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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 14938

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Dr. Rosario Cultrera

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Department of Traslational Medicine, Infectious Diseases Unit, University ‘S. Anna’ Hospital of Ferrara, 44124 Ferrara, Italy
Interests: antimicrobial therapy; multidrug-resistant bacteria; immunocompromised patients; human parasitic diseases; antibiotic stewardship
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Dear Colleagues,

Increasingly growing antimicrobial resistance represents a real global emergency that calls for particular attention on the appropriate use of antibiotics, especially those recently introduced for the treatment of infections with multidrug-resistant organisms (MDROs).

Outpatient antibiotic therapy (OPAT) allows for a reduction in hospitalization days, allowing the patient to have a better quality of life if they can finish the antibiotic treatment cycle at home. OPAT also makes it possible to avoid hospitalization itself for the treatment of infections in patients at low risk of clinical complications. Early discharge and de-hospitalization lower the risk of exposing the patient to hospital infections from MDRO and avoid hypokinetic syndrome due to prolonged hospitalization in elderly patients, reducing the management costs of infectious diseases themselves.

The correct use of antibiotics in hospitalized patients requires the definition of appropriateness criteria for the prescription and adequate dosages and times of antibiotic therapy. For this purpose, for example, it would be important to distinguish bacterial colonization from infection to reserve therapy for patients suffering with the latter. It is also important to implement careful source control.

The correlation between antimicrobial therapy in hospital and OPAT is increasingly topical. This Special Issue seeks contributions that can better define aspects related to OPAT and hospital therapy. Particularly encouraged are those contributions that encompass a novel aspect in the definition of criteria for the appropriateness of antibiotic therapy in two settings.

Dr. Rosario Cultrera
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

antimicrobial resistance
outpatient
epidemiology
in hospital infections
antibiotic stewardship
source control
antibiotic prescribing

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Published Papers (7 papers)

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Research

16 pages, 1160 KiB

Open AccessArticle

Antimicrobial Stewardship Intervention for the Family Caregiver Attending Primary Health Care Setting: A Quasi-Experimental Study

by Ammena Y. Binsaleh, Mahmoud S. Abdallah, Basma Mohamed Osman, Mostafa M. Bahaa, Nawal Alsubaie, Thanaa A. Elmasry, Mohamed Yasser, Mamdouh Eldesoqui, Abdel-Naser Abdel-Atty Gadallah, Manal A. Hamouda, Nashwa Eltantawy, Fatma A. Mokhtar and Ramy M. El Sabaa

Antibiotics 2024, 13(12), 1145; https://doi.org/10.3390/antibiotics13121145 - 29 Nov 2024

Cited by 1 | Viewed by 1308

Abstract

Background: Antimicrobial resistance (AMR) has been identified as one of the top ten public health threats facing humanity. Aim: The purpose of this study was to assess the effect of an antimicrobial stewardship educational intervention on family caregivers’ knowledge and practices in primary healthcare settings in Egypt. Methods: A quasi-experimental, one-group pretest-posttest design involving a sample of 300 family caregivers attending family health centers. The data were collected using questionnaires that assessed caregiver knowledge and self-reported practices regarding AMR before and after the intervention (primary outcomes). The intervention combined tailored knowledge and practice components that carefully evaluated participants’ knowledge regarding AMR, health risk, antibiotic usage, and prevention of infection. Furthermore, their practice of using antibiotics, including previous antibiotic exposure, their antibiotic use during the past year, reasons for taking antibiotics, ways of obtaining antibiotics, and reasons for discontinuing of antibiotic therapy were also recorded. Results: The pre-intervention assessment revealed poor knowledge and practice regarding antibiotic use. Post-intervention, mean knowledge scores increased significantly from 18.36 to 23.28 (t = 19.5, p < 0.0001), while mean practice scores improved from 9.83 to 12.37 (t = 6.4, p < 0.0001). Conclusions: The intervention successfully improved caregivers’ knowledge and practices regarding AMR. However, there are some limitations that could affect the generalization, and the impact of the results such as the relatively small sample size recruited from a single center, lack of a control group, reliance on self-reported data, and lack of long-term follow-up. Future studies should aim to address these constraints in order to assess the intervention’s effectiveness. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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7 pages, 210 KiB

Open AccessArticle

Amoxicillin/Clavulanic Acid in Transrectal Biopsy of the Prostate—An Alternative in Times of Ciprofloxacin Obsolescence and Fosfomycin Limitation?

by Philipp J. Spachmann, Sophie E. Fischer, Christopher Goßler, Stefan Denzinger, Maximilian Burger, Johannes Breyer, Wolfgang Otto, Marco J. Schnabel, Johannes Bründl and Bernd Rosenhammer

Antibiotics 2024, 13(10), 940; https://doi.org/10.3390/antibiotics13100940 - 6 Oct 2024

Viewed by 1468

Abstract

Recently, the German Federal Institute for Medicines and Medical Products restricted the use of fosfomycin in transrectal biopsy of the prostate (TRBP). Accordingly, the need for other antibiotic agents for prophylaxis in TRBP is urgent since antibiotic prophylaxis is mandatory in accordance with these guidelines. After the restriction of the use of ciprofloxacin, and before the use of fosfomycin in Germany was falsely allowed, amoxicillin/clavulanic acid was evaluated as an alternative for antibiotic prophylaxis in TRBP. Regarding hospitalization for post-interventional infections, 359 patients at the Department of Urology of the University of Regensburg, at Caritas-St. Josef Medical Center as a single center, underwent TRBP between 2 July 2019 and 30 June 2020. Regarding antibiotic prophylaxis, the post-interventional hospitalization rate due to bacterial complications was relevant. Of the 359 patients, 10 (2.8%) had an infection requiring hospitalization post-TRBP. A total of 349 (97.2%) patients had no infection-related hospitalization. This corresponds to an incidence rate of only 2.8%. Referring to the previous infection rates under the now obsolete ciprofloxacin, amoxicillin/clavulanic acid can show a similar, if not tendentially even lower, risk of infection, and so this substance can be an alternative for antibiotic prophylaxis in TRBP. Another advantage is that, according to the WHO’s AWaRe classification, amoxicillin/clavulanic acid is one of the so-called Access antibiotics. This study is limited as rectal swabs and urine cultures were not performed on every patient before TRBP. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

11 pages, 847 KiB

Open AccessArticle

Days of Antibiotic Spectrum Coverage (DASC) as a Metric for Evaluating the Impact of Prospective Audit and Feedback (PAF) against Long-Term Broad-Spectrum Antibiotic Use

by Yuichi Shibata, Jun Hirai, Nobuaki Mori, Nobuhiro Asai, Mao Hagihara and Hiroshige Mikamo

Antibiotics 2024, 13(9), 804; https://doi.org/10.3390/antibiotics13090804 - 25 Aug 2024

Cited by 1 | Viewed by 1534

Abstract

The present study aimed to evaluate the impact of prospective audit and feedback (PAF) on the use of inpatient broad-spectrum antibiotics for more than 10 days using days of therapy (DOT) and a novel metric called days of antibiotic spectrum coverage (DASC) to assess whether the antimicrobial spectrum was narrowed. Conducted at Aichi Medical University Hospital in Japan, the study compared a six-month baseline period (April to September 2022) with a six-month intervention period (April to September 2023). The primary outcome measures were changes in DOT/patient and DASC/patient for broad-spectrum antibiotics. Propensity score matching was performed between two periods and a total of 172 patients were included in the study (pre-intervention, n = 86; intervention, n = 86). The DASC/patient of broad-spectrum antibiotics was statistically decreased in the intervention period compared to that in the baseline period (153.3 vs. 122.7, p < 0.05). Additionally, our PAF intervention led to a switch to narrow-spectrum antimicrobial therapy without increasing all-cause 30-day mortality (5.8% vs. 5.8%, p = 1.0). However, the DOT/patient, DASC/patient, and DASC/DOT of all antimicrobials were not significantly changed. Our study concluded that we should reconsider the timing of PAF intervention by evaluating the effort of PAF by using DOT and DASC. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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16 pages, 1939 KiB

Open AccessArticle

Exploring the Impact of Antibiotics on Fever Recovery Time and Hospital Stays in Children with Viral Infections: Insights from Advanced Data Analysis

by Mohammed Al Qahtani, Saleh Fahad AlFulayyih, Sarah Saleh Al Baridi, Sara Amer Alomar, Ahmed Nawfal Alshammari, Reem Jassim Albuaijan and Mohammed Shahab Uddin

Antibiotics 2024, 13(6), 518; https://doi.org/10.3390/antibiotics13060518 - 1 Jun 2024

Cited by 1 | Viewed by 2077

Abstract

Background: Antibiotic overuse in pediatric patients with upper respiratory tract infections (UR-TIs) raises concerns about antimicrobial resistance. This study examines the impact of antibiotics on hospital stay duration and fever resolution in pediatric patients diagnosed with viral infections via a multiplex polymerase chain reaction (PCR) respiratory panel. Methods: In the pediatric ward of Imam Abdulrahman Bin Faisal Hospital, a retrospective cohort analysis was conducted on pediatric patients with viral infections confirmed by nasopharyngeal aspirates from October 2016 to December 2021. Cohorts receiving antibiotics versus those not receiving them were balanced using the gradient boosting machine (GBM) technique for propensity score matching. Results: Among 238 patients, human rhinovirus/enterovirus (HRV/EV) was most common (44.5%), followed by respiratory syncytial virus (RSV) (18.1%). Co-infections occurred in 8.4% of cases. Antibiotic administration increased hospital length of stay (LOS) by an average of 2.19 days (p-value: 0.00). Diarrhea reduced LOS by 2.26 days, and higher albumin levels reduced LOS by 0.40 days. Fever and CRP levels had no significant effect on LOS. Time to recovery from fever showed no significant difference between antibiotic-free (Abx0) and antibiotic-received (Abx1) groups (p-value: 0.391), with a hazard ratio of 0.84 (CI: 0.57–1.2). Conclusions: Antibiotics did not expedite recovery but were associated with longer hospital stays in pediatric patients with acute viral respiratory infections. Clinicians should exercise caution in prescribing antibiotics to pediatric patients with confirmed viral infections, especially when non-critical. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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11 pages, 1028 KiB

Open AccessArticle

The Application of Knowledge-Based Clinical Decision Support Systems to Detect Antibiotic Allergy

by Nayoung Han, Ock Hee Oh, John Oh, Yoomi Kim, Younghee Lee, Won Chul Cha and Yun Mi Yu

Antibiotics 2024, 13(3), 244; https://doi.org/10.3390/antibiotics13030244 - 7 Mar 2024

Cited by 1 | Viewed by 2256

Abstract

Prevention of drug allergies is important for patient safety. The objective of this study was to evaluate the outcomes of antibiotic allergy-checking clinical decision support system (CDSS), K-CDS^TM. A retrospective chart review study was performed in 29 hospitals and antibiotic allergy alerts data were collected from May to August 2022. A total of 15,535 allergy alert cases from 1586 patients were reviewed. The most frequently prescribed antibiotics were cephalosporins (48.5%), and there were more alerts of potential cross-reactivity between beta-lactam antibiotics than between antibiotics with the same ingredients or of the same class. Regarding allergy symptoms, dermatological disorders were the most common (38.8%), followed by gastrointestinal disorders (28.4%). The 714 cases (4.5%) of immune system disorders included 222 cases of anaphylaxis and 61 cases of severe cutaneous adverse reactions. Alerts for severe symptoms were reported in 6.4% of all cases. This study confirmed that K-CDS can effectively detect antibiotic allergies and prevent the prescription of potentially allergy-causing antibiotics among patients with a history of antibiotic allergies. If K-CDS is expanded to medical institutions nationwide in the future, it can prevent an increase in allergy recurrence related to drug prescriptions through cloud-based allergy detection CDSSs. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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13 pages, 1479 KiB

Open AccessArticle

Efficacy of Continuous vs. Intermittent Administration of Cefepime in Adult ICU Patients with Gram-Negative Bacilli Bacteremia: A Randomized Double-Blind Clinical Study

by Carlos Arturo Álvarez-Moreno, Laura Cristina Nocua-Báez, Guillermo Ortiz, Juan Carlos Torres, Gabriel Montenegro, Williams Cervera, Luis Fernando Zuluaga and Alonso Gómez

Antibiotics 2024, 13(3), 229; https://doi.org/10.3390/antibiotics13030229 - 29 Feb 2024

Cited by 1 | Viewed by 2658

Abstract

Introduction: The objective of this study was to compare the continuous infusion of cefepime with the intermittent infusion in patients with sepsis caused by Gram-negative bacilli (GNB). Methods: Randomized 1:1 multicenter double-blinded placebo-controlled study with allocation concealment; multicenter study in the intensive care units of Colombia. Patients with sepsis, severe sepsis or septic shock, and GNB-suspected bacteremia. Cefepime was administered for 7 to 14 days over 30 m intermittently every 8 h over 24 h plus continuous saline solution (0.9%) (G1) or 3 g administered continuously plus saline solution every 8 h (0.9%) (G2). The percentage of clinical response at 3, 7, and 14 days, relapse at 28 days, and mortality at discharge were measured. Results: The recruitment was stopped at the suggestion of the Institutional Review Board (IRB) following an FDA alert about cefepime. Thirty-two patients were randomized; 25 received the intervention, and GNB bacteremia was confirmed in 16 (9 G1 and 7 G2). Favorable clinical response in days 3, 7, and 14 was 88.8%, 88.8%, and 77.8% (G1) and was similar for G2 (85.7%). There were no relapses or deaths in G2, while in G1, one relapse and two deaths were observed. Conclusions: The results of this study support the use of cefepime for the treatment of Gram-negative infections in critically ill patients, but we could not demonstrate differences between continuous or intermittent administration because of the small sample size, given the early suspension of the study. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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11 pages, 2265 KiB

Open AccessArticle

Community Antibiotic Consumption in Cyprus for the Period 2015 to 2022

by Eirini Mitsoura, Ioannis Kopsidas, Pambos Charalambous, Georgios Papazisis, Nikolaos Raikos and Zoi Dorothea Pana

Antibiotics 2024, 13(1), 52; https://doi.org/10.3390/antibiotics13010052 - 4 Jan 2024

Cited by 1 | Viewed by 2763

Abstract

Background: Cyprus currently reports to ESAC-Net the total consumption of antimicrobials, without distinguishing between hospital and community-based antibiotic use. As a result, these data can only provide generalized insights into antimicrobial trends in the country. Aim: This study is a first attempt to retrospectively analyze community antibiotic consumption in Cyprus for the period of 2015 to 2022. Material and Methods: Data on community antimicrobial consumption between 2015 and 2022 were extracted from Pharmatrack’s database. Orally administered dispensed antibiotics were categorized under the J01 group of the WHO Anatomical Therapeutic Chemical (ATC) classification and by the WHO’s AWaRe classification of antibiotics. Antibiotic consumption was calculated in both packages consumed and per 1000 inhabitants, overall, by year of consumption and districts. Results: During the period of 2015–2022, there was variability in the mean outpatient antibiotic consumption per 1000 inhabitants among the five districts in Cyprus. Community consumption increased by 38% throughout the study period. Additionally, a decrease of 3% in the consumption of WHO ‘Access’ antibiotics was observed, accompanied with a concurrent increase of 3% in the ‘Watch’ group. Specifically, in 2022 the WHO ‘Access’ group consumption in the Cypriot community was 48%, significantly lower than the WHO’s goal of 60% and the EU’s goal of 70% for ‘Access’ antibiotic consumption. Conclusions: Antibiotic consumption in the community of Cyprus between 2015 and 2022 demonstrated substantial variability among districts, with higher consumption in less populated areas. There was an increasing trend in community consumption over the years and a decreasing trend in the percentage of ‘Access’ antibiotics prescribed. Full article

(This article belongs to the Special Issue Antibiotic Use in Outpatients and Hospitals)

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