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Antibiotic Surveillance and Rational Use in Special Populations: Enhancing Stewardship...
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Antibiotic Surveillance and Rational Use in Special Populations: Enhancing Stewardship for Vulnerable Groups

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 31 August 2026 | Viewed by 5331

Special Issue Editors

Dr. Phumzile P Skosana

E-Mail Website
Guest Editor
Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
Interests: antibiotic stewardship; surveillance systems; special populations; rational use of antibiotics; infectious disease management
Dr. Filippo Mariano

E-Mail Website
Guest Editor
1. Department of Medical Sciences, University of Turin, Corso AM Dogliotti, 10126 Turin, Italy
2. Nephrology, Dialysis and Transplantation U, AOU City of Health and Science, CTO Hospital, Via G. Zuretti 29, 10126 Turin, Italy
Interests: acute kidney injury; continuous renal replacement therapy; citrate anticoagulation; burns; polytrauma; septic shock
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The global rise of antimicrobial resistance (AMR) presents one of the most pressing challenges to public health, necessitating urgent action across all levels of healthcare and society. Among the most vulnerable to the impacts of AMR are special population groups, including children, the elderly, immunocompromised individuals, pregnant women, and those with chronic conditions. In these populations, the rational use of antibiotics becomes even more critical to ensure effective treatment outcomes while minimizing the risk of AMR.

This Special Issue aims to explore the intersection of antibiotic surveillance and rational use of antibiotics within these special populations, shedding light on both the unique challenges and the promising strategies for improving antimicrobial stewardship. Surveillance plays an important role in tracking antibiotic use patterns, identifying misuse or overuse, and informing targeted interventions.

However, effective antibiotic stewardship in these populations requires a tailored approach that considers factors such as pharmacokinetics, comorbidities, and sensitivity to infections. It is important to examine current surveillance systems in place, discuss their effectiveness, and propose ways to refine and expand these systems to ensure they meet the specific needs of these populations.

The importance of rational antibiotic use cannot be overstated. Not only does it directly affect patient outcomes, but it also plays a critical role in decreasing the growing threat of AMR globally. By focusing on the nuanced and diverse needs of special populations, this Special Issue contributes to ongoing efforts to enhance patient safety, protect public health, and promote the responsible use of antibiotics.

Dr. Phumzile P Skosana
Dr. Filippo Mariano
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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

  • antibiotic stewardship
  • surveillance systems
  • special populations
  • rational use of antibiotics
  • infectious disease management

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Published Papers (5 papers)

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22 pages, 4716 KB  
Article
Appraisal of Multidrug-Resistant Listeria monocytogenes and Salmonella spp. Recovered from Commercial Meat Samples in the Eastern Cape, South Africa: Implications for Public Health Safety
by Luyanda Msolo, Zanda Mbiko, Sindisiwe Nokhatyana and Antony Ifeanyi Okoh
Antibiotics 2026, 15(2), 175; https://doi.org/10.3390/antibiotics15020175 - 5 Feb 2026
Abstract
Background: Multidrug-resistant bacteria have quadrupled globally, impacting effective treatment of infectious diseases. A growing concern is that many Gram-negative and Gram-positive bacteria harbor genes conferring resistance to various antibiotics including colistin. The alarming emergence of colistin resistance is exacerbated by the growing [...] Read more.
Background: Multidrug-resistant bacteria have quadrupled globally, impacting effective treatment of infectious diseases. A growing concern is that many Gram-negative and Gram-positive bacteria harbor genes conferring resistance to various antibiotics including colistin. The alarming emergence of colistin resistance is exacerbated by the growing threat of MDR Salmonella species and Listeria monocytogenes (LMO), which pose an escalating risk to global public health. Materials and Methods: In the present study, red meat samples were collected from randomly selected key retail markets in the Eastern Cape province, South Africa, and were evaluated for the incidence of LMO and the Salmonella species using standard culture-based and molecular methods. The confirmed isolates were subjected to antibiotic susceptibility testing. Results: This study demonstrated the occurrence of multidrug-resistant LMO (62%) and Salmonella species (spp.) (58%) in the red meat specimen. There were high resistance rates in both LMO and Salmonella isolates, with LMO exhibiting resistance to penicillin (89%), colistin (81%), nitrofurantoin (78%), and erythromycin (29%), while Salmonella showed resistance to trimethoprim (96.87%), tetracycline, and colistin (90.62%). Antibiotic resistance genes were also detected including BlaTem, erm, Sul1, Sul2 and mcr 1–6. Notably, Salmonella did not harbor any mcr genes that were screened in this study, whereas Listeria isolates harbored the mcr 2 (10%), 3 (7%), 4 (10%), and 6 (3%), with mcr 5 being the most prevalent with 57%. Conclusions: These findings highlight a threat to food security and public health, emphasizing the need for sturdier food handling procedures to ensure safety, enhanced antimicrobial stewardship, and alternative therapeutic strategies to combat antibiotic-resistant pathogens. 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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16 pages, 546 KB  
Article
Behavioural Determinants of Appropriate Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes: A Qualitative Study of Stakeholders’ Perspectives
by Indira Coenen, Sien Lenie, Kristien Coteur, Carmel Hughes and Veerle Foulon
Antibiotics 2026, 15(1), 5; https://doi.org/10.3390/antibiotics15010005 - 19 Dec 2025
Viewed by 347
Abstract
Background/Objectives: Urinary tract infections (UTIs) are the primary indication for antibiotic use in nursing homes (NHs); yet inappropriate prescribing, including incorrect initiation, excessive prophylactic prescribing and prolonged treatment duration, is common. This study aimed to identify key determinants of appropriate antibiotic prescribing [...] Read more.
Background/Objectives: Urinary tract infections (UTIs) are the primary indication for antibiotic use in nursing homes (NHs); yet inappropriate prescribing, including incorrect initiation, excessive prophylactic prescribing and prolonged treatment duration, is common. This study aimed to identify key determinants of appropriate antibiotic prescribing for UTIs in NHs by exploring the behaviours and perspectives of relevant stakeholders. Methods: Interviews and focus group sessions with regard to a purposive sample of 4 NHs and healthcare professionals were conducted between June 2023 and April 2024 in Flanders (Belgium). The topic guide was developed based on the Theoretical Domains Framework (TDF). A combination of deductive and inductive coding was used to identify behavioural determinants within each TDF domain. Key behavioural determinants were identified based on their importance, relevance, and feasibility. Results: We conducted 31 semi-structured interviews with residents/relatives (n = 13), physicians (n = 9), pharmacists (n = 10), and NH management (n = 5) and held 4 focus group sessions with nurses (n = 16) and nurse aides (n = 10). Appropriate antibiotic prescribing for UTIs in NHs was influenced by a complex interplay of behavioural determinants. Key behavioural determinants included lack of knowledge of guidelines, lack of self-reflection and monitoring, fear of missing complications, feelings of powerlessness, prioritising residents’ comfort, hierarchical relations with treating physicians being dominant, social pressure to prescribe, and the NH as a challenging context. Conclusions: This study identified key behavioural determinants that should be targeted to optimise antibiotic prescribing for UTIs in NHs. These findings underscore the need to conduct a theory-informed, multifaceted intervention to support behaviour change across professional roles and improve antimicrobial stewardship in this setting. 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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15 pages, 536 KB  
Article
Determining the Use and Reasons for Non-De-Escalation of Empiric Carbapenem Therapy in a Private Hospital in South Africa
by Petro de Klerk, Lindi A. Zikalala-Mabope and Phumzile P. Skosana
Antibiotics 2025, 14(12), 1220; https://doi.org/10.3390/antibiotics14121220 - 3 Dec 2025
Viewed by 490
Abstract
Background: Due to the rising incidence of ESBL-producing bacterial infections, the use of carbapenems has increased over recent decades. Carbapenems are part of the group of last-resort antimicrobials and are used widely as empirical therapy, which is contributing to the growing rate of [...] Read more.
Background: Due to the rising incidence of ESBL-producing bacterial infections, the use of carbapenems has increased over recent decades. Carbapenems are part of the group of last-resort antimicrobials and are used widely as empirical therapy, which is contributing to the growing rate of antimicrobial resistance (AMR). De-escalation has been proven to be a successful tool in antimicrobial stewardship programmes (ASPs) in minimising the occurrence of AMR and decreasing the use of antimicrobials. The purpose of the study was to find the reasons why prescribers do not de-escalate from empiric carbapenem therapy. Methods: This retrospective quantitative study was conducted in a private hospital in South Africa. The infection markers and cultures of these patients were considered. Results: De-escalation was practiced in 17% of the patients. Empiric carbapenem therapy was started in 11.2% of patients and the most prescribed carbapenem was ertapenem (62.4%). Cultures were available in 71.1% of the study population. De-escalation was not performed in 83% of patients, mostly since their infection markers decreased with carbapenem therapy (45.9%) or because of culture unavailability (28.9%). Conclusion: The study came to the conclusion that prescribers do not want to de-escalate once their patients are improving on current treatment or if there are no cultures available. 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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12 pages, 467 KB  
Article
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
Viewed by 751
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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27 pages, 654 KB  
Perspective
Neonatology: First Exposure to Antibiotics from the Ethical Perspective of Parents, Physicians, and Regulators
by Iliya Mangarov, Simeon Iliev, Yulian Voynikov, Valentina Petkova, Iva Parvova, Antoaneta Tsvetkova and Irina Nikolova
Antibiotics 2025, 14(9), 936; https://doi.org/10.3390/antibiotics14090936 - 16 Sep 2025
Cited by 1 | Viewed by 3254
Abstract
Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. [...] Read more.
Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. For parents, the birth of a very preterm infant (before 32 weeks of gestation) turns what should be a happy event into a period filled with deep uncertainty and distress. Maintaining hope amid these difficulties relies heavily on maintaining regular communication with and trusting the medical team. Clinical realities in the NICU include a high risk of infection that requires multiple medications, including antibiotics. There is an inverse relationship between gestational age and pharmaceutical exposure. Parents worry about the amount of medication their child receives and the potential long-term effects on development. Over the past thirty years, initiatives such as antimicrobial stewardship programs have worked to reduce antibiotic use and treatment duration in the NICU, emphasizing proper care for premature infants worldwide. This article examines the ethical landscape from the perspectives of three primary stakeholders: parents, healthcare providers, and regulatory bodies. The key ethical question is whether these groups achieve meaningful cooperation or if institutional and professional priorities overshadow clinical practice. In the NICU, decision-making responsibility mainly lies with the medical team, as parents often have limited influence over treatment decisions, and regulatory oversight usually occurs indirectly. This concentration of authority underscores the complex and critical nature of neonatal intensive care. 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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