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The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on...
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The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics

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 (30 September 2024) | Viewed by 18845

Special Issue Editors

Dr. Fabio Arena

E-Mail Website
Guest Editor
Department of Clinical and Experimental Medicine, University of Foggia, Via Luigi Pinto, 71122 Foggia, Italy
Interests: bacteriology; virulence; antimicrobial resistance; new diagnostic approaches
Dr. Gianfranco La Bella

E-Mail Website
Guest Editor
1. Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
2. Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
Interests: molecular biology; foodborne pathogens; antibiotic resistance; clinical microbiology; pathogens; microbial genetics; molecular typing

Special Issue Information

Dear Colleagues,

The spread of multidrug-resistant (MDR) organisms, particularly among Gram-negative (G-neg) bacteria, is a matter of serious concern. Invasive infections (particularly bloodstream infections, BSIs) sustained by MDR organisms are correlated with significant patient morbidity and mortality worldwide.

The excess mortality associated with BSIs is mainly attributed to the limited availability of active drugs.

Several new antibiotics with activity against MDR G-neg bacteria have been released in recent years. These drugs have fundamentally changed the therapeutic approach for invasive MDR G-neg bacterial infections.

Monitoring the in vitro activity of these new antibiotics over time is of fundamental importance for the identification of antimicrobial management and antimicrobial resistance containment strategies.

This Special Issue seeks to publish manuscripts that could expand knowledge on the epidemiology of antimicrobial resistance in BSI, particularly regarding the activity of new drugs against MDR G-neg bacteria. Studies aimed at investigating the epidemiology, microbiology and risk factors associated with mortality from MDR bacterial bloodstream infections are welcome.

Dr. Fabio Arena
Dr. Gianfranco La Bella
Guest Editors

Manuscript Submission Information

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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

  • bacteremia
  • sepsis
  • septic shock
  • multi-drug resistance
  • surveillance
  • risk factors

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Published Papers (6 papers)

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Research

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12 pages, 1913 KiB  
Article
Diversity, Distribution, and Resistance Profiles of Bacterial Bloodstream Infections in Three Tertiary Referral Hospitals in Rwanda Between 2020 and 2022
by Misbah Gashegu, Vedaste Ndahindwa, Edson Rwagasore, Albert Tuyishime, Clarisse Musanabaganwa, Noel Gahamanyi, Isabelle Mukagatare, Djibril Mbarushimana, Christopher Aird Green, Tafadzwa Dzinamarira, Ayman Ahmed and Claude Mambo Muvunyi
Antibiotics 2024, 13(11), 1084; https://doi.org/10.3390/antibiotics13111084 - 14 Nov 2024
Cited by 1 | Viewed by 1596
Abstract
Background: The burden of bacterial bloodstream infections (BSIs) is rapidly increasing in Africa including Rwanda. Methods: This is a retrospective study that investigates the diversity, distribution, and antimicrobial susceptibility profiles of BSI bacteria in three tertiary referral hospitals in Rwanda between [...] Read more.
Background: The burden of bacterial bloodstream infections (BSIs) is rapidly increasing in Africa including Rwanda. Methods: This is a retrospective study that investigates the diversity, distribution, and antimicrobial susceptibility profiles of BSI bacteria in three tertiary referral hospitals in Rwanda between 2020 and 2022. Results: A total of 1532 blood culture tests were performed for visiting patients. Overall, the proportions of Gram-negative and Gram-positive bacteria were 48.2% and 51.8, respectively. Staphylococcus aureus was the predominant species accounting for 25% of all Gram-positive BSI species, and Klebsiella species represented 41% of all Gram-negative BSI species. Antimicrobial susceptibility testing revealed that Amikacin exhibited the highest activity against Enterobacter spp., Serratia spp., and Escherichia coli in >92% of cases and Klebsiella spp. in 75.7%. Meropenem and Imipenem were highly efficacious to Salmonella spp. (100% susceptibility), Enterobacter spp. (96.2% and 91.7%, respectively), and Escherichia coli (94.7% and 95.5%, respectively). The susceptibility of Enterococcus spp., S. aureus, and Streptococcus spp. to Vancomycin was 100%, 99.5%, and 97.1%, respectively. Klebsiella spp. was highly sensitive to Colistin (98.7%), Polymyxin B (85.6%), Imipenem (84.9%), and Meropenem (78.5%). Conclusions: We recommend strengthening the implementation of integrated transdisciplinary and multisectoral One Health including AMR stewardship for the surveillance, prevention, and control of AMR in Rwanda. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)
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10 pages, 251 KiB  
Article
Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant Acinetobacter baumannii Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis
by Antonella Frattari, Ennio Polilli, Laura Timelli, Francesca Spagnuolo, Paolo Fazii and Giustino Parruti
Antibiotics 2024, 13(11), 1001; https://doi.org/10.3390/antibiotics13111001 - 23 Oct 2024
Cited by 1 | Viewed by 1537
Abstract
Background: Multidrug-resistant Acinetobacter baumannii (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. [...] Read more.
Background: Multidrug-resistant Acinetobacter baumannii (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. Methods: We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic Acinetobacter baumannii infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. Results: Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11–2.02), SAPS II (OR: 1.05, CI: 1.01–1.1), SOFA score (OR: 1.37, CI: 1.06–1.76), lymphocytopenia (OR: 32.5, CI: 3.45–306.4), viral reactivation (OR: 9.75, CI: 1.72–55.4), and cholinesterase drop <1600 U/L (OR: 39.7, CI: 5.8–271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98–2.05), lymphocytopenia (OR: 18.2, CI: 0.87–371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77–123.7). Conclusions: Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients’ care. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)
12 pages, 640 KiB  
Article
The Molecular Mouse System: A New Useful Tool for Guiding Antimicrobial Therapy in Critically Ill Septic Patients
by Carola Mauri, Alessandra Consonni, Elena Briozzo, Chiara Giubbi, Elisa Meroni, Silvia Tonolo and Francesco Luzzaro
Antibiotics 2024, 13(6), 517; https://doi.org/10.3390/antibiotics13060517 - 1 Jun 2024
Cited by 3 | Viewed by 2398
Abstract
Bloodstream infections (BSI) caused by multidrug-resistant (MDR) bacteria, pose a major threat for patients, especially for those who are immunosuppressed. Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with BSI to enable an adequate and [...] Read more.
Bloodstream infections (BSI) caused by multidrug-resistant (MDR) bacteria, pose a major threat for patients, especially for those who are immunosuppressed. Rapid pathogen detection and characterization from positive blood cultures are crucial in the management of patients with BSI to enable an adequate and timely antimicrobial therapy. This study aimed to investigate the potential role of the Molecular Mouse system, a new CE IVD molecular test designed to rapidly detect the causative agents of bacteremia and their resistance determinants, in the management of the therapy in critically ill patients. Agreement between the results of the Molecular Mouse and the conventional routine method was also considered. Overall, 100 positive blood cultures were collected from septic critically ill patients from May 2023 to January 2024 and analyzed with Molecular Mouse and routine protocols. The new instrument consistently agreed with the routine protocols in the case of monomicrobial blood cultures, while some discrepancies were obtained in the polymicrobial samples. Antimicrobial resistance genes were detected in 35 samples, with vanA and CTX-M-1/9 groups being the most frequently detected targets. Therapy was adjusted in 42 critically ill patients confirming the importance of new rapid molecular tests in the management of positive blood cultures, to adjust empirical therapy and use new antibiotics accurately. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)
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Review

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13 pages, 807 KiB  
Review
Infective Endocarditis by Lactobacillus Species—A Narrative Review
by Petros Ioannou, Afroditi Ziogou, Ilias Giannakodimos, Alexios Giannakodimos, Stella Baliou and George Samonis
Antibiotics 2024, 13(1), 53; https://doi.org/10.3390/antibiotics13010053 - 4 Jan 2024
Cited by 13 | Viewed by 3755
Abstract
Bacteria of the genus Lactobacillus are microaerophilic or aerotolerant anaerobic Gram-positive non-spore-forming rods. They are considered essential members of the human gut microbiome; however, recent studies have revealed that these microorganisms are less predominant in the gut microbiome than initially thought. Lactobacillus spp. [...] Read more.
Bacteria of the genus Lactobacillus are microaerophilic or aerotolerant anaerobic Gram-positive non-spore-forming rods. They are considered essential members of the human gut microbiome; however, recent studies have revealed that these microorganisms are less predominant in the gut microbiome than initially thought. Lactobacillus spp. is mainly known for its use as a probiotic in foods and supplements to prevent and treat specific issues such as infectious diseases, irritable bowel syndrome, and diabetes mellitus. However, Lactobacillus spp. may occasionally cause infections such as bacteremia or infective endocarditis (IE). The present study aimed to review all cases of IE by Lactobacillus spp. and describe the epidemiology, microbiology, clinical characteristics, treatment, and outcomes of this infection by collecting relevant data from studies existing in Pubmed and Scopus until 28 September 2023. A total of 77 studies containing data for 82 patients were included. The median age was 56 years, and 69.6% were male. A prosthetic valve was present in 16% of patients, and 17.3% had previously been on probiotics. The aortic valve was the most commonly involved intracardiac site, followed by the mitral valve. Fever, embolic phenomena, sepsis, and heart failure were the most common clinical presentations. Aminoglycosides and penicillin were the most commonly used antimicrobials for definitive treatment. Surgery was performed in 53.7% of patients. Overall mortality was 17.1%. IE in prosthetic valves and presentation with shock were independently associated with overall mortality. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)
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10 pages, 270 KiB  
Review
Bloodstream Infection and Gram-Negative Resistance: The Role for Newer Antibiotics
by Jessica Waters and Andrew F. Shorr
Antibiotics 2023, 12(6), 977; https://doi.org/10.3390/antibiotics12060977 - 29 May 2023
Cited by 2 | Viewed by 2837
Abstract
Gram-negative resistance remains a major challenge. Rates of in vitro resistance to commonly utilized antibiotics have skyrocketed over the last decade. Clinicians now encounter multidrug-resistant organisms routinely. Fortunately, newer agents, such as ceftazidime–avibactam, ceftolozone–tazobactam, meropenem–vaborbactam, and cefiderocol, have been developed and are now [...] Read more.
Gram-negative resistance remains a major challenge. Rates of in vitro resistance to commonly utilized antibiotics have skyrocketed over the last decade. Clinicians now encounter multidrug-resistant organisms routinely. Fortunately, newer agents, such as ceftazidime–avibactam, ceftolozone–tazobactam, meropenem–vaborbactam, and cefiderocol, have been developed and are now available for use against these pathogens. Clinical trials with these novel therapies have focused on multiple infection types ranging from complicated urinary tract infections to nosocomial pneumonia. Nonetheless, there remains little information about the efficacy of these drugs for bacteremia. To better appreciate the types and limitations of the evidence supporting the role for these unique molecules in bloodstream infection, one requires an appreciation of the initial clinical trials supporting the regulatory approval of these antibiotics. Furthermore, physicians must understand the subsequent case series and reports specifically focusing on outcomes for patients with bacteremia treated with these drugs. Despite the limitations of the data and reports relating to treatment for bacteremia with these antibiotics, each agent appears to be efficacious and can provide good outcomes in bloodstream infections due to resistant pathogens. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)

Other

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19 pages, 808 KiB  
Systematic Review
New Antimicrobials for the Treatment of Neonatal Sepsis Caused by Multi-Drug-Resistant Bacteria: A Systematic Review
by Chiara Poggi and Carlo Dani
Antibiotics 2023, 12(6), 956; https://doi.org/10.3390/antibiotics12060956 - 24 May 2023
Cited by 9 | Viewed by 5935
Abstract
Background: Infections by multi-drug-resistant (MDR) organisms are sharply increasing in newborns worldwide. In low and middle-income countries, a disproportionate amount of neonatal sepsis caused by MDR Gram negatives was recently reported. Newborns with infections by MDR organisms with limited treatment options may benefit [...] Read more.
Background: Infections by multi-drug-resistant (MDR) organisms are sharply increasing in newborns worldwide. In low and middle-income countries, a disproportionate amount of neonatal sepsis caused by MDR Gram negatives was recently reported. Newborns with infections by MDR organisms with limited treatment options may benefit from novel antimicrobials. Methods: We performed a literature search investigating the use in newborns, infants and children of novel antimicrobials for the treatment of MDR Gram negatives, namely ceftazidime/avibactam, ceftolozane/tazobactam, cefiderocol, meropenem/vaborbactam, imipenem/relebactam, and Gram positives with resistance of concern, namely ceftaroline and dalbavancin. PubMed, EMBASE, and Web of Science were searched. Results: A total of 50 records fulfilled the inclusion criteria. Most articles were case reports or case series, and ceftazidime/avibactam was the most studied agent. All studies showed favorable efficacy and safety profile in newborns and across different age cohorts. Conclusions: novel antibiotics may be considered in newborns for the treatment of MDR Gram negatives with limited treatment options and for Gram positives with resistance concerns. Further studies are needed to address their effectiveness and safety in newborns. Full article
(This article belongs to the Special Issue The Epidemiology of Antimicrobial Resistance in Bloodstream Infections: Focus on Activity of New Antibiotics)
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