Antimicrobial Resistance and Healthcare Associated Infections

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

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 54221

Special Issue Editors


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Guest Editor
1. Infection Control Department, Instituto Central, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
2. Infection Control Department, Hospital do Servidor Público Estadual de São Paulo, São Paulo 04039-000, Brazil
Interests: infection control; antimicrobial resistance; antimicrobial stewardship; microbiology
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 470, São Paulo 05403-000, Brazil
2. Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazi
Interests: infection control; antimicrobial resistance; antimicrobial stewardship; microbiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is a global health and development threat that requires urgent multisector action in order to achieve goals and to implement effective prevention measures.

Healthcare-associated infections (HCAI) due to microorganisms that are antimicrobial resistant are today one of the most important challenges in modern medicine. One major preventive goal is preventing infections and maintaining optimal antimicrobial treatment, so that we could consequently prevent all avoidable HCAI but especially make sure that non-avoidable infections are at the very least treatable.

Misuse and overuse of antimicrobials are the main drivers in the development of multidrug-resistant pathogens. In the same manner, inadequate infection prevention and control promotes the spread of these microorganisms. In addition, the costs of AMR to the economy are significant, and the same is true for death, disability, prolonged illness resulting in longer hospital stays, and the need for more expensive medicines and financial challenges that have a negative impact both at an individual and social level.

To aid the understanding of potential gaps in evidence, this scoping Special Issue explores the literature on epidemiology, problem pathogens, treatment approaches, preventive measures, diagnostic tools, stewardship, and antimicrobial resistance in the COVID-19 era and beyond hospitals, such as in agriculture, livestock, and the environment.

Without effective antimicrobials and resistance control, the success of modern medicine in treating other diseases, including surgical procedures, cancer, and immunological disorders, would be at increased risk.

Prof. Dr. Thaís Guimarães
Prof. Dr. Silvia Figueiredo Costa
Guest Editors

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Keywords

  • antimicrobial resistance
  • healthcare-associated infections
  • epidemiology
  • treatment
  • stewardship
  • diagnostic
  • prevention

Published Papers (16 papers)

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13 pages, 473 KiB  
Article
Staphylococcus spp. Causatives of Infections and Carrier of blaZ, femA, and mecA Genes Associated with Resistance
by Laryssa Ketelyn Lima Pimenta, Carolina Andrade Rodrigues, Arlindo Rodrigues Galvão Filho, Clarimar José Coelho, Viviane Goes, Mariely Estrela, Priscila de Souza, Melissa Ameloti Gomes Avelino, José Daniel Gonçalves Vieira and Lilian Carneiro
Antibiotics 2023, 12(4), 671; https://doi.org/10.3390/antibiotics12040671 - 29 Mar 2023
Cited by 4 | Viewed by 3418
Abstract
Staphylococcus spp. have been associated with cases of healthcare associated infections due to their high incidence in isolates from the hospital environment and their ability to cause infections in immunocompromised patients; synthesize biofilms on medical instruments, in the case of negative coagulase species; [...] Read more.
Staphylococcus spp. have been associated with cases of healthcare associated infections due to their high incidence in isolates from the hospital environment and their ability to cause infections in immunocompromised patients; synthesize biofilms on medical instruments, in the case of negative coagulase species; and change in genetic material, thus making it possible to disseminate genes that code for the acquisition of resistance mechanisms against the action of antibiotics. This study evaluated the presence of blaZ, femA, and mecA chromosomal and plasmid genes of Staphylococcus spp. using the qPCR technique. The results were associated with the phenotypic expression of resistance to oxacillin and penicillin G. We found that the chromosomal femA gene was present in a greater proportion in S. intermedius when compared with the other species analyzed, while the plasmid-borne mecA gene was prevalent in the S. aureus samples. The binary logistic regression performed to verify the association among the expression of the genes analyzed and the acquisition of resistance to oxacillin and penicillin G were not significant in any of the analyses, p > 0.05. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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18 pages, 5092 KiB  
Article
Efficacy and Safety of Colistin versus Tigecycline for Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens—A Meta-Analysis
by Dina Abushanab, Ziad G. Nasr and Daoud Al-Badriyeh
Antibiotics 2022, 11(11), 1630; https://doi.org/10.3390/antibiotics11111630 - 15 Nov 2022
Cited by 1 | Viewed by 2615
Abstract
Background: We intended to compare the efficacy and safety outcomes of colistin versus tigecycline as monotherapy or combination therapy against multi-drug resistant (MDR) and extensively drug-resistant (XDR) pathogens. Methods: A search was conducted in PubMed, Cochrane CENTRAL, EMBASE, and in the grey literature [...] Read more.
Background: We intended to compare the efficacy and safety outcomes of colistin versus tigecycline as monotherapy or combination therapy against multi-drug resistant (MDR) and extensively drug-resistant (XDR) pathogens. Methods: A search was conducted in PubMed, Cochrane CENTRAL, EMBASE, and in the grey literature (i.e., ClinicalTrials.gov and Google Scholar) up to May 2021. Outcomes were clinical response, mortality, infection recurrence, and renal and hepatic toxicity. We pooled odd ratios (OR) using heterogeneity-guided random or fixed models at a statistical significance of p < 0.05. Results: Fourteen observational studies involving 1163 MDR/XDR pathogens, receiving tigecycline versus colistin monotherapy or combination, were included. Base-case analyses revealed insignificant differences in the clinical response, reinfection, and hepatic impairment. The 30-day mortality was significantly relatively reduced with tigecycline monotherapy (OR = 0.35, 95% CI 0.16–0.75, p = 0.007). The colistin monotherapy significantly relatively reduced in-hospital mortality (OR = 2.27, 95%CI 1.24–4.16, p = 0.008). Renal impairment rates were lower with tigecycline monotherapy or in combination, and were lower with monotherapy versus colistin-tigecycline combination. Low-risk of bias and moderate/high evidence quality were associated with all studies. Conclusions: Within the limitations of this study, it can be concluded that there were no statistically significant differences in main efficacy outcomes between colistin and tigecycline monotherapies or combinations against MDR/XDR infections, except for lower rates of 30-day mortality with tigecycline and in-hospital mortality with colistin. Tigecycline was associated with favourable renal toxicity outcomes. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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25 pages, 6881 KiB  
Article
Investigating the Antibacterial Activity and Safety of Zinc Oxide Nanoparticles versus a Commercial Alcohol-Based Hand-Sanitizer: Can Zinc Oxide Nanoparticles Be Useful for Hand Sanitation?
by Aliaa Ismail, Nermeen R. Raya, Ahmed Orabi, Alaa M. Ali and Yasmin Abo-zeid
Antibiotics 2022, 11(11), 1606; https://doi.org/10.3390/antibiotics11111606 - 11 Nov 2022
Cited by 5 | Viewed by 2839
Abstract
Hand hygiene is the key factor to control and prevent the spread of infections, for example, hospital-acquired infections (HAIs). People commonly use alcohol-based hand sanitizers to assure hand hygiene. However, frequent use of alcohol-based hand sanitizers in a pandemic situation (e.g., COVID-19) was [...] Read more.
Hand hygiene is the key factor to control and prevent the spread of infections, for example, hospital-acquired infections (HAIs). People commonly use alcohol-based hand sanitizers to assure hand hygiene. However, frequent use of alcohol-based hand sanitizers in a pandemic situation (e.g., COVID-19) was associated with serious drawbacks such as skin toxicity including irritation, skin dermatitis, and skin dryness or cracking, along with peeling, redness, or itching with higher possibility of infection. This demands the development of alternative novel products that are effective as alcohol-based hand sanitizers but have no hazardous effects. Zinc oxide nanoparticles (ZnO-NPs) are known to have broad-spectrum antimicrobial activity, be compatible with the biological system and the environment, and have applicable and economic industrial-scale production. Thus, ZnO-NPs might be a good candidate for hand sanitation. To the best of our knowledge, the antibacterial activity of ZnO-NPs in comparison to alcohol-based hand sanitizers has not yet been studied. In the present work, a comparative study of the antibacterial activity of ZnO-NPs vs. Sterillium, a commercial alcohol-based hand sanitizer that is commonly used in Egyptian hospitals, was performed against common microorganisms known to cause HAIs in Egypt, including Acinetobacter baumannii, Klebsiella pneumoniae, Methicillin-resistant Staphylococcus aureus (MRSA), and Staphylococcus aureus. The safety profiles of ZnO-NPs and Sterillium were also assessed. The obtained results demonstrated the superior antibacterial activity and safety of ZnO-NPs compared to Sterillium. Therefore, ZnO-NPs could be a promising candidate for hand sanitation in comparison to alcohol-based hand sanitizers; however, several studies related to long-term toxicity and stability of ZnO-NPs and investigations into their antimicrobial activity and safety in healthcare settings are still required in the future to ascertain their antimicrobial activity and safety. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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9 pages, 1046 KiB  
Article
Virulomic Analysis of Multidrug-Resistant Klebsiella pneumoniae Isolates and Experimental Virulence Model Using Danio rerio (Zebrafish)
by Edson Luiz Tarsia Duarte, Camila Fonseca Rizek, Evelyn Sanchez Espinoza, Ana Paula Marchi, Saidy Vasconez Noguera, Marina Farrel Côrtes, Bianca H. Ventura Fernandes, Thais Guimarães, Claudia M. D. de Maio Carrilho, Lauro V. Perdigão Neto, Priscila A. Trindade and Silvia Figueiredo Costa
Antibiotics 2022, 11(11), 1567; https://doi.org/10.3390/antibiotics11111567 - 7 Nov 2022
Cited by 1 | Viewed by 1877
Abstract
This study evaluates a possible correlation between multidrug-resistant Klebsiella pneumoniae strains and virulence markers in a Danio rerio (zebrafish) model. Whole-genome sequencing (WGS) was performed on 46 strains from three Brazilian hospitals. All of the isolates were colistin-resistant and harbored blaKPC-2. [...] Read more.
This study evaluates a possible correlation between multidrug-resistant Klebsiella pneumoniae strains and virulence markers in a Danio rerio (zebrafish) model. Whole-genome sequencing (WGS) was performed on 46 strains from three Brazilian hospitals. All of the isolates were colistin-resistant and harbored blaKPC-2. Ten different sequence types (STs) were found; 63% belonged to CC258, 22% to ST340, and 11% to ST16. The virulence factors most frequently found were type 3 fimbriae, siderophores, capsule regulators, and RND efflux-pumps. Six strains were selected for a time-kill experiment in zebrafish embryos: infection by ST16 was associated with a significantly higher mortality rate when compared to non-ST16 strains (52% vs. 29%, p = 0.002). Among the STs, the distribution of virulence factors did not differ significantly except for ST23, which harbored a greater variety of factors than other STs but was not related to a higher mortality rate in zebrafish. Although several virulence factors are described in K. pneumoniae, our study found ST16 to be the only significant predictor of a virulent phenotype in an animal model. Further research is needed to fully understand the correlation between virulence and sequence types. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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20 pages, 20675 KiB  
Article
Emergence of a Novel Lineage and Wide Spread of a blaCTX-M-15/IncHI2/ST1 Plasmid among Nosocomial Enterobacter in Guadeloupe
by Matthieu Pot, Yann Reynaud, David Couvin, Alexis Dereeper, Séverine Ferdinand, Sylvaine Bastian, Tania Foucan, Jean-David Pommier, Marc Valette, Antoine Talarmin, Stéphanie Guyomard-Rabenirina and Sébastien Breurec
Antibiotics 2022, 11(10), 1443; https://doi.org/10.3390/antibiotics11101443 - 20 Oct 2022
Cited by 3 | Viewed by 2469
Abstract
Between April 2018 and August 2019, a total of 135 strains of Enterobacter cloacae complex (ECC) were randomly collected at the University Hospital Center of Guadeloupe to investigate the structure and diversity of the local bacterial population. These nosocomial isolates were initially identified [...] Read more.
Between April 2018 and August 2019, a total of 135 strains of Enterobacter cloacae complex (ECC) were randomly collected at the University Hospital Center of Guadeloupe to investigate the structure and diversity of the local bacterial population. These nosocomial isolates were initially identified genetically by the hsp60 typing method, which revealed the clinical relevance of E. xiangfangensis (n = 69). Overall, 57/94 of the third cephalosporin-resistant strains were characterized as extended-spectrum-β-lactamase (ESBL) producers, and their whole-genome was sequenced using Illumina technology to determine the clonal relatedness and diffusion of resistance genes. We found limited genetic diversity among sequence types (STs). ST114 (n = 13), ST1503 (n = 9), ST53 (n = 5) and ST113 (n = 4), which belong to three different Enterobacter species, were the most prevalent among the 57 ESBL producers. The blaCTXM-15 gene was the most prevalent ESBL determinant (56/57) and was in most cases associated with IncHI2/ST1 plasmid replicon carriage (36/57). To fully characterize this predominant blaCTXM-15/IncHI2/ST1 plasmid, four isolates from different lineages were also sequenced using Oxford Nanopore sequencing technology to generate long-reads. Hybrid sequence analyses confirmed the circulation of a well-conserved plasmid among ECC members. In addition, the novel ST1503 and its associated species (ECC taxon 4) were analyzed, in view of its high prevalence in nosocomial infections. These genetic observations confirmed the overall incidence of nosocomial ESBL Enterobacteriaceae infections acquired in this hospital during the study period, which was clearly higher in Guadeloupe (1.59/1000 hospitalization days) than in mainland France (0.52/1,000 hospitalization days). This project revealed issues and future challenges for the management and surveillance of nosocomial and multidrug-resistant Enterobacter in the Caribbean. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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8 pages, 478 KiB  
Article
Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients
by Thaís Guimarães, Igor Carmo Borges, Fernanda de Souza Spadão, Livia Mariano, Marina de Mattos Nascimento, Hermes Higashino, Flavia Rossi, Vanderson Rocha and Silvia Figueiredo Costa
Antibiotics 2022, 11(9), 1269; https://doi.org/10.3390/antibiotics11091269 - 19 Sep 2022
Cited by 3 | Viewed by 2228
Abstract
Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance [...] Read more.
Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016–2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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13 pages, 778 KiB  
Article
Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia
by Aléia Faustina Campos, Tiago Arantes, Amanda Magalhães Vilas Boas Cambiais, Ana Paula Cury, Camila Guimarães Tiroli, Flávia Rossi, Luiz Marcelo Sa Malbouisson, Silvia Figueiredo Costa and Thaís Guimarães
Antibiotics 2022, 11(9), 1226; https://doi.org/10.3390/antibiotics11091226 - 9 Sep 2022
Cited by 3 | Viewed by 2680
Abstract
Combination of strategies for rapid diagnostics tests (RDT) with real-time intervention could improve patient outcomes. We aimed to assess the impact on clinical outcomes, antimicrobial consumption, and costs in patients with gram-negative bacteremia. We designed a quasi-experimental study among 216 episodes of gram-negative [...] Read more.
Combination of strategies for rapid diagnostics tests (RDT) with real-time intervention could improve patient outcomes. We aimed to assess the impact on clinical outcomes, antimicrobial consumption, and costs in patients with gram-negative bacteremia. We designed a quasi-experimental study among 216 episodes of gram-negative bacteremia using RDT (MALDI-TOF and detection of resistance genes) directly from blood culture bottles combined with real-time communication of results. Our study did not demonstrate impact on 30-day mortality (25% vs. 35%; p = 0.115). Hospital and ICU length of stay were significantly lower in the intervention period ((44 days vs. 39 days; p = 0.005) and (17 days vs. 13 days; p = 0.033)), respectively. The antimicrobial consumption was 1381 DOT/1000 days in the pre-intervention period compared to 1262 DOT/1000 days in the intervention period (p = 0.032). Antimicrobials against gram-positive and carbapenems had a significantly reduced consumption in the intervention period. Our intervention showed no impact on 30 days-mortality, but demonstrated an impact on hospital and ICU length of stay, as well as antimicrobials consumption and costs. Knowledge of resistance genes adds value and information for safe decision making that can result in direct and indirect benefits related to the economic burden of antibiotic overuse and bacterial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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8 pages, 257 KiB  
Article
Metronidazole for Treatment of Clostridioides difficile Infections in Brazil: A Single-Center Experience and Risk Factors for Mortality
by Joana Darc Freitas Alves, Augusto Yamaguti, João Silva de Mendonça, Cristiano de Melo Gamba, Cibele Lefreve Fonseca, Daniela K. S. Paraskevopoulos, Alexandre Inacio de Paula, Nair Hosino, Silvia Figueiredo Costa and Thaís Guimarães
Antibiotics 2022, 11(9), 1162; https://doi.org/10.3390/antibiotics11091162 - 28 Aug 2022
Cited by 1 | Viewed by 1368
Abstract
We describe the epidemiology of C. difficile infections (CDIs) focused on treatment and analyze the risk factors for mortality. This is a retrospective cohort study of CDI cases with a positive A/B toxin in the stool in 2017–2018. We analyzed the demographic data, [...] Read more.
We describe the epidemiology of C. difficile infections (CDIs) focused on treatment and analyze the risk factors for mortality. This is a retrospective cohort study of CDI cases with a positive A/B toxin in the stool in 2017–2018. We analyzed the demographic data, comorbidities, previous use of antimicrobials, severity, and treatment, and we performed multivariate analysis to predict the 30-days mortality. We analyzed 84 patients, 37 (44%) of which were male, where the mean age was 68.1 years and 83 (99%) had comorbidities. The percentage of positivity of the A/B toxin was 11.6%, and the overall incidence density was 1.78/10,000 patient days. Among the patients, 65.4% had previous use of antimicrobials, with third-generation cephalosporins being the class most prescribed, and 22.6% of cases were severe. Treatment was prescribed for 70 (83.3%) patients, and there was no statistically significant difference between the initial treatment with metronidazole and vancomycin even in severe cases. The 30-day mortality was 7/84 (8.3%), and the risk factors associated with mortality was a severity score ≥2 (OR: 6.0; CI: 1.15–31.1; p = 0.03). In this cohort of CDI-affected patients with comorbidities and cancer, metronidazole was shown to be a good option for treating CDIs, and the severity score was the only independent risk factor for death. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
14 pages, 2960 KiB  
Article
Both Manuka and Non-Manuka Honey Types Inhibit Antibiotic Resistant Wound-Infecting Bacteria
by Samantha R. Hewett, Stephany D. Crabtrey, Esther E. Dodson, C. Alexander Rieth, Richard M. Tarkka and Kari Naylor
Antibiotics 2022, 11(8), 1132; https://doi.org/10.3390/antibiotics11081132 - 20 Aug 2022
Cited by 4 | Viewed by 4076
Abstract
Postoperative infections are a major concern in United States hospitals, accounting for roughly 20% of all hospital-acquired infections yearly. Wound-infecting bacteria, in particular, have a high rate of drug resistance (up to 65%), creating life-threatening complications. Manuka honey, native to New Zealand, has [...] Read more.
Postoperative infections are a major concern in United States hospitals, accounting for roughly 20% of all hospital-acquired infections yearly. Wound-infecting bacteria, in particular, have a high rate of drug resistance (up to 65%), creating life-threatening complications. Manuka honey, native to New Zealand, has been FDA-approved for wound treatment in the United States after studies demonstrated its ability to inhibit a variety of bacterial species and facilitate wound healing. The aim of this study was to identify alternative (non-manuka) honey types that can be specifically used against antibiotic resistance bacteria in wound infections. We utilized a honey-plate method to measure the minimum inhibitory concentration (MIC) of honey to avoid the limitations of agar diffusion, where large, nonpolar polyphenols (which will not diffuse efficiently) play an important role in bioactivity. This study demonstrated that there are several alternative (non-manuka) honey types, particularly fresh raw Arkansas wildflower honeys, that comparably inhibit the growth of the antibiotic-resistant bacterial species specifically implicated in wound infections. Concentrations of 10–30% honey inhibited the growth of the highly antibiotic-resistant organisms colloquially referred to as “superbugs”, which the WHO declared in 2017 to be in critical need of new antibiotics. There was no statistical difference between manuka honey and fresh summer Arkansas wildflower honey in overall bacterial inhibition. These results could transform wound care in the United States, where manuka honey can be expensive and difficult to obtain and where antibiotic resistance remains a troubling concern for wound treatment. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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8 pages, 256 KiB  
Article
Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil
by Amanda Thurler Palomo, Ana Paula Maia Pires, Marcelo Fernando Matielo, Rafael de Athayde Soares, Christiano Pecego, Roberto Sacilotto, Alexandre Inacio de Paula, Nair Hosino, Cristiano de Melo Gamba, Cibele Lefreve Fonseca, Daniela K. S. Paraskevopoulos, Augusto Yamaguti, João Silva de Mendonça, Silvia Figueiredo Costa and Thaís Guimarães
Antibiotics 2022, 11(8), 1125; https://doi.org/10.3390/antibiotics11081125 - 19 Aug 2022
Cited by 3 | Viewed by 1902
Abstract
Diabetic foot infections (DFIs) are one of the causes of hospitalization in diabetic patients and, when this occurs, empirical antibiotic therapy is necessary. We have conducted a retrospective study of patients with DFI that required hospitalization to evaluate microbiologic profile and the susceptibility [...] Read more.
Diabetic foot infections (DFIs) are one of the causes of hospitalization in diabetic patients and, when this occurs, empirical antibiotic therapy is necessary. We have conducted a retrospective study of patients with DFI that required hospitalization to evaluate microbiologic profile and the susceptibility pattern of these infections. We evaluated 320 patients, of which 223 (69.7%) were male with a media age of 71 years with 276 isolates. Gram-positive bacteria were responsible for 188 (68.1%) of the isolates, while Gram-negative bacilli were responsible for 88 (31.9%). E. faecalis was the most prevalent pathogen, followed by S. aureus and coagulase negative Staphylococci. Among Gram-negative pathogens, P. aeruginosa was the most prevalent agent. Regarding the susceptibility profile, we found ampicillin-sensitive enterococci in 89% of the cases, oxacillin-sensitive S. aureus in 47%, but in coagulase-negative staphylococci, oxacillin was sensible only in 20%. The susceptibility profile of Gram-negatives was very good with 76% susceptibility of P. aeruginosa to ceftazidime and meropenem. The other prevalent Enterobacterales had great susceptibility to ceftazidime, piperacillin-tazobactam and 100% susceptibility to meropenem, with the exception of K. pneumoniae, which had 75% susceptibility to meropenem. Knowledge of microbiological profile and susceptibility patterns of patients with DFIs is useful to guide empirical therapy. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
11 pages, 1036 KiB  
Article
Comparative In Vitro Activity of Ceftolozane/Tazobactam against Clinical Isolates of Pseudomonas aeruginosa and Enterobacterales from Five Latin American Countries
by Juan Carlos García-Betancur, Elsa De La Cadena, María F. Mojica, Cristhian Hernández-Gómez, Adriana Correa, Marcela A. Radice, Paulo Castañeda-Méndez, Diego A. Jaime-Villalon, Ana C. Gales, José M. Munita and María Virginia Villegas
Antibiotics 2022, 11(8), 1101; https://doi.org/10.3390/antibiotics11081101 - 13 Aug 2022
Cited by 4 | Viewed by 1947
Abstract
Background: Ceftolozane/tazobactam (C/T) is a combination of an antipseudomonal oxyiminoaminothiazolyl cephalosporin with potent in vitro activity against Pseudomonas aeruginosa and tazobactam, a known β-lactamase inhibitor. The aim of this study was to evaluate the activity of C/T against clinical isolates of P. aeruginosa [...] Read more.
Background: Ceftolozane/tazobactam (C/T) is a combination of an antipseudomonal oxyiminoaminothiazolyl cephalosporin with potent in vitro activity against Pseudomonas aeruginosa and tazobactam, a known β-lactamase inhibitor. The aim of this study was to evaluate the activity of C/T against clinical isolates of P. aeruginosa and Enterobacterales collected from five Latin American countries between 2016 and 2017, before its clinical use in Latin America, and to compare it with the activity of other available broad-spectrum antimicrobial agents. Methods: a total of 2760 clinical isolates (508 P. aeruginosa and 2252 Enterobacterales) were consecutively collected from 20 hospitals and susceptibility to C/T and comparator agents was tested and interpreted following the current guidelines. Results: according to the CLSI breakpoints, 68.1% (346/508) of P. aeruginosa and 83.9% (1889/2252) of Enterobacterales isolates were susceptible to C/T. Overall, C/T demonstrated higher in vitro activity than currently available cephalosporins, piperacillin/tazobactam and carbapenems when tested against P. aeruginosa, and its performance in vitro was comparable to fosfomycin. When tested against Enterobacterales, it showed higher activity than cephalosporins and piperacillin/tazobactam, and similar activity to ertapenem. Conclusions: these results show that C/T is an active β-lactam agent against clinical isolates of P. aeruginosa and Enterobacterales. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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13 pages, 281 KiB  
Article
Empiric Usage of “Anti-Pseudomonal” Agents for Hospital-Acquired Urinary Tract Infections
by Ori Rahat, Murad Shihab, Elhai Etedgi, Debby Ben-David, Inna Estrin, Lili Goldshtein, Shani Zilberman-Itskovich and Dror Marchaim
Antibiotics 2022, 11(7), 890; https://doi.org/10.3390/antibiotics11070890 - 4 Jul 2022
Viewed by 1514
Abstract
Hospital-acquired urinary tract infection (HAUTI) is one of the most common hospital-acquired infections, and over 80% of HAUTI are catheter-associated (CAUTI). Pseudomonas aeruginosa, as well as other non-glucose fermenting Gram negative organisms (NGFGN, e.g., Acinetobacter baumannii), are frequently covered empirically with [...] Read more.
Hospital-acquired urinary tract infection (HAUTI) is one of the most common hospital-acquired infections, and over 80% of HAUTI are catheter-associated (CAUTI). Pseudomonas aeruginosa, as well as other non-glucose fermenting Gram negative organisms (NGFGN, e.g., Acinetobacter baumannii), are frequently covered empirically with “anti-Pseudomonals” being administered for every HAUTI (and CAUTI). However, this common practice was never trialed in controlled settings in order to quantify its efficacy and its potential impacts on hospitalization outcomes. There were 413 patients with HAUTI that were included in this retrospective cohort study (2017–2018), 239 (57.9%) had CAUTI. There were 75 NGFGN infections (18.2% of HAUTI, 22.3% of CAUTI). P. aeruginosa was the most common NGFGN (82%). Despite multiple associations per univariable analysis, recent (3 months) exposure to antibiotics was the only independent predictor for NGFGN HAUTI (OR = 2.4, CI-95% = 1.2–4.8). Patients who received empiric anti-Pseudomonals suffered from worse outcomes, but in multivariable models (one for each outcome), none were independently associated with the empiric administration of anti-Pseudomonals. To conclude, approximately one of every five HAUTI (and CAUTI) are due to NGFGN, which justifies the practice of empiric anti-Pseudomonals for patients with HAUTI (and CAUTI), particularly patients who recently received antibiotics. The practice is not associated with independent deleterious impacts on outcomes. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
14 pages, 1341 KiB  
Article
Healthcare Professionals’ Knowledge and Beliefs on Antibiotic Prophylaxis in Cesarean Section: A Mixed-Methods Study in Benin
by Angèle Modupè Dohou, Valentina Oana Buda, Severin Anagonou, Françoise Van Bambeke, Thierry Van Hees, Francis Moïse Dossou and Olivia Dalleur
Antibiotics 2022, 11(7), 872; https://doi.org/10.3390/antibiotics11070872 - 28 Jun 2022
Cited by 2 | Viewed by 1603
Abstract
A low adherence to recommendations on antibiotic prophylaxis has been reported worldwide. Since 2009, cesarean sections have been performed under user fee exemption in Benin with a free kit containing the required supplies and antibiotics for prophylaxis. Despite the kit, the level of [...] Read more.
A low adherence to recommendations on antibiotic prophylaxis has been reported worldwide. Since 2009, cesarean sections have been performed under user fee exemption in Benin with a free kit containing the required supplies and antibiotics for prophylaxis. Despite the kit, the level of antibiotic prophylaxis achievement remains low. We conducted a convergent parallel design study in 2017 using a self-administered questionnaire and interviews to assess the knowledge and explore the beliefs of healthcare professionals regarding antibiotic prophylaxis in three hospitals. Of the 35 participants, 33 filled out the questionnaire. Based on the five conventional criteria of antibiotic prophylaxis, the mean level of knowledge was 3.3 out of 5, and only 15.2% scored 5 out of 5. From the verbatim of 19 interviewees, determinants such as suboptimal patient status health, low confidence in antibiotics, some disagreement with the policy, inappropriate infrastructures and limited financial resources in hospitals, poor management of the policy in the central level, and patient refusal to buy antibiotics can explain poor practices. Because of the dysfunction at these levels, the patient becomes the major determinant of adequate antibiotic prophylaxis. Policymakers have to consider these determinants for improving antibiotic prophylaxis in a way that ensures patient safety and reduces the incidence of antimicrobial resistance. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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10 pages, 852 KiB  
Article
Microbial Landscape and Antibiotic Susceptibility Dynamics of Skin and Soft Tissue Infections in Kazakhstan 2018–2020
by Sholpan S. Kaliyeva, Alyona V. Lavrinenko, Yerbol Tishkambayev, Gulzira Zhussupova, Aissulu Issabekova, Dinara Begesheva and Natalya Simokhina
Antibiotics 2022, 11(5), 659; https://doi.org/10.3390/antibiotics11050659 - 13 May 2022
Cited by 5 | Viewed by 3309
Abstract
Skin and soft tissue inflammatory diseases of bacterial origin occupy a significant part of hospitalizations to emergency departments. One of the most common causes of sepsis is soft tissue infection, which accounts for about a quarter of all nosocomial infections. The aim of [...] Read more.
Skin and soft tissue inflammatory diseases of bacterial origin occupy a significant part of hospitalizations to emergency departments. One of the most common causes of sepsis is soft tissue infection, which accounts for about a quarter of all nosocomial infections. The aim of this study was to determine the differences in microbial landscape and antibiotic susceptibility of soft tissue infection pathogens among adults and children during the period 2018–2020. We studied 110 samples of pus admitted to the Scientific Research laboratory of the Karaganda Medical University from 2018 to 2020. Each sample was studied using the standard and express methods. The antibiotic susceptibility was determined by using the diffuse disk method in accordance with the CLSI 2018 recommendations. As such, 50% of S. epidermidis strains in children and 30% in adults were methicillin resistant. Differences in the resistance of S. aureus strains in children and adults were insignificant. Thus, methicillin-resistant S. aureus (MRSA) was not detected in children, but in adults, on the other hand, their percentage was 12.5%. The third cause of infection in adults was E. coli (13.72%), among which 75% were multidrug resistant. A. baumanii was found in 4.9% of adult patients’ samples, of which 60% were multidrug resistant. The effectiveness of the most prescribed antibiotics decreased due to the isolated strain resistance. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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14 pages, 2334 KiB  
Article
An 18-Year Dataset on the Clinical Incidence and MICs to Antibiotics of Achromobacter spp. (Labeled Biochemically or by MAL-DI-TOF MS as A. xylosoxidans), Largely in Patient Groups Other than Those with CF
by Claudio Neidhöfer, Christina Berens and Marijo Parčina
Antibiotics 2022, 11(3), 311; https://doi.org/10.3390/antibiotics11030311 - 25 Feb 2022
Cited by 8 | Viewed by 1963
Abstract
Achromobacter spp. are intrinsically multidrug-resistant environmental microorganisms which are known to cause opportunistic, nosocomial, and sometimes chronic infections. The existing literature yields scarcely any larger datasets, especially with regard to the incidence in patient groups other than those with cystic fibrosis. The aim [...] Read more.
Achromobacter spp. are intrinsically multidrug-resistant environmental microorganisms which are known to cause opportunistic, nosocomial, and sometimes chronic infections. The existing literature yields scarcely any larger datasets, especially with regard to the incidence in patient groups other than those with cystic fibrosis. The aim of this study was to fill this gap. We present a retrospective analysis of 314 clinical and 130 screening isolates detected in our diagnostic unit between 2004 and 2021, combined with patients’ demographic and clinical information (ward type and length of hospitalization), and the results of routine diagnostic antibiotic MIC determination. We found the apparent increase in prevalence in our diagnostic unit, in which cystic fibrosis patients are an underrepresented group, in large part to be attributable to an overall increase in the number of samples and, more importantly, changes in the diagnostic setting, such as the introduction of rigorous screening for Gram-negative multidrug-resistant pathogens. We found these Achromobacter spp. to be most commonly detected in urine, stool, wounds and airway samples, and found the resistance rates to vary strongly between different sample types. Intestinal carriage is frequently not investigated, and its frequency is likely underestimated. Isolates resistant to meropenem can hardly be treated. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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Review

Jump to: Research

21 pages, 1528 KiB  
Review
Recent Developments in Methicillin-Resistant Staphylococcus aureus (MRSA) Treatment: A Review
by Palanichamy Nandhini, Pradeep Kumar, Suresh Mickymaray, Abdulaziz S. Alothaim, Jayaprakash Somasundaram and Mariappan Rajan
Antibiotics 2022, 11(5), 606; https://doi.org/10.3390/antibiotics11050606 - 29 Apr 2022
Cited by 79 | Viewed by 16699
Abstract
Staphylococcus aureus (S. aureus) is a Gram-positive bacterium that may cause life-threatening diseases and some minor infections in living organisms. However, it shows notorious effects when it becomes resistant to antibiotics. Strain variants of bacteria, viruses, fungi, and parasites that have [...] Read more.
Staphylococcus aureus (S. aureus) is a Gram-positive bacterium that may cause life-threatening diseases and some minor infections in living organisms. However, it shows notorious effects when it becomes resistant to antibiotics. Strain variants of bacteria, viruses, fungi, and parasites that have become resistant to existing multiple antimicrobials are termed as superbugs. Methicillin is a semisynthetic antibiotic drug that was used to inhibit staphylococci pathogens. The S. aureus resistant to methicillin is known as methicillin-resistant Staphylococcus aureus (MRSA), which became a superbug due to its defiant activity against the antibiotics and medications most commonly used to treat major and minor infections. Successful MRSA infection management involves rapid identification of the infected site, culture and susceptibility tests, evidence-based treatment, and appropriate preventive protocols. This review describes the clinical management of MRSA pathogenesis, recent developments in rapid diagnosis, and antimicrobial treatment choices for MRSA. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Healthcare Associated Infections)
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