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Metagenomics as a Transformative Tool for Antibiotic Resistance Surveillance: Highlighting the Impact of Mobile Genetic Elements with a Focus on the Complex Role of Phages
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Rare or Unusual Non-Fermenting Gram-Negative Bacteria: Therapeutic Approach and Antibiotic Treatment Options
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Emergence of Carbapenem-Resistant blaPOM-1 Harboring Pseudomonas otitidis Isolated from River Water in Ghana
Journal Description
Antibiotics
Antibiotics
is an international, peer-reviewed, open access journal on all aspects of antibiotics, published monthly online by MDPI. The Croatian Pharmacological Society (CPS) is affiliated with Antibiotics and its members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q1 (Infectious Diseases) / CiteScore - Q1 (General Pharmacology, Toxicology and Pharmaceutics )
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 15 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
4.6 (2024);
5-Year Impact Factor:
4.9 (2024)
Latest Articles
Implementation and Early Outcomes of an Antimicrobial Stewardship Program in South Korea
Antibiotics 2025, 14(8), 834; https://doi.org/10.3390/antibiotics14080834 (registering DOI) - 17 Aug 2025
Abstract
Background: Antimicrobial stewardship programs (ASPs) are essential for promoting the rational use of antibiotics and combating resistance. In South Korea, implementation has recently accelerated, but real-world data on short-term program performance remain limited. This study evaluated the early outcomes of a newly
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Background: Antimicrobial stewardship programs (ASPs) are essential for promoting the rational use of antibiotics and combating resistance. In South Korea, implementation has recently accelerated, but real-world data on short-term program performance remain limited. This study evaluated the early outcomes of a newly launched ASP at a tertiary hospital. Methods: This retrospective, single-center study analyzed ASP activity from January to April 2025. Interventions included prospective audit and feedback for restricted antibiotics and recommendations for prolonged antibiotic prescriptions (≥14 days). The primary outcome was the monthly rejection rate of restricted antibiotics. Secondary outcomes included days of therapy (DOT) for restricted antibiotics and the acceptance rate of interventions for prolonged prescriptions. Results: The monthly rejection rate of restricted antibiotics remained stable between 3.65% and 4.68%. Although the DOT values did not show statistical significance, they demonstrated a moderate inverse correlation with the rejection rate (Pearson’s r = –0.868, p = 0.132). Among 826 prolonged prescriptions, 513 (62.1%) received ASP intervention. Acceptance of recommendations increased over time, from 67.0% in January to 82.5% in April. Interventions were primarily based on insufficient evidence of infection or inappropriate antibiotic selection. Conclusions: The newly implemented ASP demonstrated feasibility and early impact in improving antibiotic oversight. Despite the short observation period, the findings suggest a positive influence on prescribing practices. Longer-term studies are needed to evaluate sustained clinical outcomes and broader applicability in diverse healthcare settings.
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(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)
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Open AccessArticle
Electron Beam Irradiation for Efficient Antibiotic Degradation in Aqueous Solutions
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Anastasia Oprunenko, Ulyana Bliznyuk, Victoria Ipatova, Alexander Nikitchenko, Igor Gloriozov, Arcady Braun, Timofey Bolotnik, Polina Borshchegovskaya, Elena Kozlova, Irina Ananieva and Igor Rodin
Antibiotics 2025, 14(8), 833; https://doi.org/10.3390/antibiotics14080833 - 15 Aug 2025
Abstract
Background: Recently, extensive use of antibiotics has increased the amount of antibiotic residues in the natural water environment. Methods: This study presents an experimental investigation into the degradation of penicillins, tetracyclines, streptomycin and chloramphenicol in aqueous solutions when exposed to 1 MeV accelerated
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Background: Recently, extensive use of antibiotics has increased the amount of antibiotic residues in the natural water environment. Methods: This study presents an experimental investigation into the degradation of penicillins, tetracyclines, streptomycin and chloramphenicol in aqueous solutions when exposed to 1 MeV accelerated electrons with doses of 0.1, 1, 3 and 7 kGy using HPLC-HRMS analysis. Results: It was found that electron beam irradiation with a dose of 7 kGy ensures 98–99% removal of antibiotics, with the initial concentrations ranging from 15 mg/L to 30 mg/L depending on the class of antibiotic. The mathematical model proposed in the study, which estimates the dose dependencies of the relative concentrations of antibiotics and their degradation products in aqueous solutions, reveals different decomposition rates of antibiotics of different classes due to the different radiosensitivities of antibiotics. It has been found that tetracycline has a considerably higher radiation–chemical yield compared to the other antibiotics when exposed to accelerated electrons. Conclusions: Using density functional theory in combination with the mathematical model, we have developed a novel approach to establishing a quantitative irradiation marker of antibiotic degradation as a result of irradiation, which involves finding the degradation product whose formation requires a minimum number of ionization events. Using such an approach, it is possible to establish the extent of antibiotic degradation in water after irradiation with different doses and find the optimal irradiation doses for industrial water treatment.
Full article
(This article belongs to the Special Issue Antibiotics and Environment − Research and Development toward the One Health Approach)
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Open AccessArticle
Spontaneous Emergence of Cefiderocol Resistance in Klebsiella pneumoniae KPC-163: Genomic and Transcriptomic Insights
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Irene Luu, Vyanka Mezcord, Jenny Escalante, German M. Traglia, Marisel R. Tuttobene, Cecilia Rodriguez, Chun Fu Cheng, Quentin Valle, Rajnikant Sharma, Marcelo E. Tolmasky, Robert A. Bonomo, Gauri Rao, Fernando Pasteran and Maria Soledad Ramirez
Antibiotics 2025, 14(8), 832; https://doi.org/10.3390/antibiotics14080832 - 15 Aug 2025
Abstract
Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an urgent public health threat due to its rapid dissemination and resistance to last-line antibiotics. Cefiderocol (FDC), a novel siderophore cephalosporin, targets resistant Gram-negative pathogens by exploiting bacterial iron uptake mechanisms. However, resistance to FDC is emerging
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Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an urgent public health threat due to its rapid dissemination and resistance to last-line antibiotics. Cefiderocol (FDC), a novel siderophore cephalosporin, targets resistant Gram-negative pathogens by exploiting bacterial iron uptake mechanisms. However, resistance to FDC is emerging among Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae strains. This study characterizes a spontaneous FDC-resistant subpopulation (IHC216) derived from a KPC-producing strain (KPNMA216) using comprehensive genomic, transcriptional, and phenotypic analyses. Methods: Given the whole-genome sequencing results, where mutations were identified in genes involved in transcriptional regulation and membrane permeability (ompC) among others, in the present work we further explore their potential implications and conduct a more detailed analysis of the IHC216 genome. A qRT-PCR analysis highlighted significant downregulation of classical siderophore-mediated iron acquisition systems (fepA, cirA, iroN) and upregulation of alternative iron uptake pathways (iucA, fiU), reflecting a switch in iron acquisition strategies. Results: A notable downregulation of blaKPC-163 correlated with restored susceptibility to carbapenems, indicating collateral susceptibility. Altered expressions of pbp2 and pbp3 implicated adaptive changes in cell wall synthesis, potentially affecting FDC resistance mechanisms. Furthermore, enhanced oxidative stress responses via upregulated sodC expression and increased capsule production were observed. Conclusions: These findings underscore the complex interplay of genetic and transcriptional adaptations underlying FDC resistance, highlighting potential therapeutic vulnerabilities.
Full article
(This article belongs to the Special Issue Microbial Resistance to Carbapenems: Epidemiology, Detection and Treatment Options)
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Open AccessArticle
FTIR-Derived Feature Insights for Predicting Time-Dependent Antibiotic Resistance Progression
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Mitchell Bonner, Claudia P. Barrera Patiño, Andrew Ramos Borsatto, Jennifer M. Soares, Kate C. Blanco and Vanderlei S. Bagnato
Antibiotics 2025, 14(8), 831; https://doi.org/10.3390/antibiotics14080831 (registering DOI) - 15 Aug 2025
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Background/Objectives: The progression of antibiotic resistance is increasingly recognized as a dynamic and time-dependent phenomenon, challenging conventional diagnostics that define resistance as a binary trait. Methods: Biomolecules have fingerprints in Fourier-transform infrared spectroscopy (FTIR). The targeting of specific molecular groups, combined with principal
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Background/Objectives: The progression of antibiotic resistance is increasingly recognized as a dynamic and time-dependent phenomenon, challenging conventional diagnostics that define resistance as a binary trait. Methods: Biomolecules have fingerprints in Fourier-transform infrared spectroscopy (FTIR). The targeting of specific molecular groups, combined with principal component analysis (PCA) and machine learning algorithms (ML), enables the identification of bacteria resistant to antibiotics. Results: In this work, we investigate how effective classification depends on the use of different numbers of principal components, spectral regions, and defined resistance thresholds. Additionally, we explore how the time-dependent behavior of certain spectral regions (different biomolecules) may demonstrate behaviors that, independently, do not capture a complete picture of resistance development. FTIR spectra were obtained from Staphylococcus aureus exposed to azithromycin, trimethoprim/sulfamethoxazole, and oxacillin at sequential time points during resistance induction. Combining spectral windows substantially improved model performance, with accuracy reaching up to 96%, depending on the antibiotic and number of components. Early resistance patterns were detected as soon as 24 h post-exposure, and the inclusion of all three biochemical windows outperformed single-window models. Each spectral region contributed distinctively, reflecting biochemical remodeling associated with specific resistance mechanisms. Conclusions: These results indicate that antibiotic resistance should be viewed as a temporally adaptive trajectory rather than a static state. FTIR-based biochemical profiling, when integrated with ML, enables projection of phenotypic transitions and supports real-time therapeutic decision-making. This strategy represents a shift toward adaptive antimicrobial management, with the potential to personalize interventions based on dynamic resistance monitoring through spectral biomarkers.
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Antibiotic Prophylaxis in Instrumented Lumbar Spine Surgery: Cefazolin Outperforms Clindamycin Regardless of Duration
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Zoltán Nagy, Dóra Szabó, Gergely Agócs, Konrád Szilágyi, Zsanett Rojcsik, József Budai, Zoltán Papp, Csaba Padányi, Loránd Erőss, László Sipos and Péter Banczerowski
Antibiotics 2025, 14(8), 830; https://doi.org/10.3390/antibiotics14080830 - 15 Aug 2025
Abstract
Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics,
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Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics, primarily cefazolin and clindamycin, as well as the role of the duration of antibiotic prophylaxis in the development of SSI in instrumented lumbar spine surgeries through retrospective analysis. Methods: We performed a retrospective analysis of data from 915 patients who underwent instrumented lumbar spine surgery between 2016 and 2024 in a university center database. We examined the incidence of SSI according to the type of antibiotic used (cefazolin 1 g or 2 g, or clindamycin 0.6 g) and the duration of prophylaxis (single dose versus 72 h administration). We used the Fisher test and Welch test as a statistical analysis to examine the differences between SSI rates. Results: The incidence of SSI was 11.7%. We measured a significantly lower infection rate with cefazolin compared to clindamycin (OR = 0.45; 95% CI: 0.23–0.94; p = 0.0206), regardless of the duration of antibiotic administration. The 72 h cefazolin prophylaxis showed a slight but statistically insignificant advantage over single dose prophylaxis. The risk of SSI was significantly higher in multi-segment surgeries (p = 0.0005). Conclusions: Cefazolin is a more effective prophylactic antibiotic than clindamycin during instrumented lumbar spine surgery. The duration of antibiotic administration has less influence on the risk of SSI development; therefore, short-term, adequate-dose cefazolin prophylaxis is recommended, which also minimizes the risk of antimicrobial resistance and side effects.
Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)
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Open AccessReview
Clostridioides difficile in Peripartum Women: Review of Outcomes and Treatment
by
Ravina Kullar, Stuart Johnson and Ellie J. C. Goldstein
Antibiotics 2025, 14(8), 829; https://doi.org/10.3390/antibiotics14080829 - 15 Aug 2025
Abstract
Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States with increasing rates in younger patients and those in the community. CDI incidence may also be on the rise in peripartum women. Methods: We conducted
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Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States with increasing rates in younger patients and those in the community. CDI incidence may also be on the rise in peripartum women. Methods: We conducted a literature review to assess the incidence and outcomes of CDI in the peripartum population and review treatment options. Results: Peripartum patients have a high risk of complications and adverse events associated with CDI. Most patients have been treated with vancomycin or metronidazole; however, cases of patients recurring on standard treatment have been described, with patients having successful outcomes with fidaxomicin or fecal microbiota transplantation (FMT). Probiotics have been shown to be safe in peripartum women; however, the role in preventing primary and secondary CDI has not been studied. Conclusions: Peripartum women that develop CDI are at increased risk for complications. Treatment includes vancomycin, metronidazole, or fidaxomicin or FMT for recurrent cases.
Full article
(This article belongs to the Special Issue A Themed Issue in Honor of Dr. Lynne V. McFarland—Clostridioides difficile Infection and Impact of Antibiotics on the Intestinal Microbiome)
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A Comprehensive Review of Antibiotic Resistance in the Oral Microbiota: Mechanisms, Drivers, and Emerging Therapeutic Strategies
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Ena Kulis, Ivan Cvitkovic, Nikola Pavlovic, Marko Kumric, Doris Rusic and Josko Bozic
Antibiotics 2025, 14(8), 828; https://doi.org/10.3390/antibiotics14080828 - 15 Aug 2025
Abstract
Recent advances in microbiome research have highlighted the oral cavity as a complex and dynamic ecosystem, home to over 700 microbial species that play critical roles in both oral and systemic health. The oral microbiota not only maintains local tissue homeostasis but also
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Recent advances in microbiome research have highlighted the oral cavity as a complex and dynamic ecosystem, home to over 700 microbial species that play critical roles in both oral and systemic health. The oral microbiota not only maintains local tissue homeostasis but also serves as a reservoir for antimicrobial resistance (AMR) genes, contributing to the global spread of resistance. Frequent and sometimes inappropriate antibiotic use in dental practice, along with exposure to antiseptics and biocides, drives the emergence and horizontal transfer of resistance determinants within oral biofilms. This review synthesizes current knowledge on the molecular mechanisms and ecological drivers of AMR in the oral microbiome, emphasizing the clinical implications of dysbiosis and drug-resistant infections. The authors advocate for the development of dental clinical guidelines tailored to the unique characteristics of the oral microbiota, focusing on personalized therapy through molecular diagnostics, standardized AMR risk assessment, and the integration of non-antibiotic strategies such as probiotics and photodynamic therapy. Continuous education in antimicrobial stewardship and the implementation of oral-specific AMR surveillance is also highlighted as an essential component of effective resistance management. To support rational prescribing, a dedicated mobile application has been developed, leveraging microbiota data and resistance profiles to guide evidence-based, targeted therapy and reduce unnecessary antibiotic use. Collectively, these strategies aim to preserve antibiotic efficacy, ensure patient safety, and promote sustainable infection management in the dental field.
Full article
(This article belongs to the Special Issue Antimicrobial Therapy in Oral Diseases)
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Open AccessArticle
Nanopore Sequencing-Driven Mapping of Antimicrobial Resistance Genes in Selected Escherichia coli Isolates from Pigs and Poultry Layers in Nigeria
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Akinlabi Oladele Ogunleye, Prakash Ghosh, Adja Bousso Gueye, Foluke Olajumoke Jemilehin, Adelekan Oluseyi Okunlade, Veronica Olatimbo Ogunleye, Rea Maja Kobialka, Finja Rausch, Franziska Tanneberger, Adebowale Titilayo Philip Ajuwape, Ousmane Sow, George Olusegun Ademowo, Ulrike Binsker, Ahmed Abd El Wahed, Uwe Truyen, Yakhya Dieye and Cheikh Fall
Antibiotics 2025, 14(8), 827; https://doi.org/10.3390/antibiotics14080827 - 14 Aug 2025
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Background: Despite the huge burden of deaths associated with or attributable to antimicrobial resistance, studies on sequencing based antimicrobial resistance (AMR) monitoring in Africa are scarce, specifically in the animal sector. Objective and Methods: With a view to deploy rapid AMR monitoring through
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Background: Despite the huge burden of deaths associated with or attributable to antimicrobial resistance, studies on sequencing based antimicrobial resistance (AMR) monitoring in Africa are scarce, specifically in the animal sector. Objective and Methods: With a view to deploy rapid AMR monitoring through leveraging advanced technologies, in the current study, nanopore sequencing was performed with 10 E. coli strains isolated from rectal swabs of pigs and poultry layers in Nigeria. Two sequence analysis methods including command line, where bacterial genomes were assembled, and subsequently antimicrobial resistance genes (ARGs) were detected through online databases, and EPI2ME, an integrated cloud-based data analysis platform with MinION, was used to detect ARGs. Results: A total of 95 ARGs were identified and most of the genes are known to be expressed in the chromosome. Interestingly, few genes including qnrS1, qnrS15, qnrS10, kdpE, cmlA1, MIR-14, sul3 and dfrA12 were identified which were previously reported as transferred through MGEs. The antibiotic susceptibility assay determined that the E. coli isolates were resistant to Penicillin (100%), Ciprofloxacin (70%), tetracycline (50%) and Ampicillin (40%). The accuracies of the command line and EPI2ME methods have been found to be 57.14% and 32.14%, respectively, in predicting AMR. Moreover, the analysis methods showed 62.5% agreement in predicting AMR for the E. coli isolates. Conclusions: Considering the multiple advantages of nanopore sequencing, the application of this rapid and field-feasible sequencing technique holds promise for rapid AMR monitoring in LMICs, including Nigeria. However, the development of a robust sequence analysis pipeline and the optimization of the existing analysis tools are crucial to streamline the deployment of nanopore sequencing in LMICs for AMR monitoring both in animal and human sectors.
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Open AccessArticle
Diminishing Efficacy of Second-Line Levofloxacin-Based Quadruple Therapy in Helicobacter pylori Eradication: A Prospective Real-World Study in Vietnam Amid Rising Antibiotic Resistance
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Thong Duy Vo, Thao Thu Ngan and Thuy Thi Thanh Trinh
Antibiotics 2025, 14(8), 826; https://doi.org/10.3390/antibiotics14080826 - 14 Aug 2025
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Background/Objectives: Helicobacter pylori (H. pylori) infection remains highly prevalent in Vietnam, associated with chronic gastritis, peptic ulcers, and gastric cancer. This study aimed to evaluate the real-world eradication rate of levofloxacin-based bismuth quadruple therapy (PALB) as second-line treatment, assess adherence,
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Background/Objectives: Helicobacter pylori (H. pylori) infection remains highly prevalent in Vietnam, associated with chronic gastritis, peptic ulcers, and gastric cancer. This study aimed to evaluate the real-world eradication rate of levofloxacin-based bismuth quadruple therapy (PALB) as second-line treatment, assess adherence, and identify associated factors with treatment success. Methods: We conducted a prospective cohort study including 225 patients with confirmed failure of classical bismuth-based quadruple therapy. All received a 14-day PALB regimen. H. pylori eradication was assessed using 13C-urea breath test and/or rapid urease test 4–12 weeks after treatment. Results: Eradication rates were 78.2% (mITT) and 78.6% (PP), with 95% CIs overlapping the 80% benchmark. Adherence was high (91.6%) and significantly associated with success (OR = 2.93; 95% CI: 1.11–7.74; p = 0.039). No other factors were significantly associated. Conclusions: While PALB remains a valid second-line therapy, its efficacy may be declining, though not statistically inferior to 80%. Improving adherence and strengthening stewardship are essential.
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Lessons from Four Years (2021–2024) of Klebsiella Pneumoniae Resistance Surveillance Epidemiological Trends in a Romanian Intensive Care Unit
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Mihai Sava, Bogdan Ioan Vintila, Alina Simona Bereanu, Anca Maria Fratila and Ioana Roxana Codru
Antibiotics 2025, 14(8), 825; https://doi.org/10.3390/antibiotics14080825 - 12 Aug 2025
Abstract
Background: Klebsiella pneumoniae represents a major cause of healthcare-associated infections in intensive care units, with resistance profiles ranging from multidrug-resistant to extensively drug-resistant and pandrug-resistant. Critically ill patients, who often require invasive devices and prolonged antibiotic therapy, are especially vulnerable to colonization
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Background: Klebsiella pneumoniae represents a major cause of healthcare-associated infections in intensive care units, with resistance profiles ranging from multidrug-resistant to extensively drug-resistant and pandrug-resistant. Critically ill patients, who often require invasive devices and prolonged antibiotic therapy, are especially vulnerable to colonization and infection by these strains. Surveillance data on resistance trends and specimen-specific patterns in Romanian intensive care units (ICUs) remain limited. Methods: We conducted a four-year surveillance study (2021–2024) in a tertiary Romanian ICU, analyzing K. pneumoniae isolates collected from diverse clinical specimens. Resistance phenotypes were classified as MDR, XDR, PDR, or susceptible based on standard definitions. Trends over time were assessed using Cramér’s V and correspondence analysis, while stratification by specimen type evaluated associations between anatomical site and resistance profiles. Results: A total of 254 K. pneumoniae isolates were analyzed. MDR strains predominated in 2021 and 2022 but sharply declined by 2024 (from 80% to 8.3%). In parallel, XDR and PDR phenotypes increased substantially, indicating a shift toward more complex resistance profiles. A significant temporal association was found (Cramér’s V = 0.43), with 2024 marked by a sharp decline in MDR isolates and a predominance of XDR and PDR phenotypes, reflecting an advanced resistance profile. Specimen-type analysis showed tracheal aspirates as the main reservoir for resistant strains, followed by urine and blood cultures, with a weaker but meaningful association (Cramér’s V = 0.24). Conclusions: These findings reveal a change in resistance patterns in ICU-acquired K. pneumoniae infections, with MDR strains being displaced by XDR and PDR phenotypes. These findings highlight the urgent need for time- and specimen-informed resistance monitoring and adaptive antimicrobial stewardship. Without targeted interventions, gains made in controlling MDR strains risk being rapidly eclipsed by the spread of highly resistant organisms.
Full article
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
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Protective Effects of Luteolin on Glaesserella parasuis-Induced Injury: An In Vitro Study with Porcine Vascular Endothelial Cells
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Pu Guo, Xuwen Liu, Xiaoyi Li, Awais Ihsan, Zhongyuan Wu, Shulin Fu, Chun Ye, Yinsheng Qiu, Xu Wang, Qirong Lu and Yu Liu
Antibiotics 2025, 14(8), 824; https://doi.org/10.3390/antibiotics14080824 - 12 Aug 2025
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Background: Glaesserella parasuis (GPS) is a conditional pathogen that colonizes the upper respiratory tract in pigs and causes Glässer’s disease, resulting in high morbidity and mortality in piglets. GPS infection increases the vascular endothelial permeability, but the mechanism has not been fully
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Background: Glaesserella parasuis (GPS) is a conditional pathogen that colonizes the upper respiratory tract in pigs and causes Glässer’s disease, resulting in high morbidity and mortality in piglets. GPS infection increases the vascular endothelial permeability, but the mechanism has not been fully elucidated. Luteolin (Lut) is a naturally occurring flavonoid found in plants such as vegetables, herbs, and fruits, but its potential to treat the increased vascular endothelial permeability caused by GPS infection has not been evaluated. Results: This study revealed that GPS infection induces increased vascular endothelial permeability in porcine iliac artery endothelial cells (PIECs) by increasing the gene expressions of tumor necrosis factor (TNF), interleukin 6 (IL-6), IL-8, and IL-1β, and by regulating F-actin cytoskeleton reorganization. Mechanistically, GPS infection or Cluster of differentiation 44 (CD44) overexpression significantly increased the expressions of vascular-endothelial-permeability-related proteins (CD44; vascular endothelial growth factor (VEGFA); matrixmetalloProteinase-3 (MMP-3); MMP-9; and SRC proto-oncogene, non-receptor tyrosine kinase (c-Src)) and increased the vascular endothelial permeability; these changes were alleviated by a Lut treatment or CD44 silencing in the PIECs. Conclusions: This study comprehensively illustrates the potential targets and molecular mechanism of Lut in alleviating the GPS-induced increase in vascular endothelial permeability. The CD44 pathway and Lut may be an effective target and antibiotic alternative, respectively, to prevent the increased vascular endothelial permeability caused by GPS.
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Unique Regulation of Sed-1 β-Lactamase in Citrobacter sedlakii: Insights on Resistance to Third-Generation Cephalosporin
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Mako Watanabe, Ryuichi Nakano, Keizo Yamamoto, Akiyo Nakano, Yuki Suzuki, Kai Saito, Satoko Nakashima, Kentaro Endo, Kazuya Narita and Hisakazu Yano
Antibiotics 2025, 14(8), 823; https://doi.org/10.3390/antibiotics14080823 - 12 Aug 2025
Abstract
Background: The Citrobacter genus harbors class C (AmpC) and class A β-lactamases. Citrobacter freundii produces an inducible AmpC β-lactamase controlled by the LysR-type transcriptional regulator AmpR and cytosolic amidase AmpD. Citrobacter sedlakii produces the class A β-lactamase Sed-1, whose expression is believed to
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Background: The Citrobacter genus harbors class C (AmpC) and class A β-lactamases. Citrobacter freundii produces an inducible AmpC β-lactamase controlled by the LysR-type transcriptional regulator AmpR and cytosolic amidase AmpD. Citrobacter sedlakii produces the class A β-lactamase Sed-1, whose expression is believed to be regulated by the transcriptional regulator SedR and AmpD. Objectives:C. sedlakii NR2807, isolated in Japan, is resistant to third-generation cephalosporins and displays extended-spectrum β-lactamase characteristics. Here, we sought to understand the mechanism for successful resistance to third-generation cephalosporins by investigating the regulators controlling Sed-1 production. Methods: Plasmids containing blaSed-1 and sedR (pCR2807) or truncated sedR (pCR2807ΔSedR) were constructed and introduced into Escherichia coli. Antibiotic-resistant mutants of NR2807 were obtained, and enzyme kinetics were assessed. Results: The AmpD mutant (pCR2807/ML4953) showed an 8-fold increase in cefotaxime MIC and an 8.46-fold increase in Sed-1 activity compared to the wild-type (pCR2807/ML4947). However, induction of pCR2807/ML4947 also led to a 1.32-fold higher Sed-1 activity, indicating semi-inducibility. Deletion of sedR (pCR2807ΔSedR/ML4947) led to a 4-fold decrease in cefotaxime MIC and 1.93-fold lower Sed-1 activity, confirming SedR as an activator. While wild-type C. sedlakii ATCC51115 is susceptible to third-generation cephalosporins, the AmpD mutation in NR2807 led to Sed-1 overproduction and resistance to this class of antibiotics. Finally, mutagenesis revealed that amino acid substitution in Sed-1 conferred resistance to ceftazidime and extended-spectrum β-lactamase characteristics. Conclusions: Sed-1 producers, though usually susceptible to third-generation cephalosporins, may develop extended-spectrum β-lactamase traits due to AmpD or Sed-1 mutations, thereby requiring careful monitoring.
Full article
(This article belongs to the Special Issue Genomic Characterization of Antimicrobial Resistance and Evolution Mechanism of Bacteria)
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Diagnostic Accuracy of Presepsin and Its Impact on Early Antibiotic De-Escalation in Burn-Related Sepsis
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Seontai Park, Dohern Kym, Jaechul Yoon, Yong Suk Cho and Jun Hur
Antibiotics 2025, 14(8), 822; https://doi.org/10.3390/antibiotics14080822 - 11 Aug 2025
Abstract
Background/Objectives: Despite overlapping inflammatory responses and frequent culture-negative results in severe burn patients, early and accurate sepsis diagnosis remains challenging. We aimed to evaluate the diagnostic performance of seven candidate biomarkers and their clinical utility, particularly in culture-negative cases. Methods: We conducted a
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Background/Objectives: Despite overlapping inflammatory responses and frequent culture-negative results in severe burn patients, early and accurate sepsis diagnosis remains challenging. We aimed to evaluate the diagnostic performance of seven candidate biomarkers and their clinical utility, particularly in culture-negative cases. Methods: We conducted a prospective diagnostic accuracy study (January 2021–December 2022; N = 221) in the burn intensive care unit, applying a two-step feature selection to 41 candidate variables. Seven top biomarkers—presepsin, procalcitonin (PCT), albumin, C-reactive protein (CRP), prothrombin time (PT), hematocrit (Hct), and D-dimer—were measured at the moment of clinical sepsis suspicion, concurrently with blood cultures and prior to empirical antibiotic administration, within ±2 h of Sequential Organ Failure Assessment (SOFA). Diagnostic performance was evaluated using a Receiver Operating Characteristic (ROC) curve analysis to determine the area under the curve (AUC), Youden index-derived cut-offs, decision curve analysis, and Net Reclassification Improvement (NRI). Results: Presepsin achieved the highest overall AUC (0.810; 95% CI, 0.742–0.878) and outperformed other markers in culture-negative cases (AUC, 0.846 vs. 0.604; p = 0.015). In the decision curve analysis, presepsin and PCT maintained the largest net benefits at high thresholds, although PT, D-dimer, and Hct also retained smaller positive benefits. Patients were stratified into high- vs. low-risk groups for survival analysis using Youden index cut-offs; Cox regression confirmed PCT (Hazard Ratio 3.78; p < 0.001) and PT (HR 2.12; p = 0.018) as a significant mortality predictor, with presepsin showing borderline significance (HR 3.14; p = 0.055). Conclusions: The high rate of culture-negative sepsis reflects early antibiotic use suppressing culture yield rather than resistance patterns alone. Presepsin’s rapid rise and preserved accuracy under pre-sampling antibiotics suggest its value for early sepsis detection and antimicrobial stewardship. Future work will incorporate polymicrobial and multidrug-resistant bloodstream infection profiles to refine biomarker utility.
Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Prevention in Intensive Care Unit)
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Clinical Characteristics and Follow-Up of Children with Primary Haematogenous Osteomyelitis and Septic Arthritis: Eight Years of Experience from Hungary
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Szofia Hajósi-Kalcakosz, Erzsébet Varga, Dorottya Őri, Csaba Ráskai, Borbála Zsigmond, Beáta Visy, Ferenc Fekete, Andrea Horváth, Orsolya Dobay and Bálint Gergely Szabó
Antibiotics 2025, 14(8), 821; https://doi.org/10.3390/antibiotics14080821 - 11 Aug 2025
Abstract
Introduction: Paediatric acute haematogenous bone and joint infections (BJIs) are serious conditions. This study aimed to analyse the characteristics of paediatric acute haematogenous osteomyelitis (AHO) and septic arthritis (SA) in Hungary, with a focus on causative pathogens, clinical outcomes, and long-term complications. Methods
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Introduction: Paediatric acute haematogenous bone and joint infections (BJIs) are serious conditions. This study aimed to analyse the characteristics of paediatric acute haematogenous osteomyelitis (AHO) and septic arthritis (SA) in Hungary, with a focus on causative pathogens, clinical outcomes, and long-term complications. Methods: A retrospective cohort study was conducted at a Hungarian tertiary referral centre between 2015 and 2022. Children aged 18 years or younger diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) within two months of symptom onset were included. Exclusion criteria were chronic infection, post-operative infections, or wound-related infections. Complicated AHO was defined by intraosseous abscess or necrosis confirmed radiologically or intraoperatively. The primary outcome was surgical intervention beyond 30 days after diagnosis; secondary outcomes included long-term complications. Results: Forty patients were included (77.5% male, median age 8.7 years). AHO was diagnosed in 8 patients (20.0%), complicated AHO in 22 (55.0%), and SA in 10 (25.0%). MRI had the highest diagnostic sensitivity (97.0%). Pathogens were identified in 72.5% of cases; Staphylococcus aureus (S. aureus) was most common (57.5%), followed by Salmonella and Streptococcus pyogenes (5% each). Surgery was required in 90.0% of SA cases, 77.2% of complicated AHO, and 37.5% of uncomplicated AHO. Long-term complications occurred in 10%, mainly with S. aureus and complicated AHO. Conclusions: Paediatric BJIs, especially due to S. aureus, often require surgery and cause long-term sequelae.
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(This article belongs to the Special Issue Bone and Joint Infections: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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The Small Molecule Inhibitor of the Type III Secretion System Fluorothiazinone Affects Flagellum Surface Presentation and Restricts Motility in Gram-Negative Bacteria
by
Alexey Slonov, Mariam Abdulkadieva, Egor Kalinin, Natalya Bondareva, Lydia Kapotina, Svetlana Andreevskaya, Natalia Shevlyagina, Anna Sheremet, Elena Sysolyatina, Vladimir Zhukhovitsky, Mikhail Vasiliev, Oleg Petrov, Svetlana Ermolaeva, Nailya Zigangirova and Alexander Gintsburg
Antibiotics 2025, 14(8), 820; https://doi.org/10.3390/antibiotics14080820 - 11 Aug 2025
Abstract
Background/Objectives: Fluorothiazinone (FT), a small molecule of the 2,4-disubstituted-4H-[1,3,4]-thiadiazine-5-one class, is known to inhibit the type III secretion system (T3SS) in Gram-negative bacteria and has shown therapeutic potential in animal models and clinical trials. Given the evolutionary relationship between the T3SS and the
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Background/Objectives: Fluorothiazinone (FT), a small molecule of the 2,4-disubstituted-4H-[1,3,4]-thiadiazine-5-one class, is known to inhibit the type III secretion system (T3SS) in Gram-negative bacteria and has shown therapeutic potential in animal models and clinical trials. Given the evolutionary relationship between the T3SS and the bacterial flagellar apparatus, this study aimed to investigate the effects of FT on bacterial motility and flagellum assembly. Methods: Motility was assessed in Pseudomonas aeruginosa, Proteus mirabilis, pathogenic Escherichia coli, and Listeria monocytogenes using a semisolid agar assay and a microfluidic motility system. The mechanism of FT’s action was further examined through time-course analysis, Western blotting of surface flagella proteins, and transmission electron microscopy (TEM). Results: FT inhibited motility of P. aeruginosa, P. mirabilis, and E. coli in a dose-dependent manner, while L. monocytogenes motility remained unaffected. The inhibitory effect was not immediate but delayed 2–3 h post FT addition. Western blotting revealed the absence of surface flagella in EHEC grown with FT, and TEM confirmed structural disruption of flagella in P. mirabilis. Conclusions: FT selectively inhibits flagellum-based motility in Gram-negative bacteria. Obtained data suggested FT interference with flagellum biosynthesis rather than disruption of rotation. Motility inhibition can contribute to FT therapeutic effects on Gram-negative bacterial infections.
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(This article belongs to the Section Novel Antimicrobial Agents)
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Clonal Diversity of Extraintestinal Pathogenic Escherichia coli Strains Isolated from Canine Urinary Tract Infections in Brazil
by
Luciana Sartori, João Pedro Rueda Furlan, Fábio Parra Sellera, Fernanda Borges Barbosa, Yohanna Carvalho dos Santos Aoun Chikhani, Gabriel Gandolfi and Terezinha Knöbl
Antibiotics 2025, 14(8), 819; https://doi.org/10.3390/antibiotics14080819 - 10 Aug 2025
Abstract
Background/Objectives: Extraintestinal pathogenic Escherichia coli (ExPEC) strains, particularly those belonging to phylogenetic group B2, are clinically significant due to their frequent involvement in urinary tract infections (UTIs) and display antimicrobial resistance profiles. While the association of phylogroup B2 E. coli with human urinary
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Background/Objectives: Extraintestinal pathogenic Escherichia coli (ExPEC) strains, particularly those belonging to phylogenetic group B2, are clinically significant due to their frequent involvement in urinary tract infections (UTIs) and display antimicrobial resistance profiles. While the association of phylogroup B2 E. coli with human urinary tract infections is well established, the growing number of reports of ExPEC strains in canine UTIs highlights their clinical relevance in small animal medicine and raises concerns about their potential role in zoonotic transmission. This study investigated the microbiological and genomic features of E. coli strains isolated from dogs with UTIs in São Paulo, Brazil. Methods: Between March and May 2023, a total of 60 E. coli strains from canine UTIs were screened for antimicrobial susceptibility and phylotyping. Accordingly, four strains (6.6%) were identified as multidrug-resistant (MDR) or belonging to phylogroup B2 and, therefore, were submitted for characterization by whole-genome sequencing. Results: The four E. coli strains exhibited diverse antimicrobial resistance profiles, including resistance to third- and fourth-generation cephalosporins and fluoroquinolones. Phylogenetic groups B1, B2, and G, and sequence types (ST) 73, ST224, ST1193, and ST12960 were identified. The resistome included clinically important β-lactam resistance genes, such as blaCTX-M-55 and blaCMY-2, as well as mutations in the quinolone-resistance-determining region. Virulence factors associated with ExPEC pathogenesis, including adhesion, iron acquisition, immune evasion, and toxin, were detected. Plasmid sequences were identified as carrying antimicrobial resistance and virulence genes, highlighting the potential for horizontal gene transfer. Conclusions: Our findings underscore the importance of genomic surveillance in companion animals to better understand the epidemiology of ExPEC strains and monitor the spread of MDR strains.
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(This article belongs to the Special Issue Antimicrobial Resistance and Infections in Animals)
Open AccessArticle
Colistin-Resistant Escherichia coli Isolated from Houseflies and Feces of Cattle and Pigs at a Slaughterhouse in Lima, Peru
by
Andrea Carhuallanqui, Lorena Villafana, Rosa Gonzalez-Veliz, José F. Cobo-Díaz, Avelino Álvarez-Ordoñez and Daphne Doris Ramos-Delgado
Antibiotics 2025, 14(8), 818; https://doi.org/10.3390/antibiotics14080818 - 10 Aug 2025
Abstract
Background: Pigs and cattle have been implicated as reservoirs of antimicrobial resistance genes (ARGs) that can spread to humans, and houseflies are considered potential carriers of bacteria with ARGs that could contribute to their spread to the environment, including food, animals, and humans.
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Background: Pigs and cattle have been implicated as reservoirs of antimicrobial resistance genes (ARGs) that can spread to humans, and houseflies are considered potential carriers of bacteria with ARGs that could contribute to their spread to the environment, including food, animals, and humans. Methods: In this study, 107, 145, and 127 Escherichia coli strains were isolated from houseflies, pigs, and cattle, respectively, from a slaughterhouse in Lima, Peru. Antimicrobial susceptibility testing was performed using the Kirby–Bauer method, where thirteen antibiotics were used. Strains were also plated on CHROMagar COL-APSE agar, and colistin’s minimum inhibitory concentration (MIC) was determined. Colistin-resistant E. coli strains were subjected to whole genome sequencing. Results: 7.8% (8/107), 1.38% (2/145), and 0.79% (1/127) of E. coli strains isolated from houseflies, pigs, and cattle, respectively, were resistant to colistin (MIC ≥ 4 µg/mL). ARGs associated with resistance to more than 6 different antibiotic classes were identified, including tetracyclines, beta-lactams, fluoroquinolones, nitroimidazoles, trimethoprim and amphenicols. Conclusions: This study suggests that flies could contribute to the dissemination of ARG carrying bacteria and shows the potential risk of animals and meat production systems as reservoirs of ARG carrying bacteria.
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(This article belongs to the Special Issue Virulence, Antimicrobial Resistance and Biofilm Production in Veterinary, Zoonotic and Food-Related Pathogens)
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Prevalence and Characterization of the Antimicrobial Resistance and Virulence Profiles of Staphylococcus aureus in Ready-to-Eat (Meat, Chicken, and Tuna) Pizzas in Mansoura City, Egypt
by
Sara Amgad Elsalkh, Amira Ibrahim Zakaria, Samir Mohammed Abd-Elghany, Kálmán Imre, Adriana Morar and Khalid Ibrahim Sallam
Antibiotics 2025, 14(8), 817; https://doi.org/10.3390/antibiotics14080817 - 10 Aug 2025
Abstract
Introduction: Staphylococcus aureus is a high-priority foodborne pathogen contributing to several food poisoning outbreaks. Methicillin- and vancomycin-resistant S. aureus (MRSA and VRSA), pose significant public health concerns due to their potential for serious illness, antibiotic resistance, and transmission within both healthcare and
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Introduction: Staphylococcus aureus is a high-priority foodborne pathogen contributing to several food poisoning outbreaks. Methicillin- and vancomycin-resistant S. aureus (MRSA and VRSA), pose significant public health concerns due to their potential for serious illness, antibiotic resistance, and transmission within both healthcare and community settings. These bacteria can cause numerous infections, ranging from skin and soft tissue infections to life-threatening conditions like bloodstream infections, pneumonia, and endocarditis. Although several publications are concerned with Staphylococcus aureus contamination in ready-to-eat (RTE) food products, little published data is available about its prevalence in pizza, which is widely distributed and consumed worldwide. Methods: The current study is intended to determine the prevalence, virulence genes, and antimicrobial resistance profiles of S. aureus in three hundred ready-to-eat pizza samples (100 each of meat, chicken, and canned tuna pizzas) collected from different restaurants in Mansoura City, Egypt. The typical colonies on Baird–Parker selective agar supplemented with egg yolk tellurite emulsion were counted and further confirmed based on Gram staining, coagulase testing, catalase testing, carbohydrate fermentation, and thermostable nuclease production. The genomic DNA of the confirmed coagulase-positive isolates was prepared and subjected to PCR analyses for detecting the nuc gene, mecA (methicillin resistance gene), and vancomycin resistance gene (vanA), as well as six selected S. aureus virulence genes: sea, seb, sec, sed, hla, and tsst. The antimicrobial resistance profile of the S. aureus isolates was determined against 16 antimicrobial agents belonging to six classes using the agar disc diffusion method according to the Clinical and Laboratory Standards Institute guidelines (CLSI), except for oxacillin and vancomycin, which were assessed using the MIC test. Results: The results revealed that 56% (56/100), 56% (56/100), and 40% (40/100) of chicken, meat, and canned tuna pizzas were positive for S. aureus, with an overall prevalence of 50.7% (152/300). All 560 isolates (100%) were verified as S. aureus based on molecular confirmation of the nuc gene. Interestingly, 48.6% (272/560) and 8.6% (48/560) of the isolates tested were identified as methicillin- and vancomycin-resistant S. aureus (MRSA and VRSA) through detection of mecA and vanA genes, respectively. Among the S. aureus isolates tested, the hla gene was detected in 87.1% (488/560), while the enterotoxin genes sea, seb, sec, and sed were identified in 50% (280/560), 78.6% (440/560), 9.8% (55/560), and 24.5% (137/560) of isolates, respectively. All recovered isolates (n = 560) were classified as multidrug-resistant and were resistant to penicillin, oxacillin, and ampicillin. Moreover, 77% (431/560), 24% (134/560), 8% (45/560), and 8.6% (48/560) of isolates were resistant to cefotaxime, ciprofloxacin, azithromycin, and vancomycin, respectively. Conclusions: The current study emphasizes that ready-to-eat pizza is highly contaminated with multidrug-resistant S. aureus, highlighting the urgent need for rationalizing antibiotic use in both veterinary and human medicine to prevent the transmission of resistant bacteria through the food chain. Additionally, strict adherence to good hygienic practices throughout all stages of the food chain is essential to minimize overall contamination and enhance food safety.
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(This article belongs to the Special Issue The Antimicrobial Resistance in the Food Chain)
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Phenotypic Characterization of pilA, pilB, and pilD Mutants of Acinetobacter baumannii 5075: Impacts on Growth, Biofilm Formation, and Tazobactam Response
by
Joel H. Salinas, Jr., Fatma Pinar Gordesli-Duatepe, Angelica Diaz-Sanchez and Nehal I. Abu-Lail
Antibiotics 2025, 14(8), 816; https://doi.org/10.3390/antibiotics14080816 - 9 Aug 2025
Abstract
Background/Objectives: The Type IV pilus assembly system in Acinetobacter baumannii is a major determinant of its pathogenicity, playing a role in surface-associated functions via the biogenesis of Type IV pili (T4P). Tazobactam (TAZ) is a well-characterized β-lactamase inhibitor, primarily used in combination with
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Background/Objectives: The Type IV pilus assembly system in Acinetobacter baumannii is a major determinant of its pathogenicity, playing a role in surface-associated functions via the biogenesis of Type IV pili (T4P). Tazobactam (TAZ) is a well-characterized β-lactamase inhibitor, primarily used in combination with β-lactam antibiotics such as piperacillin (PIP) to counteract bacterial resistance mechanisms. While A. baumannii resistance to β-lactam antibiotics has been well studied, the influence of T4P on its susceptibility to TAZ remains largely unexplored. For this reason, we investigated how multidrug-resistant A. baumannii 5075 (AB5075) responds to TAZ by assessing the roles of pilA, pilB, and pilD in bacterial growth and biofilm formation under direct TAZ exposure, with a focus on phenotypic characterization rather than molecular mechanisms. Methods: Bacterial growth kinetics were quantified by measuring the optical densities of cell suspensions and the colony forming units per volume (CFUs/mL) at different time intervals. Time-kill assays and microtiter dish biofilm formation assays were used to evaluate how effectively TAZ can inhibit growth and biofilm formation, respectively. Results: Time–kill assays confirmed that 32 µg/mL of TAZ inhibited growth in both wild-type (WT) and mutant strains, with the pilD mutant showing initial resistance before eventual inhibition. Biofilm assays showed that the pilA mutant had the highest biofilm formation at 8 h, surpassing the WT strain. A prolonged 32 µg/mL of TAZ exposure (24–36 h) significantly reduced biofilm production across all strains, with inhibition rates reaching 89% for the WT, 82% for the pilA mutant, 91% for the pilB mutant, and 86% for the pilD mutant. Conclusion: These findings deepen our understanding of the strain-specific roles of T4P components in growth and biofilm regulation in AB5075, and highlight the potential of TAZ as a therapeutic strategy against biofilm-associated infections.
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(This article belongs to the Special Issue Antibiotic Resistance and Virulence Mechanisms in Gram-Negative Bacteria: An Alliance for Success)
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Effects of Antiseptic Formulations on Oral Microbiota and Related Systemic Diseases: A Scoping Review
by
Angela Angjelova, Elena Jovanova, Alessandro Polizzi, Rosalia Leonardi and Gaetano Isola
Antibiotics 2025, 14(8), 815; https://doi.org/10.3390/antibiotics14080815 - 8 Aug 2025
Abstract
Background: Oral antiseptic formulations are widely used as adjuncts in oral hygiene to reduce pathogenic microorganisms and prevent oral diseases. While these agents are effective in controlling biofilm, their broader effects may disrupt the oral microbiota’s balance, potentially contributing to systemic health implications.
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Background: Oral antiseptic formulations are widely used as adjuncts in oral hygiene to reduce pathogenic microorganisms and prevent oral diseases. While these agents are effective in controlling biofilm, their broader effects may disrupt the oral microbiota’s balance, potentially contributing to systemic health implications. The complex relationship between antiseptic use, microbial composition, and systemic outcomes remains insufficiently mapped. Objective: This scoping review aimed to explore and map the current evidence regarding the impact of antiseptic formulations on oral microbiota composition and to examine their potential associations with systemic diseases. Methods: A comprehensive literature search was performed using PubMed, Scopus, and Web of Science up to June 2025. Studies were included if they investigated antiseptic formulations commonly used in oral healthcare—such as chlorhexidine, essential oils, and cetylpyridinium chloride—and reported effects on oral microbiota and/or systemic health. Eligible study types included human clinical trials, observational studies, in vitro, and animal studies. Two reviewers independently screened and selected studies, with disagreements resolved by consensus. Data extraction focused on study design, antiseptic agents, microbial outcomes, and systemic implications. A total of 12 studies were included and charted. Results: The included studies demonstrated that oral antiseptics effectively reduce pathogenic microorganisms and improve clinical outcomes in oral diseases such as gingivitis and periodontitis. However, several studies also reported alterations in commensal microbial communities, suggesting a potential for dysbiosis. Some studies indicated possible links between antiseptic-induced microbial changes and systemic conditions, including cardiovascular and respiratory diseases. Conclusions: The evidence highlights a dual effect of antiseptic formulations: while beneficial in controlling oral pathogens, they may disrupt microbial homeostasis with possible systemic consequences. Further research is needed to evaluate long-term effects and develop targeted, microbiota-preserving oral hygiene strategies.
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(This article belongs to the Special Issue Antimicrobial Therapy in Oral Diseases)
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