing AMS. Statistical analyses were performed, encompassing descriptive statistics, Pearson correlation, and multiple linear regression.</p><p><strong>Results: </strong>A total of 1,651 nurses aswered the survey, with a participation rate of 50.8%. The participant demographic revealed that 77% were female, and they had an average of 15 years of experience. Workplace and regional factors were found to significantly impact both AMS practices and attitudes. Surgical nurses reported higher practices scores (β = 0.467, P <.01), while critical care nurses scored lower (β= -0.398, P <.01). Regarding perceptions of structure, workplace characteristics significantly influenced nurses' scores, indicating lower perceptions among surgical nurses compared to their medical counterparts (β= -0.315, P <.01).</p><p><strong>Conclusions: </strong>The study reveals the intricate interplay between internal and external factors that impact nurses' AMS competence. This underscores the urgent need for targeted interventions and education initiatives to enhance nurses' AMS competencies. Specifically, addressing variations in settings and nurses' behaviours becomes imperative for achieving improved patient outcomes.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"16"},"PeriodicalIF":4.8,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and practices regarding antibiotic use and antimicrobial resistance among urban slum dwellers in Uganda.","authors":"Regina Ndagire, Ekwaro A Obuku, Ivan Segawa, Fiona Atim, Catherine Nassozi Lwanira, Rachel Nante Wangi, Moses Ocan","doi":"10.1186/s13756-025-01517-6","DOIUrl":"10.1186/s13756-025-01517-6","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) remains a public health threat especially in low-and-middle-income countries (LMICs). Urban slum dwellers are at higher risk of developing AMR than the general population. The aim of this study was to assess the knowledge, attitude and practices (KAP) regarding antibiotic use and AMR and the associated socio-demographic determinants among urban slum dwellers in Uganda.</p><p><strong>Methods: </strong>A cross sectional study was conducted among 371 adults of Bwaise slum in Uganda selected through multi-stage cluster sampling techniques. An interviewer administered questionnaire was used to collect data on participants' socio-demographics, KAP regarding antibiotic use and AMR. The responses to the KAP were aggregated into scores for each participant which were later dichotomized by the mean to form the predictors variables. Analysis was done in STATA 17.0. A modified Poisson regression model was used to determine predictors of each of KAP, while considering a 5% significance level.</p><p><strong>Results: </strong>The study enrolled 371 participants of which 238(64.2%) were females. The median (IQR) age of the participants was 31 [24, 40] years. Over half of the respondents, 205(55.3%) were married and 157(42.3%) had primary level education. Of all participants, 177 (47.7%), 184 (49.6%) and 205 (55.3%) had good knowledge, a positive attitude and good practices regarding antibiotic use and AMR respectively. Being single (aPR = 0.75, p-value = 0.040) was negatively associated with good knowledge of antibiotic use and resistance, while having acquired tertiary education level (aPR = 1.88, p-value < 0.001) and self-employed (aPR = 1.36, p = 0.017) were associated with good knowledge of antibiotic use and resistance. Male gender (aPR = 1.25, p-value = 0.036) and monthly income < 300,000 UGX (aPR = 1.42, p-value = 0.003) were associated with a positive attitude towards antibiotic use and resistance. Likewise tertiary level of education (aPR = 0.64, p-value = 0.033) was negatively associated with good practices of antibiotic use and resistance.</p><p><strong>Conclusion and recommendations: </strong>Residents of urban slums have limited knowledge of antibiotic use and AMR with minimal understanding of AMR concepts. Education level, gender, occupational status are key players in people's understanding and practices of antibiotic use and AMR. There's need for context specific health education programs. Health promotion messaging should emphasize AMR concepts and dangers of drug misuse. Antimicrobial stewardship initiatives should trickle down to the local citizen.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"12"},"PeriodicalIF":4.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and perception of antimicrobial stewardship program among healthcare professionals in the hospitals of ministry of health and population, Egypt: antimicrobial stewardship toolkit survey.","authors":"Yara Mohsen Abd El Azeem Khalaf, Zahira Metwally Gad, Mostafa Ahmed Arafa, Marwa Shawky Abdou","doi":"10.1186/s13756-025-01525-6","DOIUrl":"10.1186/s13756-025-01525-6","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) has been recognized by international policymakers as a serious threat due to its current and projected influence on global population health, healthcare expenditures and gross domestic product (GDP). The present work aimed to assess the awareness, perceptions, and practices of healthcare professionals regarding the implementation of the Antimicrobial Stewardship program (ASP).</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 310 health care professionals. A self-administered questionnaire based on Antimicrobial Stewardship Toolkit for Acute and Long-Term Care Facilities; Greater New York Hospital Association (GNYAHA) was used to assess perceptions and knowledge about AMR and automatic selective perception.</p><p><strong>Results: </strong>A total of 310 healthcare professionals participated in the study, of which 60.6% were females, with a mean age of 37.32 ± 8.71, mean years of working of 6.0 ± 5.95 and mean years of experience of 7.97 ± 7.14. The mean scores for AMR awareness, antibiotic (AB) prescribing practices, ASP perception, and intervention beliefs were 73.05 ± 11.21, 32.97 ± 8.22, 52.85 ± 13.99, and 18.24 ± 2.71, respectively. Bivariate analysis showed that profession, primary work unit, staff position significantly affect the AMR awareness and ASP perception, while only staff position affect intervention beliefs. The Multivariate linear regression showed that working in pharmacy, ABs prescribing practice and ASP perception were independent predictors of AMR awareness. Years of work in hospital, AMR awareness and ASP perception were the independent predictors of ABs prescribing practice. AMR awareness, ABs prescribing practice and intervention beliefs were independent predictors of ASP perception while ASP perception was the only independent predictors of intervention beliefs.</p><p><strong>Conclusions: </strong>The study found a high level of awareness and practice regarding AMR and ASP among healthcare professionals. Pharmacists had higher levels of AMR awareness and ASP perception than physician in different specialities. Levels of AMR awareness, ABs prescribing practice, ASP perception and intervention beliefs affect each other in different ways. Linear regression supported our findings that pharmacists had a higher level of AMR awareness, while years of work in hospital had a significant effect on ABs prescribing practice.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"13"},"PeriodicalIF":4.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-method study on antimicrobial resistance infection drivers in neonatal intensive care units: pathways, risks, and solutions.","authors":"Almaw Genet Yeshiwas, Gashaw Melkie Bayeh, Tilahun Degu Tsega, Sintayehu Simie Tsega, Asay Alamneh Gebeyehu, Zufan Alamrie Asmare, Rahel Mulatie Anteneh, Amare Genetu Ejigu, Ahmed Fentaw Ahmed, Zeamanuel Anteneh Yigzaw, Abathun Temesgen, Anley Shiferaw Enawgaw, Getasew Yirdaw, Wosenyelesh Desalegn, Chalachew Yenew","doi":"10.1186/s13756-025-01520-x","DOIUrl":"10.1186/s13756-025-01520-x","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) in neonatal intensive care units (NICUs) complicates treatment of healthcare-associated infections, causing high morbidity and mortality, especially among low-birth-weight and critically ill infants. This study evaluates AMR prevalence, risk factors, outcomes and infection control measures at Felege Hiwot Hospital, aiming to guide clinical practices, antimicrobial stewardship, and improved neonatal health outcomes.</p><p><strong>Methods: </strong>This mixed-methods study (Oct 2022-Jun 2023) assessed AMR in NICU neonates by analyzing 420 blood samples, environmental swabs, and staff insights. Bivariable and multivariable regressions identified significant variables, and content analysis was used for qualitative data.</p><p><strong>Results: </strong>Out of 420 samples, 35% tested positive for AMR pathogens, with Coagulase-Negative Staphylococci (16.7%), Klebsiella pneumoniae (12.9%), and Acinetobacter spp. (5.6%) being the most prevalent. Resistance rates for Gentamicin, Cotrimoxazole, and Ciprofloxacin were alarmingly high (98-100%), while Amikacin demonstrated low resistance (3.0-5.56%), indicating potential efficacy. Among the neonates admitted, 91.8% survived, and 8.2% succumbed. Risk factor analysis revealed that improper PPE usage (AOR 3.90, p < 0.001), non-functional handwashing sinks (AOR 3.20, p < 0.001), and inadequate disinfection practices (AOR 2.70, p < 0.001) were strongly associated with microbial contamination. Environmental factors, including cockroach presence (AOR 1.80, p = 0.040) and high traffic flow (AOR 2.10, p = 0.005), were also significant contributors. The qualitative data analysis confirmed that improper PPE use, inadequate disinfection practices, pest control challenges, and non-functional handwashing sinks significantly contributed to microbial contamination risks in the NICU, aligning with the quantitative findings.</p><p><strong>Conclusions: </strong>This study underscores key factors driving AMR in NICUs, such as inadequate IPC practices and environmental contamination, alongside high resistance to Cotrimoxazole and Ciprofloxacin. Amikacin shows promise as an effective treatment for CONS. Urgent actions, including strengthened IPC measures, staff training, and environmental management, are crucial to combat AMR, ensuring improved neonatal care and outcomes.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"15"},"PeriodicalIF":4.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing intranasal povidone-iodine in the orthopedic trauma surgery setting to prevent surgical site infections: a qualitative study of healthcare provider perspectives.","authors":"A M Racila, Erin C Balkenende, Loreen A Herwaldt, Michael C Willey, Linda D Boyken, Jean G Pottinger, Brennan S Ayers, Kimberly C Dukes, Melissa A Ward, Marin L Schweizer","doi":"10.1186/s13756-025-01526-5","DOIUrl":"10.1186/s13756-025-01526-5","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are associated with morbidity, mortality, and increased costs. Staphylococcus aureus is the most common cause of SSIs and approximately 30% of hemodialysis patients carry this organism in their nares. Unlike mupirocin, intranasal povidone-iodine (PVI) is applied only the day of surgery to prevent surgical site infections. Thus, intranasal PVI could be valuable in orthopedic trauma surgery settings where time to prepare a patient for surgery is limited.</p><p><strong>Methods: </strong>We conducted a small phase IV post-marketing study from 2020 to 2021 in an academically affiliated hospital wherein staff administered intranasal PVI pre- and post-operatively to consenting patients undergoing orthopedic fixation procedures for traumatic fractures. Before implementing the PVI intervention, we conducted a human factors task analysis to determine the optimal time and hospital location to perform PVI decolonization for patients receiving these orthopedic fixation procedures. After the post-marketing study was completed, we conducted qualitative interviews with healthcare staff to determine barriers and facilitators that could affect staff members' likelihood of administering PVI to patients. We aligned our inductive interview findings with strategies defined in Powell and colleagues' Expert Recommendations for Implementing Change (ERIC) framework to facilitate generalizability and standardized reporting of implementation strategies.</p><p><strong>Results: </strong>Our human factors task analysis identified the Day of Surgery Admissions (DOSA) as the appropriate context for PVI administration within surgical workflow, as there was downtime during this period and direct patient-provider communication could occur. Two DOSA nurses, one postoperative nurse, and one orthopedic trauma surgeon agreed to be interviewed. Facilitators of intranasal PVI administration included emphasizing the non-invasiveness of PVI nasal swabs to patients and emphasizing intranasal PVI efficacy to staff and patients. While the nurse participants felt that having PVI orders with other medication orders in the EMR helped them identify patients enrolled in the study and who required PVI, entering these orders increased the surgeon's workflow and presented a time barrier.</p><p><strong>Conclusions: </strong>Macro- and micro-level contextual factors should be considered when tailoring implementation to healthcare settings. Our findings reinforce prior work demonstrating the value of incorporating human factors engineering methodologies into infection control and prevention implementation approaches.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"14"},"PeriodicalIF":4.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection prevention and control without borders: comparison of guidelines on multidrug-resistant organisms in the northern Dutch-German cross-border region.","authors":"Cansu Cimen, Matthijs S Berends, Mariëtte Lokate, Corinna Glasner, Jörg Herrmann, Erik Bathoorn, Axel Hamprecht, Andreas Voss","doi":"10.1186/s13756-025-01528-3","DOIUrl":"10.1186/s13756-025-01528-3","url":null,"abstract":"<p><p>Infections due to multidrug-resistant organisms (MDROs) are a health threat due to increasing patient morbidity and mortality and the burden on healthcare systems. Robust infection prevention and control (IPC) measures are needed to minimize their emergence in hospitals. Therefore, various international and national IPC guidelines exist, yet the lack of harmonized IPC guidelines complicates the management of patients seeking healthcare across European borders. This study explores the similarities and differences in IPC measures for vancomycin-resistant enterococci (VRE) and multidrug-resistant (MDR) Enterobacterales both on local and national levels within the northern Dutch-German cross-border region. In Germany, IPC efforts are often led by hospital hygiene doctors, whereas in the Netherlands, they involve a collaboration between infection preventionists and clinical microbiologists, with local variations. The local guidelines in both countries, as expected, are based on national recommendations, yet introduce specific regulations in various aspects. The Dutch guidelines are more stringent for VRE management compared to the German guidelines, often imposing additional local measures beyond national requirements. The Dutch and German guidelines largely diverge in definitions of MDR Gram-negative bacteria. Unlike the Dutch guidelines, the German guidelines do not currently recommend screening or isolation for extended-spectrum beta-lactamase-producing Enterobacterales. For carbapenem-resistant and carbapenemase-producing Enterobacterales, there is no notable distinction between the countries' guidelines, with both sharing the objective of maintaining a low prevalence and actively working towards containment. Inconsistencies in guidelines can lead to inefficient information exchange and inconsistent hygienic measures during patient transfers. Despite common commitments, differences in focus may reflect evolving understanding of MDRO transmission and ongoing debates on their management. Our findings highlight the divergence of IPC guidelines for the management of MDROs across two countries and call for collaboration in cross-border regions to increase the effectiveness of MDRO management in these regions and improve patient care.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"11"},"PeriodicalIF":4.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global trends of ceftazidime-avibactam resistance in gram-negative bacteria: systematic review and meta-analysis.","authors":"Yang Wang, Mohammad Sholeh, LunDi Yang, Matin Zafar Shakourzadeh, Masoumeh Beig, Khalil Azizian","doi":"10.1186/s13756-025-01518-5","DOIUrl":"10.1186/s13756-025-01518-5","url":null,"abstract":"<p><strong>Background: </strong>The emergence of antimicrobial resistance in Gram-negative bacteria (GNB) is a major global concern. Ceftazidime-avibactam (CAZ-AVI) has been identified as a potential treatment option for complicated infections.</p><p><strong>Objectives: </strong>This meta-analysis aimed to evaluate the global resistance proportions of GNB to CAZ-AVI comprehensively.</p><p><strong>Methods: </strong>Studies were searched in Scopus, PubMed, and EMBASE (until September 2024), and statistical analyses were conducted using STATA software (version 20.0).</p><p><strong>Results: </strong>CAZ-AVI resistance proportions were determined in 136 studies, with 25.8% (95% CI 22.2-29.7) for non-fermentative gram-negative bacilli and 6.1% (95% CI 4.9-7.4) for Enterobacterales. The CAZ-AVI resistance proportion significantly increased from 5.6% (95% CI 4.1-7.6) of 221,278 GNB isolates in 2015-2020 to 13.2% (95% CI 11.4-15.2) of 285,978 GNB isolates in 2021-2024. Regionally, CAZ-AVI resistance was highest in Asia 19.3% (95% CI 15.7-24.23.4), followed by Africa 13.6% (95% CI 5.6-29.2), Europe 11% (95% CI 7.8-15.2), South America 6.1% (95% CI 3.2-11.5) and North America 5.3% (95% CI 4.2-6.7). Among GNB resistance profiles, colistin-resistant isolates and XDR isolates exhibited the highest resistance proportions (37.1%, 95% CI 14-68 and 32.1%, 95% CI 18.5-49.6), respectively), followed by carbapenem-resistant isolates and MDR isolates [(25.8%, 95% CI 22.6-29.3) and (13%, 95% CI 9.6, 17.3)].</p><p><strong>Conclusion: </strong>A high proportion of GNB isolates from urinary tract infections remained susceptible to CAZ-AVI, indicating its potential as a suitable treatment option. However, the increasing resistance trends among GNB are concerning and warrant continuous monitoring to maintain CAZ-AVI's effectiveness against GNB infections.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"10"},"PeriodicalIF":4.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship in the community setting: a qualitative exploratory study.","authors":"Rose I Okonkwo, Henry Ndukwe, Gary Grant, Sohil Khan","doi":"10.1186/s13756-025-01524-7","DOIUrl":"10.1186/s13756-025-01524-7","url":null,"abstract":"<p><strong>Background: </strong>Existing evidence underscores inappropriate antimicrobial prescribing and use in the community setting. Increased and inappropriate antimicrobial use are major factors contributing to the emergence and transmission of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programmes are critical for mitigating AMR, enhancing patient outcomes, and reducing healthcare costs. Despite the existing Australian National Action Plan on AMR, optimisation of antimicrobial use in the community setting remains inadequately investigated. This study explored health professionals' perspectives on community AMS practices and systems, identifying challenges and areas for improvement.</p><p><strong>Methods: </strong>This qualitative study utilised semi-structured interviews to explore the perspectives of 17 different health professionals from diverse community practice settings in South-East Queensland, Australia. Interviews were audio-recorded, anonymised, and transcribed verbatim. Data were thematically analysed, with NVivo 12 utilised for organisation and analysis. Data were then mapped and examined using the Elements of Medicines Stewardship (EMS), which aligns with United States Centers for Disease Control and Prevention- Core Elements of Antibiotic Stewardship. This was reported following the consolidated criteria for reporting qualitative research checklist.</p><p><strong>Results: </strong>Four main themes described the health professionals' insights on community AMS practices and systems. Thematic analysis from these findings reveals a state of ambiguity and fragmentation in the community AMS practices and systems. In comparison to the hospital-based AMS system, the Australian community AMS system appears to be in its nascent stages of development. Applying the EMS is essential for developing and implementing community AMS strategies to enhance practices and systems.</p><p><strong>Conclusion: </strong>The study identified key health system factors that impact the implementation of community AMS programmes and highlighted the need for developing community-specific governance and frameworks that integrate multidisciplinary strategies to support effective implementation and enhance patient outcomes. This research will inform community AMS intervention strategies, influencing policy and practice to advance sustainable healthcare and address antimicrobial resistance.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"9"},"PeriodicalIF":4.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan.","authors":"Shairyar Afzal, Mishal Bajwa, Nabeel Ahmed, Jawaria Jabeen, Mian Shahzeb Haroon, Rana Muhammad Zahid Mushtaq, Zikria Saleem","doi":"10.1186/s13756-025-01521-w","DOIUrl":"10.1186/s13756-025-01521-w","url":null,"abstract":"<p><strong>Background: </strong>Consistent and timely access to antibiotics is a hallmark of an antimicrobial stewardship program (ASP) and can be achieved through good procurement practices. However, flawed procurement modules result in poor antibiotic supply management within health facilities of low- and middle-income countries (LMICs), including Pakistan, exacerbating antimicrobial resistance (AMR). This study seeks to understand hospital pharmacists' perspectives on the antibiotic procurement process, its efficiency in ensuring consistent access to antibiotics, and the role of clinical pharmacists in rational procurement.</p><p><strong>Methods: </strong>Semi-structured interviews with 24 purposively selected hospital pharmacists from secondary healthcare facilities in Punjab, Pakistan, were conducted utilizing a qualitative case study methodology. Data analysis was conducted using MAXQDA 2024 software, following a thematic analysis technique using a codebook approach to thematic analysis.</p><p><strong>Results: </strong>The study identified five central themes: (1) The state of antibiotic use in hospitals is characterized by a lack of antibiotic use policy, resulting in mostly empirical and irrational prescribing practices. (2) Medicine availability significantly influences prescribing decisions, often taking precedence over clinical needs. (3) The procurement process, although structured, is flawed owing to rigid adherence to the Standard Medicine List (SML). (4) Rationality in procurement is compromised by disregard for AMR, with decisions driven more by cost and demand than clinical evidence. (5) The clinical acumen of pharmacists is underutilized in procurement due to multifarious barriers.</p><p><strong>Conclusion: </strong>Antibiotic procurement is the mainstay of implementing an ASP in hospitals. This study elucidates significant policy, practice, and education gaps regarding antibiotic use and procurement in Pakistan. There is a critical need for comprehensive antibiotic policies, including a revision in SML, enhancing pharmacist authority in procurement decisions, more rational prescribing, and ensuring access to antibiotics through more informed and data-driven processes to combat AMR effectively.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"7"},"PeriodicalIF":4.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}