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Antibiotics
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Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities,...
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Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition

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 July 2025 | Viewed by 6721

Special Issue Editors

Dr. Islam M. Ghazi

E-Mail Website
Guest Editor
Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
Interests: clinical trials; preclinical lab work including animal and invitro models; data collection and analysis; contributing to development; optimization and stewardship for antibacterial agents
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Ahmed El Yazbi

E-Mail Website
Guest Editor
Department of Pharmacology & Toxicology, Alalamein International University, Alexandria 51718, Egypt
Interests: metabolic dysfunction; low-grade inflammation; microbiota

Special Issue Information

Dear Colleagues,

The first edition of the Special Issue “Antibiotics Use and Stewardship in Hospitals and Outpatients Care Facilities” was published in 2023. It is a successful Special Issue with 19 papers and has encouraged us to open a second edition on the same topic.

As a continuation of the Special Issue published in 2023, the second edition will also explore the following fields:

  • Assessment of the prevalence and treatment outcomes of resistant phenotypes (ESBL, CRE, MRSA, and VRSA) in hospitalized patients;
  • Prevalence of concurrent infections, treatment outcome assessment, and ASP activities in special patient groups (immunocompromised patients; COVID-19 patients; pregnant women; neonates and pediatric patients; patients with genetic blood coagulopathy diseases (thalassemia, sickle cell, G6PD, etc.);
  • Impact of implementing rapid diagnostic tools for antimicrobial susceptibility testing;
  • Impact of implementing ASP strategies in outpatient and inpatient health facilities on infections, resistance patterns, healthcare costs, morbidity, and mortality rates;
  • Impact of the implementation of pre- and post-operative prophylaxis protocols;
  • Practices that improve antimicrobial stewardship and optimize outcomes;
  • Discovery of new antimicrobials or repurposing of existing antimicrobials.

Dr. Islam M. Ghazi
Prof. Dr. Ahmed El Yazbi
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 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
  • novel antibiotics
  • microbial resistance
  • optimizing treatment
  • pharmacokintics/pharmacodynamics

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Further information on MDPI's Special Issue policies can be found here.

Related Special Issue

Published Papers (5 papers)

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16 pages, 507 KiB  
Article
Monitoring Plasma Concentrations of Intravenously Administered Fosfomycin to Prevent Drug-Related Adverse Events: A Retrospective Observational Study
by Kathrin Marx, Nina Malmström, Marie Quast, Annette Glas, Ralph Wendt, Martina Kinzig, Fritz Sörgel, Maike Fedders, Thilo Bertsche and Christoph Lübbert
Antibiotics 2025, 14(6), 548; https://doi.org/10.3390/antibiotics14060548 - 27 May 2025
Viewed by 77
Abstract
Background: Fosfomycin is used as a combination partner for the treatment of severe non-urinary tract infections. Individualized dosing of fosfomycin based on therapeutic drug monitoring (TDM) has the potential to reduce drug-related adverse events (AEs). Methods: This retrospective study used routine data from [...] Read more.
Background: Fosfomycin is used as a combination partner for the treatment of severe non-urinary tract infections. Individualized dosing of fosfomycin based on therapeutic drug monitoring (TDM) has the potential to reduce drug-related adverse events (AEs). Methods: This retrospective study used routine data from patients receiving intravenous fosfomycin therapy. Plasma concentrations of fosfomycin were categorized into three different ranges: <64 mg/L, 64–128 mg/L, and >128 mg/L. Subsequently, the influence of acute kidney injury (AKI) on reaching the specific plasma concentration ranges and the occurrence of AEs was analyzed. Results: The study included 143 patients (median age 73 years, 66.4% male) with fosfomycin plasma measurements. Beta-lactam antibiotics were most frequently used in combination (62.2%), followed by tetracyclines (12.2%), cotrimoxazole (8.1%), and other agents (17.5%). Fosfomycin concentrations were >128 mg/L in 45% (36/80) of patients with normal renal function, 70.4% (38/54) of patients with AKI stages I to III, and 77.8% (7/9) of patients with renal replacement therapy. AEs occurred in 54% (77/143), mainly hypernatremia (42.6%), hypokalemia (39.9%), and gastrointestinal symptoms (19.6%), with the median fosfomycin plasma concentration being significantly higher in patients with AEs (158 mg/L vs. 131 mg/L, p = 0.01). Multivariate logistic regression analysis revealed that patients aged ≥70 years (OR 3.70, 95% CI 1.24–11.5; p = 0.02) and patients with fosfomycin plasma concentrations > 128 mg/L (OR 3.30, 95% CI 1.09–10.4; p = 0.04) had a higher risk of AEs. Conclusions: There was a significant association between high plasma exposure and the occurrence of AEs. In particular, the impact of acute renal insufficiency on fosfomycin plasma concentrations should be considered. Individualized fosfomycin dosing based on TDM and the intensive monitoring of renal function contribute to reducing drug-related side effects. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition)
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22 pages, 307 KiB  
Article
The Impact of the COVID-19 Pandemic on Pediatric Microbial Resistance Patterns and Abandonment Rates in Western Romania—An Interdisciplinary Study
by Dan Dumitru Vulcanescu, Iulia Cristina Bagiu, Tiberiu Liviu Dragomir, Virgiliu Bogdan Sorop, Mircea Diaconu, Octavia Harich, Sonia Aniela Tanasescu, Florin Szasz, Luiza Vlaicu, Cosmin Goian and Florin George Horhat
Antibiotics 2025, 14(4), 411; https://doi.org/10.3390/antibiotics14040411 - 16 Apr 2025
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Abstract
Background: The COVID-19 pandemic in Romania exacerbated pediatric antimicrobial resistance (AMR). Overuse of broad-spectrum antibiotics may be related to increased multidrug-resistant bacteria. The main aim of this study was to assess pediatric AMR trends and phenotypes, while a secondary objective was to investigate [...] Read more.
Background: The COVID-19 pandemic in Romania exacerbated pediatric antimicrobial resistance (AMR). Overuse of broad-spectrum antibiotics may be related to increased multidrug-resistant bacteria. The main aim of this study was to assess pediatric AMR trends and phenotypes, while a secondary objective was to investigate the potential links with hospital abandonment. Methods: This retrospective study from the Children’s Emergency Hospital “Louis Țurcanu”, Timișoara, focused on AMR patterns in 2019 pre-pandemic, 2021 pandemic, and 2023 post-pandemic. The following phenotypes were assessed: MRSA, MRCoNS, VRE, ESBL, CRO, MDR, XDR, and PDR. Results: There were 3530 total patients and 6885 total samples. There were 69.92% of the total samples resistant to at least one antimicrobial class, (72.69% in 2019, 67.05% in 2021, 69.16% in 2023). Specifically, resistance towards penicillins remained high across the entire period (57.45–60.93%), while the following classes presented elevated resistance in the pandemic: cephalosporins (42.91%), combination therapies (40.95%), reserve antibiotics (38.89%), and cyclines (13.83%). As for resistance phenotypes, MRSA and MRCoNS peaked during the pandemic (36.08% and 81.43%, respectively) while VRE remained relatively constant. Overall ESBL declined in 2023 to 14.45%, while overall CRO peaked during the pandemic (8.81%). Overall MDR fell during the pandemic (64.47%), while overall XDR peaked in 2019 (9.87%). No PDR cases were observed. Pediatric abandonment was an increasing concern, with regional cases rising from 5.42% (2019) to 9.83% (2023). Compared to the general population, increased antimicrobial resistance in abandoned patients was observed for fluoroquinolones (50.00%), Aminogycolsides (60.00%), reserve antibiotics (70.00%), cephalosporins (60.00%), and urinary antibiotics (60.00%). Resistance to cephalosporins (OR = 5.17, p = 0.0304) and reserve antibiotics (OR = 5.64, p = 0.0049) were key predictors of abandonment risk. Conclusions: The COVID-19 pandemic influenced resistance trends, with notable peaks in MRSA, MRCoNS, and CRO. Post-pandemic patterns suggest continued escalation of resistance. The association between resistant infections and pediatric abandonment highlights the need for robust antimicrobial stewardship and social intervention policies. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition)
16 pages, 2310 KiB  
Article
Influence of Educational Films on Antiviral Prescription for COVID-19: Insights from Web-Based Survey in Japan
by Kosaku Komiya, Akihiko Hagiwara, Yuichiro Shindo, Kazufumi Takamatsu, Naoki Nishimura, Yukako Takechi, Eiki Ichihara, Takahiro Takazono, Shinyu Izumi, Shimpei Gotoh, Seiichiro Sakao, Takehiro Izumo, Kazuko Yamamoto, Kazuhiro Yatera, Hiroshi Kakeya, Yoko Shibata, Keisuke Tomii, Hironori Sagara, Yuka Sasaki, Toyohiro Hirai, Akihito Yokoyama, Hiroshi Mukae and Takashi Oguraadd Show full author list remove Hide full author list
Antibiotics 2025, 14(3), 276; https://doi.org/10.3390/antibiotics14030276 - 7 Mar 2025
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Abstract
Background: Prescribing antiviral agents for severe acute respiratory syndrome coronavirus 2 requires careful consideration based on the patient’s risk factors for severe disease progression and their vaccination status. However, effective interventions ensuring the appropriate use of antiviral agents by physicians have yet to [...] Read more.
Background: Prescribing antiviral agents for severe acute respiratory syndrome coronavirus 2 requires careful consideration based on the patient’s risk factors for severe disease progression and their vaccination status. However, effective interventions ensuring the appropriate use of antiviral agents by physicians have yet to be fully established. Thus, this study evaluated the impact of an educational film on antiviral prescription rates for coronavirus disease 2019 (COVID-19). Methods: This prospective, nationwide, web-based survey enrolled 1500 physicians. They were instructed to view a short educational film and assess the necessity of prescribing antiviral agents in 16 fictitious scenarios featuring adult patients with COVID-19 with varying risk factors for severe disease and vaccination statuses. We compared the antiviral prescription rates before and after viewing the educational film. Results: There was a significant increase in the antiviral prescription rates after viewing the educational film, particularly nirmatrelvir/ritonavir prescribed in cases involving immunocompromised patients (from 31.3% to 49.4%) and those with obesity (from 15.1% to 33.7%) who were unvaccinated and had no risk of drug interactions. However, viewing the educational film made little to no impact on the prescription rates for the patients with hypertension and hyperlipidemia or those with no underlying conditions. Conclusions: Short educational films may promote the appropriate use of antiviral agents for COVID-19. However, their impact on altering prescription behavior appears limited and varies according to the clinical context. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition)
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15 pages, 1304 KiB  
Article
Longitudinal Trends in In-Patient Antibiotic Consumption According to the WHO Access, Watch, Reserve (AWaRe) Antibiotic Groups and Cost: An Analysis of Data at a National Antimicrobial Consumption Network (NAC-NET) Site in North India over 7 Years (2017–2023)
by Niti Mittal, Ashish Tayal, Suneel Kumar, Reevanshi Dhawan, Nidhi Goel and Rakesh Mittal
Antibiotics 2024, 13(7), 673; https://doi.org/10.3390/antibiotics13070673 - 19 Jul 2024
Viewed by 3139
Abstract
(1) Background: Antibiotic surveillance data are crucial to map out strategies to promote their optimal use at hospital and community levels. We conducted a comprehensive analysis of longitudinal trends in antibiotic consumption over 7 years at a core “National Antimicrobial Consumption Network” site [...] Read more.
(1) Background: Antibiotic surveillance data are crucial to map out strategies to promote their optimal use at hospital and community levels. We conducted a comprehensive analysis of longitudinal trends in antibiotic consumption over 7 years at a core “National Antimicrobial Consumption Network” site in North India. (2) Methods: In-patient antibiotic consumption data (2017–2023) were obtained from the hospital’s central drug store and organised as follows: defined daily dose per 100 bed-days; antibiotic consumption as per the WHO access, watch and reserve classification; trends in overall and different antibiotic classes’ consumption; paediatric formulations of antibiotics; and hospital’s annual expenditure on antibiotics. (3) Results: During the 7-year study period, no significant trend could be observed in the overall antibiotic consumption (average annual percent change, AAPC: 9.22; 95% CI: −16.46, 34.9) and cost (AAPC: 13.55; −13.2, 40.3). There was a higher proportion of the consumption of antibiotics in the “reserve” group from 2021 onwards compared to previous years, but the overall trend over 7 years was not significant (AAPC: 319.75; −137.6, 777.1). Antibiotic combinations, classified under the WHO “not recommended” category, comprised a significant proportion of antibiotics consumed. A remarkably increased consumption of azithromycin and doxycycline was recorded during 2020 and 2021, coinciding with the COVID-19 pandemic. (4) Conclusions: Some recommendations to optimise antibiotic use are promoting the use of narrow spectrum “access” group agents; linking antimicrobial resistance and consumption data to formulate effective therapeutic and prophylactic antibiotic use guidelines; and the adoption of restrictive antibiotic policy. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition)
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8 pages, 533 KiB  
Brief Report
Impact of Education on Inappropriate Antibiotic Prescription for Respiratory Tract Infection Based on Physicians’ Justifications: A Web-Based Survey in Japan
by Ryohei Kudoh, Kosaku Komiya, Norihito Kaku, Yuichiro Shindo, Tatsuya Hayashi, Kei Kasahara, Tomohiro Oishi, Naruhiko Ishiwada, Makoto Ito, Hiroshi Yotsuyanagi, Naoki Hasegawa, Kazuhiro Tateda, Muneki Hotomi and Katsunori Yanagihara
Antibiotics 2024, 13(11), 1022; https://doi.org/10.3390/antibiotics13111022 - 30 Oct 2024
Viewed by 1162
Abstract
Background: Antibiotics are inappropriately prescribed for respiratory tract infections for various reasons. The differences of the effects of education based on these reasons has not been fully elucidated. This study assessed the impact of an educational film on antibiotic prescription patterns according [...] Read more.
Background: Antibiotics are inappropriately prescribed for respiratory tract infections for various reasons. The differences of the effects of education based on these reasons has not been fully elucidated. This study assessed the impact of an educational film on antibiotic prescription patterns according to physicians’ prescribing justifications. Methods: This was a secondary analysis of a nationwide web-based survey involving 1100 physicians. The physicians were required to view a short educational film and determine the need for prescribing antibiotics in simulated scenarios of different acute respiratory tract infectious diseases. The associations between the reasons for antibiotic prescription to patients not requiring antibiotics before viewing the educational film and the positive effects of the intervention were analyzed. Results: The educational intervention positively affected prescribing trends among physicians who prescribed antibiotics for “fever” in mild acute rhinosinusitis (prescription rates from 100% to 25.9%), “pus in the laryngopharynx” in mild acute pharyngitis (prescription rates from 100% to 29.6%), and “purulent sputum” in acute bronchitis without chronic lung disease (prescription rates from 100% to 29.9%) before viewing the film. In contrast, no benefits were observed when the justification was “patient’s desire for antibiotics” in mild acute pharyngitis (prescription rates from 100% to 48.5%) and acute bronchitis without chronic lung disease (prescription rates from 100% to 44.0%) or “parents’ desire for antibiotics” in narrowly defined common cold in children (prescription rates from 100% to 45.7%). Conclusions: although educational interventions might reduce inappropriate antibiotic prescription by providing accurate knowledge about respiratory tract infections, they appear ineffective for physicians who prescribe antibiotics based on patients’ or parents’ desires for antibiotic treatment. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in Hospitals and Outpatient Care Facilities, 2nd Edition)
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