Search Results (110)

Background and Objectives: The susceptibility of burn patients to infections with multidrug-resistant organisms (MDROs) is high. The aim of this study is to describe the local patterns of antimicrobial resistance in a Romanian burn unit and to identify risk factors associated with the acquisition of extensively drug-resistant (XDR) pathogens. Materials and Methods: We conducted a one-year, observational, retrospective single-centre cohort study including all burn patients with at least one positive culture admitted to our unit during 2024. In order to identify the pathogens and perform antibiograms, we used routine microbiological diagnostic tests. A multivariable logistic regression model was used to identify XDR risk factors. We also compiled a cumulative antibiogram using the first non-duplicate isolate per patient, following the CLSI M39 guidelines. Results: Among the 180 total admissions, 128 (71.1%) had at least one positive microbiological culture, resulting in 643 bacterial isolates out of 559 samples. The most frequently identified species were A. baumannii, P. aeruginosa, S. aureus, and K. pneumoniae. We isolated MDROs in 59.37% of patients, and 26.56% had at least one XDR pathogen isolated during hospitalisation. We identified three independent predictors for the isolation of XDR pathogens: a higher Abbreviated Burn Severity Index (ABSI) score (aOR 6.12; p = 0.001), hospital length of stay (LOS) (aOR 1.02; p = 0.030), and the number of bacterial species identified per sample, representing polymicrobial growth (aOR 5.91; p = 0.001). Conclusions: Our findings highlight a significant percentage of MDR and XDR pathogens and provide the foundation for antimicrobial stewardship measures, using the local cumulative antibiogram for empirical therapy. Full article

Background: The increasingly indiscriminate use of antibiotic therapy in the neonatal period has led to the emergence of multidrug-resistant organisms (MDROs), which are responsible for sepsis that is increasingly difficult to treat and associated with high morbidity and mortality. Increasingly frequently, in neonatal intensive care units (NICUs), it is necessary to use last-generation antibiotics belonging to the RESERVE group according to the current classification of the World Health Organization (WHO). Methods: Among these drugs, ceftazidime-avibactam, ceftolozane-tazobactam and meropenem-vaborbactam are increasingly used in infections caused by Enterobacterales (i.e., E. cloacae complex, Klebsiella spp.), which are often responsible for late-onset sepsis (LOS) in newborns, especially in preterms. Results: Here, we present the experience of four newborn patients in the city of Palermo, treated over a period of 3 years. Conclusions: The comparison between different diagnostic–therapeutic management approaches and a review of the most recent literature can contribute to identifying more standardized pharmacological schemes, especially in the neonatal period, where scientific evidence about this topic is still very limited. Full article

Background/Objectives: Infection prevention and control (IPC) programs combine pathogen-targeted measures (e.g., admission screening) with hospital-wide standard precautions (e.g., hand hygiene, HH). We assessed temporal associations between screening, HH, antimicrobial stewardship (AMS), and hospital-level outcomes in a tertiary paediatric hospital. Methods: This study was a retrospective hospital-wide ecological time-series at the Children’s Memorial Health Institute. Annual aggregate data: 2011–2024 for screening, colonisation, and healthcare-associated infections (HAIs) with alert pathogens; 2016–2024 for antibiotic consumption (ATC J01, systemic antibacterials). Process indicators: number of screening tests and alcohol-based hand rub (ABHR) consumption per 1000 patient-days (PD). Outcomes: colonisations/HAIs per 1000 PD and defined daily doses (DDD) per 1000 PD overall and by class. Trends used linear regression and Spearman’s rank correlation. Results: Screening intensity increased from 39 to 150/1000 PD (slope +8.3/year; R² = 0.90; p < 0.001). Detected colonisation rose (2.5 → peak 8.05/1000 PD in 2023; slope +0.39; R² = 0.81; p < 0.001), while multidrug-resistant-organism (MDRO)-attributable HAIs remained low/stable (0.27–0.62/1000 PD; slope −0.014; p = 0.023). ABHR consumption increased from 26.1 to 78.0 L/1000 PD in 2020 (p < 0.001) and partially normalised to 60.0 in 2024 (>2 × baseline). Overall ATC J01 showed no long-term linear trend (~278–356 DDD/1000 PD; +2.57/year; p = 0.46), but class mix shifted: carbapenems, fluoroquinolones, and amoxicillin–clavulanate decreased; third/fourth-generation cephalosporins, piperacillin/tazobactam, and glycopeptides increased. Conclusions: In this tertiary paediatric setting, expansion of risk-based admission screening and sustained implementation of horizontal IPC measures were accompanied by increased detection of colonisation with alert pathogens, while MDRO-attributable HAIs remained low and stable at the hospital level. Over the same period, AMS activity coincided with a redistribution in antibiotic class use without a clear long-term reduction in total antibiotic consumption. These hospital-level findings are descriptive and hypothesis-generating; causal inference is limited by the ecological study design, and the heterogeneous, multispecialty structure of a tertiary paediatric centre. Full article

Background: Sepsis remains a leading cause of morbidity and mortality, particularly when caused by multidrug-resistant organisms (MDROs). Early identification of colonising or infecting pathogens may inform initial antimicrobial selection. Surveillance cultures, providing microbiological data prior to infection onset, could guide timely and targeted therapy. This retrospective study analysed routine surveillance culture results from patients with bloodstream infection (BSI) episodes, assessing pathogen prevalence, resistance phenotypes, and concordance with specimen type in haemato-oncology (HO) and acute care (AC) settings. Methods: Data were retrieved from the institutional Laboratory Information System of the Department of Clinical Microbiology and ATB Centre, General University Hospital in Prague, covering 1 January to 31 December 2024. All positive blood cultures containing ESCAPE pathogens (excluding Clostridioides difficile) were reviewed. Corresponding surveillance culture records were analysed to evaluate concordance with subsequent BSI episodes. Results: In 2024, 6046 AC and 7267 HO surveillance cultures were performed; MDRO prevalence was 5% and 6.56%, respectively. ESBL-producing Enterobacterales predominated (AC 86.9%, HO 81.6%). In HO, BSI-causing Gram-negative and Gram-positive pathogens were frequently detected in rectal swabs, whereas in AC, concordance was higher with upper and lower respiratory tract samples. Rectal screening detected 100% of E. coli and K. pneumoniae BSI episodes in HO. Other specimen types showed limited concordance. Conclusions: Surveillance culture utility varies by specimen type and clinical setting. In both HO and AC units, these cultures provided valuable insights into colonisation and resistance patterns, supporting early risk stratification and guiding initial therapy in high-risk patients. Full article

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia and from 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mortality. Escherichia coli is the leading cause of UTIs in transplant patients, but multidrug-resistant (MDR) pathogens are a growing concern, especially in Saudi Arabia. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multidrug-resistant UTIs in kidney transplant recipients. Methods: This retrospective cohort study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia, between March and May 2022. Adult patients (≥18 years) who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. Results: Seventy-five of 491 screened patients (15.3%) experienced recurrent UTIs, contributing to a total of 219 episodes. Klebsiella pneumoniae was the most frequent pathogen, isolated in 94 episodes (42.9%). Key risk factors for recurrence included complicated UTIs (OR = 4.60, p = 0.005), multidrug-resistant organisms (MDROs) (OR = 3.14, p = 0.021), and ureteric stents (OR = 4.07, p = 0.042). Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillins were used for uncomplicated infections. A significant post-UTI rise in serum creatinine was observed (p < 0.001). Conclusions: Recurrent UTIs predominantly caused by K. pneumoniae are common in kidney transplant recipients, particularly in patients over 45, with multidrug-resistant organisms, or with ureteric stents. While a direct causal link to graft loss was not established, these infections can lead to increased creatinine levels, hospitalizations, and healthcare costs and increased carbapenem use. These findings highlight the critical need for institution-specific antimicrobial stewardship programs focused on infection prevention and optimized antibiotic use to improve outcomes in this vulnerable population. Full article

Background: Antimicrobial Resistance (AMR) and the emergence of multidrug-resistant organisms (MDROs) represent major public health threats. Although traditionally linked to hospital-acquired infections (HAIs), MDROs are becoming gradually more prevalent in community-onset infections. Objectives: The objective of this study is to identify major risk factors associated with community-onset MDRO infections among patients admitted to the hospital. Methods: This is a retrospective study of patients admitted to the Internal Medicine Departments of the University General Hospital of Ioannina from July 2022 to August 2023 and had a microbiologically confirmed infection. Patients with HAIs were excluded. Data were extracted from both electronic and paper-based medical records and included variables such as demographics, baseline comorbidities, previous antibiotic use, previous hospitalizations, the type of MDRO and infection, and clinical outcomes. Statistical analysis included descriptive statistics, univariate analyses, and subsequently multiple binary regression models. Each regression model was adjusted for age and sex. Results: Our cohort included 125 participants with a mean age of 77.9 years, with the majority (58.4%) being female. The overall prevalence of MDRO infections was 43.2% (54/125). Notably, the presence of a permanent urinary catheter was associated with a nearly fourfold increase in the risk of community-onset MDRO infections (OR = 3.69; 95% CI: 1.35–10.05; p = 0.011), while prior hospitalization (OR = 3.33; 95% CI: 1.48–7.51; p = 0.004), the Charlson index score (OR = 3.08; 95% Cl: 1.1–8.68; p = 0.033) and previous antibiotic use (OR = 2.18; 95% CI: 0.98–4.84; p = 0.057) were also significant potential risk factors. Conclusions: The identification of key risk factors associated with community-onset MDRO infections in patients admitted to the hospital can assist clinicians in early stratification and rational selection of initial empirical antimicrobial treatment, support antimicrobial stewardship programs, promote targeted public health interventions, and encourage more judicious antibiotic use. Full article

Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article

Background: This study aimed to describe cefiderocol prescription and associated patient outcomes at a U.S. academic medical center for various multidrug-resistant organisms (MDRO). Notably, limited real-world data exist on cefiderocol’s clinical use in regions where metallo-β-lactamase (MBL)-producing organisms are prevalent. Methods: A retrospective chart review was conducted on adult inpatients who received ≥24 h of cefiderocol between January 2023 and July 2024. Data collected included microbiology, carbapenemase type (CARBA-5), treatment indication, susceptibility profiles, and clinical outcomes: 30-day mortality, re-infection, and re-admission. Descriptive statistics were used. Results: Seventy-six patients were included, with most receiving cefiderocol for carbapenem-resistant Enterobacterales (CRE) (63%) or P. aeruginosa (17%) infections. Overall, 96% of cases met institutional prescribing criteria. NDM was the predominant carbapenemase (77% of CRE isolates). Cefiderocol was used definitively in 68% of cases. The median duration of therapy was 7 days. Thirty-day mortality was 20%, highest among patients with A. baumannii complex (33%). Re-infection and re-admission occurred in 21% and 32% of patients, respectively. Susceptibility to cefiderocol was highest for P. aeruginosa (100%), Stenotrophomonas (100%), and CRE (88%), but only 50% for A. baumannii complex. Conclusions: Cefiderocol was primarily used in accordance with institutional criteria and demonstrated favorable susceptibility against most target pathogens. However, poor outcomes in A. baumannii complex infections highlight the need for cautious use and the need for rapid diagnostics for early targeted therapy in multidrug-resistant infections. Full article

Background: Antimicrobial resistance (AMR) is a growing global health threat, with children in low- and middle-income countries bearing a disproportionate burden. Data on resistance patterns and diagnostic practices in pediatric populations remain limited. This study evaluated diagnostic utilization and AMR among children hospitalized with bacterial infections at a national referral hospital in Kenya. Methods: We conducted a retrospective cohort study of pediatric inpatients (0–12 years) admitted with bacterial infections between 2017 and 2021. Patient records were identified using ICD-10 codes and reviewed for diagnostic testing and antimicrobial susceptibility. Descriptive statistics were conducted to show infection counts, diagnostic testing, and resistance outcomes. Results: Among 1608 patients, 1009/1608 (63%) were infants under one year. Culture was conducted in 640/1608 (40%) and antimicrobial sensitivity testing in 111/640 (17%) patients. Gastroenteritis (46%) was the most common infection and blood the most frequently collected specimen (31%). Of 1039 cultured specimens, 896/1039 (86%) showed no growth. The most commonly isolated organisms were Klebsiella pneumoniae 19/128 (15%), Staphylococcus epidermidis (13%, 17/128), and Enterococcus faecium (13%, 16/128). Notably, K. pneumoniae showed 100% resistance to third-generation cephalosporins, suggestive of ESBL production. Among the tested samples, 92/128 (72%) had MDROs, and 26/92 (28%) were extensively drug-resistant (XDR). Among the patients tested, 84/111 (76%) had MDROs, of which 25/84 (30%) were XDR. Children under 5 years had higher odds (OR = 5.84, 95% CI: 1.17-38.21) of having MDRO infections, as well as those with multiple admissions (OR = 3.77, 95% CI: 1.06–20.34). Further, increasing age was inversely associated with MDRO presence. The odds of MDRO infection decreased by 24% for every year increase in age (aOR = 0.76; 95% CI: 0.60–0.93; p = 0.006). Conclusions: The findings highlight the limited diagnostic use and a high burden of MDROs and XDR infections in hospitalized children. Strengthening diagnostic capacity and pediatric antimicrobial stewardship is urgently needed in such settings. Full article

Hospital infection prevention is critical to patient safety, yet data on the prevalence and contributing factors of healthcare-associated infections (HAIs) in Aljouf, Saudi Arabia, are scarce. This retrospective cross-sectional study aimed to investigate the prevalence, microbiological profile, and associated risk factors of HAIs among intensive care unit (ICU) patients in a referral hospital between January 2020 and December 2023. Medical records of 260 ICU patients were reviewed for demographic details, comorbidities, infection types, pathogens, and invasive device use. Forty patients (15.38%) developed HAIs with the highest prevalence in 2020 (50.0%). Infections were more common in males (56.5%) and those aged ≥56 years (54.6%). The predominant infections were catheter-associated urinary tract infections (47.5%), ventilator-associated pneumonia (35.0%), and central line-associated bloodstream infections (17.5%). Klebsiella pneumoniae (35.0%) and Acinetobacter baumannii (27.5%), pathogens commonly associated with multidrug resistance, were the most frequently isolated organisms. All HAI cases involved invasive device use with the use of three or more devices significantly increasing infection risk (p < 0.05). Additionally, 85% of infected patients had chronic conditions, primarily hypertension or diabetes. These findings emphasize the urgent need for strengthened infection control practices and targeted antimicrobial strategies to reduce HAIs and improve ICU patient outcomes in underreported regions. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter (CRA) cause significant mortality and morbidity among the elderly population. We conducted a territory-wide point prevalence survey in Hong Kong to estimate the prevalence of MRSA and resistant Acinetobacter among residents of residential care homes of the elderly (RCHEs). A total of 26 RCHEs with 1529 residents were recruited, including 20 private homes and 6 non-private homes. The size of the homes ranged from 13 to 135 residents, with a median of 57 residents. Overall, the prevalence rates of MRSA, CRA, and multidrug-resistant Acinetobacter were 33.9% (95% CI: 31.5–36.3%), 8.1% (95% CI: 6.8–9.6%), and 0.8% (95% CI: 0.4–1.4%), respectively. Private homes had a greater prevalence of MDROs than non-private homes did, whereas RCHEs in the Hong Kong region had a greater prevalence of most resistant organisms, followed by those in the Kowloon region and then those in the New Territories. We detected a high prevalence of MRSA during the COVID-19 pandemic, with additional information on CRA that was not previously known. Continuous surveillance and stringent infection control measures are needed to combat these resistant pathogens among this vulnerable population. Full article

Background: Urinary tract infections (UTIs) remain a leading cause of community- and hospital-onset bacterial infections worldwide. Although many countries have implemented antimicrobial resistance (AMR) surveillance systems, longitudinal multicenter data on key uropathogens in Korea remain limited. Methods: We retrospectively evaluated Escherichia coli and Klebsiella pneumoniae isolates from patients with clinically diagnosed UTIs at three tertiary-care Korean hospitals (2012–2021). Using a harmonized Observational Medical Outcomes Partnership Common Data Model (OMOP CDM), we analyzed antibiotic susceptibility based on Clinical and Laboratory Standards Institute breakpoints. Trends in resistance to key antibiotics (including fluoroquinolones, cephalosporins, and carbapenems) were assessed using the Cochran–Armitage test. Results: From 2012 to 2021, ESBL-producing E. coli and K. pneumoniae increased from 24.1% to 38.2% and 39.2% to 46.4%, respectively. The rates for K. pneumoniae remained stable over the last 6 years, and for E. coli, they remained stable over the last 3 years. Resistance rates for E. coli increased from 44.5% to 60.0% (ciprofloxacin) and from 26.3% to 40.2% (cefotaxime), while carbapenem resistance (ertapenem) remained low, at 0.3% to 1.2%. In contrast, K. pneumoniae exhibited high resistance levels to fluoroquinolones, cephalosporins, and other broad-spectrum antibiotics, with notable increases in resistance to ertapenem, from 3.0% to 18.1%, and imipenem, from 0.4% to 16.8%. This escalation mainly stemmed from the rise in ertapenem (6.6% to 17.0%) and imipenem (0.8% to 14.6%) resistance rates among Klebsiella-ESBL producers. Conclusions: We conclude that in Korea, the proportion of ESBL-producing E. coli and K. pneumoniae increased significantly from 2012 to 2018 and has since remained stable for the last 3 years (E. coli) and 6 years (K. pneumoniae). Although carbapenem resistance in E. coli remains low, K. pneumoniae has experienced a significant rise, primarily attributable to its ESBL-producing strains. These findings underscore the importance of vigilant antimicrobial stewardship and continuous surveillance to guide empirical UTI therapies in Korean clinical practice. Full article

Background and Objectives: This study aims to identify risk factors associated with MDRO infections and assess their impact on patient outcomes in Egyptian ICUs. Materials and Methods: The widespread overuse of antimicrobials has led to antibiotic multidrug resistance, posing significant challenges in intensive care units (ICUs) and leading to increased morbidity, mortality, and healthcare costs. A prospective observational study was conducted over 12 months, including 113 adult patients admitted to the ICU with confirmed bacterial infections. Comprehensive medical assessments and routine investigations were performed, including multisource cultures based on clinical suspicion. Patient histories, underlying conditions, and disease progression were documented. Patients were classified into two groups: those infected with MDROs and those without MDRO infections. Results: Significant differences were observed between patients with and without MDRO infections regarding temperature, pH, PaO₂, HCO₃, serum creatinine levels, high-dose inotropes, and inotrope dependence (p-values: 0.01, 0.028, 0.036, 0.008, <0.001, 0.013, 0.029, 0.039, <0.001, and 0.003, respectively). Additionally, cerebrovascular stroke and renal failure were significantly more frequent in MDRO-infected patients (p-values: 0.048 and 0.007, respectively). MDROs accounted for 42% of infections. The most commonly detected MDRO was Klebsiella spp. (52%). Patients with MDRO infections showed significantly higher mortality (42.6%), increased incidence of ARDS, invasive ventilation, and longer ventilation durations. Independent risk factors included prior antibiotic use (OR: 3.2; 95% CI: 1.5–6.8) and invasive device presence (OR: 2.7; 95% CI: 1.2–5.9). Conclusions: Cerebrovascular stroke and renal failure appear to be risk factors for MDRO infections. MDRO infections in ICUs are associated with poor clinical outcomes and increased complications. Improved antimicrobial stewardship and targeted prevention strategies are urgently required. Full article

Due to the significant number of microbiologically negative periprosthetic joint infections (PJIs), understanding the trend in etiology and resistance patterns is essential for the correct management of these infections. Currently, few studies have been published in Spain. In this study, we analyzed the incidence, clinical characteristics, etiology, and antibiotic resistance in patients with PJIs over the last 5 years in Navarra. In this multicentric and retrospective study, all patients diagnosed with PJIs in Navarra from 2019 to 2023 were included. Of the total 156 PJIs, 23% had negative cultures and 56% of these patients had been treated with antibiotics prior to sampling. Staphylococcus epidermidis with methicillin resistance was the predominant etiological agent, followed by Staphylococcus aureus and Cutibacterium acnes. Forty percent of the Gram-positive cocci (GPC) and 35% of the Gram-negative bacilli (GNB) were multidrug-resistant organisms (MDROs). Quinolone resistance was 46% for staphylococci and 18% for Gram-negatives. In addition, 9% of staphylococci were resistant to rifampicin. Antibiotic therapy administration prior to sampling is one of the main problems for microbiological diagnosis and is present more frequently in culture-negative PJIs (56%). New sequencing techniques could improve this difficulty. The high percentage of resistance in the microorganisms causing PJI leads us to reconsider the empirical treatment for suspected PJI, with the use of different therapeutic approaches depending on the time of infection and the possible use of new non-antibiotic therapies. Full article

Background: Antibiotic resistance (AR) is a global public health crisis, largely driven by the misuse and overuse of antibiotics. This study aimed to assess the level of knowledge, attitude, and practice (KAP) toward AR among non-medical university students in Riyadh, Saudi Arabia and identify factors that influence antibiotic use. Methods: A cross-sectional survey was conducted with 672 students from both public and private universities in Riyadh. Data were collected using a self-administered questionnaire covering sociodemographic characteristics and KAP regarding antibiotics. Results: The findings indicated that 59.1% of students had sufficient knowledge of antibiotics, while 60% had positive attitudes, and 60.6% exhibited responsible practices. However, 40.9% of students demonstrated insufficient knowledge, and factors such as age, gender, and field of study significantly impacted KAP outcomes. Females had 65.8% higher odds of demonstrating a positive attitude toward AR prevention, compared to males, and 52% higher odds of adopting appropriate practices than males. The primary source of information on antibiotics was healthcare professionals, particularly doctors. Conclusions: These findings underscore the need for targeted educational interventions to enhance awareness and promote the responsible use of antibiotics among university students, helping to mitigate the threat of antibiotic resistance. Full article