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Antibiotics
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Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections...
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Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 40945

Special Issue Editor

Dr. Alberto Enrico Maraolo

E-Mail Website
Guest Editor
Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
Interests: evidence-based medicine; infectious diseases; meta-analysis; antimicrobial stewardship; nosocomial infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Resistance to common antimicrobials is one of the worst problems of our times. It represent a significant hurdle to an easy management of infection in many patients, especially the most vulnerabile (e.g., immunosuppressed, those undergoing intensive care, children). Many factors has fuelled the widespread emergence of antimicrobial resistance among both Gram-negative and Gram-positive bacteria. Morevoer, another element of concern is represented by resistance in fungi. For many years, the pipeline has not provided a valid response to this serious issue, but in recent times, novel compounds have enlarged the antimicrobial armamentarium. This Special Issue welcomes manuscript submissions that address the current and new strategies to deal with antimicrobial resistance in bacteria and fungi.

Dr. Alberto Enrico Maraolo
Guest Editor

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

  • bacterial infections
  • fungal infections
  • multidrug-resistance
  • antibiotics
  • antifungals
  • antimicrobial stewardship
  • novel drugs

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Published Papers (8 papers)

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Editorial

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3 pages, 181 KiB  
Editorial
Editorial for the Special Issue: “Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms”
by Alberto Enrico Maraolo
Antibiotics 2022, 11(4), 426; https://doi.org/10.3390/antibiotics11040426 - 23 Mar 2022
Viewed by 1605
Abstract
The pandemic driven by the SARS-CoV-2 infection has compelled health services globally to direct all available human and economic resources toward fighting the novel coronavirus [...] Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)

Research

Jump to: Editorial, Other

11 pages, 269 KiB  
Article
Perspectives of Healthcare Professionals Regarding Factors Associated with Antimicrobial Resistance (AMR) and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia
by Mohamed A. Baraka, Amany Alboghdadly, Samar Alshawwa, Asim Ahmed Elnour, Hassan Alsultan, Taha Alsalman, Hussain Alaithan, Md. Ashraful Islam, Kareem Ahmed El-Fass, Yehia Mohamed, Abdulsalam A. Alasseri and Khairi Mustafa Fahelelbum
Antibiotics 2021, 10(7), 878; https://doi.org/10.3390/antibiotics10070878 - 19 Jul 2021
Cited by 11 | Viewed by 4302
Abstract
Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. [...] Read more.
Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted survey specific with closed-ended questions. A value of p < 0.05 was considered to be statistically significant. All data analysis was performed using the Statistical Package for Social Sciences (IBM SPSS version 23.0). 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All of the respondents acknowledged effectiveness, previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) as being key factors influencing physicians’ choice during antimicrobial prescribing. The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials were reported to be common practices. Furthermore, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials, and the use of antimicrobials without a physician’s prescription (i.e., self-medication) represent key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
10 pages, 539 KiB  
Article
Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study
by Daniele Roberto Giacobbe, Chiara Russo, Veronica Martini, Silvia Dettori, Federica Briano, Michele Mirabella, Federica Portunato, Chiara Dentone, Sara Mora, Mauro Giacomini, Marco Berruti and Matteo Bassetti
Antibiotics 2021, 10(7), 763; https://doi.org/10.3390/antibiotics10070763 - 23 Jun 2021
Cited by 7 | Viewed by 2823
Abstract
A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use [...] Read more.
A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
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19 pages, 277 KiB  
Article
Cefiderocol-Based Combination Therapy for “Difficult-to-Treat” Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives
by Davide Fiore Bavaro, Alessandra Belati, Lucia Diella, Monica Stufano, Federica Romanelli, Luca Scalone, Stefania Stolfa, Luigi Ronga, Leonarda Maurmo, Maria Dell’Aera, Adriana Mosca, Lidia Dalfino, Salvatore Grasso and Annalisa Saracino
Antibiotics 2021, 10(6), 652; https://doi.org/10.3390/antibiotics10060652 - 29 May 2021
Cited by 63 | Viewed by 7340
Abstract
Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of [...] Read more.
Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
10 pages, 1452 KiB  
Article
Existence of Multiple ESBL Genes among Phenotypically Confirmed ESBL Producing Klebsiella pneumoniae and Escherichia coli Concurrently Isolated from Clinical, Colonization and Contamination Samples from Neonatal Units at Bugando Medical Center, Mwanza, Tanzania
by Vitus Silago, Dory Kovacs, Happyness Samson, Jeremiah Seni, Louise Matthews, Katarina Oravcová, Athumani M. Lupindu, Abubakar S. Hoza and Stephen E. Mshana
Antibiotics 2021, 10(5), 476; https://doi.org/10.3390/antibiotics10050476 - 21 Apr 2021
Cited by 30 | Viewed by 9716
Abstract
The proportions and similarities of extended-spectrum β-lactamase (ESBL) producing K. pneumoniae (ESBL-KP) and E. coli (ESBL-EC) carrying multiple ESBL genes is poorly known at our setting. This study investigated the existence of multiple ESBL genes (blaCTX-M, blaTEM, and bla [...] Read more.
The proportions and similarities of extended-spectrum β-lactamase (ESBL) producing K. pneumoniae (ESBL-KP) and E. coli (ESBL-EC) carrying multiple ESBL genes is poorly known at our setting. This study investigated the existence of multiple ESBL genes (blaCTX-M, blaTEM, and blaSHV) among ESBL-KP and ESBL-EC concurrently isolated from clinical, colonization, and contamination samples from neonatology units in Mwanza-Tanzania. Twenty and 55 presumptive ESBL-EC and ESBL-KP, respectively, from a previous study archived at −80 °C were successfully recovered for this study. Isolates were screened and confirmed for production of ESBLs by phenotypic methods followed by multiplex PCR assay to determine ESBL genes. All (100%) and 97.3% of presumptive ESBL isolates were phenotypically confirmed by Clinical and Laboratory Standards Institute (CLSI) and modified double-disc synergy methods, respectively. About 93.3% (70/75) of phenotypically confirmed ESBL isolates had at least one ESBL gene, whereby for 62.9% (44/70), all ESBL genes (blaCTX-M, blaTEM, and blaSHV) were detected. Eight pairs of ESBL bacteria show similar patterns of antibiotics susceptibility and ESBL genes. ESBL-KP and ESBL-EC, concurrently isolated from clinical, colonization and contamination samples, harbored multiple ESBL genes. Further, eight pairs of ESBL isolates had similar patterns of antibiotics susceptibility and ESBL genes, suggesting transmission of and/or sharing of mobile genetic elements (MGEs) among ESBL-KP and ESBL-EC. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
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13 pages, 2653 KiB  
Article
Bacteriocin-Like Inhibitory Substances from Probiotics as Therapeutic Agents for Candida Vulvovaginitis
by Enas Mamdouh Hefzy, Mahmoud A. F. Khalil, Amal A. Ibrahim Amin, Hossam M. Ashour and Yasser Fathy Abdelaliem
Antibiotics 2021, 10(3), 306; https://doi.org/10.3390/antibiotics10030306 - 17 Mar 2021
Cited by 19 | Viewed by 4188
Abstract
Probiotics can potentially prevent and treat diseases. We examined the inhibitory activity of bacteriocin-like inhibitory substances (BLISs) from potentially probiotic lactobacilli and streptococci on Candida albicans and non-Candida albicans clinical isolates from women with vulvovaginitis. Using agar well diffusion assays, BLISs inhibited [...] Read more.
Probiotics can potentially prevent and treat diseases. We examined the inhibitory activity of bacteriocin-like inhibitory substances (BLISs) from potentially probiotic lactobacilli and streptococci on Candida albicans and non-Candida albicans clinical isolates from women with vulvovaginitis. Using agar well diffusion assays, BLISs inhibited both Candida albicans and non-Candida albicans isolates. The BLIS from L. pentosus isolates had the highest anti-Candida activity (33/45; 73.3%), followed by BLISs from isolates of L. paracasei subsp. paracasei (31/45; 68.9%), L. rhamnosus I (30/45; 66.7%), L. delbrueckii subsp. lactis I (30/45; 66.7%), and S. uberis II (30/45; 66.7%). Upon characterization according to the retained activity under variable physical and chemical conditions, the BLISs showed stability against heat, pH, and surfactants, but were protease-sensitive, which suggests a proteinaceous nature of the active substances. Using crystal violet assays, the BLISs reduced the Candida biofilm biomass significantly as compared to a control group that lacked BLISs. In vivo testing of the antagonistic activity was performed using the Galleria mellonella (G. mellonella) larvae model. BLISs significantly improved survival in G. mellonella larvae treated with Candida isolates on the first, second, and seventh days, as compared to larvae inoculated with Candida only (p < 0.01). The results show that BLISs can be used as biotherapeutic agents in vulvovaginal candidiasis. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
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Other

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22 pages, 4103 KiB  
Systematic Review
Oral Vancomycin Prophylaxis for Primary and Secondary Prevention of Clostridioides difficile Infection in Patients Treated with Systemic Antibiotic Therapy: A Systematic Review, Meta-Analysis and Trial Sequential Analysis
by Alberto Enrico Maraolo, Maria Mazzitelli, Emanuela Zappulo, Riccardo Scotto, Guido Granata, Roberto Andini, Emanuele Durante-Mangoni, Nicola Petrosillo and Ivan Gentile
Antibiotics 2022, 11(2), 183; https://doi.org/10.3390/antibiotics11020183 - 30 Jan 2022
Cited by 21 | Viewed by 5805
Abstract
Background: Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality as well as high propensity of recurrence. Systemic antibiotic therapy (SAT) represents the top inciting factor of CDI, both primary and recurrent (rCDI). Among the many strategies aimed to prevent CDI [...] Read more.
Background: Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality as well as high propensity of recurrence. Systemic antibiotic therapy (SAT) represents the top inciting factor of CDI, both primary and recurrent (rCDI). Among the many strategies aimed to prevent CDI in high-risk subjects undergoing SAT, oral vancomycin prophylaxis (OVP) appears promising under a cost-effectiveness perspective. Methods: A systematic review with meta-analysis and trial sequential analysis (TSA) of studies assessing the efficacy and the safety of OVP to prevent primary CDI and rCDI in persons undergoing SAT was carried out. PubMed and EMBASE were searched until 30 September 2021. The protocol was pre-registered on PROSPERO (CRD42019145543). Results: Eleven studies met the inclusion criteria, only one being a randomized controlled trial (RCT). Overall, 929 subjects received OVP and 2011 represented the comparator group (no active prophylaxis). OVP exerted a strong protective effect for CDI occurrence: odds ratio 0.14, 95% confidence interval 0.04–0.38. Moderate heterogeneity was observed: I2 54%. This effect was confirmed throughout several subgroup analyses, including prevention of primary CDI versus rCDI. TSA results pointed at the conclusive nature of the evidence. Results were robust to a variety of sensitivity and quantitative bias analyses, although the underlying evidence was deemed as low quality. No differences between the two groups were highlighted regarding the onset of vancomycin-resistant Enterococcus infections. Conclusions: OVP appears to be an efficacious option for prevention of CDI in high-risk subjects undergoing SAT. Nevertheless, additional data from RCTs are needed to establish OVP as good clinical practice and define optimal dosage and duration. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
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11 pages, 2077 KiB  
Case Report
Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre’s Syndrome
by Andreaserena Recchia, Marco Cascella, Sabrina Altamura, Felice Borrelli, Nazario De Nittis, Elisabetta Dibenedetto, Maria Labonia, Giovanna Pavone and Alfredo Del Gaudio
Antibiotics 2021, 10(12), 1526; https://doi.org/10.3390/antibiotics10121526 - 14 Dec 2021
Cited by 2 | Viewed by 3855
Abstract
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. [...] Read more.
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone. Full article
(This article belongs to the Special Issue Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms)
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