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Antimicrobial Resistance in the Community Setting: The Other Side of the Coin

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A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 December 2025) | Viewed by 17870

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Dr. Luigi Principe

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Microbiology and Virology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
Interests: antibiotic; resistance; microbiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is a serious global concern. It is a well-known challenge in hospital settings, especially caused by tracing techniques and the continuous monitoring of resistance determinants. On the other hand, the diffusion of AMR in community settings still remains a somewhat unknown problem, mostly due to larger and less-controlled antibiotic consumption. Hence, AMR in the community setting is largely underestimated, while common bacterial pathogens have become progressively more resistant to traditional antibiotics. Moreover, the most recently approved antibiotics are only for hospital use, hence they do not represent an available weapon in the battle against AMR in community settings.

This Special Issue takes into account all aspects of AMR and the virulence traits of pathogens isolated in community settings from human, animal and environmental contexts, following a One Health approach. Moreover, the application of molecular, diagnostic and whole-genome sequencing represents an important tool to better understand antimicrobial resistance mechanisms. Articles or reviews regarding pandrug- (PDR), extensive drug- (XDR) or multidrug-resistant (MDR) pathogens, Staphylococcus aureus, Enterococcus spp., Streptococcus pneumoniae and Streptococcus spp., Haemophilus spp., Moraxella spp., Mycobacterium spp., Neisseria meningitidis and gonorrhoeae, Salmonella spp., Shigella spp, Campylobacter spp., anaerobes, fungi (yeasts and molds) and typical hospital pathogens acquired in community settings are encouraged. In addition, manuscripts concerning the following specific areas of interest are welcome:

In vitro and in vivo studies on clinical isolates;
Case reports or case series (including viral and bacterial coinfections);
Epidemiological and molecular investigation of outbreaks;
AMR in human, animal or environmental contexts;
Antimicrobial activity of non-antibiotic molecules against clinical isolates;
Rare or emerging resistance determinants;
Rare or emerging virulence factors;
New associations between resistance determinants and pathogens;
Typical hospital pathogens acquired in community settings.

Dr. Luigi Principe
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

emerging resistance
multidrug resistance
emerging virulence
community setting
Staphylococcus aureus
Enterococcus spp.
Streptococcus spp.
Haemophilus spp.
Moraxella spp.
Mycobacterium spp.
Neisseria spp.
Salmonella spp.
Shigella spp.
Campylobacter spp.
anaerobes
fungi

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Published Papers (7 papers)

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14 pages, 643 KB

Open AccessArticle

Acquisition Origin Matters: Clinical, Microbiological and Immunological Characteristics and Treatment Effects in Community- vs. Hospital-Acquired Septic Shock

by Irene Coloretti, Martina Tosi, Emanuela Biagioni, Federica Morselli, Elena Munari, Jacopo Bertolini, Sara Ferrari, Marianna Meschiari, Erica Franceschini, Nathan D. Nielsen, Stefano Busani and Massimo Girardis

Antibiotics 2026, 15(2), 169; https://doi.org/10.3390/antibiotics15020169 - 5 Feb 2026

Viewed by 870

Abstract

Background: Septic shock is a leading cause of mortality worldwide, with community-acquired (CA) and hospital-acquired (HA) infections representing distinct clinical entities. The differences in clinical characteristics, immune response profiles, and effects of sepsis treatments between CA and HA septic shock have not been fully elucidated. Methods: This retrospective cohort study included 726 adults with septic shock who were admitted to two ICUs at Modena University Hospital between January 2006 and September 2024. Patients were classified as having CA or HA septic shock based on the origin of the infection. Clinical, microbiological, and immunological data, treatments, and outcomes were analysed. Immune cell dynamics were assessed during the first week after the onset of the shock. Multivariable Cox regression models were used to identify predictors and the effects of treatment on ICU mortality. Results: Among 344 patients with CA and 382 with HA septic shock, those with CA had higher severity scores but lower ICU and in-hospital mortality. Patients with HA exhibited a higher prevalence of multidrug-resistant organisms and more comorbidities. Immunologically, CA survivors showed increasing lymphocyte counts over time, whereas HA survivors mainly demonstrated recovery in T helper cells. Therapeutic strategies were similar between groups; however, continuous renal replacement therapy was more frequent in patients with HA. Neither appropriate empiric antibiotics nor steroids or immunoglobulin therapy independently improved mortality in the multivariate analyses. Conclusions: CA and HA septic shock differ significantly in terms of clinical severity, microbiological aetiology, immune recovery patterns, and outcomes. The lack of mortality benefit from standard treatments highlights the need for personalised management strategies that integrate clinical, immunological, and microbiological data to optimise care in septic shock subpopulations. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

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12 pages, 1048 KB

Open AccessArticle

Antifungal Susceptibility Trends Among Filamentous Fungi: An Epidemiological Evaluation on Aspergillus spp., Fusarium spp., and Scedosporium spp. from Southern Italy

by Maddalena Calvo, Marta Caccamo, Dalila Maria Cammarata and Laura Trovato

Antibiotics 2026, 15(2), 146; https://doi.org/10.3390/antibiotics15020146 - 2 Feb 2026

Viewed by 838

Abstract

Background/Objectives: Antifungal resistance among filamentous fungi is an increasing global concern with significant implications for clinical management. Herein, we propose a study aiming to investigate in vitro susceptibility patterns and epidemiology of filamentous fungi in Southern Italy, focusing on MIC distributions and resistance trends. Methods: We reported susceptibility results from Aspergillus spp., Fusarium spp., and Scedosporium/Lomentospora spp. clinical isolates, which underwent azoles, echinocandins, and amphotericin B in vitro testing. Results: Aspergillus fumigatus was the most frequently isolated species, showing an alarming increase in reduced susceptibility to amphotericin B (9.1%). The highest MIC ranges for this antifungal drug emerged in the case of A. fumigatus (1–4 mg/L) and A. terreus (2–8 mg/L), while A. flavus (0.5–4 mg/L) and A. niger (0.25–4 mg/L) showed lower values. As regarding azoles, all the Aspergillus spp. strains exhibited variable MIC values, reporting a 0.06–16 mg/L MIC range for itraconazole, 0.125–1 mg/L for voriconazole, and 0.03–1 mg/L for posaconazole. Fusarium solani exhibited high MICs for azoles (8 mg/L) and amphotericin B (2–4 mg/L), while F. oxysporum and F. proliferatum showed lower MICs (0.25–2 mg/L for amphotericin B and a MIC range of 0.5–8 mg/L for posaconazole). Lomentospora prolificans and Scedosporium apiospermum demonstrated multidrug resistance across all tested antifungals, reporting MIC ranges of 4–8 mg/L for amphotericin B, 0.25–16 mg/L for posaconazole, 0.25–8 mg/L for voriconazole, and 0.125–8 for itraconazole. Conclusions: Our data highlight the critical emergence of reduced antifungal susceptibility among filamentous fungi in Southern Italy, underlining the importance of epidemiological surveillance, precise species identification, and optimized susceptibility testing in the case of mould etiology for invasive fungal infections. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

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15 pages, 451 KB

Open AccessArticle

Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis

by Maria Mazzitelli, Alberto Enrico Maraolo, Umberto Barbieri, Vincenzo Scaglione, Lolita Sasset, Lucrezia Furian, Umberto Cillo, Gino Gerosa, Monica Loy, Emanuele Cozzi, Patrizia Burra, Federico Rea and Annamaria Cattelan

Antibiotics 2026, 15(2), 119; https://doi.org/10.3390/antibiotics15020119 - 26 Jan 2026

Cited by 2 | Viewed by 694

Abstract

Background: Enterococcus faecium bloodstream infections (EF-BSI) cause significant morbidity and mortality in solid organ transplant (SOT) recipients, with the role of vancomycin resistance (VR) remaining controversial as an independent driver. Methods: This was a retrospective cohort study including SOT recipients with EF-BSI at our institution from 2019 to 2023. We used Cox proportional hazards regression to identify predictors of 30-day all-cause mortality. A time-dependent covariate was used to model the effects of receiving targeted, effective antibiotic therapy. Results: A total of 79 patients were included (26.6%, with VR). The overall 30-day mortality was 12.7% (10/79). In univariable analysis, septic shock (Hazard Ratio, HR: 17.1, 95% CI: 3.64–80.8, p < 0.001), the need for Continuous Venovenous Hemofiltration (HR: 6.40, 95% CI: 1.85–22.1, p = 0.003), and a Pitt Bacteremia Score ≥ 2 (HR: 5.17, 95%CI: 1.10–24.3, p = 0.038) were associated with increased mortality, while source control was protective (HR: 0.20, 95% CI: 0.05–0.76, p = 0.018). In the final multivariable model, only septic shock remained an independent predictor of 30-day mortality (HR: 11.4, 95% CI: 1.63–79.5, p = 0.014). VR was not significantly associated with mortality, though the confidence interval was wide and included clinically meaningful effects (HR: 2.07, 95% CI: 0.40–10.6, p = 0.4). Conclusions: In SOT recipients with EF-BSI, 30-day mortality is overwhelmingly driven by the host’s physiological response, manifested as septic shock, rather than the VR profile of the pathogen. The early recognition of severe sepsis/septic shock and the aggressive implementation of supportive care and source control measures in this setting are crucial. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

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8 pages, 271 KB

Open AccessCommunication

Analysis of Antimicrobial Resistance Genes (ARGs) in Enterobacterales and A. baumannii Clinical Strains Colonizing a Single Italian Patient

by Alessandra Piccirilli, Elisa Meroni, Carola Mauri, Mariagrazia Perilli, Sabrina Cherubini, Arianna Pompilio, Francesco Luzzaro and Luigi Principe

Antibiotics 2023, 12(3), 439; https://doi.org/10.3390/antibiotics12030439 - 23 Feb 2023

Cited by 4 | Viewed by 2941

Abstract

The dramatic increase in infections caused by critically multidrug-resistant bacteria is a global health concern. In this study, we characterized the antimicrobial resistance genes (ARGs) of K. pneumoniae, P. mirabilis, E. cloacae and A. baumannii isolated from both surgical wound and rectal swab of a single Italian patient. Bacterial identification was performed by MALDI-TOF MS and the antimicrobial susceptibility was carried out by Vitek 2 system. The characterization of ARGs was performed using next-generation sequencing (NGS) methodology (MiSeq Illumina apparatus). K. pneumoniae, P. mirabilis and E. cloacae were resistant to most β-lactams and β-lactam/β-lactamases inhibitor combinations. A. baumannii strain was susceptible only to colistin. The presence of plasmids (IncN, IncR, IncFIB, ColRNAI and Col (MGD2)) was detected in all Enterobacterales but not in A. baumannii strain. The IncN plasmid and bla_NDM-1 gene were found in K. pneumoniae, P. mirabilis and E. cloacae, suggesting a possible transfer of this gene among the three clinical species. Conjugation experiments were performed using K. pneumoniae (1 isolate), P. mirabilis (2 isolates) and E. cloacae (2 isolates) as donors and E. coli J53 as a recipient. The bla_NDM-1 gene was identified by PCR analysis in all transconjugants obtained. The presence of four different bacterial species harboring resistance genes to different classes of antibiotics in a single patient substantially reduced the therapeutic options. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

10 pages, 269 KB

Open AccessCommunication

Real-Life Experience of Molnupiravir in Hospitalized Patients Who Developed SARS-CoV2-Infection: Preliminary Results from CORACLE Registry

by Tommaso Lupia, Silvia Corcione, Nour Shbaklo, Lucio Boglione, Stefano Torresan, Simone Mornese Pinna, Barbara Rizzello, Roberta Bosio, Valentina Fornari, Maria Teresa Brusa, Silvio Borrè and Francesco Giuseppe De Rosa

Antibiotics 2022, 11(11), 1541; https://doi.org/10.3390/antibiotics11111541 - 3 Nov 2022

Cited by 4 | Viewed by 2391

Abstract

Real-life experience of molnupiravir treatment is lacking, especially in people hospitalized for underlying diseases not related to COVID-19. We conducted a retrospective analysis regarding molnupiravir therapy in patients with SARS-CoV-2 infection admitted for underlying diseases not associated with COVID-19. Forty-four patients were included. The median age was 79 years (interquartile range [IQR]: 51–93 years), and most males were 57,4%. The median Charlson Comorbidity Index and 4C score were, respectively, 5 (IQR: 3–10) and 9.9 (IQR: 4–12). Moreover, 77.5% of the patients had at least two doses of the anti-SARS-CoV-2 vaccine, although 10.6% had not received any SARS-CoV-2 vaccine. Frequent comorbidities were cardiovascular diseases (68.1%), and diabetes (31.9%), and most admissions were for the acute chronic heart (20.4%) or liver (8.5%) failure. After molnupiravir started, 8 (18.1%) patients developed acute respiratory failure, and five (11.4%) patients died during hospitalisation. Moreover, molnupiravir treatment does not result in a statistically significant change in laboratory markers except for an increase in the monocyte count (p = 0.048, Z = 1.978). Molnupiravir treatment in our analysis was safe and well tolerated. In addition, no patients’ characteristics were found significantly related to hospital mortality or an increase in oxygen support. The efficacy of the molecule remains controversial in large clinical studies, and further studies, including larger populations, are required to fill the gap in this issue. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

Other

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18 pages, 1843 KB

Open AccessSystematic Review

Prevalence of Antibiotic-Resistant Shigella spp. in Bangladesh: A Systematic Review and Meta-Analysis of 44,519 Samples

by Saleh Ahmed, Md Imrul Hasan Chowdhury, Shabiha Sultana, Sayeda Sadia Alam, Mahfuza Marzan and Md Asiful Islam

Antibiotics 2023, 12(5), 817; https://doi.org/10.3390/antibiotics12050817 - 26 Apr 2023

Cited by 22 | Viewed by 4612

Abstract

Shigella is the leading global etiological agent of shigellosis, especially in poor and underdeveloped or developing nations with insufficient sanitation such as Bangladesh. Antibiotics are the only treatment option for the shigellosis caused by Shigella spp. as no effective vaccine exists. However, the emergence of antimicrobial resistance (AMR) poses a serious global public health concern. Therefore, a systematic review and meta-analysis were conducted to establish the overall drug resistance pattern against Shigella spp. in Bangladesh. The databases of PubMed, Web of Science, Scopus, and Google Scholar were searched for relevant studies. This investigation comprised 28 studies with 44,519 samples. Forest and funnel plots showed any-drug, mono-drug, and multi-drug resistance. Any fluoroquinolone had a resistance rate of 61.9% (95% CI: 45.7–83.8%), any trimethoprim–sulfamethoxazole—60.8% (95% CI: 52.4–70.5%), any azithromycin—38.8% (95% CI: 19.6–76.9%), any nalidixic acid—36.2% (95% CI: 14.2–92.4%), any ampicillin—34.5% (95% CI: 25.0–47.8%), and any ciprofloxacin—31.1% (95% CI: 11.9–81.3%). Multi-drug-resistant Shigella spp. exhibited a prevalence of 33.4% (95% CI: 17.3–64.5%), compared to 2.6% to 3.8% for mono-drug-resistant strains. Since resistance to commonly used antibiotics and multidrug resistance were higher, a judicious use of antibiotics, the promotion of infection control measures, and the implementation of antimicrobial surveillance and monitoring programs are required to tackle the therapeutic challenges of shigellosis. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

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15 pages, 905 KB

Open AccessSystematic Review

Candida lipolytica Bloodstream Infection in an Adult Patient with COVID-19 and Alcohol Use Disorder: A Unique Case and a Systematic Review of the Literature

by Omar Simonetti, Verena Zerbato, Sara Sincovich, Lavinia Cosimi, Francesca Zorat, Venera Costantino, Manuela Di Santolo, Marina Busetti, Stefano Di Bella, Luigi Principe and Roberto Luzzati

Antibiotics 2023, 12(4), 691; https://doi.org/10.3390/antibiotics12040691 - 1 Apr 2023

Cited by 5 | Viewed by 4050

Abstract

Candida lipolytica is an uncommon Candida species causing invasive fungemia. This yeast is mainly associated with the colonisation of intravascular catheters, complicated intra-abdominal infections, and infections in the paediatric population. Here, we report a case of C. lipolytica bloodstream infection in a 53-year-old man. He was admitted for an alcohol withdrawal syndrome and mild COVID-19. Among the primary risk factors for candidemia, only the use of broad-spectrum antimicrobials was reported. The empiric treatment was commenced with caspofungin and then targeted with intravenous fluconazole. Infective endocarditis was ruled out using echocardiography, and PET/TC was negative for other deep-seated foci of fungal infection. The patient was discharged after blood culture clearance and clinical healing. To the best of our knowledge, this is the first case of C. lipolytica candidemia in a patient with COVID-19 and alcohol use disorder. We performed a systematic review of bloodstream infections caused by C. lipolytica. Clinicians should be aware of the possibility of C. lipolytica bloodstream infections in patients with alcohol use disorder, especially in a COVID-19 setting. Full article

(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)

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