Antibiotics

19 pages, 2727 KB

Open AccessArticle

Efflux-Mediated Macrolide Resistance in Clinical Streptococcus Isolates: A Comparative Molecular Study

by Salsabeel M. Moshewh, Salma E. Mohamed, Praveen Kumar, Abdelgadir E. Eltom, Supriya R. Jagdale, Einas A. Osman, Saher S. Ahmed, Nour A. M. Farajallah and Sara Ali

Antibiotics 2025, 14(11), 1148; https://doi.org/10.3390/antibiotics14111148 - 13 Nov 2025

Abstract

Background: Efflux-mediated macrolide resistance represents an emerging threat in Streptococcus infections globally. However, molecular epidemiological data from the Gulf region, particularly the United Arab Emirates (UAE), remain limited. This study addresses this knowledge gap by investigating efflux pump resistance mechanisms in clinical Streptococcus [...] Read more.

Background: Efflux-mediated macrolide resistance represents an emerging threat in Streptococcus infections globally. However, molecular epidemiological data from the Gulf region, particularly the United Arab Emirates (UAE), remain limited. This study addresses this knowledge gap by investigating efflux pump resistance mechanisms in clinical Streptococcus isolates. Methods: A cross-sectional study analyzed 100 clinical isolates (99 Streptococcus and 1 Enterococcus) from Thumbay Hospital, Ajman, UAE (October–December 2024). Antimicrobial susceptibility testing for minimum inhibitory concentration (MIC) determination was performed using the DxM 1096 MicroScan WalkAway system (Beckman Coulter Inc., Brea, CA, USA; LabProv4.42). PCR detected mef(A/E), msr(D), and tet(K) resistance genes with sequencing confirmation. Comparative genomic analysis was performed using a total of 30 publicly available Streptococcus genomes: 15 from India and 15 from Saudi Arabia. Statistical analysis employed chi-square tests, Fisher’s exact tests, and multivariate logistic regression with Bonferroni correction (α = 0.05). Results: Among the isolates, erythromycin resistance occurred in 39 isolates (39%, 95% CI: 29.4–49.2%) and clindamycin resistance in 31 isolates (31%, 95% CI: 22.1–40.9%). The mef(A/E) gene was detected in 31 isolates (31%, 95% CI: 22.1–40.9%), and msr(D) in 3 isolates (3%, 95% CI: 0.6–8.5%), with co-occurrence in 3 isolates (3%). No isolates harbored tet(K). Multivariate analysis identified mef(A/E) as the strongest predictor of macrolide resistance (OR = 18.7, 95% CI: 7.9–44.2, p < 0.001). Regional comparison revealed significant differences: mef(A/E) prevalence was 31% (UAE), 87% (India), and 0% (Saudi Arabia) (p < 0.001). Conclusions: This study provides the first molecular characterization of efflux-mediated macrolide resistance in UAE Streptococcus isolates. The predominance of mef(A/E)-mediated resistance with confirmed efflux activity highlights the clinical significance of active surveillance and targeted antimicrobial stewardship in the region. Full article

(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)

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11 pages, 769 KB

Open AccessArticle

Recurrent and Multidrug-Resistant UTI Treatments in Kidney Transplant Patients: A Retrospective Study from Saudi Arabia

by Khalid A. Alzahrani, Redwan Y. Mirdad, Anas T. Khogeer, Buthainah B. Alammash, Abdulfattah Y. Alhazmi, Nouf E. Alotaibi, Abdullah S. Alshammari, Abdulmalik S. Alotaibi and Mohammed A. Alnuhait

Antibiotics 2025, 14(11), 1147; https://doi.org/10.3390/antibiotics14111147 - 13 Nov 2025

Abstract

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia and from 4.5% to 85% in the Middle East. These infections can significantly impact [...] Read more.

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia and from 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mortality. Escherichia coli is the leading cause of UTIs in transplant patients, but multidrug-resistant (MDR) pathogens are a growing concern, especially in Saudi Arabia. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multidrug-resistant UTIs in kidney transplant recipients. Methods: This retrospective cohort study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia, between March and May 2022. Adult patients (≥18 years) who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. Results: Seventy-five of 491 screened patients (15.3%) experienced recurrent UTIs, contributing to a total of 219 episodes. Klebsiella pneumoniae was the most frequent pathogen, isolated in 94 episodes (42.9%). Key risk factors for recurrence included complicated UTIs (OR = 4.60, p = 0.005), multidrug-resistant organisms (MDROs) (OR = 3.14, p = 0.021), and ureteric stents (OR = 4.07, p = 0.042). Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillins were used for uncomplicated infections. A significant post-UTI rise in serum creatinine was observed (p < 0.001). Conclusions: Recurrent UTIs predominantly caused by K. pneumoniae are common in kidney transplant recipients, particularly in patients over 45, with multidrug-resistant organisms, or with ureteric stents. While a direct causal link to graft loss was not established, these infections can lead to increased creatinine levels, hospitalizations, and healthcare costs and increased carbapenem use. These findings highlight the critical need for institution-specific antimicrobial stewardship programs focused on infection prevention and optimized antibiotic use to improve outcomes in this vulnerable population. Full article

(This article belongs to the Special Issue The Battle Against Urinary Tract Infections: The Role of Antibiotics)

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13 pages, 539 KB

Open AccessArticle

Genomic and Phenotypic Characterization of Two High-Risk Klebsiella pneumoniae Clones (ST258-blaKPC-2 and ST11-blaNDM-1) from a Greek Tertiary Hospital

by Ilias S. Frydas, Emmanouil Kouklakis, Georgios Meletis, Andigoni Malousi, Maria Anna Kyriazidi, Fani Chatzopoulou, Irini Amargianitaki, Kallirhoe Kalinderi, Maria Mavridou, Stella Mitka, Evangelia Panagiotaki and Maria Chatzidimitriou

Antibiotics 2025, 14(11), 1146; https://doi.org/10.3390/antibiotics14111146 - 12 Nov 2025

Abstract

Background/Objectives: Klebsiella pneumoniae ST258 and ST11 are global high-risk antimicrobial-resistant clones known for their virulence and resistance gene dissemination. This study aims to identify these clones in a Greek tertiary hospital and understand their resistance profiles and transmission dynamics. Methods: In [...] Read more.

Background/Objectives: Klebsiella pneumoniae ST258 and ST11 are global high-risk antimicrobial-resistant clones known for their virulence and resistance gene dissemination. This study aims to identify these clones in a Greek tertiary hospital and understand their resistance profiles and transmission dynamics. Methods: In January 2025, we isolated two distinct carbapenem-resistant K. pneumoniae in a Greek tertiary hospital: INT18S from an ICU patient’s bronchioalveolar lavage and INT20U from a urine sample in the emergency unit. Antimicrobial susceptibility testing (via Microscan system) and Whole-Genome Sequencing (WGS) were conducted on both isolates and their genomes were submitted to the NCBI. Results: The INT18S isolate carried the bla_KPC-2 gene and belonged to the ST258 clone. The INT20U isolate carried the bla_NDM-1 gene and belonged to the ST11 clone lineage. Both isolates contained at least one of the extended spectra β-lactamase genes tested (TEM, SHV, OXA-1 and CTX-M group). Conclusions: The co-existence of the high-risk K. pneumoniae clones ST258 and ST11 in different hospital departments increases the risk of resistance gene transfer and suggests potential intra-hospital transmission pathways. Understanding their resistance profiles is critical for guiding treatment strategies and preventing the spread of multidrug-resistant pathogens. Full article

(This article belongs to the Special Issue Recent Developments in Antimicrobial Resistance Epidemiology and Antimicrobial Therapy for Clinically Relevant Bacteria)

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16 pages, 2594 KB

Open AccessArticle

The Potential Roles of Prophages in the Pathogenicity of Klebsiella pneumoniae Strains from Kenya

by Juliah K. Akhwale, Ivy J. Mutai and Janet Y. Nale

Antibiotics 2025, 14(11), 1145; https://doi.org/10.3390/antibiotics14111145 (registering DOI) - 12 Nov 2025

Abstract

Background/Objectives: Antimicrobial resistance (AMR) in Klebsiella pneumoniae poses a serious threat to healthcare, especially in sub-Saharan Africa (SSA). To complement AMR infection control in Kenya, here, clinical and environmental genomes were investigated to determine the potential roles prophages play in K. pneumoniae pathogenicity. [...] Read more.

Background/Objectives: Antimicrobial resistance (AMR) in Klebsiella pneumoniae poses a serious threat to healthcare, especially in sub-Saharan Africa (SSA). To complement AMR infection control in Kenya, here, clinical and environmental genomes were investigated to determine the potential roles prophages play in K. pneumoniae pathogenicity. Methods: Prophages were extracted from 89 Kenyan K. pneumoniae genomes. The intact prophages were examined for virulence genes carriage, and their phylogenetic relationships were established. Results: Eighty-eight (~99%) of the genomes encode at least a single prophage, and there is an average of four prophages and 2.8% contributory genomes per bacterial strain. From the 364 prophages identified, 250 (68.7%) were intact, while 58 (15.9%) and 57 (15.7%) were questionable and incomplete, respectively. Approximately, 30% of the intact prophages encode 38 virulence genes that are linked to iron uptake (8), regulation (6), adherence (5), secretion system (4), antiphagocytosis (4), autotransporter (4), immune modulation (3), invasion (2), toxin (1) and cell surface/capsule (1). Phylogenetic analyses revealed three distinct clades of the intact prophages irrespective of their hosts, sources and locations, which support the plasticity of the genomes and potential to mediate horizontal gene transfer. Conclusions: This study provides first evidence showing the diverse prophages that are encoded in K. pneumoniae from SSA with particular focus on Kenyan strains. This also shows the potential roles these prophages play in the pathogenicity and success of K. pneumoniae and could improve knowledge and complement control strategies in the region and across the globe. Further work is needed to show the expression of these genes through lysogenisation. Full article

(This article belongs to the Special Issue Combating Antimicrobial Resistance Spread in Food and Drinks Using Bacteriophage Technologies)

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13 pages, 2733 KB

Open AccessArticle

The Domination of Penicillin G Degradation in Natural Surface Water: Effect of Calcium Ion and Biological Dissolved Organic Matter

by Feng Sheng, Jingyi Ling, Na Mi, Jixing Wan, Lu Yang, Ming Li, Chao Wang and Jiaqi Shi

Antibiotics 2025, 14(11), 1144; https://doi.org/10.3390/antibiotics14111144 - 11 Nov 2025

Abstract

Background: Although hydrolysis and photolysis are important pathways for penicillin antibiotics degradation in aquatic ecosystems, the degradation mechanism of penicillin antibiotics in real natural waters is rarely reported. Furthermore, the dominant factors influencing this process are poorly understood. Methods: Therefore, five natural waters [...] Read more.

Background: Although hydrolysis and photolysis are important pathways for penicillin antibiotics degradation in aquatic ecosystems, the degradation mechanism of penicillin antibiotics in real natural waters is rarely reported. Furthermore, the dominant factors influencing this process are poorly understood. Methods: Therefore, five natural waters were selected to simulate both the hydrolysis and photolysis processes of penicillin G (PG) in aqueous environments. Results: Our results demonstrated that the half-life of PG hydrolysis ranged from 44 h to 141 h in natural water, and aqueous Ca²⁺ ion was the most important factor controlling the hydrolytic degradation of PG. Moreover, several biological dissolved organic matter (DOM, microbial by-product compounds) could also promote the PG hydrolysis reaction. Direct photolysis of PG is dominated in natural water, for which half-life photodegradation rates were 6 h in both blank and natural water, suggesting that salinity and DOM have little influence on penicillin photolysis. The hydrolysis reaction mainly involved the cleavage of the ester bond in the β-lactam ring and a decarboxylation process, while photolysis degradation principally included the hydroxylation of the benzene ring and destruction of the thiazole ring. Conclusions: This study demonstrates the significant factors influencing hydrolysis and photolysis of penicillin antibiotics in an aquatic ecosystem, which can improve the estimates of ecological risk of antibiotic pharmaceuticals in a realistic environment. Full article

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13 pages, 2539 KB

Open AccessArticle

Phylogenomics and Antimicrobial Resistance of Clinical Bacteroides Isolates from a Tertiary Hospital in Southern Thailand

by Mingkwan Yingkajorn, Thunchanok Yaikhan, Worawut Duangsi-Ngoen, Chollachai Klaysubun, Thitaporn Dechathai, Sarunyou Chusri, Kamonnut Singkhamanan, Rattanaruji Pomwised, Monwadee Wonglapsuwan and Komwit Surachat

Antibiotics 2025, 14(11), 1143; https://doi.org/10.3390/antibiotics14111143 - 11 Nov 2025

Abstract

Background/Objectives: Bacteroides species are key members of the human gut microbiota but can act as opportunistic pathogens. This study investigated the genomic features of clinical Bacteroides isolates from southern Thailand. Methods: Sixteen isolates were collected from body fluids, tissues, and pus [...] Read more.

Background/Objectives: Bacteroides species are key members of the human gut microbiota but can act as opportunistic pathogens. This study investigated the genomic features of clinical Bacteroides isolates from southern Thailand. Methods: Sixteen isolates were collected from body fluids, tissues, and pus at Songklanagarind Hospital (2022–2024). Whole-genome sequencing was performed on the BGI platform, followed by genome assembly, annotation, average nucleotide identity (ANI), pairwise single-nucleotide polymorphism (SNP) analysis, antimicrobial resistance (AMR) gene profiling, plasmid prediction, virulence screening, and phylogenetic analysis. Results: ANI and SNP analysis revealed two clusters: one comprising B. ovatus, B. intestinigallinarum, and B. thetaiotaomicron, and another mainly B. fragilis with one B. hominis isolate. All isolates were resistant to ampicillin, cephalothin, and penicillin; six B. fragilis strains were resistant to all tested antibiotics. The β-lactamase gene cepA was detected in all B. fragilis isolates, and plasmids were predicted in two genomes. Three virulence types (capsule formation, lipopolysaccharide modification, and stress response) were identified. Phylogenomic analysis confirmed species-level assignments and revealed underrecognized lineages, emphasizing the value of genome-based approaches for accurate classification. Conclusions: Clinical Bacteroides isolates display diverse resistance and virulence profiles, highlighting the importance of strain-level genomic surveillance. Full article

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13 pages, 522 KB

Open AccessArticle

Bacterial Profile and Antibiotic Resistance of ESKAPEE Pathogens Isolated in Intensive Care Units from Blood Cultures: A Cross-Sectional Study from Abu Dhabi, United Arab Emirates (2018–2022)

by Ayesha Abdulla Al Marzooqi, Maryam Mohammed Bashir, Mohammed Ahmed Khogali, Abubaker Suliman, Collins Timire, Farida Ismail Al Hosani and Faisal Musleh Al Ahbabi

Antibiotics 2025, 14(11), 1142; https://doi.org/10.3390/antibiotics14111142 - 11 Nov 2025

Abstract

Background: Antibiotic resistance is a significant health problem in healthcare settings, especially intensive care units (ICUs), where patients are critically ill. This study aims to identify the bacterial profile and antibiotic resistance patterns of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, [...] Read more.

Background: Antibiotic resistance is a significant health problem in healthcare settings, especially intensive care units (ICUs), where patients are critically ill. This study aims to identify the bacterial profile and antibiotic resistance patterns of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli (ESKAPEE) in blood specimens collected from adult patients admitted to the ICUs of public hospitals in Abu Dhabi, United Arab Emirates. The World Health Organization lists these pathogens as priority pathogens that greatly threaten humans. Methods: This cross-sectional study used routinely collected data through the AMR surveillance system between 2018 and 2022. Results: A total of 838 culture-positive blood specimens were reported during the study period, and 965 ESKAPEE pathogens were isolated. The most frequently isolated bacteria were Klebsiella pneumoniae (31%), Escherichia coli (22%), and Staphylococcus aureus (20%). Acinetobacter baumannii exhibited high resistance to Amikacin (81%), Meropenem (72%), and Imipenem (87%). Escherichia coli demonstrated resistance to Imipenem (42%) and Cefotaxime (54%). Klebsiella pneumoniae showed resistance to Imipenem (37%) and Cefotaxime (39%). Staphylococcus aureus showed resistance to Penicillin G (80%), Oxacillin (4%), and Ciprofloxacin (54%). Conclusions: The study showed a high prevalence of resistance in the most frequently isolated ESKAPEE pathogens in adult ICU patients. This brings into focus the need for appropriate infection control measures and strong antibiotic stewardship programs. The findings of the study support the ongoing efforts to deploy a better diagnostic tool for rapid pathogen identification, which is key in the targeted management of patients with bloodstream infection, especially in ICUs. Full article

(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)

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18 pages, 1750 KB

Open AccessArticle

Antimicrobial Use and Manure Management Among Pig and Poultry Farmers in Malawi

by Amon Abraham, Andrew G. Mtewa, Chimwemwe Chiutula, Richard Lizwe Steven Mvula, Alfred Maluwa, Fasil Ejigu Eregno and John Njalam’mano

Antibiotics 2025, 14(11), 1141; https://doi.org/10.3390/antibiotics14111141 - 11 Nov 2025

Abstract

Background/objectives: Antimicrobial resistance (AMR) is a growing public health concern, and misuse of antibiotics in livestock farming contributes to its emergence. In Blantyre, Malawi, small-scale pig and poultry farming is widespread, but the knowledge, attitudes, and practices (KAP) driving antimicrobial use (AMU) remain [...] Read more.

Background/objectives: Antimicrobial resistance (AMR) is a growing public health concern, and misuse of antibiotics in livestock farming contributes to its emergence. In Blantyre, Malawi, small-scale pig and poultry farming is widespread, but the knowledge, attitudes, and practices (KAP) driving antimicrobial use (AMU) remain poorly understood. This study aimed to assess the KAP regarding AMU and manure management among pig and poultry farmers in Blantyre, Malawi. Methods: This cross-sectional study surveyed 118 randomly selected farmers to assess AMU patterns, sources of antibiotics, adherence to withdrawal periods, disposal practices, and awareness of AMR and regulations. Data was collected using a structured questionnaire and analyzed with descriptive statistics and inferential tests (with statistical significance set at p < 0.05). Results: Antibiotic use was reported by 88% of farmers, primarily for therapy (93.3%) and prophylaxis (85.6%), including for viral diseases such as Newcastle disease in poultry and African swine fever in pigs. Oxytetracycline (91.5%), penicillin (50.8%), and trimethoprim-sulfamethoxazole (39.8%) were the most used antibiotics, predominantly sourced from agrovet shops (73.7%). While 61% of farmers knew antibiotic misuse could lead to AMR, significant gaps were observed: 68.6% had no formal training, 55.9% were unaware of regulations, and 42% sold/consumed products before the end of the withdrawal period. Most farmers disposed of expired antibiotics (80.5%) and packaging (92.4%) in household waste. Higher education and prior training were significantly associated with good knowledge. Conclusions: This study reveals significant knowledge–practice gaps and high-risk behaviors, such as misuse for viral diseases and unsafe disposal, that exacerbate AMR risks. Interventions must prioritize targeted farmer education, strengthening of veterinary extension services, and stricter regulation of agrovet shops to promote antimicrobial stewardship and support Malawi’s National Action Plan on AMR. Full article

(This article belongs to the Special Issue Antimicrobial Resistance and Infections in Animals)

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20 pages, 1765 KB

Open AccessArticle

Widespread Distribution of Carbapenem-Resistant Klebsiella spp. in Clinical and Environmental Settings

by Karla Vanessa Molina Maldonado, Julia Marchese Pereira, Tamires Nascimento da Costa, Gabriel Lemos Buss, Kethlen Natiele de Almeida Pereira, Anelise Baptista da Silva, Gertrudes Corção, Ândrea Celestino de Souza, Amanda Silva Martins, Diego Rodrigues Falci, Ariane Baptista Monteiro, Claudia Flores, Kayo Bianco, Maysa Mandetta Clementino, Carlos Alexandre Sanchez Ferreira, Renata Medina-Silva and Sílvia Dias de Oliveira

Antibiotics 2025, 14(11), 1140; https://doi.org/10.3390/antibiotics14111140 - 10 Nov 2025

Abstract

Background/Objectives: Klebsiella spp., particularly K. pneumoniae, are major opportunistic pathogens in healthcare settings driven by carbapenemase- and ESBL-producing strains. We assessed antimicrobial resistance and biofilm formation abilities in Klebsiella spp. from a Brazilian tertiary hospital and related environments and characterized [...] Read more.

Background/Objectives: Klebsiella spp., particularly K. pneumoniae, are major opportunistic pathogens in healthcare settings driven by carbapenemase- and ESBL-producing strains. We assessed antimicrobial resistance and biofilm formation abilities in Klebsiella spp. from a Brazilian tertiary hospital and related environments and characterized capsular types. Methods: Over six months (July–December 2023), 303 carbapenem-resistant Klebsiella spp. were collected from clinical specimens (n = 198), ICU/non-ICU surfaces (n = 79), hospital sewage (n = 22), and stream water (n = 4). Species were identified by MALDI-TOF. Susceptibility testing covered eight antibiotic classes, focusing on carbapenems and polymyxin B. Biofilm formation was quantified by crystal violet, and capsular typing used wzi/K-locus approaches. Results: Most isolates (70.95%) had meropenem MICs ≥ 128 μg/mL, while 77.6% (n = 235) remained susceptible to polymyxin B. Resistance profiles largely consisted of extensive drug resistance (95.4%), with 1.3% exhibiting pandrug resistance, including isolates from bed rails. Biofilm formation was detected in 96.7% of isolates, mainly weak (67.6%) or moderate (28%), with 4.4% being strong producers. Among the Klebsiella isolates analyzed, 21 K types were identified with an uneven distribution dominated by K64, followed by K24, K173, and K50. K75 was the only K type detected across all sources—clinical isolates, bed-rail surfaces (non-ICU), wastewater, and fluvial water. Conclusions: Carbapenem-resistant Klebsiella spp. exhibited widespread resistance, with residual susceptibility to aminoglycosides, ceftazidime–avibactam, and polymyxins. Environmental reservoirs—hospital surfaces, sewage, and stream water—harbored resistant biofilm producers, reinforcing their role in persistence and dissemination. K-typing revealed concentrated distribution (predominantly K64) and cross-source K75. These findings underscore the urgency of integrated strategies combining molecular surveillance, antimicrobial stewardship, and environmental control. Full article

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14 pages, 937 KB

Open AccessArticle

Shared Decision-Making in Veterinary Clinics: A Cross-Sectional Study Examining Effects on Appropriate Antibiotic Prescribing and Value-Driven Factors Influencing It

by Huiling Guo, Lay See Ong, Zoe Jane-Lara Hildon, Timothy Chua, Boon Han Teo and Angela Chow

Antibiotics 2025, 14(11), 1139; https://doi.org/10.3390/antibiotics14111139 - 10 Nov 2025

Abstract

Background: Shared decision-making (SDM) can improve appropriate antibiotic prescribing in human primary care clinics, but little is known about it in the veterinary setting. This study examines the association between SDM and antibiotic prescribing for cats and dogs in veterinary clinics, then determines [...] Read more.

Background: Shared decision-making (SDM) can improve appropriate antibiotic prescribing in human primary care clinics, but little is known about it in the veterinary setting. This study examines the association between SDM and antibiotic prescribing for cats and dogs in veterinary clinics, then determines the key factors influencing SDM through a value-driven approach. Methods: This cross-sectional study surveyed 41 veterinarians practicing in Singapore veterinary clinics. Appropriate antibiotic prescribing was defined as concordance with local antibiotic guidelines for companion animals, while an adapted SDM-Q-9-Doc scale measured SDM on antibiotic prescribing with pet owners. Questions were developed to measure constructs of the VALUE model and factor analysis was conducted to identify latent factors. Multivariable logistic and linear regressions were performed to assess the association between SDM and antibiotic prescribing, and determinants of SDM, respectively. Results: Antibiotics were most inappropriately prescribed for cats/dogs with ear infections (cocci observed) (63%), and periodontal disease (59%). Engaging owners in SDM (AOR 1.31; 95% CI 1.05, 1.62; p = 0.014) was positively associated with appropriate antibiotic prescribing for cats/dogs with periodontal disease. After adjusting for age, gender, clinic role and practice type, veterinarians with a higher overall VALUE score (β = 0.14; 95% CI 0.02, 0.26; p = 0.021) were more likely to engage in SDM with owners on antibiotic prescribing. Conclusions: SDM with pet owners improves appropriate antibiotic prescribing for cats and dogs, though effects vary by clinical scenario. Aligning AMR-related values between veterinary clinics and veterinarians to enable effective communication with pet owners can promote SDM and subsequently drive appropriate antibiotic prescribing for pet cats and dogs. Full article

(This article belongs to the Special Issue Epidemiology, Impact and Mitigation of Antimicrobial Resistance in Veterinary Medicine, 3rd Edition)

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60 pages, 2976 KB

Open AccessReview

Anti-Infective-Associated AKI: A Narrative Review of the Epidemiology, Mechanisms, Risk Factors, Biomarkers, Clinical Course, Monitoring, Prevention, and Therapeutic Strategies

by Iman Karimzadeh, Sandra L. Kane-Gill and Binglei Ma

Antibiotics 2025, 14(11), 1138; https://doi.org/10.3390/antibiotics14111138 - 10 Nov 2025

Abstract

Acute kidney injury (AKI) occurs commonly in hospitalized patients, especially patients in intensive care units (ICUs). Medications are among the major causative factors of AKI. This narrative review addressed and updated different aspects of anti-infective-associated AKI, including amphotericin B, cidofovir, foscarnet, polymyxins, vancomycin, [...] Read more.

Acute kidney injury (AKI) occurs commonly in hospitalized patients, especially patients in intensive care units (ICUs). Medications are among the major causative factors of AKI. This narrative review addressed and updated different aspects of anti-infective-associated AKI, including amphotericin B, cidofovir, foscarnet, polymyxins, vancomycin, and aminoglycosides. There is no standard definition or operational criteria to describe anti-infective-associated AKI. Characteristically, it usually occurs during the first two weeks of treatment and is typically dose dependent. Functional resolution occurs, but kidney injury can affect renal functional reserve and increase susceptibility to future AKI events. A variety of pathophysiological mechanisms impacting glomerular, tubular, and interstitial components of the kidney are usually responsible for the development of AKI from anti-infective medications. Oxidative stress and inflammation play a pivotal role in the pathogenesis of antibiotic-related AKI. Numerous patient-related, medication-related, and co-administered-related scenarios have been demonstrated as risk factors for anti-infective-induced AKI. Apart from traditional indexes of kidney function (serum creatinine and urine output), novel biomarkers of kidney function (e.g., serum cystatin C) and damage (e.g., urinary kidney-injury molecule-1 and neutrophil gelatinase-associated lipocalin) have been noticed in recent clinical studies with promising findings. The efficiency of preventive strategies against anti-infective-associated AKI in most cases appears to be variable, relative, and modest. Close and regular monitoring of kidney function parameters is crucial during treatment with nephrotoxic antibiotics. Currently, there is no definitive treatment modalities for the management of AKI with anti-infectives. Therefore, supportive care is the mainstay of treatment. Full article

(This article belongs to the Section Pharmacokinetics and Pharmacodynamics of Drugs)

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14 pages, 5465 KB

Open AccessArticle

Genomic Characterization of Multiple Antibiotic-Resistant Enterococcus in Farm Animals in Ningxia Province, China

by Haoyu Zhao, Wen Zhang, Tianran Tang, Likun Zhang, Shengling Cui, Shengli Chen, Huafang Hao, Yating Deng, Weimin Zhang, Qi Yang, Zengqi Yang, Qian Shao and Juan Wang

Antibiotics 2025, 14(11), 1137; https://doi.org/10.3390/antibiotics14111137 - 10 Nov 2025

Abstract

Background/Objectives: In an era of increasing bacterial resistance, Enterococcus, as a reservoir of antibiotic resistance genes, poses a serious threat to public health. Methods: This study conducted antibiotic susceptibility tests, whole-genome sequencing, and bioinformatics analysis on 89 Enterococcus isolates from chickens, pigs, [...] Read more.

Background/Objectives: In an era of increasing bacterial resistance, Enterococcus, as a reservoir of antibiotic resistance genes, poses a serious threat to public health. Methods: This study conducted antibiotic susceptibility tests, whole-genome sequencing, and bioinformatics analysis on 89 Enterococcus isolates from chickens, pigs, cattle, and sheep in Ningxia Autonomous Region. Results: The resistance rates of Enterococcus to clindamycin, cefoxitin, sulfamethoxazole, and tamoxifen were all above 95%, and 96.6% (86/89) of the isolates were multi-antibiotic resistant. There were significant differences in resistance phenotypes among different species, with Enterococcus from pigs showing significantly higher resistance than those from other animals. optrA was commonly found in Enterococcus from pigs, accounting for 61.5% (8/13). ST480, ST16, ST116, and ST300 were the main MLST types, and ST16 was one of the important pathogenic Enterococcus types. Conclusions: The study revealed the occurrence of inter-species transmission events of Enterococcus. In conclusion, this study comprehensively described the resistance spectrum, sequence characteristics, and transmission features of resistance genes in Enterococcus isolated from farm animals, and emphasized the possibility of the spread of resistance genes carried by Enterococcus from farm animals to humans. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Stefan Schwarz—Antimicrobial Resistance of Bacteria of Animal Origin: Diagnostics, Monitoring, Mechanisms and Epidemiology)

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24 pages, 1861 KB

Open AccessArticle

Diagnostic Stewardship Trends and Antimicrobial Resistance Profiles of Bacteria Isolated in Zambia: A Five-Year Retrospective Study (2020–2024)

by Joseph Yamweka Chizimu, Aubrey Chichonyi Kalungia, Steward Mudenda, Zoran Muhimba, Chileshe Lukwesa, Webrod Mufwambi, Amon Siame, Kelvin Mwangilwa, Priscilla Gardner, Jimmy Hangoma, Victor Daka, Chikwanda Chileshe, Ntombi B. Mudenda, Maisa Kasanga, Misheck Shawa, Herman Chambaro, Duncan Chanda, Taona Sinyawa, Bertha Chibwe, Kaunda Kaunda, Kaunda Yamba, O-Tipo Shikanga, Freddie Masaninga, Mpela Chibi, Sandra Diana Mwadetsa, Doreen Mainza Shempela, Mwendalubi Albert Hadunka, Samson Mukale, Andrew Bambala, Malambo Mutila, Loveness Sakalimbwe, Fred Mulako Simwinji, Geoffrey Mainda, Chie Nakajima, Ruth Nakazwe, Fusya Goma, Nyambe Sinyange, Yasuhiko Suzuki, John Bwalya Muma and Roma Chilengi Show full author list Hide full author list

Antibiotics 2025, 14(11), 1136; https://doi.org/10.3390/antibiotics14111136 - 10 Nov 2025

Abstract

Background/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. [...] Read more.

Background/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. Methods: This descriptive, retrospective study analysed routine laboratory data from January 2020 to December 2024 at seven designated AMR surveillance sentinel sites across Zambia. Data on clinical specimens submitted for antimicrobial susceptibility testing were extracted from WHONET and analysed by year, specimen type, and antimicrobial susceptibility profile. Results: A total of 184,788 bacteriology specimens were processed over five years. Urine was the most frequently collected specimen, peaking above 20,000 in 2024. Escherichia coli was the most commonly isolated organism among 15 priority pathogens, comprising 25.9% of the 30,013 isolates. Though a statistically significant increasing trend in total organism isolations was observed annually, only Shigella sp. demonstrated a substantial increase in non-susceptibility to azithromycin (p = 0.027). High resistance was observed with doxycycline, azithromycin, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin, exhibiting resistance ranging from 50% to 80%. Critical AMR alerts included 65% for Vancomycin-Resistant Enterococcus (VRE), 72% for linezolid, and 44% for carbapenems, and possible ESBL-producing Enterobacterales showing the highest overall resistance at 35%, across sentinel sites. Conclusions: Zambia faces a concerning and significant increase in AMR, with high resistance prevalence across commonly used antibiotics. Critical resistance alerts for VRE, linezolid, carbapenems, and possible ESBL-producing Enterobacterales underscore an urgent need for robust antimicrobial stewardship and continuous diagnostic surveillance. Full article

(This article belongs to the Special Issue Antibiotic Resistance: From the Bench to Patients, 2nd Edition)

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12 pages, 467 KB

Open AccessArticle

Antibiotic Resistance in Urinary Pathogens Among Kidney Transplant Recipients: A Persistent Threat

by Büşra Çalışır, Abdullah İbrahim Çalışır, Oktay Rodoplu, Abdulmecit Yıldız, Alparslan Ersoy and Cüneyt Özakın

Antibiotics 2025, 14(11), 1135; https://doi.org/10.3390/antibiotics14111135 - 10 Nov 2025

Abstract

Background: Urinary tract infections (UTIs) are the most common infections after kidney transplantation and significantly affect patient outcomes. In these immunosuppressed patients, antibiotic resistance is of particular concern due to recurrent infections and limited treatment options. The aim of this study was to [...] Read more.

Background: Urinary tract infections (UTIs) are the most common infections after kidney transplantation and significantly affect patient outcomes. In these immunosuppressed patients, antibiotic resistance is of particular concern due to recurrent infections and limited treatment options. The aim of this study was to evaluate the distribution of microorganisms isolated from urine cultures of kidney transplant patients and to assess their antimicrobial susceptibility patterns. Methods: This retrospective study included all adult kidney transplant recipients with positive urine cultures during 2023–2024. Microorganisms were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and antimicrobial susceptibility testing was performed with the Phoenix System according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Results: A total of 363 urine samples from 123 patients (85% female) were analyzed. E. coli (49%) and Klebsiella spp. (24%) were the predominant uropathogens. High resistance rates to ciprofloxacin and trimethoprim–sulfamethoxazole (TMP–SMX) were observed in both species, while carbapenem resistance remained low. Elevated resistance to multiple antibiotics was also detected among Pseudomonas aeruginosa and Acinetobacter spp., highlighting the importance of continued microbiological surveillance in this population. Conclusions: Gram-negative bacteria were the predominant pathogens causing UTIs in kidney transplant recipients. The high resistance rates to ciprofloxacin and TMP–SMX emphasize the need for local antimicrobial surveillance and individualized empirical therapy. Systematic and ongoing monitoring of resistance patterns is essential to optimize infection management in this vulnerable patient group. Full article

(This article belongs to the Special Issue Antibiotic Surveillance and Rational Use in Special Populations: Enhancing Stewardship for Vulnerable Groups)

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29 pages, 859 KB

Open AccessReview

Phage Therapy for Acinetobacter baumannii Infections: A Review on Advances in Classification, Applications, and Translational Roadblocks

by Yilin Wang, Liuyan Li, Yuqi Liang, Kehan Xu, Ying Ye and Maozhang He

Antibiotics 2025, 14(11), 1134; https://doi.org/10.3390/antibiotics14111134 - 8 Nov 2025

Abstract

The global spread of carbapenem-resistant Acinetobacter baumannii (CRAB) poses a severe public health threat, driving growing interest in phage-based precision antibacterial strategies. This systematic review synthesizes recent advances in the field of A. baumannii phage. Modern taxonomy, based on whole-genome phylogeny, has reclassified [...] Read more.

The global spread of carbapenem-resistant Acinetobacter baumannii (CRAB) poses a severe public health threat, driving growing interest in phage-based precision antibacterial strategies. This systematic review synthesizes recent advances in the field of A. baumannii phage. Modern taxonomy, based on whole-genome phylogeny, has reclassified the majority of A. baumannii phages into the class Caudoviricetes, revealing distinct evolutionary clades that correlate with host tropism and biological properties, superseding the traditional morphological families (Myoviridae, Siphoviridae, Podoviridae). To overcome limitations of natural phage therapy, such as narrow host range, cocktail therapies (ex vivo resistance mutation rates < 5%) and phage-antibiotic synergism (enabling antibiotic efficacy at 1/4 minimum inhibitory concentration) have significantly enhanced antibacterial efficacy. Preclinical models demonstrate that phage therapy efficiently clears pathogens in pneumonia models and promotes the healing of burn wounds and diabetic ulcers via immunomodulatory mechanisms. Technical optimizations include nebulized inhalation delivery achieving 42% alveolar deposition, and thermosensitive hydrogels enabling sustained release over 72 h. Genetic engineering approaches, such as host range expansion through tail fiber recombination and CRISPR/Cas-mediated elimination of lysogeny, show promise. However, the genetic stability of engineered phages requires further validation. Current challenges remain, including limited host spectrum, the absence of clinical translation standards, and lagging regulatory frameworks. Future efforts must integrate metagenomic mining and synthetic biology strategies to establish a precision medicine framework encompassing resistance monitoring and personalized phage formulation, offering innovative solutions against CRAB infections. Full article

(This article belongs to the Special Issue Antibiotic Resistance in Hospital-Acquired Infections)

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13 pages, 3851 KB

Open AccessArticle

Novel Isolate of Halobacteriovorax Capable of Killing Multi-Drug-Resistant Escherichia coli and Salmonella

by Stefania Di Lullo, Silvia Pieralisi, Giulia Talevi, Gabriele Angelico, Elena Rocchegiani, Francesca Leoni, Maira Napoleoni, Diego Maiolatesi, Francesca Barchiesi, Sara Nardi, Annalisa Petruzzelli, Claudia Gabucci, Angela Conti, Gianluigi Cardinali and Donatella Ottaviani

Antibiotics 2025, 14(11), 1133; https://doi.org/10.3390/antibiotics14111133 - 8 Nov 2025

Abstract

Background/Objectives: Due to the rising problem of antimicrobial resistance, there is increasing attention in the scientific community towards alternative approaches to combat Antimicrobial-Resistant (AMR) pathogens that do not involve the use of antibiotics. In this regard, the European Medicines Agency (EMA) and the [...] Read more.

Background/Objectives: Due to the rising problem of antimicrobial resistance, there is increasing attention in the scientific community towards alternative approaches to combat Antimicrobial-Resistant (AMR) pathogens that do not involve the use of antibiotics. In this regard, the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) have promoted experimentation with predatory bacteria to fight antibiotic resistance. With the aim of identifying predatory bacteria suitable for the control of antibiotic-resistant bacteria, in this work we isolated a strain of Halobacteriovorax from an estuarine aquatic environment using a CTX-M-producing E. coli strain as prey and characterized it with respect to optimal physico-chemical parameters for growth and predation. Furthermore, we studied its predatory capacity against other E. coli strains and Multi-Drug-Resistant (MDR) Salmonella. Finally, we conducted challenge experiments to evaluate the growth of predator and prey over time. Methods: The Halobacteriovorax strain, designated HE7, was identified by 16S rRNA analysis. To isolate Halobacteriovorax and to evaluate its predatory ability towards different preys, the double-layer agar plating technique was applied. Results: HE7 showed in vitro predatory activity against all MDR strains of E. coli and Salmonella tested. In the 10⁷ predator/10³ prey and 10⁷ predator/10⁷ prey challenges, HE7 after 6 h achieved the total killing and a reduction of about 6 logs in the prey, respectively, maintaining this effect for up to 24 h. Conclusions: The results of this study highlight that HE7, but more generally Halobacteriovorax, could find application both alone and in an integrated context of antimicrobial strategies as an alternative to antibiotics. Full article

(This article belongs to the Special Issue Antibiotic Residues, Antimicrobial Resistance and Intervention Strategies of Foodborne Pathogens, 2nd Edition)

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13 pages, 493 KB

Open AccessArticle

Changing Bacterial Profiles and Antibiotic Susceptibility Patterns in Spontaneous Ascites Infection: A Shift in Empiric Combination Antibiotic Therapy?

by Ceren Kaplankıran and Ender Serin

Antibiotics 2025, 14(11), 1132; https://doi.org/10.3390/antibiotics14111132 - 8 Nov 2025

Abstract

Background/Objectives: This study aimed to determine bacteria that grow in spontaneous ascites infection and their antibiotic susceptibility. Materials and Methods: A total of 291 cases of cirrhosis-related ascites were retrospectively analyzed between January 2007 and September 2015. Simple ascites, spontaneous ascites infection, spontaneous [...] Read more.

Background/Objectives: This study aimed to determine bacteria that grow in spontaneous ascites infection and their antibiotic susceptibility. Materials and Methods: A total of 291 cases of cirrhosis-related ascites were retrospectively analyzed between January 2007 and September 2015. Simple ascites, spontaneous ascites infection, spontaneous bacterial peritonitis, and culture results were recorded. Due to increasing antibiotic resistance, theoretically appropriate antibiotics were paired, and their susceptibility was evaluated in order to review our empirical antibiotic choices and evaluate new empirical treatment options. Results: In all cultures, 48.1% were Gram-positive cocci and 50.6% were Gram-negative bacilli. Multidrug-resistant bacteria grew in 16 cultures (22.2%). The most common bacterium was Escherichia coli, and the second most common bacteria were coagulase-negative staphylococci (CoNS). According to all culture data, the rate of antibiotic susceptibility was third- and fourth-generation cephalosporins between 76.4 and 68%, 68% for ampicillin-sulbactam, 81.8% for piperacillin-tazobactam, 66% for ciprofloxacin, 71% for levofloxacin, 30% for tetracycline, and 45% for penicillin. Beta-lactam group antibiotic susceptibility of CoNS was 25% for penicillin and 53% for ampicillin-sulbactam; 52% had methicillin resistance. The rate of resistance to quinolones was 35%. Multidrug resistance was detected in 40% of CoNS (eight cases). When theoretically appropriate antibiotics were paired, combination therapy increased the susceptibility rates. Conclusions: The increase in Gram-positive infections and resistance to other antibiotic groups indicates empirical antibiotic selection based on local microbial culture results and antibiotic susceptibility. Our results are crucial to allowing for more rational and successful use of antibiotics. Full article

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Graphical abstract

19 pages, 1320 KB

Open AccessSystematic Review

Prevalence and Resistance Profiles of Acinetobacter baumannii in ICU Patients in Saudi Arabia: A Systematic Review and Meta-Analysis

by Alaa Alibrahim, Farooq Ahmed Wani, Ohoud Shafi Alruwaili, Sadeem Altaymani, Zaid Ali Alharbi, Sayyaf Alsubaiei, Saleh Aldhuwayhi, Mohammed Alsaeed and Mohammed Alibrahim

Antibiotics 2025, 14(11), 1131; https://doi.org/10.3390/antibiotics14111131 - 7 Nov 2025

Abstract

Background: Acinetobacter baumannii (A. baumannii), a critical nosocomial pathogen, poses a significant threat in intensive care units (ICUs) due to its multidrug-resistant (MDR) strains. This study systematically reviews and performs a meta-analysis on the prevalence and antibiotic resistance profiles of [...] Read more.

Background: Acinetobacter baumannii (A. baumannii), a critical nosocomial pathogen, poses a significant threat in intensive care units (ICUs) due to its multidrug-resistant (MDR) strains. This study systematically reviews and performs a meta-analysis on the prevalence and antibiotic resistance profiles of MDR A baumannii (MDR-A. baumannii) in ICU patients in Saudi Arabia. Methods: A comprehensive search in PubMed, Saudi Digital Library, Scopus, and Web of Science, focusing on studies from January 2014 to September 2025, was performed. The present study followed the reporting guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-2020). Data on study characteristics, sample sizes, patient demographics, prevalence of MDR-AB, and antibiotic resistance profiles were extracted and analyzed. Quality assessment was conducted using the Joanna Briggs Institute. Results: The prevalence of MDR-AB in ICU patients varied significantly across studies, with retrospective studies reporting rates from 3.37% to 69% and prospective studies ranging from 3.9% to 72.73%. Colistin remained highly effective, showing 100% susceptibility in some studies. Meanwhile, resistance to carbapenems like imipenem and meropenem often exceeds 50%. Additional antibiotics with notable resistance included gentamicin, tigecycline, ampicillin/sulbactam, trimethoprim-sulfamethoxazole, ceftazidime, piperacillin/tazobactam, and third-generation cephalosporins. Mechanisms of resistance frequently involved OXA-type carbapenemases, particularly OXA-23. While OXA-23 was the most frequently detected carbapenemase, recent genomic data have also revealed the presence of metallo-β-lactamases, such as IMP-type genes, in ICU isolates. Conclusions: MDR-A. baumannii poses a substantial challenge in Saudi Arabian ICUs, with high prevalence and significant resistance to commonly used antibiotics. The results highlight the critical need for continuous monitoring, cautious antibiotic stewardship, and strict infection control methods to manage and lessen the effects of MDR-AB in ICUs. Full article

(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)

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20 pages, 368 KB

Open AccessSystematic Review

Long-Term Therapy with Long-Acting Lipoglycopeptide Antibiotics in the Treatment of Cardiovascular Prosthetic Infections: A Systematic Review

by Francesca Gavaruzzi, Guido Granata, Alessandro Capone, Pierangelo Chinello and Stefania Cicalini

Antibiotics 2025, 14(11), 1130; https://doi.org/10.3390/antibiotics14111130 - 7 Nov 2025

Abstract

Background: Dalbavancin and oritavancin are long-acting lipoglycopeptides increasingly used off-label for a variety of Gram-positive infections. While their efficacy has been described in osteomyelitis, bacteremia, and infective endocarditis, evidence specifically addressing cardiovascular prosthetic infections such as prosthetic valve endocarditis (PVE), cardiac implantable [...] Read more.

Background: Dalbavancin and oritavancin are long-acting lipoglycopeptides increasingly used off-label for a variety of Gram-positive infections. While their efficacy has been described in osteomyelitis, bacteremia, and infective endocarditis, evidence specifically addressing cardiovascular prosthetic infections such as prosthetic valve endocarditis (PVE), cardiac implantable electronic device (CIED) infections, left ventricular assist device infections (LVAD), and prosthetic vascular graft infections (PVGI) remains limited. These conditions are particularly challenging due to biofilm formation, difficulties in achieving surgical source control, and the frequent need for prolonged or suppressive therapy. Objectives: This systematic review aimed to summarize the available literature on the use of dalbavancin and oritavancin in cardiovascular prosthetic infections, with a focus on therapeutic strategies, clinical outcomes, and safety. Methods: We performed a systematic search of PubMed, Embase, Scopus, and Cochrane Library up to 24 June 2025 in accordance with PRISMA guidelines. Eligible studies included adults treated with dalbavancin or oritavancin for cardiovascular prosthetic infections. Data on study characteristics, population demographics, causative pathogens, and microbiological profiles, antibiotic regimens, treatment duration, use of therapeutic drug monitoring (TDM), indication or non-indication for chronic suppressive therapy, adverse events, clinical outcomes, and clinical efficacy were extracted. Results: Twenty studies comprising 113 patients were identified, of whom 111 received dalbavancin and 2 oritavancin. The main infections were PVE, CIED, LVAD, and PVGI. Dalbavancin was most effective as consolidation therapy after surgery or device removal, with high cure rates. Prolonged regimens were used as bridging or in partially treated cases, sometimes supported by TDM or PET/CT. Chronic suppressive therapy, mainly for LVAD and PVGI infections, achieved variable outcomes with relapses in about one fifth of patients. Adverse events were infrequent and generally mild. Conclusions: The included studies were highly diverse, conducted in various settings and with different objectives. Eight of the twenty included studies were single case reports on dalbavancin and oritavancin, highlighting the predominance of individual case descriptions in the available literature. Long-acting lipoglycopeptides may represent a valuable option for cardiovascular prosthetic infections. Their role appears most favorable as consolidation after adequate source control, while chronic suppressive use showed heterogeneous outcomes. This systematic review was registered on Open Science Framework. This work was supported by grants from the Italian Ministry of Health through Ricerca Corrente, Linea 3, Progetto 3. Full article

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