Journal Description
Antibiotics
Antibiotics
is an international, peer-reviewed, open access journal on all aspects of antibiotics, published monthly online by MDPI.
- 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 (Pharmacology and Pharmacy) / CiteScore - Q1 (General Pharmacology, Toxicology and Pharmaceutics )
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 15.8 days after submission; acceptance to publication is undertaken in 2.5 days (median values for papers published in this journal in the second half of 2024).
- 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:
4.3 (2023);
5-Year Impact Factor:
4.6 (2023)
Latest Articles
Genomic Insights into Colistin and Tigecycline Resistance in ESBL-Producing Escherichia coli and Klebsiella pneumoniae Harboring blaKPC Genes in Ecuador
Antibiotics 2025, 14(2), 206; https://doi.org/10.3390/antibiotics14020206 - 17 Feb 2025
Abstract
Intriducion: Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are resistant to third-generation cephalosporins (3GCs), carbapenems, colistin, and tigecycline, making them a major public health priority, mainly within the developing world. However, their genomic epidemiology and possible determinants
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Intriducion: Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are resistant to third-generation cephalosporins (3GCs), carbapenems, colistin, and tigecycline, making them a major public health priority, mainly within the developing world. However, their genomic epidemiology and possible determinants of resistance remain to be elucidated. Thus, this study aimed to perform a genomic characterization of E. coli and K. pneumoniae, both of which are resistant to last-line antibiotics, isolated from humans, poultry, and a dairy farm environment within Ecuador. Methods: This study analyzed nine 3GC-resistant E. coli isolates harboring the mcr-1 gene (six from poultry farms, two from human infections, and one from dairy farm compost), together with ten isolated colistin- and carbapenem-resistant K. pneumoniae clinical samples. Results: The E. coli isolates of human origin belonged to ST609 and phylogroup A, while the poultry and compost isolates belonged to phylogroups A, B1, E, and F. Diverse STs of the K. pneumoniae isolates included ST13 (five isolates), ST258 (four isolates), and ST86 (one isolate). Within the E. coli isolates, blaCTX-M-55, blaCTX-M-65, blaCTX-M-15, and blaCTX-M-2 genes were identified. This study also identified blaCMY-2 and blaKPC-3 (the latter in a carbapenem-susceptible isolate). In E. coli, the plasmid-borne mcr-1.1 gene was identified across all E. coli isolates within an IncI2 plasmid. Tigecycline-reduced susceptibility or resistance was related to missense amino acid substitutions coded in the marA and acrA genes. Within K. pneumoiae, blaCTX-M-15 and blaCTX-M-65, on the one hand, and blaKPC-2 and blaKPC-3, on the other, were associated with 3GC and carbapenem resistance, respectively. The blaKPC-2 allele was identified in a ~10 kb Tn4401 transposon (tnpR–tnpA–istA–istB–blaKPC-2–tnpA). In K pneumoniae, sequence data and phenotypic analysis linked a nonsense amino acid substitution coded in the mgrB (K3*) gene and missense amino acid substitutions coded in the marA, acrA, arnB, eptA, pmrB, pmrJ, and phoQ genes to colistin resistance. Meanwhile, tigecycline resistance was linked to nonsense and missense amino acid substitutions coded within the ramR sequence. Additionally, this study identified several integron structures, including Int191 (5′CS-dfrA14-3′CS), which was the most prevalent integron (Int) among E. coli and K. pneumoniae isolates in this study, followed by Int0 (5′CS-3′CS) and Int18 (5′CS-dfrA1-3′CS). Conclusions: These results contribute to the genomic epidemiology of MDR E. coli and K. pneumoniae in our setting and to the worldwide epidemiology in the One Health approach.
Full article
Open AccessArticle
Prognostic Value of C-Reactive Protein in Primary Total Hip Arthroplasty
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Moritz Mederake, Ulf Krister Hofmann and Georgios Eleftherakis
Antibiotics 2025, 14(2), 205; https://doi.org/10.3390/antibiotics14020205 - 16 Feb 2025
Abstract
Background/Objectives: Periprosthetic joint infections (PJIs) are feared complications in arthroplasty and are associated with an increased mortality rate. PJI prevention is of paramount importance since treatment is difficult. In case of an infection, it is crucial to diagnose it at an early
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Background/Objectives: Periprosthetic joint infections (PJIs) are feared complications in arthroplasty and are associated with an increased mortality rate. PJI prevention is of paramount importance since treatment is difficult. In case of an infection, it is crucial to diagnose it at an early stage in order to initiate adequate therapy. The Musculoskeletal Infection Society (MSIS) proposed a catalog of different major and minor diagnostic criteria in 2011 to define a PJI. They were adapted in the following years. One of these criteria is the blood level of C-reactive protein (CRP). CRP is a non-specific acute-phase protein that also increases in response to various non-infectious inflammatory responses. CRP is also routinely obtained prior to total hip arthroplasty (THA) to screen for possible contraindications for arthroplasty such as an acute infection. The validity of this approach has rarely been investigated. The aim of this study was to evaluate the diagnostic value of perioperative CRP in patients receiving a THA. Methods: A total of 239 patients were included in this study and retrospectively analyzed. CRP values were obtained preoperatively and three values postoperatively. Sensitivity, specificity, area under the curve (AUC) and optimal thresholds were calculated. Results: In the whole group, 10 patients developed a PJI. No significance was demonstrated between patients without and with later PJI in terms of preoperative CRP (p = 0.182), postoperative CRP (p = 0.167), relative CRP increase (p = 0.684) and respective CRP differences (p = 0.456). We were not able to find cut-off values with adequate sensitivity and specificity. Conclusions: Perioperative CRP values do not seem to be helpful in predicting further PJI. Rather, they should be used as a screening tool to detect ongoing infections in the individual patient prior to THA. This trial should encourage studies with more statistical power due to the small effect sizes.
Full article
(This article belongs to the Special Issue Prevention, Diagnostic and Antibiotic Treatment of Periprosthetic Joint and Fracture Related Infection, 2nd Edition)
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Open AccessArticle
Pharmacogenetics and Pharmacokinetics of Moxifloxacin in MDR-TB Patients in Indonesia: Analysis for ABCB1 and SLCO1B1
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Nurul Annisa, Nadiya N. Afifah, Prayudi Santoso, Vycke Yunivita, Lindsey H. M. te Brake, Rob E. Aarnoutse, Melisa I. Barliana and Rovina Ruslami
Antibiotics 2025, 14(2), 204; https://doi.org/10.3390/antibiotics14020204 - 16 Feb 2025
Abstract
Background/Objectives: Studies show that SNPs in ABCB1 rs2032582 and SLCO1B1 rs4149015 affect the PK profile of moxifloxacin, a key drug for MDR-TB. This study aimed to assess the genotype frequencies of ABCB1 rs2032582 and SLCO1B1 rs4149015; describe moxifloxacin AUC0–24 and C
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Background/Objectives: Studies show that SNPs in ABCB1 rs2032582 and SLCO1B1 rs4149015 affect the PK profile of moxifloxacin, a key drug for MDR-TB. This study aimed to assess the genotype frequencies of ABCB1 rs2032582 and SLCO1B1 rs4149015; describe moxifloxacin AUC0–24 and Cmax; and evaluate the association between genotype variations and moxifloxacin AUC0–24 and Cmax, corrected for the effect of other determinants in MDR-TB patients in Indonesia. Methods: The genotypes were identified using DNA sequencing. Plasma samples for PK analysis were collected at either two or four timepoints post-dose, at steady state. AUC0–24 values were assessed with a limited sampling formula. A multivariate linear regression analysis identified the determinants for moxifloxacin AUC0–24 and Cmax. Results: We recruited 204 MDR-TB patients for PG analysis, with 80 providing PK samples. The majority of the ABCB1 and SLCO1B1 genotypes were wildtype (GG), 41.7% and 93.6%, respectively. The geometric mean AUC0–24 for moxifloxacin was 78.6 mg·h/L and that for Cmax was 6.1 mg/L. No statistically significant difference in exposure to moxifloxacin could be shown between the genotypes. Sex, age, and dose in mg/kg/body weight were significant determinants of the AUC0–24 of moxifloxacin. Conclusions: The major genotype of ABCB1 rs2032582 and SLCO1B1 rs4149015 was wildtype, and the exposure to moxifloxacin was high but not related to the studied genotype in an Indonesian population.
Full article
(This article belongs to the Section Pharmacokinetics and Pharmacodynamics of Drugs)
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The Microbiological Background of Medication-Related Osteonecrosis of the Jaw (MRONJ): Clinical Evidence Based on Traditional Culture and Molecular Biological Detection Methods
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Zsanett Kövér, Márió Gajdács, Beáta Polgár, Dóra Szabó and Edit Urbán
Antibiotics 2025, 14(2), 203; https://doi.org/10.3390/antibiotics14020203 - 15 Feb 2025
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Background: Medication-related osteonecrosis of the jaw (MRONJ) is a common adverse event following antiresorptive treatment, leading to chronic inflammation and exposed, necrotic bone surfaces in the jawbone. There is an increasing recognition of the role of compositional changes in the colonizing members
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Background: Medication-related osteonecrosis of the jaw (MRONJ) is a common adverse event following antiresorptive treatment, leading to chronic inflammation and exposed, necrotic bone surfaces in the jawbone. There is an increasing recognition of the role of compositional changes in the colonizing members of the oral microbiota implicated in triggering and/or maintaining MRONJ. The aim of our study was to characterize the culturable and non-culturable microbiota—with particular focus on Actinomyces spp. and Actinomyces-like organisms (ALOs)—from surgically removed bone samples of MRONJ patients and healthy control subjects. Methods: n = 35 patients (median age: 70 years) in various stages of MRONJ, with a history of receiving oral or intravenous antiresorptive treatment were included in the study. The controls (n = 35; median age: 35 years) consisted of otherwise healthy individuals undergoing tooth extraction. Traditional, quantitative, aerobic, and anaerobic culture, and Actinomyces-specific PCR was performed for all bone samples from patients and controls, while microbiome analyses—based on 16S rRNA sequencing—were carried out in 5-5 randomly selected samples. Mann–Whitney U test, Wilcoxon rank sum test (alpha diversity), and PERMANOVA analysis (beta diversity) were performed. Results: In MRONJ samples, 185 anaerobic isolates, corresponding to 65 different species were identified (vs. 72 isolates, corresponding to 27 different species in the control group). The detection of Actinomyces spp. and ALOs was more common in MRONJ bone samples, based on traditional culture (65.7% vs. 17.1%; p < 0.001) and PCR (82.9% vs. 37.1%; p < 0.001), respectively. The isolation of Fusobacterium spp. (22 vs. 7; p = 0.001), Prevotella spp. (22 vs. 6; p = 0.034), and Gram-positive anaerobic cocci (GPAC) (30 vs. 9; p = 0.016) was significantly more common in MRONJ patient samples. The microbiota of the controls’ bone samples were characterized by a considerable dominance of Streptococcus spp. and Veillonella spp, while the bacterial abundance rates were substantially more heterogeneous in MRONJ bone samples. Notable differences were not observed among the samples related to the abundance of Actinomyces in the bone microbiota. Conclusions: According to the “infection hypothesis”, alterations in the oral microbiome—with Actinomyces and ALOs being the most relevant—may play a key role in the development, aggravation, and progression of MRONJ. The timely detection of Actinomyces in necrotic bone is crucial, as it has important therapeutic implications.
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Open AccessArticle
Interprofessional Therapeutic Drug Monitoring of Piperacillin/Tazobactam Enhances Care for Patients with Acute-on-Chronic Liver Failure in the ICU: A Retrospective Observational Pilot Study
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Stephan Schmid, Katharina Zimmermann, Chiara Koch, Patricia Mester, Georgios Athanasoulas, Jonas Buttenschoen, Daniel Fleischmann, Sophie Schlosser-Hupf, Vlad Pavel, Tobias Schilling, Martina Müller and Alexander Kratzer
Antibiotics 2025, 14(2), 202; https://doi.org/10.3390/antibiotics14020202 - 14 Feb 2025
Abstract
Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing syndrome in patients with liver cirrhosis, often triggered by bacterial infections. Piperacillin/Tazobactam is a key antibiotic in this setting, and therapeutic drug monitoring (TDM) helps optimize its dosing. This study evaluates the impact
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Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing syndrome in patients with liver cirrhosis, often triggered by bacterial infections. Piperacillin/Tazobactam is a key antibiotic in this setting, and therapeutic drug monitoring (TDM) helps optimize its dosing. This study evaluates the impact of an interprofessional TDM strategy for Piperacillin/Tazobactam in ACLF patients in the ICU. Methods: This retrospective ICU study evaluated an interprofessional TDM approach for optimizing Piperacillin/Tazobactam dosing in critically ill ACLF patients. The team, consisting of physicians, clinical pharmacists, and staff nurses, engaged in shared decision making, collaboratively interpreting TDM results and adjusting the dosing accordingly. This study included 26 patients with ACLF who underwent initial TDM and 7 who received follow-up TDM. Piperacillin/Tazobactam dosing was modified based on TDM recommendations, with serum concentrations measured weekly. Adherence to and the implementation of interprofessional dosing recommendations were systematically analyzed to assess the impact of this approach. Results: The initial TDM showed that 30.8% of patients had Piperacillin/Tazobactam levels within the target range, while 53.8% were above and 15.4% below. The interprofessional team recommended dose reductions in seven patients, increases in three, and no change in eleven, with five requiring antibiotic modifications. At the first follow-up TDM, 20.0% reached target levels, while 80.0% remained above, with no subtherapeutic cases. The team recommended one further dose reduction and maintained dosing in four patients. All recommendations were fully implemented, demonstrating strong adherence to the collaborative protocol. Conclusions: The interprofessional TDM strategy optimized Piperacillin/Tazobactam dosing in ACLF patients with full adherence to the recommendations. This collaborative approach improves outcomes and supports global efforts to curb antibiotic resistance.
Full article
(This article belongs to the Special Issue Antibiotics in the Critically Ill Patient)
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What Is the Impact of Antibiotic Resistance Determinants on the Bacterial Death Rate?
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Bruno T. S. Luz, João S. Rebelo, Francisca Monteiro and Francisco Dionisio
Antibiotics 2025, 14(2), 201; https://doi.org/10.3390/antibiotics14020201 - 14 Feb 2025
Abstract
Objectives: Antibiotic-resistant bacteria are widespread, with resistance arising from chromosomal mutations and resistance genes located in the chromosome or in mobile genetic elements. While resistance determinants often reduce bacterial growth rates, their influence on bacterial death under bactericidal antibiotics remains poorly understood. When
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Objectives: Antibiotic-resistant bacteria are widespread, with resistance arising from chromosomal mutations and resistance genes located in the chromosome or in mobile genetic elements. While resistance determinants often reduce bacterial growth rates, their influence on bacterial death under bactericidal antibiotics remains poorly understood. When bacteria are exposed to bactericidal antibiotics to which they are susceptible, they typically undergo a two-phase decline: a fast initial exponentially decaying phase, followed by a persistent slow-decaying phase. This study examined how resistance determinants affect death rates during both phases. Methods: We analyzed the death rates of ampicillin-exposed Escherichia coli populations of strains sensitive to ampicillin but resistant to nalidixic acid, rifampicin, or both, and bacteria carrying the conjugative plasmids RN3 or R702. Results: Single mutants resistant to nalidixic acid or rifampicin decayed faster than sensitive cells during the early phase, whereas the double-resistant mutant exhibited prolonged survival. These contrasting impacts suggest epistatic interactions between both chromosomal mutations. Persistent-phase death rates for chromosomal mutants did not differ significantly from wild-type cells. In contrast, plasmid-carrying bacteria displayed distinct dynamics: R702 plasmid-bearing cells showed higher persistent-phase death rates than plasmid-free cells, while RN3 plasmid-bearing cells exhibited lower rates. Conclusions: Bactericidal antibiotics may kill bacteria resistant to other antibiotics more effectively than wild-type cells. Moreover, epistasis may occur when different resistance determinants occur in the same cell, impacting the bactericidal potential of the antibiotic of choice. These results have significant implications for optimizing bacterial eradication protocols in clinical settings, as well as in animal health and industrial food safety management.
Full article
(This article belongs to the Special Issue Addressing the Challenge of Antibiotic Resistance with Existing Antibiotics)
Open AccessArticle
Antimicrobial Susceptibility Profiles of Commensal Staphylococcus spp. Isolates from Turkeys in Hungarian Poultry Farms Between 2022 and 2023
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László Kovács, Ábel Szabó, Franciska Barnácz, Bence Csirmaz, Ákos Jerzsele and Ádám Kerek
Antibiotics 2025, 14(2), 200; https://doi.org/10.3390/antibiotics14020200 - 14 Feb 2025
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Background: The poultry industry is one of the most rapidly growing sectors, producing the highest amount of animal-derived protein per unit time while also being the second-largest consumer of antibiotics. The widespread and accelerating spread of antimicrobial resistance (AMR) underscores the necessity of
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Background: The poultry industry is one of the most rapidly growing sectors, producing the highest amount of animal-derived protein per unit time while also being the second-largest consumer of antibiotics. The widespread and accelerating spread of antimicrobial resistance (AMR) underscores the necessity of regular monitoring studies. Periodic assessments, especially focusing on commensal strains, can serve as indicators of emerging resistance patterns. Methods: This study assesses the antimicrobial susceptibility profiles of putative commensal Staphylococcus strains (n = 166) isolated from large-scale turkey flocks in Hungary using minimal inhibitory concentration (MIC) determination. The isolated strains were tested against antibiotics of veterinary and public health importance. The results were analyzed using the Kruskal–Wallis test and the Mann–Whitney U test, as well as t-tests. Additionally, correlation analysis and principal component analysis were performed. Results: Our findings revealed the highest resistance rates to tiamulin (90.4%), doxycycline (79.5%), and enrofloxacin (68.7%). Conclusions: These results reflect the extensive antibiotic use in the poultry sector, which contributes to the widespread presence of antimicrobial resistance. As regular monitoring and the identification of trends can aid in mitigating the spread of resistance, these findings should be complemented by data on antibiotic usage at the surveyed farms in further studies. The observed resistance rate of 18.1% to vancomycin is particularly concerning from a public health perspective, given that comparative human data show only a 0.05% resistance rate. Additionally, for multidrug-resistant strains, next-generation sequencing should be utilized to elucidate the genetic mechanisms underlying resistance, particularly in strains exhibiting high levels of resistance to vancomycin, which is of critical importance in human medicine, as well as to the critically important enrofloxacin and the widely used doxycycline and tiamulin. However, the limitations of the study should also be acknowledged, including the relatively small sample size, which is significantly lower than that of available human data, as well as the spatial distribution of the samples.
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Open AccessArticle
Decade-Long Trends in Antibiotic Prescriptions According to WHO AWaRe Classification Among Severe Acute Respiratory Infection Patients at Tertiary Hospitals in Bangladesh (2011–2020)
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Fahmida Chowdhury, Saju Bhuiya, Mohammad Abdul Aleem, Tanzir Ahmed Shuvo, Gazi Md. Salahuddin Mamun, Probir Kumar Ghosh, Lubaba Shahrin, Samin Yasar Khan, Md Ariful Islam and Mahmudur Rahman
Antibiotics 2025, 14(2), 199; https://doi.org/10.3390/antibiotics14020199 - 14 Feb 2025
Abstract
Background: To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO’s AWaRe classification. Methods: We analyzed data from hospital-based influenza surveillance from January
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Background: To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO’s AWaRe classification. Methods: We analyzed data from hospital-based influenza surveillance from January 2011 to December 2020 across nine Bangladeshi tertiary-level hospitals. Surveillance physicians collected WHO-defined SARI patient data, including demographics, clinical characteristics, and antibiotic prescriptions. Descriptive statistics and parametric and non-parametric tests were used for the analysis. Results: Of 21,566 SARI patients [median age 20 years (IQR: 1.33–45), 66% male], 91% were prescribed at least one antibiotic. A total of 25,133 antibiotics were prescribed, of which 47.0% were third-generation cephalosporins, 16.5% were macrolides, and 11.1% were beta-lactam/beta-lactamase inhibitors. According to the AWaRe classification, 28.7% were in the Access group, while 71.3% were in the Watch group, and none were from the Reserve group. A downward trend in Access group (30.4% to 25.1%; p = 0.010) and an upward trend in Watch group antibiotic prescription (69.6% to 74.9%; p = 0.010) were observed. We identified that patients aged < 5 years (aOR: 1.80; 95% CI: 1.44–2.25), who were treated in government hospitals (aOR: 1.45; 95% CI: 1.35–1.57), patients with the presence of lung diseases (aOR: 1.56; 95% CI: 1.35–1.80) had an increased likelihood of being prescribed Watch group antibiotics. Conclusions: This study reveals a concerning pattern of antibiotic overuse among SARI patients in Bangladesh, with a growing trend over the past decade towards increased Watch group antibiotic prescriptions. Only one-third of the prescribed antibiotics were from the Access group, falling short of the two-thirds threshold recommended by the WHO. Effective ASPs are crucial to optimize antibiotic prescriptions and mitigate the risk of antimicrobial resistance.
Full article
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
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Open AccessArticle
Exploring the Therapeutic Potential of Antibiotics in Hyperglycemia-Induced Macrophage Dysfunctions
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Montira Yossapol, Piyarat Srinontong, Worapol Aengwanich, Monchaya Panil, Supissara Somsup, Justice Opare Odoi and Jaroon Wandee
Antibiotics 2025, 14(2), 198; https://doi.org/10.3390/antibiotics14020198 - 14 Feb 2025
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Background: Diabetes mellitus exacerbates immune dysfunction, leading to higher susceptibility to infections. This study investigated the effects of antibiotics on macrophage functions under high glucose conditions to mimic a diabetic context. Methods: Using murine macrophage cell line RAW 264.7, the present study evaluated
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Background: Diabetes mellitus exacerbates immune dysfunction, leading to higher susceptibility to infections. This study investigated the effects of antibiotics on macrophage functions under high glucose conditions to mimic a diabetic context. Methods: Using murine macrophage cell line RAW 264.7, the present study evaluated the cytotoxicity, phagocytosis, bactericidal activity, and pro-inflammatory cytokine production after treatment with four antibiotics: oxytetracycline, ciprofloxacin, sulfamethoxazole–trimethoprim, and cefotaxime. Results: All antibiotics demonstrated no cytotoxicity across 1×–8× MIC concentrations. Hyperglycemia significantly impaired macrophage phagocytosis and bactericidal activity while inducing pro-inflammatory mediator markers, IL-1, IL-6, TNF-α, and iNOS. Only ciprofloxacin significantly improved phagocytic achieving levels comparable to the low glucose control. Treatments with ciprofloxacin, sulfamethoxazole–trimethoprim, and cefotaxime significantly enhanced bactericidal activity without altering the pro-inflammatory cytokine profile. Conclusions: These findings underscore the negative effect of high glucose on macrophage functions and suggest that ciprofloxacin may be a potential therapeutic option for diabetes-associated infections.
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Open AccessArticle
Effect of Inadequate Treatment in Adult Patients with Community-Acquired Acute Pyelonephritis Due to Enterobacterales Under Empirical Management with Cefazolin
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Laura Cristina Nocua-Báez, Patricia Reyes and Jorge Alberto Cortes
Antibiotics 2025, 14(2), 197; https://doi.org/10.3390/antibiotics14020197 - 14 Feb 2025
Abstract
Background/Objectives: First-generation cephalosporins are used in some countries, primarily in Latin America and other low-resource regions, as a first-line or alternative empirical treatment for patients with acute pyelonephritis (AP). This study aimed to evaluate the impact of inappropriate empirical therapy with cefazolin
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Background/Objectives: First-generation cephalosporins are used in some countries, primarily in Latin America and other low-resource regions, as a first-line or alternative empirical treatment for patients with acute pyelonephritis (AP). This study aimed to evaluate the impact of inappropriate empirical therapy with cefazolin on the clinical outcomes of adult patients with community-acquired AP caused by resistant Enterobacterales, requiring hospitalization in two tertiary hospitals in Bogotá. Methods: This retrospective cohort study included hospitalized patients with community-acquired AP caused by Enterobacterales who received initial treatment with cefazolin at two tertiary-level institutions in Colombia (January 2013–2020). Inappropriate treatment was defined as a resistant isolate to cefazolin in the urine culture. Outcomes assessed included hospital stay, hospital mortality, and recurrence. Results: A total of 1031 patients were admitted, among whom 218 (21.1%) received inappropriate treatment. The mean length of stay was 4.8 (5.1) days, 996 (96.6%) survived to discharge, and 113 (11.0%) were admitted for a recurrence of AP. Inappropriate treatment had no impact on hospital stay (RRA 0.98, 95% CI 0.84–1.15) or hospital mortality (OR 1.02, 95% CI 0.47–2.19), although it was associated with a greater risk of admission because of recurrence (OR 3.7, 95% CI 2.4–5.8). Conclusions: We found that inadequate empirical treatment with cefazolin in adult patients with community-acquired acute pyelonephritis does not appear to change the length of hospital stay or in-hospital mortality in patients but is associated with an increased risk of readmission due to recurrence; this might favor the use of empirical narrow-spectrum antibiotics but with strategies that allow monitoring or early detection of microbiological non-eradication to prevent recurrence.
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(This article belongs to the Section Antibiotic Therapy in Infectious Diseases)
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Open AccessArticle
In Vitro Antiviral Activity of a Silydianin-Rich Extract from Silybum marianum Seeds Against Four Strains of Enteroviruses: EV71, Coxsackievirus B2, Coxsackievirus A10, and Poliovirus SL-1 and Its Impact on Improving Delayed Gastric Emptying in Mice
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Houda Zaher, José Francisco Quílez del Moral, Sanae Lemrabet, Neri Koutchala and Bouchaib Bencharki
Antibiotics 2025, 14(2), 196; https://doi.org/10.3390/antibiotics14020196 - 14 Feb 2025
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Background: Gastroparesis, a chronic digestive disorder characterized by delayed gastric emptying, often results from diabetes, post-surgical complications, autoimmune diseases, and neurological disorders. In approximately 50% of cases, the cause is idiopathic gastroparesis (IGD). Recent studies suggest a link between chronic enteroviral infection and
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Background: Gastroparesis, a chronic digestive disorder characterized by delayed gastric emptying, often results from diabetes, post-surgical complications, autoimmune diseases, and neurological disorders. In approximately 50% of cases, the cause is idiopathic gastroparesis (IGD). Recent studies suggest a link between chronic enteroviral infection and persistent gastrointestinal symptoms, including delayed gastric emptying. This study investigates the effects of a silydianin-rich extract from Silybum marianum seeds on enteroviral infections in vitro and the mitigation of delayed gastric emptying in mice. Silydianin, a key bioactive compound known for its liver-protective and antioxidant properties, has not been extensively studied for its impact on enteroviral infections and gastroparesis. Methods: NMR spectroscopy (1H, 13C, DEPT 135 and 2D, and HSQC) and HRMS identified silydianin as the primary compound, with minor flavonolignans. This study assessed the cytotoxicity and antiviral activity of the extract at various stages of the viral life cycle, including virucidal activity, cell protection, and post-infection effects, using neutral red assays in RD cells, with results confirmed by real-time PCR. The viruses studied included coxsackievirus B2, coxsackievirus A10, poliovirus SL-1, and enterovirus EV71. The impact on delayed gastric emptying was evaluated in a mouse model using doses of 100 and 200 mg/kg compared to a control group receiving physiological saline. Results: The silydianin-rich extract showed consistent antiviral activity, with the highest selectivity index (SI) for EV71 (4.08) during virucidal activity. It provided moderate cell protection, with EC50 values ranging from 120.88 to 186.10 µg/mL and SI values from 2.20 to 3.39. Post-infection treatment showed varying efficacy, with coxsackie A10 demonstrating the highest SI (3.90). In vivo, the extract at 200 mg/kg significantly improved gastric emptying to 96.47% and slightly increased gastrointestinal transit from 50.33% to 61.46%. Conclusions: These results suggest that silydianin may be effective for treating enteroviral infections and enhancing intestinal function, making it a promising candidate for gastroparesis treatment and warranting further research.
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Open AccessArticle
Effect of Antibiotics on Clinical and Laboratory Outcomes After Mandibular Third Molar Surgery: A Double-Blind Randomized Clinical Trial
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Fatemeh Soleymani, José Eduardo Maté Sánchez de Val, Artiom Lijnev, Mehrdad Makiabadi and Carlos Pérez-Albacete Martínez
Antibiotics 2025, 14(2), 195; https://doi.org/10.3390/antibiotics14020195 - 13 Feb 2025
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Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third
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Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third molar extraction were randomly assigned to two groups: an experimental group (EG) receiving 2 g of amoxicillin and a placebo group (PG) receiving empty capsules, one hour before the surgery and before taking the first saliva sample. Primary outcomes measured were pain levels at different time points and salivary PGE2 concentrations measured before, 24 h, and 7 days after the surgery, while secondary outcomes included changes in maximum mouth opening (MMO) immediately after the surgery at 1 day and a week post-surgery, and facial swelling at 24 h and 7 days post-surgery. Results: The results showed no significant differences between the EG and PG in terms of pain levels, salivary PGE2 concentration, MMO changes, or facial swelling at different time points (p-values > 0.05). One instance of surgical site infection was noted in the PG in the 7-day follow-up session, but it was not statistically significant (p-value = 0.303). Correlation analyses indicated that a higher number of sutures and a higher difficulty index of surgery were associated with increased pain, while longer surgery duration and osteotomy were linked to more MMO changes and facial swelling (p-values < 0.05). In addition, while longer surgery duration and performing tooth section were correlated with lower PGE2 concentrations, PGE2 concentrations were positively correlated with pain levels (p-values < 0.05). Conclusions: Based on the results of this study, administering 2 g of prophylactic amoxicillin did not significantly affect postoperative clinical or laboratory outcomes in healthy patients undergoing mandibular third molar surgery.
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Open AccessArticle
Structural Characterization of the Dimers and Selective Synthesis of the Cyclic Analogues of the Antimicrobial Peptide Cm-p5
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Fidel E. Morales-Vicente, Luis A. Espinosa, Erbio Díaz-Pico, Ernesto M. Martell, Melaine Gonzalez, Gerardo Ojeda, Luis Javier González, Armando Rodríguez, Hilda E. Garay, Octavio L. Franco, Frank Rosenau, Anselmo J. Otero-González and Ludger Ständker
Antibiotics 2025, 14(2), 194; https://doi.org/10.3390/antibiotics14020194 - 13 Feb 2025
Abstract
Background/Objectives: Cm-p5 and its cyclic monomeric and dimeric analogues are known for their antifungal, antibacterial, antiviral, and antibiofilm activities. Previously, our cyclization method produced a mixture of peptides that were difficult to separate, which was then improved by a selective synthesis of
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Background/Objectives: Cm-p5 and its cyclic monomeric and dimeric analogues are known for their antifungal, antibacterial, antiviral, and antibiofilm activities. Previously, our cyclization method produced a mixture of peptides that were difficult to separate, which was then improved by a selective synthesis of the parallel dimer and its differentiation from the antiparallel by comparison of the retention times in RP-HPLC. Methods: Here, we developed a more reliable identification method for the Cm-p5 dimer identification, which included chymotrypsin proteolytic digestion and sequencing of the different fragments by ESI-MSMS. We also improved our cyclization methods to specifically produce higher amounts of the desired cyclic variant, either cyclic monomer or dimer. Results: We show that liquid phase oxidation with 20% DMSO or iodine oxidation yields only the cyclic analogue. However, the on-resin oxidation with iodine showed greater efficacy and efficiency. Additionally, liquid phase cyclization yields the antiparallel dimer in high EtOH or peptide concentration, indicating a kinetic control. On the other hand, the parallel dimer was preferentially produced in 5% of TFE and low peptide concentration without the formation of the cyclic analogue indicating a thermodynamic control. Conclusions: In conclusion, we report that chymotryptic digestion combined with ESI-MS and MS/MS allows an unambiguous differentiation of Cm-p5 dimers. Here, we develop more selective and efficient methods for the synthesis of cyclic and dimeric analogues of Cm-p5.
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(This article belongs to the Special Issue Antimicrobial Activity of Bioactive Peptides and Their Derivatives)
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Open AccessArticle
Population-Based Prevalence of Antibiotic Residuals in Low, Moderate and High Malaria Endemicity Areas in Tanzania
by
Theopista Lotto, Joanna Gallay, Martin Zuakulu, Beatrice Ternon, Laurent Arthur Decosterd, Alexandra V. Kulinkina and Blaise Genton
Antibiotics 2025, 14(2), 193; https://doi.org/10.3390/antibiotics14020193 - 13 Feb 2025
Abstract
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Background: Inappropriate antibiotic use drives antimicrobial resistance and remains a global concern. Evidence suggests antibiotic use may be higher among malaria-negative patients compared to malaria-positive ones, but uncertainty persists, particularly in regions with varying malaria prevalence. This study measured antibiotic residuals in three
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Background: Inappropriate antibiotic use drives antimicrobial resistance and remains a global concern. Evidence suggests antibiotic use may be higher among malaria-negative patients compared to malaria-positive ones, but uncertainty persists, particularly in regions with varying malaria prevalence. This study measured antibiotic residuals in three Tanzanian regions with varying malaria epidemiology and analyzed factors influencing their presence. Methods: A cross-sectional household survey was conducted in 2015, covering a population of 6000 individuals across three regions of Tanzania. Dried blood spot samples from a subset of participants were analyzed using broad-range tandem mass spectrometry to detect residual antibiotics. Risk factors associated with antibiotic presence, including household healthcare-seeking behaviors, malaria testing, and other relevant variables, were evaluated. Results: The overall prevalence of residual antibiotics in the study population was 14.4% (438/3036; 95% CI: 11.4–15.8%). Stratified by malaria transmission intensity, antibiotic prevalence was 17.2% (95% CI: 12.9–17.2%) in Mwanza (low), 14.6% (95% CI: 10.6–15.0%) in Mbeya (moderate), and 11.2% (95% CI: 7.9–11.6%) in Mtwara (high). Trimethoprim was the most frequently detected antibiotic (6.1%), followed by sulfamethoxazole (4.4%) and penicillin V (0.001%). Conclusions: Residual antibiotic prevalence did not directly correlate with malaria endemicity but was influenced by healthcare practices, including co-prescription of antibiotics and antimalarials. The higher antibiotic use in malaria-negative cases highlights the need for improved diagnostics to reduce unnecessary use and mitigate antimicrobial resistance in malaria-endemic areas.
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Open AccessArticle
Antibiotic and Heavy Metal Resistance in Bacteria from Contaminated Agricultural Soil: Insights from a New Zealand Airstrip
by
Ali Heydari, Nick D. Kim, Patrick J. Biggs, Jacqui Horswell, Gerty J. H. P. Gielen, Alma Siggins, Collette Bromhead, Juan Carlos Meza-Alvarado and Barry R. Palmer
Antibiotics 2025, 14(2), 192; https://doi.org/10.3390/antibiotics14020192 - 13 Feb 2025
Abstract
Background/Objectives: Agricultural soils accumulate inorganic contaminants from the application of phosphate fertilisers. An airstrip located at Belmont Regional Park (BRP), near Wellington, New Zealand, has been found to have a gradient of cadmium contamination due to spillage of superphosphate fertiliser. Methods: Soil samples
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Background/Objectives: Agricultural soils accumulate inorganic contaminants from the application of phosphate fertilisers. An airstrip located at Belmont Regional Park (BRP), near Wellington, New Zealand, has been found to have a gradient of cadmium contamination due to spillage of superphosphate fertiliser. Methods: Soil samples from the BRP airstrip with a gradient of cadmium contamination, were used as a novel source to explore bacterial communities’ resistance to heavy metals (HMs) and any co-selected antibiotic (Ab) resistance. Results: Differences between BRP soil samples with higher levels of HMs compared to those with lower HM concentrations showed significantly more bacterial isolates resistant to both HMs (40.6% versus 63.1% resistant to 0.01 mM CdCl2, p < 0.05) and Abs (23.4% versus 37.8% resistant to 20 μg/mL tetracycline, p < 0.05) in soils with higher initial levels of HMs (1.14 versus 7.20 mg kg−1 Cd). Terminal restriction fragment length polymorphism (TRFLP) and 16S rDNA next-generation sequencing profiling investigated changes in HM-induced bacterial communities. Significant differences were observed among the bacterial community structures in the selected BRP soil samples. Conjugative transfer of cadmium resistance from 23–38% of cadmium-resistant isolates to a characterised recipient bacterial strain in vitro suggested many of these genes were carried by mobile genetic elements. Transconjugants were also resistant to zinc, mercury, and Abs. Higher levels of HMs in soil correlated with increased resistance to HMs, Abs, and elevated levels of HMs thus disturbed the bacterial community structure in BRP soil significantly. Conclusions: These findings suggest that HM contamination of agricultural soil can select for Ab resistance in soil bacteria with potential risks to human and animal health.
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(This article belongs to the Special Issue Antimicrobial Resistance and Environmental Health, 2nd Edition)
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Open AccessArticle
Prophage ϕSA169 Enhances Vancomycin Persistence in Methicillin-Resistant Staphylococcus aureus (MRSA)
by
Yi Li, Andrew D. Berti, Wessam Abdelhady and Yan Q. Xiong
Antibiotics 2025, 14(2), 191; https://doi.org/10.3390/antibiotics14020191 - 13 Feb 2025
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Background: Persistent methicillin-resistant Staphylococcus aureus (MRSA) endovascular infections present a significant clinical therapeutic challenge. Prophages are increasingly recognized as important genetic factors influencing the pathogenicity of S. aureus, yet their role in antibiotic persistence in MRSA remains underexplored. Our previous work demonstrated
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Background: Persistent methicillin-resistant Staphylococcus aureus (MRSA) endovascular infections present a significant clinical therapeutic challenge. Prophages are increasingly recognized as important genetic factors influencing the pathogenicity of S. aureus, yet their role in antibiotic persistence in MRSA remains underexplored. Our previous work demonstrated that prophage ϕSA169 promotes vancomycin (VAN) persistence in an experimental model of endocarditis caused by MRSA strains with a clonal complex (CC) 45 genetic background. However, it is unknown whether this persistence-promoting effect of ϕSA169 extends to other clinically relevant MRSA lineages. This study aims to elucidate the role of ϕSA169 in influencing VAN persistence across diverse MRSA genetic backgrounds. Methods: A pilot analysis of clinical data suggested that patients infected by MRSA containing ϕSA169-like prophage appear to have worse clinical outcomes. Thus, we lysogenized representative clinical resolving bacteremia (RB) MRSA strains with ϕSA169 and evaluated phenotypes closely associated with VAN persistence, including VAN susceptibility, biofilm formation, and the efficacy of VAN treatment in an experimental infective endocarditis (IE) model. Each ϕSA169 lysogenic strain was compared to its isogenic MRSA parental counterpart. Results: ϕSA169 lysogeny significantly promotes biofilm formation and enhances survival to VAN exposure under human-mimicking conditions for RB strains from CC5 and CC30. ϕSA169 lysogeny significantly reduces VAN effectiveness in the IE model due to RB lysogen from CC5 despite no detectable impact on VAN MICs. Conclusions: These results indicate that ϕSA169 promotes VAN persistence across clonal backgrounds, likely through biofilm formation and VAN tolerance. Targeting prophage could provide new strategies to combat persistent MRSA infections.
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Open AccessArticle
Multidose Dalbavancin Population Pharmacokinetic Analysis for Prolonged Target Attainment in Patients Requiring Long-Term Treatment
by
Giammarco Baiardi, Michela Cameran Caviglia, Silvia Boni, Antonello Di Paolo, Valeria Marini, Giuliana Cangemi, Alessia Cafaro, Emanuele Pontali and Francesca Mattioli
Antibiotics 2025, 14(2), 190; https://doi.org/10.3390/antibiotics14020190 - 13 Feb 2025
Abstract
Introduction: Dalbavancin (DAL) is a long-acting lipoglycopeptide active against Gram-positive bacteria, including multidrug-resistant isolates. A growing body of evidence supports its efficacy in various difficult-to-treat infections. DAL shows time-dependent bactericidal activity in vitro at free drug concentrations equal to 4×MIC values. However, the
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Introduction: Dalbavancin (DAL) is a long-acting lipoglycopeptide active against Gram-positive bacteria, including multidrug-resistant isolates. A growing body of evidence supports its efficacy in various difficult-to-treat infections. DAL shows time-dependent bactericidal activity in vitro at free drug concentrations equal to 4×MIC values. However, the optimal dosing scheme for achieving the PK/PD target in multidose treatment has not been fully established. Methods: Pharmacokinetic analysis was based on a nonlinear mixed effects modelling approach performed in NONMEM v7.5/Pirana, while R was used for data management and graphical summaries. Final model parameters were used to simulate the plasma disposition of DAL by Monte Carlo simulations to determine the multidose DAL regimen associated with a 90% target attainment of 100% fT > 4×MIC. Results: A two-compartmental model with first-order elimination and allometric-scaled bodyweight best described DAL disposition in patients with CLcr > 30 mL/min. Monte Carlo simulations showed that two 1500 mg DAL doses 7 days apart granted an optimal PTA > 90% of 100% fT > 4×MIC up to 5, 4, and 3 weeks in patients weighting from 40–80 kg, 80–120 kg and 120–200 kg, respectively. An additional third 1500 mg dose at the above time points by weight bands may extend the optimal PTA up to 9, 7, and 6 weeks of total treatment. Conclusions: Two 1500 mg DAL doses administered 7 days apart could be a valuable starting strategy for patients of all weight classes with CLcr > 30 mL/min. In patients requiring long-term DAL treatment, the optimal timing of additional administrations should be guided by routine TDM or empirically through patients’ total body weight when TDM is unavailable.
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(This article belongs to the Section Pharmacokinetics and Pharmacodynamics of Drugs)
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Antibiotic-Resistant Salmonella Circulation in the Human Population in Campania Region (2010–2023)
by
Maria Francesca Peruzy, Nicoletta Murru, Maria Rosaria Carullo, Immacolata La Tela, Antonio Rippa, Anna Balestrieri and Yolande Thérèse Rose Proroga
Antibiotics 2025, 14(2), 189; https://doi.org/10.3390/antibiotics14020189 - 12 Feb 2025
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Background/Objectives: A retrospective study was conducted to evaluate antibiotic resistance among Salmonella strains isolated during human infection using data from the computer database (SIGLA) of the Salmonella Typing Center (Ce.Ti.Sa) of the Istituto Zooprofilattico del Mezzogiorno (IZSM). Methods: From 2010 to
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Background/Objectives: A retrospective study was conducted to evaluate antibiotic resistance among Salmonella strains isolated during human infection using data from the computer database (SIGLA) of the Salmonella Typing Center (Ce.Ti.Sa) of the Istituto Zooprofilattico del Mezzogiorno (IZSM). Methods: From 2010 to 2023, the Ce.Ti.Sa laboratory tested 680 Salmonella strains against the following: amoxicillin/clavulanic acid, ampicillin, azithromycin, cefixime, cefoxitin, cefotaxime, ceftazidime, chloramphenicol, ciprofloxacin, colistin, erythromycin, gentamicin, kanamycin, meropenem, nalidixic acid, pefloxacin, streptomycin, sulfisoxazole, sulfonamides, tetracyclines, tigecycline, and trimethoprim. Results: The most common serovars were S. monophasic Typhimurium (23.2%), S. Enteritidis (16.8%), and S. Typhimurium (16.0%). Nearly all strains were resistant to azithromycin (99.4%) and showed high resistance to sulphonamides, tetracycline, streptomycin, and ampicillin. The study found that 45.8% of strains exhibited multidrug resistance. Resistance to ciprofloxacin increased over time. Serovar-specific resistance varied: S. monophasic Typhimurium was resistant to azithromycin (100.0%), tetracycline (93.0%), and ampicillin (92.4%); S. Enteritidis showed 100.0% resistance to azithromycin; S. Typhimurium had high resistance to azithromycin, streptomycin, and ampicillin; and S. Infantis was resistant to erythromycin, sulfonamides, and azithromycin. Conclusions: The study highlights a troubling prevalence of Salmonella-resistant strains, emphasizing the need for infection prevention, proper antibiotic use in humans and animals, and the development of new antibiotics.
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Clonality, Virulence Genes, and Antimicrobial Resistance of Dairy Ruminants in Mastitic Milk-Associated Staphylococcus aureus in Sicily
by
Nunziatina Russo, Nunzio Alberto Fazio, Francesca Licitra, Joanna Gajewska, Alessandro Stamilla, Rosario Salonia, Wioleta Chajęcka-Wierzchowska, Cinzia L. Randazzo, Cinzia Caggia, Francesco Antoci and Giuseppe Cascone
Antibiotics 2025, 14(2), 188; https://doi.org/10.3390/antibiotics14020188 - 12 Feb 2025
Abstract
Background: Staphylococcus aureus is one of the most prevalent pathogens causing mastitis in dairy animals and represents a serious issue of public health concern due to its resistance against multiple antimicrobials. Objectives: This study assessed 101 S. aureus isolates obtained from
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Background: Staphylococcus aureus is one of the most prevalent pathogens causing mastitis in dairy animals and represents a serious issue of public health concern due to its resistance against multiple antimicrobials. Objectives: This study assessed 101 S. aureus isolates obtained from quarter milk of animals with subclinical mastitis in the Ragusa area (Sicily, Italy). Methods: Antibiotic resistance against nine antibiotics was evaluated using the Kirby–Bauer method, and the Minimum Inhibitory Concentration (MIC) values were measured for oxacillin (OXA) and vancomycin (VA). Additionally, the isolates were genetically characterized through multiplex PCR to identify the presence of spa, mecA, mecC, pvl, vanA, vanB, and vanC genes, along with pulsed-field gel electrophoresis analysis and multi-locus sequence typing (MLST). Results: The highest rates of antibiotic resistance were found against gentamicin (47.5%) and erythromycin (29.7%), with 86.1% of strains exhibiting resistance to at least two antimicrobials and 33.7% showing resistance to three antimicrobial classes. Furthermore, the results indicated that the presence of antibiotic resistance genes was not correlated with phenotypic resistance, and a phylogenetic analysis revealed varying phenotypic resistance profiles even within the same PFGE cluster. Lastly, alongside a new allelic profile ST 9471, MLST analysis identified five additional STs clustered into three CCs, with CC5 originating from human ancestral strains through human-to-animal host transfers, making it the dominant group. Conclusions: This study provided valuable insights into regional trends, allowing for the identification of significant antibiotic-resistant patterns and offering an understanding of bacterial dynamics in these environments, underscoring the importance of routine resistance surveillance in dairy farms.
Full article
(This article belongs to the Special Issue Antimicrobial Resistance of Pathogens Isolated from Bovine Mastitis)
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Open AccessArticle
The Clinical Implications of Inappropriate Therapy in Community-Onset Urinary Tract Infections and the Development of a Bayesian Hierarchical Weighted-Incidence Syndromic Combination Antibiogram
by
Adolfo Gómez-Quiroz, Brenda Berenice Avila-Cardenas, Judith Carolina De Arcos-Jiménez, Leonardo Perales-Guerrero, Pedro Martínez-Ayala and Jaime Briseno-Ramirez
Antibiotics 2025, 14(2), 187; https://doi.org/10.3390/antibiotics14020187 - 12 Feb 2025
Abstract
Background/Objectives: The rise in multidrug-resistant pathogens complicates UTI management, particularly in empirical therapy. This study aimed to develop and describe a Bayesian hierarchical weighted-incidence syndromic combination antibiogram (WISCA) model to optimize antibiotic selection for adult patients with community-onset UTIs. Methods: A retrospective study
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Background/Objectives: The rise in multidrug-resistant pathogens complicates UTI management, particularly in empirical therapy. This study aimed to develop and describe a Bayesian hierarchical weighted-incidence syndromic combination antibiogram (WISCA) model to optimize antibiotic selection for adult patients with community-onset UTIs. Methods: A retrospective study was conducted using a Bayesian hierarchical model. Data from microbiology laboratory records and medical databases were analyzed, focusing on age, prior antibiotic exposure, and clinical characteristics. Clinical outcomes, including extended hospital stays and in-hospital mortality, were evaluated before WISCA model development. Unlike traditional antibiograms, a WISCA integrates patient-specific factors to improve antimicrobial coverage estimations. A total of 11 monotherapies and 18 combination therapies were tested against 15 pathogens, with posterior coverage probabilities and 95% highest density intervals (HDIs) used to assess coverage. Results: Inappropriate final antibiotic treatment was associated with worse outcomes. The Bayesian framework improved estimations, particularly for rare pathogen–antibiotic interactions, increasing model applicability in high-resistance settings. Combination regimens showed superior coverage, especially in MDR cases and older adults. Conclusions: This study employed a comprehensive methodological approach for WISCA development, enhancing empirical antibiotic selection by incorporating local resistance data and patient-specific factors in a middle-income Latin American country with a high antimicrobial resistance profile. These findings provide a foundation for future clinical applications and antimicrobial stewardship strategies in high-resistance environments.
Full article
(This article belongs to the Special Issue The Battle Against Urinary Tract Infections: The Role of Antibiotics)
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