Search Results (469)

Background: Antimicrobial resistance, driven by inappropriate use and overuse of antibiotics, is a major public health threat. Diarrhea and respiratory illness are the leading causes of pediatric healthcare visits in low- and middle-income countries like Bangladesh. Despite clear WHO guidelines recommending limited use of antibiotics for these conditions, potentially inappropriate or non-prescription antibiotic use remains a concern. Methods: We interviewed caregivers of 3025 under-5 children via cellphones to assess common illnesses, associated care-seeking practices, and antibiotic use for diarrhea and respiratory illnesses experienced by their children in the prior 14 days. Caregivers were identified through hospital outpatient screening and were contacted over the phone for the interview at least two months after that hospital visit. Results: Among the participants, 116 (3.8%) reported diarrheal disease and 570 (18.8%) experienced respiratory illness during the preceding 2-week recall period. Among the children with diarrhea, 52.6% received antibiotics, and 73.8% obtained them over the counter from pharmacies. Among those with respiratory illness, 26.3% received antibiotics, and 58% procured them from local drugstores without a prescription from a registered physician. For diarrhea, azithromycin and metronidazole were the commonly used antibiotics, while for respiratory illness, cefixime and azithromycin were frequently used. Notably, 68% of the diarrheal children either sought care from local drugstores, were self-medicated, or did not receive any formal treatment. Conventional practice, long wait times at healthcare facilities, distance, and poverty were the main reasons for not seeking care from a registered healthcare provider. Conclusions: Understanding community-level antibiotic use and care-seeking behavior is essential to strengthening antibiotic stewardship and child health programs. Our findings suggest the need for context-sensitive community education, improved access to appropriate care, and enforcement of regulations restricting the over-the-counter sale of antibiotics to curb irrational and excessive antibiotic use. 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

Meningitis multiplex PCR (MMP) panels are increasingly used in acute bacterial meningitis (ABM), but their clinical integration remains incompletely characterized. We evaluated MMP panel implementation using a mixed-methods approach. We included 55 adults with ABM of confirmed etiology: Group 1 (MMP plus conventional microbiology, n = 25) and Group 2 (conventional methods only, n = 30). The qualitative component comprised semi-structured interviews with infectious disease specialists, analyzed using thematic analysis. Compared with Group 2, Group 1 had a significantly shorter time from lumbar puncture to diagnosis [1.9 (IQR 1.7–2.6) vs. 27.3 (18–47.2) h] and more frequent targeted therapy [19 (76%) vs. 13 (43.3%)]. However, MMP panel use was not associated with antibiotic de-escalation [11 (44%) vs. 12 (40%)], median length of hospitalization (22 days in both groups), median duration of therapy [14 (10–21) vs. 17 (11–22) days], ICU admission [11 (44%) vs. 13 (43.3%)], or mortality [2 (8%) vs. 6 (20%)]. Interviews (n = 20) identified four themes: rapid etiological clarification, perceived limitations, antimicrobial optimization and clinical integration. MMP may facilitate rapid diagnosis, but its impact on outcomes and clinical integration remains limited. Faster availability of etiological information does not necessarily improve antimicrobial decision-making in the absence of antimicrobial stewardship programs. Full article

Background: Antimicrobial resistance (AMR) is an evolutionary crisis accelerated by inappropriate antibiotic use. While awareness studies often focus on descriptive knowledge, evidence-based predictive models identifying how cognitive deficits trigger treatment non-adherence are lacking. This study analyzed predictors of antibiotic non-adherence among university students using a multivariate behavioral-microbiological approach. Methods: A cross-sectional KAP (Knowledge, Attitude, and Practice) survey was conducted with 1044 students (Nursing: n = 620; non-healthcare: n = 424) in Northern Cyprus. A validated questionnaire assessed antimicrobial awareness. Multivariate logistic regression identified independent predictors (Adjusted Odds Ratio [AOR]) of treatment non-adherence. Results: Nursing students achieved significantly higher median scores in knowledge (9 vs. 7), attitude (10 vs. 8), and practice (9 vs. 7) compared to non-healthcare students (p < 0.001). Within the nursing cohort, a significant linear progression in KAP scores occurred from the 1st to 4th academic years (p < 0.05). The strongest independent predictor of antimicrobial non-adherence was inappropriate attitude (AOR: 2.100; 95% CI: 1.586–2.780; p < 0.001), followed by inadequate knowledge (AOR: 1.536; 95% CI: 1.160–2.033; p = 0.003). Conversely, nursing education was a significant protective factor (AOR: 0.669; p = 0.005). Conclusions: Antibiotic non-adherence is a complex psychological behavior management issue rather than merely an information deficit. Incorrect attitudes primarily drive sub-lethal dose exposure, theoretically increasing the epidemiological risk associated with resistant mutant selection. Future antimicrobial stewardship (AMS) programs must transcend traditional educational models and incorporate behavioral economics principles, such as digital nudging, to modify inappropriate attitudes. 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

Antimicrobial resistance (AMR) in companion animals is an escalating concern at the interface of veterinary medicine and public health. Dogs and cats, the most commonly treated companion species, are frequently prescribed antimicrobials for dermatological, otic, urinary, and respiratory infections—often involving drug classes that are critically important in human medicine. This overlap underscores the need for judicious use and integrated stewardship within a One Health framework. This narrative review synthesizes current evidence on AMR in companion animals and its implications for One Health. Studies were included if they reported AMR in dogs and cats and addressed zoonotic aspects. Staphylococcus pseudintermedius, S. aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus sp. are examples of clinically significant organisms that are becoming more resistant to several antibiotic classes, which can result in treatment failures and extended illness. Horizontal gene transfer facilitates the spread of resistance determinants across bacterial populations. Improved surveillance systems, prudent antibiotic use, regular culture and susceptibility testing, and enhanced antimicrobial stewardship in veterinary practice are just a few of the many strategies needed to address AMR in companion animals. The integration of companion animals into AMR surveillance, stewardship programs, and infection control strategies is essential. Coordinated One Health interventions are urgently required to mitigate the spread of AMR. Full article

Background: Antibiotic overuse in hospitals is common and linked to adverse outcomes and antimicrobial resistance. Antimicrobial stewardship programs (ASP) aim to optimize prescribing and require context-specific adaptation. Objectives: To describe the experience of implementing and strengthening ASP in hospitals from six Latin American countries by using an integrated framework. Methods: The intervention included a point-prevalence survey (PPS) of antibiotic use, a baseline checklist, a continuous online education program, and individual facility meetings to share SWOT analyses and recommendations. The latter was performed based on PPS and checklist results. The checklist covers six domains (authorities’ commitment, organization, structure, and accountability; interventions; education and training; monitoring and surveillance; and internal communication). The training program spanned 12–18 months and addressed core ASP components. Results: The PPS across 67 hospitals showed an antibiotic use prevalence of 47.9%, with 63% of prescriptions deemed appropriate. The median checklist score was 61.2%. Among the categories assessed, monitoring and surveillance achieved the highest score (median 75.0; IQR 63.9–84.0), while education received the lowest (median 43.8; IQR 29.7–62.5). A total of 80 country groups and 35 individual hospital meetings were held. Conclusions: An integrated, data-driven framework combining PPS, checklists, individual hospital meetings, and sustained training provides a scalable approach to strengthening ASP in diverse Latin American hospitals, aligning with Pan American Health Organization (PAHO) guidance and global recommendations. Full article

Antimicrobial resistance in bovine mastitis pathogens poses interconnected threats to dairy productivity and public health; however, longitudinal evidence on the association between veterinary oversight and lower resistance to critically important antimicrobials in tropical smallholder systems remains limited. This study analyzed 1347 quarter milk samples from 47 dairy farms in Saraburi Province, Thailand, submitted consecutively over five years (2020–2025), to evaluate whether participation in a veterinary-led herd health (HH) program was independently associated with reduced vancomycin resistance and multidrug resistance (MDR). Bacterial identification was conducted using standard methods, and susceptibility was determined using the Kirby–Bauer disk diffusion method. Among 1069 culture-positive samples, Streptococcus spp. (25.3%) and coagulase-negative staphylococci (16.8%) predominated. Vancomycin resistance declined from 15.9% to 5.4% between early (2020–2022) and recent (2023–2025) periods. Of the 686 isolates tested against ≥3 antibiotic classes, 61 (8.9%) were MDR; vancomycin resistance co-occurred in 34.4% of these samples. Repeated logistic regression identified non-HH farm status (OR = 4.035; p = 0.027) and early-year groups (OR = 4.611; p = 0.002) as independent risk factors for vancomycin resistance. As HH participation and year group showed a significant interaction, their joint effect for MDR was modeled: compared with non-HH farms in the early period (reference), all other combinations—including HH farms in 2023, HH farms in 2020, and non-HH farms in 2023—were associated with significantly lower odds of MDR. These findings provide the first evidence from Thailand that structured veterinary herd health programs are independently associated with lower critically important antimicrobial resistance, supporting their integration into a One-Health stewardship policy. Full article

Antimicrobial resistance (AMR) has emerged as one of the most significant global health challenges affecting both human and veterinary medicine. The growing prevalence of resistant bacterial strains in livestock and companion animals not only compromises treatment efficacy but also poses serious public health risks through potential zoonotic transmission. Recent molecular and genomic studies have shown the widespread dissemination of resistance genes across different ecological compartments, emphasizing the need for integrated monitoring systems. Antimicrobial stewardship programs and evidence-based interventions are therefore essential in veterinary medicine to mitigate these trends. This is particularly important because the emergence of multidrug-resistant (MDR) pathogens is increasingly associated with mobile genetic elements, such as plasmids, transposons, and integrons, which facilitate horizontal gene transfer within and across bacterial species. Full article

Pneumonia remains a leading cause of morbidity and mortality worldwide, with bacterial pathogens contributing significantly to its burden. While Pseudomonas aeruginosa and Acinetobacter baumannii complex are well-recognized non-fermenting Gram-negative bacteria (NFGNB) causing severe pneumonia, particularly in healthcare settings, an expanding array of other, rarer NFGNB species is increasingly implicated. These species include, but are not limited to, Achromobacter spp., Ochrobactrum spp., Burkholderia spp., Aeromonas spp., Roseomonas spp., Elizabethkingia spp., Chryseobacterium spp. Alcaligenes spp., Ralstonia spp., Cupriavidus spp., Sphingomonas spp., Rhizobium spp., Empedobacter spp., and Brevundimonas spp. In this article we aim to provide a focused review of the contemporary epidemiology and specific risk factors for pneumonia caused by this diverse group of rare NFGNB, explicitly excluding P. aeruginosa, Stenotrophomonas maltophilia, and A. baumannii. We seek to delineate the emerging patterns of pneumonia associated with Achromobacter spp., Burkholderia spp., Aeromonas spp., Roseomonas spp., Elizabethkingia spp., Pandoraea spp., Sphingomonas spp., and K. gyiorum. Moreover, we discuss antimicrobial treatment strategies for pneumonia caused by rarer NFGNB including Ochrobactrum spp., Chryseobacterium spp., Alcaligenes spp., Ralstonia spp., Cupriavidus spp., Rhizobium spp., Empedobacter spp., and Brevundimonas spp. A deeper understanding of these specific epidemiological trends and risk factors is important for guiding precise diagnostic approaches, informing antimicrobial stewardship programs, and developing targeted infection prevention and control strategies with the aim of mitigating the impact of these challenging pathogens in the clinical setting. Full article

Background/Objectives: Globally, the management of infections has been complicated greatly by the rapid emergence of antibiotic resistance among bacterial pathogens, particularly Escherichia coli (E. coli). This bacterium is commonly found in a wide range of vertebrate hosts, including livestock, which can serve as important sources of specific pathogenic or multidrug-resistant strains. Cross-contamination can occur from farm to food, posing public health concerns. Methods: This cross-sectional study examined the antibiotic resistance and virulence gene profiles of E. coli isolated from farm animals, food processing facilities (including meat and contact surfaces), and the surrounding environment (wastewater). Results: Out of 383 samples, 230 samples (60.1%) were positive for E. coli (95% CI: 55.1–64.9). The prevalence rates showed significant variation across different sources, with positive rates of 72.3% (180/249) in animal sources, 33.7% (28/83) in food sources, and 43.1% (22/51) in environmental sources. Over 80% of the isolates across all sources carried the sheA virulence gene, which is associated with hemolytic activity in E. coli. Multidrug resistance (MDR) was commonly observed, with rates of 61.1% in animal samples, 57.1% in food sources, and 50.0% in environmental samples. The E. coli isolates exhibited high levels of antibiotic resistance, particularly to streptomycin (64.9%), ampicillin (58.0%), and tetracycline (57.6%). The most common resistance gene pattern was tetA-strA-bla_TEM (22.6%). Conclusions: These findings indicate widespread occurrence of antibiotic-resistant and virulence gene-carrying E. coli strains across the farm-to-food continuum, underscoring the urgent need for enhanced antimicrobial stewardship and surveillance programs to mitigate transmission from food-producing animals and reduce public health complications. Full article

Antimicrobial resistance (AMR) represents one of the most urgent global health threats, significantly impacting patient outcomes, healthcare systems, and economic sustainability. Rapid and accurate antimicrobial susceptibility testing (AST) are essential to guide targeted therapy, reduce inappropriate antimicrobial use, and support antimicrobial stewardship programs. However, conventional phenotypic AST methods, including broth microdilution, disk diffusion, agar dilution, and gradient strip tests, remain labor-intensive and require prolonged turnaround times, often delaying optimal therapeutic decisions. Although automated commercial platforms such as VITEK 2, BD Phoenix, MicroScan WalkAway, and Sensititre ARIS have improved laboratory workflow and standardization, they still rely on culture-based approaches and typically require 16–36 h to generate minimum inhibitory concentration (MIC) results. In recent years, several innovative rapid phenotypic AST technologies have emerged, aiming to significantly shorten the time to susceptibility results while maintaining high accuracy. This review provides an overview of currently available rapid automated phenotypic platforms for MIC determination, including VITEK^® Reveal™, ASTar, FASTinov^®AST, QuickMIC^®, and the Accelerate Pheno^® system. These systems employ advanced technologies such as volatile organic compound detection, flow cytometry, microfluidics, real-time imaging, and morphokinetic cellular analysis to deliver susceptibility results within a few hours directly from positive blood cultures. We summarize their technical principles, antibiotics and pathogens included, performances, and current limitations. Overall, the implementation of rapid phenotypic AST tools has the potential to substantially improve clinical decisions, optimize antimicrobial therapy, and contribute to fight AMR. Full article

Background/Objectives: The Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM) conducts longitudinal monitoring of antimicrobial resistance (AMR) in indicator bacteria from food-producing animals. For Escherichia coli from healthy pigs, slaughterhouse-based sampling has been conducted for approximately a decade, yielding a substantial accumulation of MIC data. While JVARM reporting has traditionally focused on annual resistance proportions by drug, the availability of long-term data enables investigation of cross-drug relationships, including MIC similarity and co-resistance patterns. This study aimed to (i) identify the co-resistance structure among antimicrobial agents using MIC- and phenotype-based similarity measures and (ii) identify drug resistances most strongly associated with multidrug resistance (MDR). Methods: We analyzed broth microdilution MIC data obtained annually for E. coli isolates from healthy pigs in the JVARM program in Japan between 2012 and 2023. Antimicrobial resistance was classified from MIC results and annual resistance prevalence was calculated for each antimicrobial. For the co-resistance and MDR analyses, isolate-level data were pooled across the full study period. To identify co-resistance structure, we performed hierarchical clustering using (i) correlation-based similarity of MIC profiles and (ii) Jaccard similarity of binary resistance profiles (resistant/susceptible classification). Multidrug resistance (MDR; ≥3 antimicrobial classes) was further modeled using XGBoost with each drug resistance as a predictive feature, and feature contributions were evaluated using gain, permutation importance, and SHAP values. We also examined how SHAP-based attributions varied when the outcome definition was set to ≥1-, ≥2-, or ≥3-class resistance. Results: Within the study period, resistance remained highest for tetracycline and moderate for streptomycin, ampicillin, sulfamethoxazole–trimethoprim, and chloramphenicol, whereas resistance to other agents was low. MIC-based correlation analysis revealed coordinated variation among ampicillin, sulfamethoxazole–trimethoprim, streptomycin, chloramphenicol, and tetracycline. Separately, Jaccard similarity of binary resistance profiles identified two closely positioned co-resistance groupings (Ampicillin/Streptomycin/Tetracycline and chloramphenicol/sulfamethoxazole–trimethoprim). Ampicillin was identified as the medoid in both MIC-based and resistance-profile similarity spaces, with streptomycin also positioned near the center in both structures. In the XGBoost model for MDR (≥3 classes), ampicillin resistance was consistently the highest-contributing feature when evaluated by gain, permutation importance, and SHAP. When we examined how SHAP-based attributions varied across outcome definitions (≥1-, ≥2-, and ≥3-class resistance), feature importance largely followed resistance prevalence at ≥1–≥2 classes (tetracycline highest) but shifted at ≥3 classes to ampicillin as the top feature. Conclusions: Both MIC-based and phenotype-based analyses revealed co-resistance structures. Under the MDR definition used in this study, explainable machine-learning analyses showed that ampicillin resistance emerged as a leading resistance feature associated with MDR. Because these findings are associative rather than causal, further work will be needed to clarify mechanisms. These findings have important implications for antimicrobial resistance control in the Japanese pig sector, indicating that stewardship strategies may need to be tailored according to antimicrobial class and underlying co-resistance structure. Full article

Bloodstream infections (BSIs) are associated with substantial morbidity, mortality, and healthcare costs. Conventional diagnostics are limited by delayed results, often postponing appropriate antimicrobial therapy. This review aimed to evaluate the clinical and economic value of rapid microbiological diagnostics in BSI management. A state-of-the-art evidence synthesis was conducted using structured searches of PubMed/MEDLINE, Scopus, Web of Science, EconLit, and Google Scholar (2013–2025). Eligible studies included economic evaluations and clinical studies reporting downstream economic or resource-use outcomes. Screening and data extraction were performed by two reviewers, and findings were narratively synthesized. Fifty-nine studies were included. Rapid diagnostics consistently reduced time to pathogen identification and targeted therapy compared to conventional methods. Molecular platforms provided results within hours, while MALDI-TOF enabled identification within 30–60 min after culture positivity. Clinical benefits included earlier therapy optimization, reduced mortality, and shorter hospital stays, particularly when combined with antimicrobial stewardship programs (ASPs). Economic evaluations demonstrated improved cost-effectiveness, including reduced hospitalization, ICU utilization, and antimicrobial costs. MALDI-TOF with stewardship showed notable cost savings and improved outcomes. However, results varied depending on implementation context, infrastructure, and workflow integration. Rapid microbiological diagnostics offer significant clinical and economic benefits in BSI management, particularly when integrated with stewardship programs. Context-specific implementation is essential to maximize their value across healthcare systems. Full article

Anti-inflammatory agents, antipyretics, and antibiotics are commonly used to manage fever and pain associated with infectious diseases in both adults and children. Despite their effectiveness, inappropriate and unnecessary prescriptions remain widespread, leading to adverse patient outcomes and, in the case of antibiotics, contributing to antimicrobial resistance. Addressing these issues requires effective stewardship programs focused on educating healthcare professionals and the public on evidence-based guidelines for optimal prescribing practices. This paper explores the five “A”s fundamental to infection management in pediatric and adult patients: appropriateness, abuse, antipyretics, anti-inflammatory agents, and antibiotics. Through a comprehensive literature review, expert perspectives, and clinical guidelines, the study evaluates the roles of anti-inflammatory agents (e.g., ibuprofen), antipyretics (e.g., paracetamol), and antibiotics in clinical practice, highlighting best practices for their use. Current guidelines emphasize that antipyretics should only be administered when fever is accompanied by significant discomfort or pain, as fever itself plays a role in the immune response. Based on the available literature, experts also suggest that paracetamol should be preferred as a first-line antipyretic due to its favorable safety profile, while ibuprofen should be used with caution, particularly during respiratory infections, varicella, and severe bacterial infections, due to its potential to exacerbate complications. According to experts, special consideration is also required for patients with renal or gastrointestinal comorbidities to prevent toxicity. Regarding antibiotics, prescriptions should be limited to clear evidence of bacterial infection to avoid unnecessary patient exposure and the development of antimicrobial resistance. Stewardship programs underscore the importance of selecting the right agent, optimizing dosing, and introducing shorter treatment regimens where supported by evidence, to improve therapeutic outcomes while minimizing resistance risks. Ultimately, this paper provides practical, evidence-based recommendations to support rational prescribing of antipyretics, anti-inflammatory drugs, and antibiotics, aiming to optimize patient outcomes, prevent unnecessary toxicity, and contribute to global efforts against antimicrobial resistance. Full article