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Antibiotics
Special Issues
Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use
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Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 6394

Special Issue Editors

Prof. Dr. Dorota Pastuszak-Lewandoska

E-Mail Website
Guest Editor
Laboratory Medical Immunology, Department of Microbiology, Medical University of Lodz, Ul. Pomorska 251/C5, 92-213 Lodz, Poland
Interests: molecular microbiology; mechanisms of antimicrobial resistance; antibiotic resistance genes (ARGs); AMR control-ling methods
Dr. Filip Bielec

E-Mail Website
Guest Editor
Laboratory Medical Immunology, Department of Microbiology, Medical University of Lodz, Ul. Pomorska 251/C5, 92-213 Lodz, Poland
Interests: urinary tract infection; antimicrobials; nitrofuran derivatives; antimicrobial stewardship; antimicrobial susceptibil-ity testing; antimicrobial synergy
Dr. Małgorzata Brauncajs

E-Mail Website
Guest Editor
1. Laboratory Medical Immunology, Department of Microbiology, Medical University of Lodz, Ul. Pomorska 251/C5, 92-213 Lodz, Poland
2. Medical Microbiology Laboratory, Central Teaching Hospital of Medical University of Lodz, Lodz, Poland
Interests: multidrug resistance; antimicrobials; carbapenem resistance; antimicrobial stewardship; antimicrobial susceptibil-ity testing; antimicrobial synergy

Special Issue Information

Dear Colleagues,

The growing issue of antimicrobial resistance (AMR) poses one of the most formidable challenges to public health. Hospitals, where most patients reside and where antimicrobial agents are most frequently used, are critical places in this silent pandemic. Central to this crisis is the intricate balance between the necessity of antibiotic use and the imperative to minimize the development of resistance.

In this Special Issue, we aim to delve into the multifaceted strategies required to combat AMR within healthcare settings. Our aim is to explore this balance and offer insights into effective infection control practices, stewardship programs, and innovative approaches to antibiotic use. Key topics include, but are not limited to, the following:

  • Infection Control Measures: Highlighting the critical importance of hygiene practices, surveillance systems, and outbreak management protocols and underscoring infection prevention guidelines to curb the spread of resistant pathogens within hospitals.
  • Optimizing Antibiotic Use: Presenting evidence-based strategies, including the implementation of stewardship programs, education and training of healthcare professionals, and the development of policies that promote the judicious use of antimicrobials.
  • Research and Technological Advancements: Bringing attention to cutting-edge research and technological advancements that promise to enhance our ability to detect, monitor, and combat AMR. This includes rapid diagnostic tools for the precise and timely identification of pathogens, as well as the development of new antimicrobial agents and alternative therapies.
  • Understanding AMR: Investigating the mechanisms, causes, and consequences of clinical antimicrobial resistance to develop effective strategies to mitigate its impact.

We look forward to receiving your contributions.

Prof. Dr. Dorota Pastuszak-Lewandoska
Dr. Filip Bielec
Dr. Małgorzata Brauncajs
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

  • clinical antibiotic use
  • hospital infection control
  • healthcare-associated infections
  • resistance mitigation strategies
  • alternative therapies
  • antibiotic stewardship
  • molecular mechanisms of AMR
  • new therapeutic combinations of antibiotics
  • antimicrobial synergy

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Published Papers (6 papers)

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Research

17 pages, 1315 KiB  
Article
Cefiderocol Antimicrobial Susceptibility Testing by Disk Diffusion: Influence of Agar Media and Inhibition Zone Morphology in K. pneumoniae Metallo-β-lactamase
by Maciej Saar, Anna Wawrzyk, Dorota Pastuszak-Lewandoska and Filip Bielec
Antibiotics 2025, 14(5), 527; https://doi.org/10.3390/antibiotics14050527 - 21 May 2025
Viewed by 62
Abstract
Accurate antimicrobial susceptibility testing (AST) of cefiderocol remains a diagnostic challenge, especially in infections caused by metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae. While disk diffusion offers a cost-effective alternative to broth microdilution, it is highly sensitive to factors such as media composition and the [...] Read more.
Accurate antimicrobial susceptibility testing (AST) of cefiderocol remains a diagnostic challenge, especially in infections caused by metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae. While disk diffusion offers a cost-effective alternative to broth microdilution, it is highly sensitive to factors such as media composition and the presence of atypical colony morphology. The objective of this study was to evaluate how different agar media and interpretations of isolated colonies affect the performance and reliability of cefiderocol AST by disk diffusion. A total of 50 clinical K. pneumoniae MBL isolates were tested using disk diffusion on Columbia with blood, MacConkey, and chromogenic agars from three manufacturers. Inhibition zones were compared with MICs from broth microdilution. Statistical analyses included paired t-tests and Spearman correlation to assess media effects and zone morphology impact. Variability in inhibition zone diameters was observed between media, notably with chromogenic agar. The most consistent results were obtained using Graso Biotech and Thermo Fisher Columbia with blood agar. Isolated colonies were observed in over half the samples and, depending on how they were interpreted, led to major changes in classification accuracy. Up to 64% of results fell into the EUCAST area of technical uncertainty (ATU), and categorical agreement varied across media and interpretive criteria. Disk diffusion for cefiderocol may be used in resource-limited settings but only if rigorously standardized using validated media, consistent zone reading, and ATU-aware interpretive strategies. In borderline cases or when morphological anomalies are present, broth microdilution should be considered the sole reliable method. Clinical microbiologists are advised to exercise caution with ambiguous results and seek expert or confirmatory testing when needed. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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11 pages, 1689 KiB  
Article
Accurate Diagnosis of Pseudomonas aeruginosa Is Critical to Mitigating Development of Antibiotic Resistance
by Hala I. Al-Daghistani, Lubna F. Abu-Niaaj and Sima Zein
Antibiotics 2025, 14(5), 509; https://doi.org/10.3390/antibiotics14050509 - 15 May 2025
Viewed by 274
Abstract
Background: The accurate and rapid diagnosis of infections is critical for effective and timely treatment. Misdiagnosis often leads to the prescription of antibiotics not targeting the causing agent of infection and thus be the possible development of multidrug resistance. This collectively worsens [...] Read more.
Background: The accurate and rapid diagnosis of infections is critical for effective and timely treatment. Misdiagnosis often leads to the prescription of antibiotics not targeting the causing agent of infection and thus be the possible development of multidrug resistance. This collectively worsens the condition and might lead to unnecessary intervention or death. The abundance of Pseudomonas spp. in healthcare-settings and the environment may lead to the inaccurate diagnosis of P. aeruginosa, making the treatment of its infections challenging. P. aeruginosa is a Gram-negative, opportunistic pathogen commonly linked to healthcare-associated infections. Its pathogenicity is attributed to several virulence factors correlated to enhanced survivability and colonization, invasion of the host tissues, and the development of multidrug resistance. When advanced diagnostic facilities are limited or unaffordable, the prescription of antibiotics solely relies on identifying the bacteria by culture-based methods. Objectives: This study aims to validate the accuracy of diagnosis of fifty clinical isolates preidentified as P. aeruginosa in three healthcare facilities in Jordan. Methods: The isolates were from infected areas of patients, including skin, wounds, ears, urine, and peritoneal cavities. Morphological and biochemical tests were performed, and the validation relied on the polymerase chain reaction (PCR) amplification of the 16S ribosomal ribonucleic acid (rRNA) gene. This molecular method is affordable for medical facilities with limited finances in contrast to advanced high-cost techniques. Results: The PCR confirmed that only 60% of the isolates were P. aeruginosa. All the confirmed isolates could produce different pigments and form biofilms. Conclusions: The high percentage of isolates mistakenly identified as P. aeruginosa raises concern about the suitability of prescribed antibiotics. The present study strongly recommends using advanced molecular methods to identify the pathogens. If conventional methods remain the only diagnostic option, this study recommends frequent external validation for tests in addition to performing an antibiotic susceptibility test to pinpoint the effective antibiotics against biofilm-producing P. aeruginosa. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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12 pages, 750 KiB  
Article
Molecular Epidemiology of Clostridioides difficile Infections in Patients Hospitalized in 2017–2019 at the Central Teaching Hospital of Medical University of Lodz, Central Poland
by Agata Ptaszyńska, Anna Macieja, Dominika Rosińska-Lewandoska, Filip Bielec, Piotr Machnicki, Małgorzata Brauncajs and Dorota Pastuszak-Lewandoska
Antibiotics 2025, 14(3), 219; https://doi.org/10.3390/antibiotics14030219 - 21 Feb 2025
Cited by 1 | Viewed by 682
Abstract
Background/Objectives: Clostridioides difficile infection (CDI) represents a significant public health challenge globally, driven by its increasing prevalence, hypervirulent strains like ribotype 027 (RT027), and growing antibiotic resistance. This study aimed to evaluate the prevalence of RT027 and analyze molecular markers of vancomycin [...] Read more.
Background/Objectives: Clostridioides difficile infection (CDI) represents a significant public health challenge globally, driven by its increasing prevalence, hypervirulent strains like ribotype 027 (RT027), and growing antibiotic resistance. This study aimed to evaluate the prevalence of RT027 and analyze molecular markers of vancomycin and metronidazole resistance in stool samples from CDI patients hospitalized in Poland between 2017 and 2019. Methods: A total of 200 stool samples from confirmed CDI cases were analyzed for the presence of RT027, vanA (vancomycin resistance), and nim (metronidazole resistance) genes. DNA was extracted, and a polymerase chain reaction (PCR) was conducted using specific primers. Statistical associations between RT027 and resistance genes were evaluated using chi-square tests and logistic regression. Results: RT027 was detected in 14% of samples. The vanA gene, indicative of vancomycin resistance, was found in 52.5% of samples, while the nim gene, associated with metronidazole resistance, was present in 1.5% of cases. Co-occurrence of RT027 with vanA was not statistically significant. The study revealed no significant association between RT027 and vanA. Also, no significant association was observed between RT027 and nim due to the latter’s low prevalence. Conclusions: This study highlights a concerning prevalence of vanA among CDI cases, indicating widespread vancomycin resistance and challenging current treatment guidelines. While RT027 prevalence was moderate, no significant associations with vancomycin or metronidazole resistance were observed. These findings emphasize the need for molecular surveillance and improved antimicrobial stewardship to manage CDI effectively. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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19 pages, 2574 KiB  
Article
Efficacy of Antimicrobial Dry Fog in Improving the Environmental Microbial Burden in an Inpatient Ward
by Yashar Jalali, Andrea Kološová, Karol Džupa, Pavol Pavlovič, Monika Jalali, Peter Rácek, Nikola Zicháčková, Ján Kyselovič, Adriana Vasiková, Klaudia Glodová and Juraj Payer
Antibiotics 2024, 13(12), 1187; https://doi.org/10.3390/antibiotics13121187 - 6 Dec 2024
Viewed by 1750
Abstract
Background/Objectives: In healthcare environments with high microbial loads, effective infection control measures are critical for reducing airborne and surface contamination. One of the novel modalities in the achievement of these goals is the use of antimicrobial mists, such as droplets, in the form [...] Read more.
Background/Objectives: In healthcare environments with high microbial loads, effective infection control measures are critical for reducing airborne and surface contamination. One of the novel modalities in the achievement of these goals is the use of antimicrobial mists, such as droplets, in the form of dry fog. Although the usage of dry fog in the disinfection of contained healthcare microenvironments is well known, the effect of such a system in terms of a meaningful reduction in the microbial burden in an open inpatient ward is unclear. Our objective was to assess the impact of scheduled dry fogging on microbial reduction in such settings. Methods: We collected air and surface samples from rooms receiving daily, biweekly, or no fogging (controls) over six months, establishing the baseline contamination and evaluating the reduction trends in treated rooms. The “reduction effect” was measured by tracking microbial isolation trends before and after treatment, while the “degree of reduction” assessed differences across rooms with varied disinfection schedules. Results: The results indicate that scheduled dry fogging significantly reduced microbial loads in treated rooms, especially with daily disinfection (SE = 64.484, p = 0.002). The airborne contamination in treated rooms showed a strong downward trend over time (SE = 19.192, p < 0.001). Surface contamination remained challenging due to frequent recontamination; however, treated rooms exhibited a consistent reduction in microbial presence (SE = 2.002, p = 0.010), confirming dry fogging’s role as a valuable adjunct to routine cleaning. Conclusions: In conclusion, this study highlights that dry fogging effectively reduces microbial loads in open, high-traffic healthcare environments, supporting its use as part of a multimodal infection control strategy. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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16 pages, 1026 KiB  
Article
Point-Prevalence Survey of Antimicrobial Use and Healthcare-Associated Infections in Four Acute Care Hospitals in Kazakhstan
by Yuliya Semenova, Aizhan Yessmagambetova, Zaure Akhmetova, Manar Smagul, Akniyet Zharylkassynova, Bibigul Aubakirova, Kateryna Soiak, Zhanar Kosherova, Ainur Aimurziyeva, Larissa Makalkina, Ainur Ikhambayeva and Lisa Lim
Antibiotics 2024, 13(10), 981; https://doi.org/10.3390/antibiotics13100981 - 17 Oct 2024
Cited by 3 | Viewed by 1489
Abstract
Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital [...] Read more.
Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital antibiotic consumption via internationally recognized methodologies. Methods: PPS was conducted in four acute care hospitals in Kazakhstan on 11 May 2022, following the methodology of the European Center for Disease Prevention and Control, and included 701 patients. Antibiotic consumption in the same hospitals was assessed via the Global Antimicrobial Resistance and Use Surveillance System methodology. Results: HAIs were observed in 3.8% of patients (27/701), with intensive care unit wards accounting for 48.1% of these cases (13/27). Pseudomonas aeruginosa was the most frequently identified pathogen (5 out of 14 documented cases, 35.7%). Resistance to carbapenems was the most common resistance, followed by resistance to glycopeptides and third-generation cephalosporins. The rate of AMU was 38.2%, with an average of 1.37 antibiotics administered per patient. Surgical prophylaxis lasting more than one day was the most common indication for antimicrobial prescription (44.8%). Ceftriaxone and cefazolin are the most commonly used antibiotics. Conclusions: The results of this study are important for understanding the current situation in Kazakhstan and for informing national antimicrobial stewardship and infection control strategies. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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11 pages, 513 KiB  
Article
Clostridioides difficile Infection: Use of Inflammatory Biomarkers and Hemogram-Derived Ratios to Predict Mortality Risk in Hospitalized Patients
by Giuseppe Guido Maria Scarlata, Angela Quirino, Carmen Costache, Dan Alexandru Toc, Nadia Marascio, Marta Pantanella, Daniel Corneliu Leucuta, Abdulrahman Ismaiel, Dan Lucian Dumitrascu and Ludovico Abenavoli
Antibiotics 2024, 13(8), 769; https://doi.org/10.3390/antibiotics13080769 - 15 Aug 2024
Cited by 2 | Viewed by 1539
Abstract
Background: Clostridioides difficile infection (CDI) is a significant cause of mortality, especially in healthcare environments. Reliable biomarkers that can accurately predict mortality in CDI patients are yet to be evaluated. Our study aims to evaluate the accuracy of several inflammatory biomarkers and hemogram-derived [...] Read more.
Background: Clostridioides difficile infection (CDI) is a significant cause of mortality, especially in healthcare environments. Reliable biomarkers that can accurately predict mortality in CDI patients are yet to be evaluated. Our study aims to evaluate the accuracy of several inflammatory biomarkers and hemogram-derived ratios in predicting mortality in CDI patients, such as the neutrophil-to-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), the platelet-to-neutrophil ratio (PNR), the derived neutrophil-to-lymphocyte ratio (dNLR), C-reactive protein (CRP), the platelet-to-lymphocyte ratio (PLR), and procalcitonin (PCT). Results: NLR showed a sensitivity of 72.5% and a specificity of 58.42% with an area under curve (AUC) = 0.652. SII had a sensitivity of 77.5%, a specificity of 54.74%, and an AUC = 0.64. PNR, neutrophils, dNLR, and lymphocytes had lower AUCs which ranged from 0.595 to 0.616, with varied sensitivity and specificity. CRP, leukocytes, and platelets showed modest predictive values with AUCs below 0.6. PCT had a sensitivity of 100%, a low specificity of 7.41%, and an AUC = 0.528. Methods: We conducted a retrospective analysis of CDI patients from two different hospital settings in Italy and Romania during the COVID-19 pandemic, from 1 January 2020 to 5 May 2023. Statistical analyses included t-tests, Wilcoxon rank-sum tests, χ2 tests, and multivariate logistic regression to identify predictors of mortality. ROC analysis assessed the accuracy of biomarkers and hemogram-derived ratios. A p value < 0.05 was considered significant. Conclusions: Neutrophils, dNLR, NLR, SII, and PNR are valuable biomarkers for predicting mortality in CDI patients. Understanding these predictors can improve risk stratification and clinical outcomes for CDI patients. Full article
(This article belongs to the Special Issue Preventing Antimicrobial Resistance in Hospitals: Infection Control and Antibiotic Use)
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