Antibiotics

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21 pages, 3721 KB

Open AccessArticle

Shifting Epidemiology and Antifungal Susceptibility Patterns of Clinical Fungal Isolates in an Intensive Care Unit (ICU) from Bucharest, Romania: A Retrospective Observational Study

by Madalina (Preda) Solomon, Beatrice Mahler, Oana Popescu, Lia-Mara Ditu, Irina Gheorghe-Barbu, Laura Ioana Chivu and Loredana Sabina Cornelia Manolescu

Antibiotics 2026, 15(5), 440; https://doi.org/10.3390/antibiotics15050440 - 29 Apr 2026

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Abstract

Background: Antifungal resistance among Candida species represents a growing clinical challenge, particularly in the context of increasing prevalence of non-albicans species. Methods: We conducted a retrospective analysis of 747 fungal isolates collected between 2021 and 2026, evaluating species distribution, antifungal susceptibility profiles, minimum [...] Read more.

Background: Antifungal resistance among Candida species represents a growing clinical challenge, particularly in the context of increasing prevalence of non-albicans species. Methods: We conducted a retrospective analysis of 747 fungal isolates collected between 2021 and 2026, evaluating species distribution, antifungal susceptibility profiles, minimum inhibitory concentration (MIC) patterns, and temporal trends in resistance. Results: Non-albicans Candida species accounted for 67.5% of isolates, exceeding the proportion of Candida albicans. Fluconazole and flucytosine exhibited the highest resistance rates (16.1% and 17.4%, respectively), while amphotericin B showed the highest susceptibility rate (82.1%). MIC analysis revealed elevated MIC90 values for azoles in Candida glabrata and Candida krusei, consistent with reduced susceptibility. A significant association between antifungal agent and susceptibility profile was observed (χ² = 33.81, p < 0.001; Cramér’s V = 0.205). Temporal analysis demonstrated fluctuating resistance patterns rather than a consistent increase over time. Multidrug resistance was uncommon (2.5%), although non-susceptibility to multiple agents was more frequent (20.3%). Conclusions: The study highlights substantial variability in antifungal susceptibility across Candida species and antifungal agents, emphasizing the importance of continuous surveillance and species-specific treatment strategies. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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12 pages, 263 KB

Open AccessArticle

Balancing Speed and Cost: Economic Insights from Rapid Diagnostic Testing in Bloodstream Infections

by Gergana Lengerova, Ralitsa Raycheva, Michael M. Petrov and Todor Kantardjiev

Antibiotics 2026, 15(3), 320; https://doi.org/10.3390/antibiotics15030320 - 20 Mar 2026

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Abstract

Background: Rapid diagnostic tests (RDTs) for bloodstream infections (BSIs) reduce time to pathogen identification, yet evidence on their real-world economic and clinical value remains inconsistent. This study aimed to compare clinical outcomes, antibiotic utilization, and hospital costs associated with different rapid microbiological identification [...] Read more.

Background: Rapid diagnostic tests (RDTs) for bloodstream infections (BSIs) reduce time to pathogen identification, yet evidence on their real-world economic and clinical value remains inconsistent. This study aimed to compare clinical outcomes, antibiotic utilization, and hospital costs associated with different rapid microbiological identification methods versus standard culture. Methods: A retrospective observational study was conducted in a tertiary university hospital including 115 hospitalized patients with suspected or confirmed BSIs. Multiplex PCR (mPCR), fluorescence in situ hybridization (FISH), and MALDI-TOF MS were compared with conventional culture. Outcomes included mortality, length of stay, antibiotic-days, and direct and indirect hospital costs. Nonparametric and exploratory adjusted analyses were performed. Results: No significant differences were observed across diagnostic groups for age, sex, mortality, or length of stay. Patients tested with mPCR showed higher empirical and total antibiotic-days and increased antibiotic-related costs (p < 0.05). Median direct and indirect hospital costs were numerically lower with FISH and mPCR but did not reach statistical significance. Adjusted analyses confirmed that diagnostic modality was not independently associated with mortality or costs. Conclusions: Rapid diagnostics accelerate identification but demonstrate heterogeneous downstream clinical and economic effects. Their value appears to depend more on local implementation and antimicrobial stewardship integration than on diagnostic speed alone. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

14 pages, 1505 KB

Open AccessArticle

Antibiotic Use Among Children Requiring Respiratory Support in Intensive Care Unit (ICU) from Sofia, Bulgaria: A Single-Center Retrospective Experience

by Lilia Bozadzhieva, Dimitrinka Miteva, Lyubomila Ilarionova, Tania Teneva, Blagomir Zdravkov and Guergana Petrova

Antibiotics 2026, 15(2), 225; https://doi.org/10.3390/antibiotics15020225 - 19 Feb 2026

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Abstract

Antibiotic use in critically ill children requiring respiratory support remains controversial, particularly in the absence of standardized guidelines for patients managed with non-invasive ventilation (NIV). Evidence in this area remains limited, and real-world data are therefore valuable. Objective: This retrospective single-center study aimed [...] Read more.

Antibiotic use in critically ill children requiring respiratory support remains controversial, particularly in the absence of standardized guidelines for patients managed with non-invasive ventilation (NIV). Evidence in this area remains limited, and real-world data are therefore valuable. Objective: This retrospective single-center study aimed to describe antibiotic prescribing patterns and infectious outcomes in pediatric patients admitted to the intensive care unit (PICU) with respiratory failure, according to the type of respiratory support. Methods: Children aged 0–17 years admitted between January 2021 and February 2025 who required oxygen supplementation, NIV, or invasive mechanical ventilation (IMV) were included. Demographic characteristics, underlying conditions, infectious complications, antibiotic exposure, length of PICU stay, and outcomes were analyzed using descriptive statistics and univariate comparisons. Results: Eighty-nine patients were included. Ventilator-associated pneumonia (VAP) occurred exclusively in patients receiving IMV, and infection complications were observed more in this group compared to those receiving NIV (p = 0.005). Pseudomonas aeruginosa was the most frequently isolated pathogen. Antibiotics were administered in 82% of patients, with no significant association between the respiratory support and initiation of antibiotic therapy (p = 0.195). A higher number of antibiotics was administered in patients receiving IMV compared with those receiving oxygen therapy alone. Conclusions: Antibiotic use in children requiring respiratory support in the PICU was common and appears to be driven primarily by underlying disease and illness severity rather than by the ventilation modality alone. Infections specific to invasive ventilation, such as VAP, were more frequent in patients receiving IMV, while infection-related outcomes in non-invasive groups should be interpreted cautiously due to differences in diagnostic definitions. These findings are descriptive and hypothesis-generating and highlight the need for prospective multicenter studies to create evidence-based antibiotic stewardship strategies in pediatric critical care. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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17 pages, 1700 KB

Open AccessArticle

Risk Factors Associated with the Emergence of Multidrug-Resistant Bacteria and Fungal Infections in Walled-Off Pancreatic Necrosis

by Michael Fernandez Y Viesca, Alia Hadefi, Lukas Otero Sanchez, Martina Pezzullo, Morgane Van Wettere, Eleni Karakike, Maya Hites, Viviane De Maertelaer, Myriam Delhaye and Marianna Arvanitakis

Antibiotics 2026, 15(2), 220; https://doi.org/10.3390/antibiotics15020220 - 17 Feb 2026

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Abstract

Background: Infected pancreatic necrosis (IPN) is a serious complication of moderate-to-severe acute pancreatitis (AP), associated with high morbidity, intensive care unit (ICU) admission, organ failure, and mortality. Initial management relies on antibiotics and drainage of walled-off necrosis (WON). In the context of increasing [...] Read more.

Background: Infected pancreatic necrosis (IPN) is a serious complication of moderate-to-severe acute pancreatitis (AP), associated with high morbidity, intensive care unit (ICU) admission, organ failure, and mortality. Initial management relies on antibiotics and drainage of walled-off necrosis (WON). In the context of increasing multidrug-resistant (MDR) bacteria, identifying risk factors for MDR emergence is crucial. The impact of fungal infections (FIs) on outcomes also remains unclear. This study aimed to identify risk factors associated with the emergence of MDR bacteria and FIs during intervention for IPN. Methods: This retrospective study included 71 consecutive patients undergoing intervention for suspected IPN or symptomatic WON. Results: At first intervention, IPN was confirmed in 52 patients (73%), MDR bacteria in 19 (27%), extensively drug-resistant (XDR) bacteria in 4 (5.6%), and FI in 21 (30%). After all interventions, MDR/XDR bacteria and fungi were detected in 25 (35%)/11 (15.5%) and 42 (59%) patients, respectively. Independent risk factors for MDR emergence were the number of antibiotic changes (b, 1.70; 95% CI 1.18–2.43; p = 0.004) and need for nutritional support (NS) (b, 5.69; 95% CI 1.52–20.50; p = 0.010). No independent factor was associated with FI. The 180-day mortality did not differ across groups. The 90-day cumulative ICU admission rate was higher in IPN vs. non-IPN (63.1% vs. 29.4%, p = 0.030) and in MDR vs. non-MDR (72.2% vs. 37.1%, p = 0.005). Conclusions: Antibiotic changes and NS were independently associated with MDR emergence in IPN. No independent factors were linked to FI. ICU admission was significantly higher in IPN and MDR cases. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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24 pages, 698 KB

Open AccessArticle

Development of AWaRe-Based Quality Indicators to Assess the Appropriateness of Antibiotic Prescribing in Primary Healthcare in South Africa

by Audrey K. Chigome, Johanna C. Meyer, Adrian Brink, Sabiha Essack, Elmien Bronkhorst, Halima Dawood, Yasmina Johnson, Renier Coetzee, Chuma Maphathwana, Moloko Phaho, Phillip Malebaco, Nonhlanhla Nhlapo, Filip Djukic, Annie Heath, Aislinn Cook, Gauri Kumar, Stephen M. Campbell, Brian Godman and Marc Mendelson

Antibiotics 2026, 15(2), 196; https://doi.org/10.3390/antibiotics15020196 - 10 Feb 2026

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Abstract

Background/Objectives: The overuse and misuse of antibiotics contribute to antimicrobial resistance (AMR) globally. The appropriateness of antibiotic prescribing at the primary healthcare (PHC) level must be urgently addressed to reduce high levels of inappropriate antibiotic prescribing and associated AMR. This study aimed [...] Read more.

Background/Objectives: The overuse and misuse of antibiotics contribute to antimicrobial resistance (AMR) globally. The appropriateness of antibiotic prescribing at the primary healthcare (PHC) level must be urgently addressed to reduce high levels of inappropriate antibiotic prescribing and associated AMR. This study aimed to develop quality indicators, based on the World Health Organization (WHO)’s Access, Watch, Reserve (AWaRe) guidance, to assess the appropriateness and quality regarding antibiotic prescribing in public PHC settings in South Africa. Methods: Potential indicators were identified from indicators developed by City St George’s, University of London (SGUL); a review of AWaRe-based indicators; and the results from point prevalence surveys at PHC clinics in South Africa. The indicators were developed using the RAND/UCLA Appropriateness Method. In Round 1, 12 experts individually rated 78 indicators for clarity and appropriateness. In Round 2, 10 experts rated 89 indicators for appropriateness and feasibility during an interactive online meeting. Results: The final set had 61/89 indicators (68.5%) that were rated both appropriate and feasible with agreement. Dental infections (9/9; 100%) alongside skin and soft tissue infections (11/13; 84.6%) had the highest percentage of indicators that were rated appropriate and feasible with agreement. Lower urinary tract infections (6/11; 54.5%) and general (4/8; 50%) categories had the lowest percentage of indicators rated appropriate and feasible with agreement. Conclusions: The process proved valuable in developing potential indicators for use in future antimicrobial stewardship programmes to improve antibiotic prescribing in public sector PHC facilities in South Africa and beyond. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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12 pages, 884 KB

Open AccessArticle

Oral Vancomycin in the Treatment of Clostridioides difficile Infection: A Single-Center Observational Study in Southern Poland (2016–2022), Involving 528,887 Hospitalized Patients

by Anna Pałka, Mateusz Gajda, Norbert Kapczyński, Estera Jachowicz-Matczak, Marcin Krzanowski, Jakub Kasprzyk, Barbara Żółtowska, Jacek Czepiel and Jadwiga Wójkowska-Mach

Antibiotics 2026, 15(2), 161; https://doi.org/10.3390/antibiotics15020161 - 3 Feb 2026

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Abstract

Objectives: Clostridioides difficile infection (CDI) remains a major healthcare challenge, particularly in resource-limited settings. Methods: This retrospective, single-center study analyzed CDI epidemiology and treatment outcomes among 528,887 hospitalized patients at the University Hospital in Kraków, Poland, between 2016 and 2022. Results: A [...] Read more.

Objectives: Clostridioides difficile infection (CDI) remains a major healthcare challenge, particularly in resource-limited settings. Methods: This retrospective, single-center study analyzed CDI epidemiology and treatment outcomes among 528,887 hospitalized patients at the University Hospital in Kraków, Poland, between 2016 and 2022. Results: A total of 2341 CDI cases were confirmed, with an overall incidence of 4.32 per 1000 admissions. The highest rates were observed in geriatric and infectious diseases units. During the COVID-19 pandemic, healthcare-associated CDI cases surged, accounting for up to 89.2% of infections in 2020 with an incidence rate of 3.8 per 1000 admissions, compared with 2.5 per 1000 admissions in 2016. Vancomycin-based therapy was associated with significantly lower mortality (OR 0.73, 95% CI 0.56–0.95) compared to metronidazole, while combination therapy (vancomycin, metronidazole) showed the highest recurrence rate (17%). Fidaxomicin use was minimal (0.4%) due to limited availability. Recurrent CDI occurred in 14.2% of cases, with a relapse-free survival advantage observed in vancomycin-treated patients. The overall in-hospital case fatality rate associated with CDI was 22.5%. Conclusions: Despite stable overall CDI incidence, the study highlights the impact of increased antibiotic consumption during the pandemic on HA-CDI dynamics. The findings underscore the need for improved antimicrobial stewardship, broader access to advanced therapies such as fidaxomicin and bezlotoxumab, and enhanced diagnostic protocols. In settings with restricted therapeutic options, vancomycin remains a valuable treatment, particularly for reducing mortality. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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22 pages, 639 KB

Open AccessArticle

Psychometric Validation of the Community Antimicrobial Use Scale (CAMUS) in Primary Healthcare and the Implications for Future Use

by Nishana Ramdas, Natalie Schellack, Corrie Uys, Brian Godman, Stephen M. Campbell and Johanna C. Meyer

Antibiotics 2026, 15(1), 107; https://doi.org/10.3390/antibiotics15010107 - 21 Jan 2026

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Abstract

Background/Objectives: Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African [...] Read more.

Background/Objectives: Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African primary healthcare (PHC) are scarce. This study evaluated the reliability, structural validity, and interpretability of the Community Antimicrobial Use Scale (CAMUS) in South Africa. Methods: A cross-sectional survey was conducted with 1283 adults across 25 diverse public PHC facilities across two provinces. The 30-item theory-based tool underwent exploratory and confirmatory factor analysis (EFA/CFA), reliability, and validity testing. Results: EFA identified a coherent five-factor structure: (F1) Understanding antibiotics; (F2) Social and behavioural norms; (F3) Non-prescribed use; (F4) Understanding of AMR; and (F5) Attitudes. Internal consistency was strongest for knowledge and misuse domains (alpha approximation 0.80). Test–retest reliability was good-to-excellent (ICC: 0.72–0.89). CFA confirmed acceptable composite reliability (CR ≥ 0.63). Although average variance extracted (AVE) was low for broader behavioural constructs, indicating conceptual breadth, it was high for AMR knowledge (0.737). Construct validity was supported by positive correlations with health literacy (r = 0.48) and appropriate use intentions (r = 0.42). Measurement error metrics (SEM = 1.59; SDC = 4.40) indicated good precision for group-level comparisons. Conclusions: CAMUS demonstrated a theoretically grounded structure with robust performance in knowledge and misuse domains. While social and attitudinal domains require refinement, we believe the tool is psychometrically suitable for group-level antimicrobial use surveillance and programme evaluation in South African PHC settings and wider to help with targeting future educational programmes among patients. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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26 pages, 404 KB

Open AccessArticle

Prevalence and Associated Factors for Purchasing Antibiotics Without a Prescription Among Patients in Rural South Africa: Implications for Addressing Antimicrobial Resistance

by Tiyani Milta Maluleke, Morgan Tiyiselani Maluleke, Nishana Ramdas, Ana Golić Jelić, Amanj Kurdi, Audrey Chigome, Stephen M. Campbell, Vanda Marković-Peković, Natalie Schellack, Brian Godman and Johanna C. Meyer

Antibiotics 2025, 14(12), 1273; https://doi.org/10.3390/antibiotics14121273 - 16 Dec 2025

Cited by 3 | Viewed by 2049

Abstract

Background: Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted [...] Read more.

Background: Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to comprehensively evaluate antibiotic dispensing patterns and factors influencing this to reduce AMR. Methods: A previously piloted questionnaire was administered to patients exiting three different categories of community pharmacies in a rural province. The questionnaire included data on the prevalence of antibiotics dispensed, whether without a prescription, and the rationale for this. Results: A total of 465 patients leaving community pharmacies with a medicine were interviewed. 54.4% of interviewed patients were dispensed at least one antibiotic, with 78.7% dispensed these without a prescription from either independent or franchise pharmacies. Metronidazole (36.1%) and azithromycin (32.7%) were the most dispensed antibiotics. STIs were the most common infectious disease for which an antibiotic was dispensed (60.1%), with 99.6% dispensed without a prescription. Upper respiratory tract infections (URTIs) were the most common infection where antibiotics were dispensed with a prescription (60.0%), with little dispensing without a prescription (7.1%). The most frequently cited reasons for obtaining antibiotics without a prescription were prior use (56.8%), long waiting times at PHC clinics (15.6%), and financial constraints (6.0%). Conclusions: There is an urgent need to review community pharmacists’ scope of practice, including allowing them to prescribe antibiotics for infectious diseases such as UTIs, similar to other countries. Concomitantly, utilise trained community pharmacists to engage with prescribers to improve future antibiotic use, especially for URTIs. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

17 pages, 1085 KB

Open AccessArticle

Genetic Determinants and Clonal Composition of Levofloxacin-Resistant Streptococcus agalactiae Isolates from Bulgaria

by Vasil S. Boyanov, Alexandra S. Alexandrova and Raina T. Gergova

Antibiotics 2025, 14(11), 1121; https://doi.org/10.3390/antibiotics14111121 - 7 Nov 2025

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Abstract

Background: Levofloxacin is a broad-spectrum third-generation fluoroquinolone with bactericidal activity against Streptococcus species. We aimed to investigate the susceptibility rates of levofloxacin, the genetic determinants contributing to resistance, the serotype distribution, and the population structure of levofloxacin-resistant Streptococcus agalactiae (GBS) isolates. Methods [...] Read more.

Background: Levofloxacin is a broad-spectrum third-generation fluoroquinolone with bactericidal activity against Streptococcus species. We aimed to investigate the susceptibility rates of levofloxacin, the genetic determinants contributing to resistance, the serotype distribution, and the population structure of levofloxacin-resistant Streptococcus agalactiae (GBS) isolates. Methods: Antibiotic susceptibility testing was conducted according to the EUCAST criteria. PCR-serotyping, determination of mutations in the quinolone resistance-determining regions (QRDRs), and multi-locus sequence typing (MLST) were performed on all levofloxacin-resistant strains. Results: Among the 328 GBS isolates, 11.9% exhibited resistance to levofloxacin. We categorized the samples into two main groups: vaginal (64.1%) and extra-vaginal. The latter was further subdivided into invasive (10.3%) and non-invasive (25.6%) ones. The most common serotypes identified were V (30.8%) and III (25.6%). All examined resistant strains possessed missense mutations in the QRDR of parC (Ser79Phe/Tyr and Asp83Asn), whereas 59.0% of them exhibited additional mutation in gyrA (Ser81Leu and Glu85Lys/Ala). The MLST results disclosed six clonal complexes: CC19(64.1%), followed by CC1 (10.3%), CC452 (7.7%), and CC459 (5.1%), and CC12 and CC23, represented by single strains. Conclusions: We observed a growing resistance to fluoroquinolones that appears to exceed the average in Europe. More than half of the isolates exhibited the accumulation of mutations within the QRDRs. Rigorous monitoring is needed to prevent the emergence of MDR GBS and preserve the effectiveness of the newer generations of fluoroquinolones. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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13 pages, 215 KB

Open AccessArticle

Antibiotic Prescription Patterns in the Post-COVID-19 Era in Six European Countries: A Cross-Sectional Study

by Karel Kostev, Swati Upadhyaya, Oliver Utsch, Katarzyna Sosnowska, Marcel Konrad and Christian Tanislav

Antibiotics 2025, 14(9), 911; https://doi.org/10.3390/antibiotics14090911 - 10 Sep 2025

Cited by 4 | Viewed by 2304

Abstract

Background/Objective: After the relaxation of acute containment measures during the COVID-19 pandemic, Europe experienced a substantial rebound of non-COVID infections surpassing pre-pandemic levels and causing significant clinical burden. The aim of our study is to analyze outpatient prescription data in Germany, France, Italy, [...] Read more.

Background/Objective: After the relaxation of acute containment measures during the COVID-19 pandemic, Europe experienced a substantial rebound of non-COVID infections surpassing pre-pandemic levels and causing significant clinical burden. The aim of our study is to analyze outpatient prescription data in Germany, France, Italy, Belgium, the UK, and Poland in order to assess trends and disparities in the post-COVID landscape. Methods: The present cross-sectional study utilized data from six independently collected datasets containing details from longitudinal prescription (LRx) databases. We aimed to evaluate changes in the number of antibiotic prescriptions issued in 2022 (the first post-pandemic year) compared to 2021 (a pandemic year), as well as subsequent developments in 2023 and 2024. Analyses were stratified by age group and by sex. In addition, the most frequently prescribed antibiotics in each year and country were reported. Results: All countries experienced a marked increase in antibiotic use in 2022 compared to 2021. The year-on-year growth in 2022 ranged from +12.0% in France to a substantial +39.3% in Belgium. Germany, Poland, and the UK also showed strong increases of over 25%, while Italy rose by 21.5%. Growth slowed in 2023 and stabilized or declined in 2024, particularly in Poland, Italy, and Belgium. Pediatric antibiotic use surged in 2022, especially among children under 10 (+75% in the UK), then leveled off and even declined in some cases in 2024, while the number of antibiotic prescriptions in older adults either decreased or increased only slightly. Germany and the UK showed continued pediatric antibiotic use increases through 2023. Amoxicillin dominated prescriptions in most countries, but drug choice patterns varied widely by country. Conclusions: This study shows a clear increase in outpatient antibiotic prescriptions issued across Europe after the COVID-19 pandemic, particularly among children and teenagers. Although the overall trends are now starting to level out, some countries still show rising numbers. These findings underscore the importance of a renewed focus on antibiotic stewardship programs, particularly in outpatient and primary care settings. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

14 pages, 355 KB

Open AccessArticle

Very Early Transition to Oral Antibiotics in Uncomplicated Enterobacterales Bloodstream Infections: Effectiveness and Impact on Carbon Footprint Saving

by Aina Mateu, Ana Martínez-Urrea, Clara Gallego, Laura Gisbert, Beatriz Dietl, Mariona Xercavins, Maria López-Sánchez, Silvia Álvarez, Sergi García Rodríguez, Toni Roselló, Josefa Pérez, Esther Calbo and Lucía Boix-Palop

Antibiotics 2025, 14(8), 751; https://doi.org/10.3390/antibiotics14080751 - 25 Jul 2025

Cited by 1 | Viewed by 2583

Abstract

Background/Objective: This study aimed to evaluate the effectiveness of very early oral transition in Enterobacterales bloodstream infections (E-BSIs), identify factors associated with it, compare the effectiveness of different oral options, and assess its economic and ecological benefits. Methods: Retrospective, observational cohort [...] Read more.

Background/Objective: This study aimed to evaluate the effectiveness of very early oral transition in Enterobacterales bloodstream infections (E-BSIs), identify factors associated with it, compare the effectiveness of different oral options, and assess its economic and ecological benefits. Methods: Retrospective, observational cohort study including monomicrobial E-BSI in clinically stable adult patients by day 3 of bacteremia with oral antibiotic options. Transition to oral antibiotics by day 3 or earlier (early oral (EO) group) was compared to later transition or remaining on intravenous therapy (nEO group). Early oral transition-associated factors were analyzed. Oral high-dose beta-lactams (BLs) were compared to quinolones (QLs) or trimethoprim/sulfamethoxazole (TS). Economic and ecological costs were assessed. Results: Of 345 E-BSI, 163 (47.2%) were in the EO group, characterized by more urinary tract infections (UTIs) and shorter hospital stays. The nEO group had higher Charlson Comorbidity Index (CCI), extended-spectrum beta-lactamase (ESBL) production, greater source control need, and longer time to clinical stability. There were no significant differences in mortality and relapse. UTIs were associated with early oral transition (OR 2.02, IC 95% 1.18–3.48), while higher CCI (0.85, 0.77–0.95), source control need (0.39, 0.19–0.85), longer time to clinical stability (0.51, 0.39–0.66), and ESBL isolates (0.39, 0.19–0.80) hindered this practice. High-dose BLs and QL/TS were equally effective. Early oral transition resulted in 38.794 KgCO₂eq reduction and EUR 269,557.99 savings. Conclusions: Very early oral transition at day 3 or before in stable E-BSI patients is effective, eco-sustainable, and cost-effective; UTI is related with the early oral switch, while comorbidities, ESBL production, source control need, or longer time to clinical stability hinder this practice. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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11 pages, 511 KB

Open AccessArticle

Effects of Antibiotic De-Escalation on Outcomes in Severe Community-Acquired Pneumonia: An Inverse Propensity Score-Weighted Analysis

by Diego Viasus, Gabriela Abelenda-Alonso, Juan Bolivar-Areiza, Carlota Gudiol and Jordi Carratalà

Antibiotics 2025, 14(7), 716; https://doi.org/10.3390/antibiotics14070716 - 17 Jul 2025

Cited by 1 | Viewed by 3229

Abstract

Objective: This study aimed to assess the effect of antibiotic de-escalation on 30-day mortality, duration of intravenous (IV) antibiotic therapy and length of hospital stay (LOS) in severe community-acquired pneumonia (sCAP). Methods: We performed a retrospective analysis of prospectively collected data [...] Read more.

Objective: This study aimed to assess the effect of antibiotic de-escalation on 30-day mortality, duration of intravenous (IV) antibiotic therapy and length of hospital stay (LOS) in severe community-acquired pneumonia (sCAP). Methods: We performed a retrospective analysis of prospectively collected data from a cohort of adults diagnosed with sCAP and microbiologically confirmed etiology between 1995 to 2022. Two distinct time points of the de-escalation were analyzed: 3 and 6 days post-admission, corresponding, respectively, to the availability of microbiological results and the median time to clinical stability. Inverse propensity score-weighted binary logistic regression was used to adjust for potential confounders. Results: A total of 398 consecutive cases of sCAP were analyzed. No significant differences were observed between the de-escalation and non-de-escalation groups in terms of age, sex, comorbidities, or severity-related variables (such as impaired consciousness, shock, respiratory failure, or multilobar pneumonia). Patients in the de-escalation group had lower rates of leukopenia, bacteremia and empyema, and less need for mechanical ventilation, with variations depending on the timing of de-escalation. After adjusting for confounding factors in an inverse propensity score-weighted analysis, de-escalation within 3 or 6 days after admission was not associated with increased mortality risk (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 0.29–7.4; p = 0.63, and aOR 0.57, 95% CI 0.14–2.31, p = 0.43, respectively). Similar findings were observed for prolonged LOS. However, antibiotic de-escalation was related to a lower risk of prolonged IV antibiotic. Conclusions: Antibiotic de-escalation in microbiologically confirmed sCAP did not negatively impact clinical outcomes, supporting the safety of this strategy for optimizing antibiotic use in this serious infection. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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Review

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20 pages, 327 KB

Open AccessReview

Appropriateness and Abuse of Antipyretics, Anti-Inflammatory Drugs and Antibiotics in Children and Adults

by Giangiacomo Nicolini, Massimo Crapis, Andrea Lo Vecchio and Roberto Parrella

Antibiotics 2026, 15(5), 436; https://doi.org/10.3390/antibiotics15050436 - 27 Apr 2026

Viewed by 653

Abstract

Anti-inflammatory agents, antipyretics, and antibiotics are commonly used to manage fever and pain associated with infectious diseases in both adults and children. Despite their effectiveness, inappropriate and unnecessary prescriptions remain widespread, leading to adverse patient outcomes and, in the case of antibiotics, contributing [...] Read more.

Anti-inflammatory agents, antipyretics, and antibiotics are commonly used to manage fever and pain associated with infectious diseases in both adults and children. Despite their effectiveness, inappropriate and unnecessary prescriptions remain widespread, leading to adverse patient outcomes and, in the case of antibiotics, contributing to antimicrobial resistance. Addressing these issues requires effective stewardship programs focused on educating healthcare professionals and the public on evidence-based guidelines for optimal prescribing practices. This paper explores the five “A”s fundamental to infection management in pediatric and adult patients: appropriateness, abuse, antipyretics, anti-inflammatory agents, and antibiotics. Through a comprehensive literature review, expert perspectives, and clinical guidelines, the study evaluates the roles of anti-inflammatory agents (e.g., ibuprofen), antipyretics (e.g., paracetamol), and antibiotics in clinical practice, highlighting best practices for their use. Current guidelines emphasize that antipyretics should only be administered when fever is accompanied by significant discomfort or pain, as fever itself plays a role in the immune response. Based on the available literature, experts also suggest that paracetamol should be preferred as a first-line antipyretic due to its favorable safety profile, while ibuprofen should be used with caution, particularly during respiratory infections, varicella, and severe bacterial infections, due to its potential to exacerbate complications. According to experts, special consideration is also required for patients with renal or gastrointestinal comorbidities to prevent toxicity. Regarding antibiotics, prescriptions should be limited to clear evidence of bacterial infection to avoid unnecessary patient exposure and the development of antimicrobial resistance. Stewardship programs underscore the importance of selecting the right agent, optimizing dosing, and introducing shorter treatment regimens where supported by evidence, to improve therapeutic outcomes while minimizing resistance risks. Ultimately, this paper provides practical, evidence-based recommendations to support rational prescribing of antipyretics, anti-inflammatory drugs, and antibiotics, aiming to optimize patient outcomes, prevent unnecessary toxicity, and contribute to global efforts against antimicrobial resistance. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

19 pages, 1107 KB

Open AccessReview

Reflections on the Theoretical Prerequisites for Initial Oral Antibiotic Treatment for Paediatric Bone and Joint Infections: A Narrative Review

by Pablo Rodriguez, Ahmer Khan, Giacomo De Marco, Oscar Vazquez, Andreas Tsoupras, Ardian Ramadani, Christina Steiger, Romain Dayer and Dimitri Ceroni

Antibiotics 2026, 15(4), 353; https://doi.org/10.3390/antibiotics15040353 - 30 Mar 2026

Viewed by 808

Abstract

Paediatric osteoarticular infections (OAIs) encompass a heterogeneous group of musculoskeletal infections associated with acute septic complications, prolonged morbidity and potentially long-term sequelae. Over the past two decades, advances in microbiological diagnostics—particularly nucleic acid amplification assays—have refined the aetiological understanding of OAIs and started [...] Read more.

Paediatric osteoarticular infections (OAIs) encompass a heterogeneous group of musculoskeletal infections associated with acute septic complications, prolonged morbidity and potentially long-term sequelae. Over the past two decades, advances in microbiological diagnostics—particularly nucleic acid amplification assays—have refined the aetiological understanding of OAIs and started a new therapeutic debate regarding the most appropriate routes of antibiotic administration. Clinicians now evaluate which children can be treated safely using oral antibiotics from the outset (oral-first), which require an initial intravenous (IV) phase before a step-down to oral therapy, and which will need IV therapy all along their care pathway. Treatment debates are particularly relevant in contexts involving constrained healthcare resources and limited hospital bed availability. This narrative review summarises the essential prerequisites for prescribing oral antibiotic therapy for paediatric OAIs and proposes a pharmacokinetic/pharmacodynamic (PK/PD) framework for guiding clinical decision-making. Key considerations include: pathogen identification and resistance profiling; contemporary bacteriological epidemiology; the comparative effectiveness of IV versus oral therapy; the availability of active oral antibiotics and their penetration into bone and joint compartments; achieving adequate systemic exposure and hitting PK/PD targets after oral administration; and the clinical limitations of oral antibiotic therapy, including patient selection criteria. We argue that oral-first and early-switch strategies are best framed as structured selection processes that integrate clinical severity and source control, pathogen/minimal inhibitory concentration constraints, the feasibility of attaining PK/PD targets orally and the reliability of follow-up. No single strategy should be seen as a universal default strategy. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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11 pages, 239 KB

Open AccessBrief Report

Resistance Patterns of Neisseria gonorrhoeae in PLHIV: A Cross-Sectional Study from the Republic of Cyprus, 2015–2023

by Michaela Takos, George Siakallis, Annalisa Quattrocchi, Maria Alexandrou, Panagiota Papadamou, Loukia Panagiotou and Danny Alon-Ellenbogen

Antibiotics 2025, 14(6), 589; https://doi.org/10.3390/antibiotics14060589 - 7 Jun 2025

Cited by 1 | Viewed by 1813

Abstract

Background: The rise in antimicrobial-resistant (AMR) strains of Neisseria gonorrhoeae is internationally recognised as a critical public health concern, with limited treatment options available. The urgency of this issue prompted the European Centre for Disease Prevention and Control to establish ‘EURO-GASP’ to monitor [...] Read more.

Background: The rise in antimicrobial-resistant (AMR) strains of Neisseria gonorrhoeae is internationally recognised as a critical public health concern, with limited treatment options available. The urgency of this issue prompted the European Centre for Disease Prevention and Control to establish ‘EURO-GASP’ to monitor trends in resistance and address developments. Comprehensive data on AMR strains in people living with HIV (PLHIV) is limited, especially in Cyprus. Objectives: To analyse trends in rates of resistant N. gonorrhoeae infections and identify any correlations between patient factors that may contribute to such in PLHIV in The Republic of Cyprus. Methods: We conducted a retrospective chart review study on N. gonorrhoea resistance among PLHIV from the Gregorios HIV reference clinic in Larnaca, Cyprus, between 2015 and 2023. Antimicrobial susceptibility was assessed via disc diffusion or gradient strip method on GC II agar against a non-homogenous panel of antibiotic preparations, based on standard laboratory practice variation. Demographic and clinical data, including antibiograms, treatments and test of cure, were recorded. Statistical analysis was performed using Stata v16, with significance set at p < 0.05. The study received approval from the Cyprus National Bioethics Committee. Results: A total of 45 isolates from 39 patients were analysed, with 62% of these demonstrating resistance to at least one antibiotic. Resistance rates were not shown to change over time. We identified a statistically significant linear association between a person having a history of an STI and the number of antibiotics which the isolate is resistant to (β = 1.2; p: 0.004). Notably, a single isolate demonstrated resistance to ceftriaxone, the first-line treatment currently recommended in both Europe and the United States. This finding is particularly alarming given the critical role of ceftriaxone in the management of gonorrhoea. Conclusions: Whilst there has been no increase in resistance rates over time, the detection of ceftriaxone-resistant N. gonorrhoeae is a significant public health concern. Given that having a history of an STI makes a person more likely to develop a resistant infection, PLHIV or those who engage in risky sexual behaviours are particularly vulnerable. There is a pressing need to enhance surveillance and implement routine susceptibility testing in Cyprus, given the country’s role as a major international hub for travel and migration. Molecular analysis can further improve our understanding. Additionally, the global public health community must urgently prioritise the development of novel therapeutic agents for the treatment of gonorrhoea. Full article

(This article belongs to the Special Issue Therapy of Infectious Diseases Among Children and Adults: The Role of Antibiotics in Daily Practice)

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