Search Results (834)

Background/Objectives: The present study aimed to analyze systemic antibiotic prescription patterns in the Salerno Local Health Authority (ASL Salerno) during 2024. The objective was to describe territorial antibiotic consumption and monitor prescribing appropriateness from epidemiological, pharmacological, and antimicrobial stewardship perspectives, using the World Health Organization (WHO) AWaRe classification system as a reference. Methods: A retrospective analysis of antibiotic prescriptions was conducted across ASL Salerno in 2024. Total prescription and associated expenditures were assessed, along with distribution across districts and pharmacological classes. Antibiotics were categorized according to the Anatomical Therapeutic Chemical (ATC) system and further classified using the WHO AWaRe framework (Access, Watch, Reserve) to evaluate prescribing appropriateness and potential patterns of antimicrobial resistance. Results: More than 1 million antibiotic prescriptions were recorded, totaling approximately €15 million in expenditure. Prescribing patterns showed a predominance of penicillins and cephalosporins, followed by macrolides, fluoroquinolones, and J01X class. A substantial proportion of prescriptions belonged to the Watch category, particularly third-generation cephalosporins, fluoroquinolones, and fosfomycin. Some districts demonstrated a higher reliance on Watch antibiotics, while others showed increased use of Access agents such as amoxicillin, doxycycline, and amikacin. Conclusions: The surveillance analysis highlights significant variability in antibiotic prescribing practices within ASL Salerno and a substantial use of Watch-group antibiotics. These findings suggest the need for strengthened antimicrobial stewardship interventions, such as targeted education, auditing, and decision-support tools. Continuous monitoring of prescribing trends is essential to encourage appropriate antibiotic use and contribute to the containment of antimicrobial resistance. Full article

Background and Objectives: Healthcare-associated infections (HAIs) remain a major challenge in emergency hospital settings, where high patient turnover and empirical antibiotic use may contribute to the emergence and spread of multidrug-resistant organisms. Monitoring antibiotic consumption is essential for antimicrobial stewardship and infection prevention. This study evaluated antibiotic consumption patterns across multiple hospital units and explored their ecological relationship with HAI rates. Materials and Methods: A retrospective observational study was conducted in a tertiary-level emergency hospital in Romania between 1 January 2021 and 31 October 2025. Antibiotic consumption was quantified using Defined Daily Dose per 100 bed-days (DDD/100 bed-days) according to World Health Organization (WHO) methodology and categorized using the WHO Access, Watch, and Reserve (AWaRe) classification. HAI data were collected using standardized surveillance definitions. Statistical analyses were primarily descriptive and exploratory and included graphical trend assessment, simple linear regression for temporal trend description, and Spearman correlation analysis for exploratory ecological co-variation assessment. Results: Antibiotic consumption showed substantial variability across hospital units, without a consistent temporal trend over the study period. The Watch group predominated over the Access group from 2023 onward, while Access antibiotics remained below the WHO-recommended 60% threshold. The highest antibiotic consumption was observed in the Medical Wards, followed by Surgical Wards and the Intensive Care Unit. A total of 27 HAIs were identified (0.27 per 1000 patient-days), with the highest incidence observed in the ICU. The most frequent infections were Clostridioides difficile infections (33.3%) and catheter-associated urinary tract infections (29.6%). Exploratory ecological analyses did not identify robust associations between total antibiotic consumption and HAI rates across hospital units. A numerically elevated co-variation was observed between fluoroquinolone consumption and Clostridioides difficile infection incidence; however, this finding should be interpreted strictly as exploratory and hypothesis-generating. Conclusions: Antibiotic use varied across hospital units, with predominance of broad-spectrum agents and suboptimal adherence to WHO AWaRe targets. Reported HAI incidence remained low and should be interpreted within the limitations of routine surveillance systems and potential under-ascertainment. These findings support the value of continuous institutional surveillance of antibiotic use and HAIs while highlighting the limitations of aggregated ecological analyses. Full article

Background: Hospital-acquired infections (HAIs) represent the most significant complications in patients hospitalized for severe burn injuries, after the immediate post-burn resuscitation phase, and are associated with substantial morbidity and mortality. Methods: This is a narrative review. Evidence was extracted mainly with an in-depth search of MEDLINE, focusing on guidelines, randomized controlled trials, and relevant observational studies published in the last 25 years. The reference lists of the most relevant publications were screened to retrieve additional relevant information. Results: Wound infections, bloodstream infections, pneumonia, and urinary tract infections account for the majority of infectious complications. Their diagnosis can be challenging, particularly in the context of wound infections and sepsis. Burn severity and the resulting disruption of tissue and organ homeostasis can alter the pharmacokinetic and pharmacodynamic (PK/PD) properties of antibiotics, rendering standard dosing and administration strategies inadequate. Higher doses, prolonged or continuous infusions, and therapeutic drug monitoring may be required to optimize antibiotic exposure. The emergence of multidrug-resistant (MDR) pathogens (particularly MDR Gram-negative bacilli) has been widely reported across diverse epidemiological settings and occurs frequently in patients with prolonged hospitalization, further complicating treatment. As a result, the use of broad-spectrum antibiotics is substantial, both for empirical therapy and for targeted treatment. Although antimicrobial stewardship programs can promote more appropriate antibiotic use, evidence on how to effectively implement these strategies in Burn Intensive Care Units remains limited. Conclusions: HAIs in burn patients represent a highly complex clinical scenario. Clinical severity is often significant, diagnosis can be challenging, and MDR pathogens are very prevalent, with high consumption of broad-spectrum antibiotics. Moreover, PK/PD properties of antibiotics can be altered. Antimicrobial stewardship can promote appropriate antimicrobial use, but implementation in this setting has not been adequately studied. Close multidisciplinary collaboration between burn specialists and infectious diseases physicians is essential to ensure effective patient management. Full article

Industrial hemp (Cannabis sativa L.) has emerged as a sustainable source of bioactive compounds, with increasing interest in cosmeceutical applications for acne management. This systematic review synthesises evidence on cannabinoid-containing hemp extracts, particularly cannabidiol (CBD), with emphasis on anti-inflammatory and sebostatic mechanisms, alongside formulation considerations and supply-chain sustainability. Reporting followed PRISMA 2020 guidelines and encompassed preclinical and clinical evidence relevant to acne-associated outcomes. The review protocol was registered prospectively with PROSPERO (CRD420251272093). Across cell-based, ex vivo and early clinical studies, CBD modulated key inflammatory mediators, including TNF-α, IL-1β, IL-6 and IL-8; normalised sebocyte activity and attenuated Cutibacterium acnes (Propionibacterium acnes)-induced inflammatory signalling. Preliminary clinical observations indicate reductions in lesion counts and erythema, with generally favourable short-term tolerability; however, interpretation is limited by small sample sizes, predominantly non-randomised designs, heterogeneous formulations and frequent co-formulation with additional active ingredients. Evidence supporting direct antimicrobial efficacy and durable clinical benefit remains limited. Lipid-rich hemp seed-derived products were considered only in a contextual capacity for barrier-supportive and nutritional properties and were excluded from efficacy synthesis unless cannabinoid content was verified. Sustainability analyses highlight hemp’s low water requirements, carbon sequestration potential and relevance to Sustainable Development Goal 3 (SDG 3: Good Health and Well-Being) and Sustainable Development Goal 12 (SDG 12: Responsible Consumption and Production), supporting its role in environmentally responsible cosmeceutical development. Overall, CBD-containing hemp extracts show biologically plausible and clinically promising adjunctive potential for mild-to-moderate inflammatory acne, but current evidence remains preliminary. This review highlights the need for methodologically rigorous and transparent clinical studies, standardised formulations, validated outcome measures and the integration of sustainability metrics to strengthen evidence synthesis, clarify clinical relevance and guide responsible cosmeceutical development. Full article

Background: Robust antimicrobial consumption monitoring and correlation with antibiotic resistance trends is critical to informing evidence-based antimicrobial stewardship and is recommended by the World Health Organization Global Action Plan on the containment of antimicrobial resistance. We estimated national and hospital-level antibacterial consumption patterns in Kenya. Materials and methods: National consumption data (January 2023–December 2024) was derived from aggregated import and donation permits at the Pharmacy and Poisons Board and standardized using the WHO ATC/DDD Index 2025. Consumption data for 2020 and 2021 that had been previously submitted by Kenya to WHO GLASS was retrieved and incorporated to allow a description of trends. Hospital-level data was collected from ten facilities across the country for the period from January 2024 to April 2025. Quality of use was evaluated using the WHO Access, Watch, and Reserve (AWaRe) categorisation with high-consumption antibiotics identified using the Drug Utilization 75% metric. Results: There was a gradual increase in national antibiotic consumption from 14.3 DID in 2020 to 22.2 DID in 2024. Oral formulations accounted for more than three quarters of antibiotics consumed. Access category antibiotic consumption ranged from 50.4% to 56.9% nationally and was 61.2% at hospital level. The national consumption of Watch antibiotics increased from 38.9% in 2020 to 46.1% in 2023 and declined to 40.7% in 2024. Amoxicillin and amoxicillin/clavulanic acid were the most commonly consumed antibiotics nationally in 2020 (40%), 2021 (27%) and 2024 (33%). Azithromycin was the most commonly consumed antibiotic in 2023 (27%), rising from 10% in 2020. Among parenteral antibiotics, benzylpenicillin was the most commonly consumed in 2020 and 2021, while ceftriaxone was the most commonly consumed agent in 2023 (24%) and 2024 (41%). At hospital level, ceftriaxone accounted for 56.5% of parenteral antibiotic use in county referral hospitals. Conclusions: Kenya’s antibacterial consumption is increasing. Use of Access antibiotics remains below the WHO target of 60%. The increasing use of Watch antibiotics, and in particular ceftriaxone and azithromycin, needs to be addressed to support Kenya’s efforts against antimicrobial resistance. Full article

Background/Objectives: Few studies have examined how health policies may influence antibiotic consumption at a global level, particularly with respect to the World Health Organization (WHO) “Access” group antibiotics. Our present study aims to address this gap by investigating how health policies affect the availability of “Access” antibiotics in a middle-income country of Kazakhstan. Methods: This study employed a mixed-methods approach: the quantitative component consisted of a time series analysis of “Access” antibiotic consumption within the period 2017–2024; the qualitative component involved an analysis of health policies centered on regulating the availability of “Access” antibiotics and their prescription at the primary care level. Results: A declining trend in the consumption of “Access” antibiotics was observed during the period from 2017 to 2023; however, in 2024 there was a rebound in consumption. The consumption of “Access” antibiotics did not reach the 60% threshold recommended by the WHO. A total of 50 “Access” antibiotics were found to be unavailable in the country, of which 9 are included in the WHO Essential Medicines List. Analysis of health policies highlighted that the registration of medicines may only be initiated by the manufacturer or its representative. Furthermore, analysis of national standards of care for common infections in primary care indicated a preference for prescribing “Watch” antibiotics, or prescribing antibiotics where their use would not be indicated. Conclusions: A coordinated policy response is needed in Kazakhstan to strengthen antimicrobial stewardship, including improving the availability of “Access” antibiotics, decentralization, revising national standards of care, and addressing regulatory barriers to medicine registration. Full article

Opal glass, known for its mechanical strength, hygiene, and aesthetic appeal, contains fluorides that hinder recycling and often lead to landfilling. This study investigates the use of discarded opal glass for the production of sustainable alkali-activated materials (AAMs), contributing to waste valorization and reduced raw material consumption. By optimizing the activation process, dense products with high compressive strength, comparable to conventional concretes, were obtained using low-molarity alkaline solutions and low-temperature curing (60 °C). In addition, lightweight porous structures with porosity exceeding 80% were successfully produced through direct foaming and salt templating. The developed materials exhibited good chemical stability under aggressive conditions. Preliminary biological tests indicated antimicrobial activity and low toxicity, supporting their potential use in applications where hygiene and durability are important. The results highlight the versatility of mild alkali activation for transforming waste opal glass into dense and porous materials with tunable properties. Full article

Background: Clostridioides difficile is classified within the first 18 threats for antimicrobial resistance and is the leading cause of hospital-acquired enteric infection. Community-associated cases have notably increased in recent decades, highlighting that accurate and up-to-date statistics characterizing the epidemiology of C. difficile infection (CDI) are critical. Methods: We conducted a retrospective (2019–2023) case-control study evaluating the prevalence of CDI in 249 stool samples from hospitalized patients in the sanitary region III of Buenos Aires, Argentina. The presence of C. difficile was detected by combining EIA, PCR, and toxigenic culture via a diagnostic algorithm. Clinical and demographic data from patients were analyzed to identify CDI-associated risk factors. We also conducted a systematic review and a meta-analysis contrasting our results with 38 studies selected from different countries. Results: One in five patients presented C. difficile as the etiological agent of diarrhea. Eighty percent of the CDI+ cases carried toxigenic strains, with a third of cases associated with community environments. Age ≥ 69 years, previous use of antibiotics, previous hospitalization, and previous episodes of CDI emerged as predisposing factors for CDI in our study cohort. In an exploratory evaluation of clinical data, CDI+ patients showed higher leukocytes and platelets counts, a decreased basophil count, and increased urea concentration. At the global level, the meta-analysis reinforced advanced age, previous consumption of antibiotics, previous consumption of proton pump inhibitors, previous hospitalization, and previous CDI as risk factors for CDI. Conclusions: These results emphasize the importance of continued epidemiological surveillance of CDI. Our findings confirm previously described risk factors, both in our cohort and at the global level. Exploratory alterations in laboratory parameters were observed, although their clinical relevance and specificity require further investigation. Full article

Background: Antimicrobial stewardship programs (ASPs) are critical for promoting rational antibiotic use. While early implementation outcomes have been reported, extended follow-up sustainability and the impact on high-priority broad-spectrum antibiotics in South Korean secondary/tertiary hospitals require further validation. This study aimed to evaluate the extended outcomes and sustainability of an ASP over a 14-month period. Methods: This retrospective, single-center study analyzed ASP activities from January 2025 to February 2026 at a tertiary hospital in South Korea. Interventions included prospective audit and feedback (PAF) for restricted antibiotics and recommendations for prolonged prescriptions (≥14 days). Primary outcomes were the monthly rejection rate of restricted antibiotics and the acceptance rate of ASP interventions. Secondary outcomes included the days of therapy (DOT) per 1000 patient–days for meropenem and piperacillin/tazobactam (Pip/Taz). Results: During the 14-month period, the ASP intervention acceptance rate increased significantly from a mean of 72.0% in the implementation phase (January–April 2025) to 81.2% in the stabilization phase (May 2025–February 2026) (p = 0.035). The DOT for Pip/Taz decreased significantly from 169.4 to 151.8 per 1000 patient–days (p = 0.002), with a significant negative correlation identified between the intervention acceptance rate and Pip/Taz consumption (r = −0.625, p = 0.017). Although overall meropenem DOT showed seasonal fluctuations without reaching statistical significance across phases, a year-over-year comparison revealed a 7.5% reduction in meropenem DOT (January–February 2025: 54.8 vs. January–February 2026: 50.7 per 1000 patient–days). The rejection rate for restricted antibiotics declined from 3.8% to 2.6%, suggesting that clinicians increasingly self-regulated inappropriate prescribing attempts. Conclusions: The ASP demonstrated extended follow-up sustainability with a significant reduction in the consumption of key broad-spectrum antibiotics. A progressive increase in clinician acceptance of ASP interventions from 72.0% to 81.2%, combined with a concurrent decline in the restricted antibiotic rejection rate, reflected a measurable shift in institutional prescribing culture and confirmed the successful transition to a stabilized program. These findings support the necessity of sustained multidisciplinary ASPs, even in resource-limited settings, to combat antimicrobial resistance effectively. Full article

Microplastics (MPs) and antimicrobial resistance genes (ARGs), emerging pollutants in surface waters, are viewed as a serious risk to freshwater ecosystems and public health. This review synthesizes current scientific knowledge, regulatory approaches, and monitoring methodologies on the presence and impact of these contaminants following a drivers-pressures-state-impact-response (DPSIR) framework. Major anthropogenic factors, such as pharmaceutical consumption and agricultural intensification, are putting pressure on water bodies through industrial discharges, agricultural runoff, and untreated or inadequately treated wastewaters. In order to gauge the current environmental state and discuss the impact on human and ecosystem health within a One Health framework, it is necessary to generate monitoring data and identify methodological gaps in the interaction between MPs and ARGs. Despite recent European Union (EU) regulatory progress, such as the Drinking Water Directive and the Water Framework Directive, substantial gaps remain in methodology standardization as well as practical implementation. This review underscores the need to establish enforceable thresholds and standardize monitoring protocols to effectively mitigate the growing prevalence and consequences of these contaminants. Full article

Coxiella burnetii is an intracellular bacterium responsible for an anthropozoonosis that can be asymptomatic or manifest as acute or chronic Q fever. This extensive series of 588 patients represents one of the largest single-center studies on sporadic acute Q fever, highlighting the Canary Islands as a high-incidence region in Spain. Epidemiologically, the domestic cycle is the primary driver of infection, with caprine livestock serving as the main reservoir, showing a local prevalence of 60.4%. Transmission is predominantly airborne via aerosols; the environmental resilience of C. burnetii facilitates its transport into urban areas, where the majority of patients reside despite lacking direct animal contact. While fever, headache, and diaphoresis are hallmark symptoms, over 90% of patients exhibit transient urinalysis abnormalities, a finding that often leads to misdiagnosis and inappropriate antimicrobial use. Clinically, the non-specific (45.7%) and hepatic (44.1%) forms are most prevalent, whereas the pulmonary form (7.8%) is strongly associated with smoking and alcohol consumption. Although localized forms affecting the nervous system or skin (such as panniculitis) were observed, the overall prognosis remains excellent with no progression to chronic Q fever in this series. In summary, the extensive series described characterizes acute Q fever patients in the Autonomous Community of the Canary Islands, with features that are similar in some cases but also show notable differences compared to other national and international series. Furthermore, depending on the patients’ age, the time elapsed between the onset of clinical manifestations and hospital evaluation, and the clinical form, acute Q fever displays significant differences. Full article

The high consumption of citrus fruits generates large amounts of peel bioresidues, whose valorization represents an important strategy for sustainable agri-food systems. This study aimed to characterize the nutritional, chemical, and bioactive properties of flours obtained from orange (FL), tangerine (FT), lime (FLA), and lemon (FLO) peels, and to evaluate their potential as functional food ingredients. The flours were evaluated for proximate composition, organic acids, phenolic compounds, fatty acids, free sugars, and bioactive properties. Lime flour showed the highest protein, ash, dietary fiber, and total phenolic contents, with hesperidin identified as the predominant compound. The corresponding extracts exhibited relevant antioxidant, antimicrobial, antiproliferative, and nitric oxide (NO) production inhibitory activities, with lime flour presenting the strongest overall bioactive potential. Based on these results, lime flour was selected for application in a food model by partially replacing wheat flour (10% and 20%) in “Madalenas”, a traditional Portuguese muffin cake. The incorporation of lime flour improved product preservation compared with the control formulation and samples containing a synthetic preservative (potassium sorbate). These findings highlight the potential of citrus peel flours, particularly lime flour, as natural functional ingredients and sustainable alternatives for food formulations, contributing to waste valorization and circular economy approaches in the agri-food sector. Full article

Background: Perioperative antibiotic prophylaxis (PAP) is effective for infection prevention in implant-related surgery, with infections being the most feared complications. A total of 15% of all antibiotics in hospitals are used for surgical prophylaxis but less than 50% of them are used according to the guidelines. International guidelines recommend only a single preoperative dose for all surgical procedures. We have developed and implemented new recommendations for PAP duration in primary hip and knee arthroplasty at the University Department for Orthopaedic Surgery. Methods: The development and implementation of new recommendations regarding PAP duration were performed via the following steps: pre-interventional analysis; identification of barriers and facilitators using the Flottorp framework; analyzing the data and preparation of a tailored implementation strategy based on an educational group meeting with the development of new consented to recommendations; and dissemination; followed by postinterventional analysis of PAP duration compliance 6 months later. Results: Before the intervention, 70% of PAP was used inappropriately (longer than 24 h). The major recognized barriers were fear of prosthetic joint infection (PJI) and a lack of concern regarding global antimicrobial resistance problems. Major facilitators were a low local PJI incidence rate (0.28%), etiology of PJI and existing local experience with a single-dose regime. After implementation of new recommendations regarding the duration of PAP, the postinterventional analysis showed that 80% of PAP was used according to the new recommendations, with a significant reduction in prolonged PAP use (from 70% to 12%), leading to an important decline in antimicrobial consumption. Conclusions: Our study showed that a tailored strategy in the development and implementation of new recommendations is complex and time consuming, although necessary for successful clinical practice change. Full article

Significant amounts of food waste come from fruit processing, causing economic and environmental impacts. The waste generated is a valuable source of compounds due to its concentration of nutrients, such as dietary fiber, vitamins, minerals, lipids with mono- and polyunsaturated fatty acids, and bioactive compounds. Despite the nutritional and functional qualities of the waste, it is still commonly discarded and underutilized, demonstrating the importance of studying it. The selected fruits described in this study are widely consumed by various populations around the world and are used at an industrial scale. The objective of this review is to discuss the use of seeds from grapes, passion fruit, melon, watermelon, papaya, guava, raspberry, and pomegranate and their benefits for human consumption. The seeds stand out for the possibility of oil extraction, creating a sustainable and healthy mode of production. Due to their nutritional composition rich in polyunsaturated fatty acids, they have been shown to be beneficial to health, promoting development, strengthening the immune system, and promoting the growth and maintenance of cell membranes, cardiovascular benefits, and antimicrobial and antioxidant activity, in addition to innovation in the cosmetics sector and applicability as biofuel. Therefore, the exploitation of this type of by-product shows promise in the search for alternative sources of vegetable oils and bioactive compounds with high added nutritional value and potential nutraceutical application, helping to increase the value of food waste and thus contributing to a better use of plant resources. Full article

Background: Antimicrobial stewardship in Neonatal (NICU) and Pediatric Intensive Care Units (PICUs) is complicated by rapid physiological maturation and the high vulnerability of the developing gut microbiome. Traditional metrics fails to capture the true utilization density of antibiotics in these settings. This study evaluated antimicrobial consumption patterns and alignment with the WHO AWaRe framework in two Indonesian hospitals and its impact towards patients’ length of stay. Methods: A retrospective multicenter study was conducted at a public hospital (Haji Hospital) and a private university hospital (HU Hospital) across 2024–2025. The study population includes all admitted patients (n = 315 in NICU and n = 12 in PICU) to calculate utilization density. Consumption was quantified using Defined Daily Dose (DDD)/100 bed-days, and qualitative assessment was performed using the WHO AWaRe classification. Results: Generalized linear modeling revealed that appropriate antibiotic therapy was significantly associated with a 17% reduction in hospital length of stay (β = −0.187, p = 0.035). At HU Hospital, PICU exhibited a seven-fold higher antimicrobial density (37.56 DDD/100) compared to NICU (5.22 DDD/100). At Haji Hospital, NICU density was 4.95 DDD/100 bed-days. Weight-normalized simulations revealed weight-based dosing disparity with low absolute DDD values in neonates mask a significant biological burden and intense selection pressure on the gut resistome due to immature renal clearance. While Haji Hospital maintained high “Access” category adherence (92.21%), HU Hospital’s PICU showed a high reliance on “Watch” agents (71.27%), specifically Ceftriaxone and Meropenem, which are known drivers of multidrug resistance. Conclusions: Low absolute dosing in neonates does not equate to low therapeutic density or reduced environmental pressure. The heavy use of broad-spectrum agents in the PICU acts as a primary driver for microbiome disruption. To mitigate the emergence of multidrug-resistant organisms, stewardship must transition from adult-indexed metrics (DDD) to more precise measures like Days of Therapy (DOT) and prioritize “Access” protocols to preserve microbiome integrity. Full article