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Antibiotics
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Antibiotic Resistant Pathogens in Hospital
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Antibiotic Resistant Pathogens in Hospital

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

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 15848

Special Issue Editors

Dr. Garyphallia Poulakou

E-Mail Website
Guest Editor
3rd Dept of Internal Medicine, National and Kapodistrian University of Athens, Medical School Secretary General, Hellenic Society of Antimicrobial Chemotherapy, Athens, Greece
Interests: antimicrobial resistance; new antibiotics; viral infections (including COVID-19 and HIV); infections in critically ill patients
Dr. Marios Karvouniaris

E-Mail Website
Guest Editor
Intensive Care Unit, ACHEPA University Hospital, Thessaloniki, Greece
Interests: antimicrobial resistance; new antibiotics; infections in critically ill patients; ventilator- associated pneumonia
Prof. Dr. Matteo Bassetti

grade E-Mail Website
Guest Editor
1. Infectious Diseases, Department of Health Science, University of Genoa, Genoa, Italy
2. Infectious Diseases Clinic, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
3. Italian Society of Antiinfective Therapy (SITA), Genoa, Italy
4. ESCMID Critically Ill Patients Study Group (ESGCIP), Genoa, Italy
Interests: antimicrobial resistance; new antibiotics; viral infections (including COVID-19 and HIV); infections in critically ill patients
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The emergence of antimicrobial resistance (AMR) is a major public health problem for contemporary medicine. Antibiotic-resistant pathogens can cause difficult-to-treat infections in hospitalized patients and particularly in immunocompromised hosts. Optimism, as a result of launching several new antibiotics in recent years, has already been tempered by the emergence of resistant mechanisms. Although combating AMR was one of the many priorities for the WHO, the emergence of the COVID-19 pandemic has blurred many recent actions towards this approach. The over-prescription of antibiotics has been witnessed, almost on a worldwide scale, during the SARS-CoV2 pandemic, and the pay-off in terms of increasing rates of antibiotic-resistant pathogens is threatening.

This Special Issue addresses any aspect of antibiotic-resistant pathogens in hospitals, including the following areas:

Epidemiology: mechanisms of resistance in new and old antibiotics, the spread of known mechanisms of resistance in new settings, and antibiotic-resistant pathogens in various clinical settings, such as critically ill patients, hemato-oncology patients, and patients receiving various immunomodulating agents.

Infection control measures to prevent or contain the expansion of antibiotic-resistant pathogens in various hospital settings.

Diagnostic tools to guide early and appropriate treatment against antibiotic-resistant pathogens.

Therapeutic strategies to treat infections caused by antibiotic-resistant pathogens in the hospital: the utilization of old versus new antibiotics, the use of combination antibiotics, and the assessment of treatment duration and outcomes.

Antimicrobial stewardship studies to combat antibiotic-resistant pathogens and avoid antimicrobial over-use in this context.

The current Special Issue is particularly interested in articles that refer to the COVID-19 pandemic era.

Dr. Garyphallia Poulakou
Dr. Marios Karvouniaris
Prof. Dr. Matteo Bassetti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial resistance
  • healthcare-associated infections
  • resistance mechanisms
  • beta-lactams
  • colistin
  • carbapenem
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Acinetobacter baumannii
  • nosocomial pneumonia

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Published Papers (5 papers)

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Research

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11 pages, 911 KiB  
Article
Increase in Incidence Rates and Risk Factors for Multidrug Resistant Bacteria in Septic Children: A Nationwide Spanish Cohort Study (2013–2019)
by María Slocker-Barrio, Jesús López-Herce-Cid, Amaya Bustinza-Arriortúa, Elena Fresán-Ruiz, Iolanda Jordán-García, Juan Carlos de Carlos-Vicente, Elvira Morteruel-Arizcuren, Patricia García-Soler, Montserrat Nieto-Moro, Cristina Schüffelmann, Sylvia Belda-Hofheinz, Laura Ximena Herrera-Castillo, Sonia María Uriona-Tuma, Laia Pinós-Tella, Yolanda Peña-López and on behalf of the Pediatric-ENVIN-HELICS Study Group
Antibiotics 2023, 12(11), 1626; https://doi.org/10.3390/antibiotics12111626 - 14 Nov 2023
Cited by 1 | Viewed by 1727
Abstract
The emergence of multidrug-resistant (MDR) bacteria in children is a growing concern, particularly among septic patients, given the need for first-right dosing. Our aim was to determine the incidence rates and factors associated with MDR-sepsis in the pediatric intensive care unit (PICU), using [...] Read more.
The emergence of multidrug-resistant (MDR) bacteria in children is a growing concern, particularly among septic patients, given the need for first-right dosing. Our aim was to determine the incidence rates and factors associated with MDR-sepsis in the pediatric intensive care unit (PICU), using data from the Spanish ENVIN-HELICS PICU registry between 2013 and 2019. The rate of MDR bacteria among septic children ranged between 5.8 and 16.2% throughout this study period, with a significant increase since 2015 (p = 0.013). MDR-gram-negative bacteria (92%), particularly EBL-Enterobacterales (63.7%), were the most frequent causative microorganisms of MDR-sepsis. During this study period, sixteen MDR-sepsis (32.6%) corresponded to intrahospital infections, and 33 (67.4%) had community-onset sepsis, accounting for 10.5% of the overall community-onset sepsis. Independent risk factors associated with MDR-sepsis were antibiotics 48 h prior to PICU admission (OR 2.38) and PICU onset of sepsis (OR 2.58) in >1 year-old children, and previous malnourishment (OR 4.99) in <1 year-old children. Conclusions: There was an alarming increase in MDR among septic children in Spain, mainly by gram-negative (ESBL-Enterobacterales), mostly coming from the community setting. Malnourished infants and children on antibiotics 48 h prior to PICU are at increased risk and therefore require closer surveillance. Full article
(This article belongs to the Special Issue Antibiotic Resistant Pathogens in Hospital)
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17 pages, 3395 KiB  
Article
Phenotypic and Genotypic Analysis of Bacterial Pathogens Recovered from Patients Diagnosed with Fever of Unknown Origin in Egypt
by Shimaa H. Mostafa, Sarra E. Saleh, Eman F. Khaleel, Rehab Mustafa Badi, Khaled M. Aboshanab and Samira M. Hamed
Antibiotics 2023, 12(8), 1294; https://doi.org/10.3390/antibiotics12081294 - 7 Aug 2023
Cited by 2 | Viewed by 2044
Abstract
Fever of unknown origin (FUO) is a medical term describing fever that lasts for at least three weeks without a diagnosis being reached after extensive diagnostic evaluation. Therefore, this study aimed to identify the common pathogens causing FUO in patients admitted to Abbasia [...] Read more.
Fever of unknown origin (FUO) is a medical term describing fever that lasts for at least three weeks without a diagnosis being reached after extensive diagnostic evaluation. Therefore, this study aimed to identify the common pathogens causing FUO in patients admitted to Abbasia Fever Hospital in Egypt from January 2020 to December 2022, their antimicrobial susceptibility profiles, and associated resistance genes. The study also aimed to investigate the burden of multidrug-resistant (MDR) pathogens and the priority pathogens nominated by the World Health Organization (WHO) for posing the greatest threat to human health due to antibiotic resistance. During the study period, about 726 patients were diagnosed with FUO. After extensive investigations, the cause of the FUO was found to be infectious diseases in 479/726 patients (66.0%). Of them, 257 patients had positive bacterial cultures, including 202 Gram-negative isolates that comprised Klebsiella pneumoniae (85/202; 42.1%), Escherichia coli (71/202; 35.1%), Acinetobacter baumannii (26/202; 12.9%), and Pseudomonas aeruginosa (14/202; 6.9%) and 55 Gram-positive isolates, including Staphylococcus aureus (23/55; 41.8%), Streptococcus pneumoniae (7/55; 12.7%), and Enterococcus spp. (25/55; 45.5%). The MDR phenotype was shown by 68.3% and 65.5% of the Gram-negative and Gram-positive isolates, respectively. Carbapenem resistance (CR) was shown by 43.1% of the Gram-negative isolates. Of the 23 S. aureus isolates obtained from research participants, 15 (65.2%) were methicillin-resistant S. aureus (MRSA). A high-level aminoglycoside resistance (HLAR) phenotype was found in 52.0% of the Enterococcus sp. isolates. The PCR screening of resistance genes in the MDR isolates showed that blaOXA−48 was the most prevalent (84%) among the carbapenemase-coding genes, followed by blaVIM (9%) and then blaIMP (12%). The ESBL-coding genes blaTEM, blaCTX-M,aac(6′)-Ib, and blaSHV, were prevalent in 100%, 93.2%, 85,% and 53.4% of the MDR isolates, respectively. This study updates the range of bacteria that cause FUO and emphasizes the burden of multidrug resistance and priority infections in the region. The obtained data is of relevant medical importance for the implementation of evidence-based antimicrobial stewardship programs and tailoring existing empirical treatment guidelines. Full article
(This article belongs to the Special Issue Antibiotic Resistant Pathogens in Hospital)
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16 pages, 734 KiB  
Article
Molecular Characterization of Antibiotic Resistance Determinants in Klebsiella pneumoniae Isolates Recovered from Hospital Effluents in the Eastern Cape Province, South Africa
by Joan U. Okafor and Uchechukwu U. Nwodo
Antibiotics 2023, 12(7), 1139; https://doi.org/10.3390/antibiotics12071139 - 1 Jul 2023
Cited by 7 | Viewed by 3134
Abstract
Klebsiella pneumoniae (K. pneumoniae) is an opportunistic bacteria responsible for many nosocomial and community-acquired infections. The emergence and spread of antibiotic resistances have resulted in widespread epidemics and endemic dissemination of multidrug-resistant pathogens. A total of 145 K. pneumoniae isolates were [...] Read more.
Klebsiella pneumoniae (K. pneumoniae) is an opportunistic bacteria responsible for many nosocomial and community-acquired infections. The emergence and spread of antibiotic resistances have resulted in widespread epidemics and endemic dissemination of multidrug-resistant pathogens. A total of 145 K. pneumoniae isolates were recovered from hospital wastewater effluents and subjected to antibiogram profiling. Furthermore, the antibiotic resistance determinants were assessed among phenotypic resistant isolates using polymerase chain reaction (PCR). The isolates showed a wide range of antibiotic resistance against 21 selected antibiotics under 11 classes, with the most susceptible shown against imipenem (94.5%) and the most resistant shown against ampicillin (86.2%). The isolates also showed susceptibility to piperacillin/tazobactam (89.0%), ertapenem (87.6%), norfloxacin (86.2%), cefoxitin (86.2%), meropenem (76.6%), doripenem (76.6%), gentamicin (76.6%), chloramphenicol (73.1%), nitrofurantoin (71.7%), ciprofloxacin (79.3%), amikacin (60.7%), and amoxicillin/clavulanic acid (70.4%). Conversely, resistance was also recorded against tetracycline (69%), doxycycline (56.6%), cefuroxime (46.2%), cefotaxime (48.3%), ceftazidime (41.4%). Out of the 32 resistance genes tested, 28 were confirmed, with [tetA (58.8%), tetD (47.89%), tetM (25.2%), tetB (5.9%)], [sul1 (68.4%), sul1I (66.6%)], and [aadA (62.3%), strA (26%), aac(3)-IIa(aacC2)a (14.4%)] genes having the highest occurrence. Strong significant associations exist among the resistance determinants screened. About 82.7% of the K. pneumoniae isolates were multidrug-resistant (MDR) with a multiple antibiotics resistance index (MARI) range of 0.24 to 1.0. A dual presence of the resistant genes among K. pneumoniae was also observed to occur more frequently than multiple presences. This study reveals a worrisome presence of multidrug-resistant K. pneumoniae isolates and resistance genes in hospital waste effluent, resulting in higher public health risks using untreated surface water for human consumption. As a result, adequate water treatment and monitoring initiatives designed to monitor antimicrobial resistance patterns in the aquatic ecosystem are required. Full article
(This article belongs to the Special Issue Antibiotic Resistant Pathogens in Hospital)
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Review

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25 pages, 723 KiB  
Review
Antimicrobial Stewardship in the Hospital Setting: A Narrative Review
by Helen Giamarellou, Lamprini Galani, Theodoros Karavasilis, Konstantinos Ioannidis and Ilias Karaiskos
Antibiotics 2023, 12(10), 1557; https://doi.org/10.3390/antibiotics12101557 - 21 Oct 2023
Cited by 13 | Viewed by 5843
Abstract
The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the “End of the Miracle Drugs” due to the unjustifiable [...] Read more.
The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the “End of the Miracle Drugs” due to the unjustifiable overuse and misuse of antibiotics has prompted a critical reassessment of their usage. In response, numerous relevant medical societies have initiated a concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, grounded in evidence-based guidelines and designed to guide antibiotic utilization. Crucial to this initiative is the establishment of multidisciplinary teams within each hospital, led by a dedicated Infectious Diseases physician. This team includes clinical pharmacists, clinical microbiologists, hospital epidemiologists, infection control experts, and specialized nurses who receive intensive training in the field. These teams have evidence-supported strategies aiming to mitigate resistance, such as conducting prospective audits and providing feedback, including the innovative ‘Handshake Stewardship’ approach, implementing formulary restrictions and preauthorization protocols, disseminating educational materials, promoting antibiotic de-escalation practices, employing rapid diagnostic techniques, and enhancing infection prevention and control measures. While initial outcomes have demonstrated success in reducing resistance rates, ongoing research is imperative to explore novel stewardship interventions. Full article
(This article belongs to the Special Issue Antibiotic Resistant Pathogens in Hospital)
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19 pages, 825 KiB  
Review
ICU-Acquired Colonization and Infection Related to Multidrug-Resistant Bacteria in COVID-19 Patients: A Narrative Review
by Alexandre Gaudet, Louis Kreitmann and Saad Nseir
Antibiotics 2023, 12(9), 1464; https://doi.org/10.3390/antibiotics12091464 - 20 Sep 2023
Cited by 5 | Viewed by 2116
Abstract
A large proportion of ICU-acquired infections are related to multidrug-resistant bacteria (MDR). Infections caused by these bacteria are associated with increased mortality, and prolonged duration of mechanical ventilation and ICU stay. The aim of this narrative review is to report on the association [...] Read more.
A large proportion of ICU-acquired infections are related to multidrug-resistant bacteria (MDR). Infections caused by these bacteria are associated with increased mortality, and prolonged duration of mechanical ventilation and ICU stay. The aim of this narrative review is to report on the association between COVID-19 and ICU-acquired colonization or infection related to MDR bacteria. Although a huge amount of literature is available on COVID-19 and MDR bacteria, only a few clinical trials have properly evaluated the association between them using a non-COVID-19 control group and accurate design and statistical methods. The results of these studies suggest that COVID-19 patients are at a similar risk of ICU-acquired MDR colonization compared to non-COVID-19 controls. However, a higher risk of ICU-acquired infection related to MDR bacteria has been reported in several studies, mainly ventilator-associated pneumonia and bloodstream infection. Several potential explanations could be provided for the high incidence of ICU-acquired infections related to MDR. Immunomodulatory treatments, such as corticosteroids, JAK2 inhibitors, and IL-6 receptor antagonist, might play a role in the pathogenesis of these infections. Additionally, a longer stay in the ICU was reported in COVID-19 patients, resulting in higher exposure to well-known risk factors for ICU-acquired MDR infections, such as invasive procedures and antimicrobial treatment. Another possible explanation is the surge during successive COVID-19 waves, with excessive workload and low compliance with preventive measures. Further studies should evaluate the evolution of the incidence of ICU-acquired infections related to MDR bacteria, given the change in COVID-19 patient profiles. A better understanding of the immune status of critically ill COVID-19 patients is required to move to personalized treatment and reduce the risk of ICU-acquired infections. The role of specific preventive measures, such as targeted immunomodulation, should be investigated. Full article
(This article belongs to the Special Issue Antibiotic Resistant Pathogens in Hospital)
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