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Antibiotics
Special Issues
Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship
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Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship

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

Deadline for manuscript submissions: 31 March 2025 | Viewed by 11527

Special Issue Editor

Dr. Daniel T. Anderson

E-Mail Website
Guest Editor
Department of Pharmacy, Augusta University Medical Center, Augusta, GA 30912, USA
Interests: antimicrobial stewardship; antimicrobial resistance

Special Issue Information

Dear Colleagues,

Antimicrobial resistance represents a pressing public health concern. Robust antimicrobial stewardship programs are employed as a method of mitigating the further development of antimicrobial resistance. While there has been an influx of recent literature concerning antimicrobial resistance as a consequence of inappropriate antimicrobial utilization, there remains a need for evidence supporting innovative antimicrobial stewardship initiatives and their correlation with the prevention of antimicrobial resistance.

This Special Issue aims to provide a comprehensive update on novel or adapted antimicrobial stewardship initiatives and the relative impact seen on antimicrobial resistance. Manuscripts reporting antimicrobial resistance rates and correlations with antimicrobial utilization, as well as those describing antimicrobial stewardship program development, initiatives, and outcomes, will be considered for publication. We welcome original research articles, reviews, or meta-analyses geared at addressing the aforementioned considerations. I hope you will consider submitting your work to this Special Issue of Antibiotics.  

Dr. Daniel T. Anderson
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • antimicrobial resistance
  • treatment
  • antimicrobials

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Published Papers (5 papers)

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Research

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9 pages, 488 KiB  
Article
Clinical Outcomes in Patients Who Received a One-Time Aminoglycoside Dose for Extended-Spectrum Beta-Lactamase-Producing Enterobacterales or Pseudomonas aeruginosa Cystitis
by Kelsey Bouwman and Melissa George
Antibiotics 2024, 13(6), 552; https://doi.org/10.3390/antibiotics13060552 - 13 Jun 2024
Viewed by 2445
Abstract
The Infectious Diseases Society of America (IDSA) recommends a single dose of an aminoglycoside for uncomplicated cystitis caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) and difficult-to-treat Pseudomonas aeruginosa. However, there is very little recent clinical evidence to support this recommendation. The objective [...] Read more.
The Infectious Diseases Society of America (IDSA) recommends a single dose of an aminoglycoside for uncomplicated cystitis caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) and difficult-to-treat Pseudomonas aeruginosa. However, there is very little recent clinical evidence to support this recommendation. The objective of this study was to evaluate the safety and efficacy of a single-dose aminoglycoside for cystitis caused by ESBL-E or Pseudomonas aeruginosa. This was a multicenter, retrospective, cohort study. Patients who received ≥3 days of standard of care were compared to patients who received a one-time dose of an aminoglycoside with or without a short course of effective therapy before. The primary outcome was the rate of relapse defined as requiring escalation of antibiotics or starting new antibiotic therapy within 14 days after the completion of antibiotics. A total of 66 patients were included in this study, with 33 patients in each arm. There were more males and complicated cystitis patients in the standard-of-care group. There was no difference found in the rate of relapse. The length of stay was significantly shorter in the aminoglycoside group (4.5 ± 4.4 days vs. 14.1 ± 10.1 days, p < 0.0001). A one-time dose of an aminoglycoside did not increase the risk of relapse and was associated with a shorter length of stay when used to treat cystitis caused by ESBL-E or Pseudomonas aeruginosa. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship)
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15 pages, 358 KiB  
Article
Knowledge and Perceptions of Final-Year Nursing Students Regarding Antimicrobials, Antimicrobial Resistance, and Antimicrobial Stewardship in South Africa: Findings and Implications to Reduce Resistance
by Elisma Teague, Selente Bezuidenhout, Johanna C. Meyer, Brian Godman and Deirdré Engler
Antibiotics 2023, 12(12), 1742; https://doi.org/10.3390/antibiotics12121742 - 16 Dec 2023
Cited by 1 | Viewed by 2036
Abstract
Antimicrobial resistance (AMR) is being increasingly seen as the next pandemic due to high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide [...] Read more.
Antimicrobial resistance (AMR) is being increasingly seen as the next pandemic due to high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final-year nursing students regarding antibiotic use, AMR, and antimicrobial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms® was undertaken among six universities in South Africa offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew that ceftazidime is not a fourth-generation cephalosporin, and only 16.1% knew that clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control, respectively, increase AMR. AMS was also not a well-known concept among final-year nurses. The lack of knowledge regarding antibiotics, AMR, and AMS among final-year nurses could have important repercussions in practice once these nurses are qualified. Consequently, this information gap needs to be urgently addressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship)
28 pages, 464 KiB  
Article
A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance
by Audrey Chigome, Nishana Ramdas, Phumzile Skosana, Aislinn Cook, Natalie Schellack, Stephen Campbell, Giulia Lorenzetti, Zikria Saleem, Brian Godman and Johanna C. Meyer
Antibiotics 2023, 12(10), 1540; https://doi.org/10.3390/antibiotics12101540 - 14 Oct 2023
Cited by 9 | Viewed by 3201
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to [...] Read more.
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the ‘Access’ group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship)
16 pages, 323 KiB  
Article
A Multicenter Cross-Sectional Survey of Knowledge, Attitude, and Practices of Healthcare Professionals towards Antimicrobial Stewardship in Ghana: Findings and Implications
by Israel Abebrese Sefah, Sarentha Chetty, Peter Yamoah, Johanna C. Meyer, Audrey Chigome, Brian Godman and Varsha Bangalee
Antibiotics 2023, 12(10), 1497; https://doi.org/10.3390/antibiotics12101497 - 29 Sep 2023
Cited by 5 | Viewed by 2574
Abstract
Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. [...] Read more.
Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs’ level of knowledge (aOR = 3.02 C.I = 1.12–8.11), attitude (aOR = 0.37 C.I = 0.20–0.69) and practice (aOR = 2.09 C.I =1.09–3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship)

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7 pages, 2026 KiB  
Brief Report
Evaluation of a Pharmacist-Led Methicillin-Resistant Staphylococcus aureus Nasal PCR Testing Protocol
by Blain Thayer, Jonathan D. Edwards, Madeline G. Belk and Spencer H. Durham
Antibiotics 2024, 13(12), 1195; https://doi.org/10.3390/antibiotics13121195 - 7 Dec 2024
Viewed by 571
Abstract
Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) can cause cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, and nasal colonization with this pathogen increases the risk of infection. Due to its high negative predictive value, multiple studies support using the MRSA nasal polymerase chain [...] Read more.
Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) can cause cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, and nasal colonization with this pathogen increases the risk of infection. Due to its high negative predictive value, multiple studies support using the MRSA nasal polymerase chain reaction (PCR) test to discontinue antimicrobials that target MRSA in the setting of a negative test result. The purpose of this project was to assess the utility of a protocol to allow pharmacists the ability to order MRSA nasal PCR screenings in hospitalized patients with pneumonia. Results: The pre-protocol group included a random sample of 100 patients, and the post-protocol group included 625 patients. Vancomycin DOTs when pharmacists ordered PCRs were significantly lower compared to the pre-protocol group (p < 0.5; 95% CI, 0.46–2.24). The average length of stay and readmission rates at 30 days were significantly lower in the post-protocol group compared to the pre-protocol group (p < 0.05 and p = 0.02, respectively), but there was no significant difference in mortality (p = 0.33). Methods: A protocol was implemented at our institution that allowed pharmacists to order an MRSA nasal PCR test in patients with pneumonia. This retrospective chart review compared a cohort of patients who received vancomycin from before implementation of the protocol to patients who received vancomycin after the protocol’s implementation. The primary endpoint was vancomycin days of therapy (DOTs) between the pre-protocol group and the post-protocol group. Other endpoints assessed included the length of hospitalization, readmission rates, and mortality. Conclusions: Pharmacists ordering MRSA nasal PCR tests significantly reduced vancomycin DOTs, average length of stay, and 30-day readmission rates, contributing to positive outcomes in patients with pneumonia. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Clinical Infection and Antibiotic Stewardship)
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