Search Results (515)

Healthcare-associated infections (HAIs) caused by multidrug-resistant Klebsiella spp. represent a critical and escalating global public health threat. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been designated a critical-priority pathogen by the World Health Organization, and in the 2024 WHO Bacterial Priority Pathogens List, it was the top-ranked pathogen overall. The convergence of carbapenem resistance with hypervirulence in emerging strains has further complicated therapeutic decision-making. This review provides a narrative synthesis of the evidence published between 2020 and 2025 on the prevalence, resistance mechanisms, molecular epidemiology, clinical outcomes, and therapeutic strategies for Klebsiella pneumoniae infections acquired in healthcare settings, with particular attention to the Eastern European and Romanian context. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched for relevant publications from January 2020 to June 2025, supplemented by WHO and ECDC surveillance reports. Studies were selected narratively for their relevance to the themes addressed. No new quantitative pooling was undertaken; all summary estimates reported below are cited from the published meta-analyses and surveillance reports that generated them. In the most recent global meta-analysis of hospital-acquired CRKP infection, which pooled 61 studies and 513,307 patients from 14 countries, the global prevalence of CRKP among nosocomial K. pneumoniae infections was 28.69% (95% CI: 26.53–30.86%), with pronounced regional variation from 14.29% in high-income North America to 66.04% in South Asia, and 42.05% in Western Europe. Pooled mortality among patients infected with CRKP has been estimated in a separate meta-analysis at 42.14%, compared with 21.16% among patients infected with carbapenem-susceptible strains, rising to 54.30% in bloodstream infections. Surveillance data place Romania third in Europe for carbapenem resistance among invasive K. pneumoniae isolates, at 50.30%, with a distinctive predominance of NDM plus OXA-48-like co-producers. Ceftazidime-avibactam is recommended for KPC- and OXA-48-producing strains, whereas metallo-beta-lactamase producers require aztreonam-containing combinations. CRKP in HAIs constitutes a global epidemiological emergency characterised by marked regional heterogeneity in carbapenemase distribution, high attributable mortality and rapidly evolving molecular profiles. Locally adapted surveillance, rapid molecular diagnostics, and stewardship programmes are required since empirical therapy cannot be standardised across regions. Full article

Background/Objectives: Patient-centered antimicrobial stewardship depends not only on restricting non-prescription antibiotic access, but also on how people interpret professional advice when an antibiotic request is declined. This study explored how adults in Jordan interpreted antibiotic refusal and distinguished personally reported experiences from anticipated vignette responses and perceptions of other people’s behavior. Methods: Semi-structured interviews were conducted between November 2025 and March 2026 with 32 adults purposively recruited for variation in age, gender, region, education, caregiving status, healthcare access, and antibiotic-use experience. Thirteen participants reported a previous refusal encounter—seven involving a pharmacist and six involving a physician—whereas 19 discussed refusal primarily through vignettes. Data were analyzed using an experiential, contextualist form of reflexive thematic analysis. Results: Three themes were developed: (1) antibiotics as active and responsible care under uncertainty; (2) refusal as a negotiation of credibility and care; and (3) continued antibiotic seeking after refusal as a set of reported, anticipated, or socially attributed possibilities. Antibiotics could symbolize strength, rapid recovery, and responsible caregiving. Refusal was more readily interpreted as care when participants described or anticipated acknowledgement, a reasoned explanation, symptom-relief options, and safety-netting. Responses after refusal included acceptance and monitoring, uncertainty or clinical reassessment, and continued antibiotic seeking, but these were not equivalent forms of evidence. Conclusions: Antibiotic refusal is a trust-sensitive and context-dependent patient–provider interaction rather than a uniform behavioral pathway. The findings identify communication and access conditions that merit prospective evaluation; they do not establish that communication causes acceptance or that vignette intentions predict behavior. Full article

Background: Australia has experienced high rates of antibiotic shortages, yet little is known about how Australian pharmacists experience and manage them. This study aimed to explore Australian community and hospital pharmacists’ experiences of antibiotic shortages, including their perceived clinical impact and approaches to managing shortages. Methods: An exploratory qualitative study using semi-structured interviews was conducted with Australian community and hospital pharmacists between May and August 2024. Participants were recruited via convenience sampling through professional networks and social media. Interviews were audio-recorded, transcribed verbatim, and analysed thematically using an inductive–deductive approach, with coding performed independently by two researchers. Results: Fifteen interviews were conducted before data saturation was reached. Sixty percent of participants were female, 67% worked in hospital settings, and pharmacists were located across five Australian states. Four overarching themes were identified: factors driving shortages, communication and collaboration, impact of shortages, and mitigation and prevention. Pharmacists described antibiotic shortages as frequent and unpredictable, attributing them to supply-chain vulnerabilities, limited manufacturing, and market competition. Shortages were reported to affect treatment choice, contribute to antimicrobial resistance concerns, increase pharmacist workload and stress, and negatively affect patients. Pharmacists used strategies such as stock management, collaboration, and importing alternatives, but felt that lasting solutions required coordinated national action. Conclusions: Australian pharmacists perceive antibiotic shortages as a complex challenge affecting patient care, antimicrobial stewardship, workload, and healthcare efficiency. While pharmacists have developed reactive strategies to manage shortages, stronger communication, collaboration, and national policy coordination, alongside improved supply-chain resilience, are needed to reduce the impact of future shortages. Full article

Background: Assisted living houses an older, frailer and more heavily medicated population than ever, yet is often regulated as a social and not a clinical setting with no on-site nursing requirement. Polypharmacy accumulates where medication oversight is thinnest. Objective: To map the extent, nature and distribution of research on medication safety in assisted living in the narrow sense, and where the evidence clusters and thins. Methods: In this scoping review, PubMed and Web of Science were searched (26 May 2026; window 2010–2025) and records screened against a strict two-gate rule: assisted living in the narrow sense, explicitly labelled and central, plus a central medication-safety or coordination concept. Residential-care and long-term-care populations fell outside it. Titles, abstracts and full texts were screened and charted thematically. Results: Twenty-two sources met the strict definition, drawn from four countries: the United States (13), Finland (6), Canada (2) and the United Kingdom (1). Five themes emerged, covering burden (4), safety (4), interventions (4), antimicrobial stewardship (4) and coordination and regulation (6). A further 11 comparison-context reports were kept separately. Every randomised trial was Finnish and came from one research programme. Conclusions: Assisted living has become a high-acuity medication environment without matching oversight. The setting-specific literature is real but sparse, and rigorous deprescribing and coordination trials remain scarce. The binding constraint is structural rather than pharmacological, a missing point of clinical accountability that is patterned by regulation, so closing the gap is as much a public-health task as a clinical one. Full article

Antimicrobial resistance (AMR) is usually addressed through surveillance, prescribing policy, stewardship programs, infection prevention, and drug development. Less attention is given to an earlier educational question: how future doctors first learn to connect microorganisms, antibiotics, and resistance. In some preclinical medical curricula, microbiology provides essential knowledge of microbial structure, virulence, antimicrobial mechanisms, laboratory diagnosis, and resistance pathways, but opportunities to use this knowledge for antimicrobial reasoning may be limited. Students may therefore recall resistance mechanisms yet remain less prepared to interpret culture and susceptibility reports, consider local resistance patterns, or explain when therapy should be escalated, narrowed, optimized, or discontinued. This Perspective argues that AMR education should begin before students prescribe. Preclinical microbiology should preserve its scientific foundation while more deliberately linking microbial mechanisms to clinical scenarios, stewardship principles, microbiology report interpretation, and assessment design. Implementation should be adapted to local standards, supported by faculty development, and evaluated prospectively. Full article

Background/Objectives: The emergence of plasmid-mediated mcr genes has enabled horizontal dissemination of resistance to colistin, a last-resort antibiotic against multidrug-resistant Enterobacterales. In Tunisia, genomic data on mcr-positive Escherichia coli are still limited. This study reports the genomic characterization of human clinical mcr-positive E. coli isolates from the Military Hospital of Tunis. Methods: Between August 2023 and March 2025, seven E. coli isolates with low-level colistin-resistance (MIC = 4–8 µg/mL) were collected from six patients. They were characterized by antibiotic susceptibility testing and WGS to determine resistome, MLST, genetic relatedness, and plasmid content. Results: The E. coli isolates belonged to diverse sequence types (STs), except for two isolates collected from the same patient 2.5 months apart, which were highly related. Overall, this pattern is consistent with a polyclonal spread. The mcr-1.1 gene was located on IncI2 (n = 5) or IncX4 (n = 2) plasmids, which exhibited high similarity both among themselves and in comparison with plasmids previously reported in human and livestock isolates. Most isolates were multidrug-resistant, harboring acquired resistance genes to multiple antibiotic classes, and chromosomal mutations conferring fluoroquinolone resistance. Three isolates additionally carried chromosomal insertions of the bla_CTX-M-55 gene. Resistance to cefiderocol was observed in one isolate and was associated with CirA and Fiu truncation. Conclusions: These findings highlight ongoing dissemination of mcr-1.1-positive E. coli isolates in Tunisia, primarily driven by plasmid transfer. Continuous genomic surveillance and One Health-oriented antibiotic stewardship are essential to limit the spread of colistin-resistance and the emergence of resistance to newer agents such as cefiderocol. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. Full article

Carbapenem-resistant Enterobacterales (CRE) represent one of the most important antimicrobial resistance threats in Europe, particularly in healthcare settings. Their increasing epidemiological significance is driven by the dissemination of carbapenem-resistant Klebsiella pneumoniae, the emergence of high-risk clones, horizontal transfer of mobile genetic elements, and the convergence of antimicrobial resistance and hypervirulence. Despite the growing epidemiological importance of CRE, surveillance and preparedness remain heterogeneous across European countries, creating a need for a continent-wide assessment of existing surveillance systems, implementation gaps, and emerging challenges. This narrative review summarizes the current epidemiology of CRE in Europe and critically discusses the role of European and global surveillance systems in monitoring their spread. Particular attention is given to the European Antimicrobial Resistance Surveillance Network (EARS-Net), European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net), Healthcare-Associated Infections Surveillance Network (HAI-Net), European Surveillance of Antimicrobial Consumption Network (ESAC-Net), Point Prevalence Survey (PPS), EpiPulse/TESSy, the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) programme, and the World Health Organization Global Antimicrobial Resistance and Use Surveillance System (WHO GLASS). Although Europe has well-established surveillance infrastructures, substantial heterogeneity persists among countries with respect to microbiological and genomic diagnostic capacity, reporting practices, infection prevention and control (IPC), antimicrobial stewardship, healthcare infrastructure, and implementation of national policies. These differences limit data comparability and may delay the detection of colonization, outbreaks, and cross-border transmission. The available evidence indicates that effective CRE control requires integrated surveillance combining microbiological, genomic, epidemiological, and antimicrobial consumption data within a coordinated One Health framework. Further expansion of genomic surveillance, harmonization of surveillance indicators, strengthening of healthcare system preparedness, and wider implementation of antimicrobial stewardship programmes are identified as priority areas for improve CRE prevention and control across Europe. By integrating evidence across surveillance, diagnostics, infection prevention and control, and antimicrobial stewardship, this review highlights key gaps in current European approaches and provides a framework for prioritizing future surveillance and preparedness efforts. Full article

Background/Objectives: Urinary tract infection (UTI) is among the most common serious bacterial infections occurring in the first 90 days of life and a leading indication for parenteral antibiotic therapy. Despite its clinical importance, no randomized trial has compared empiric antibiotic regimens, route of administration, or treatment duration specifically in this population. This review synthesizes current evidence to support rational antibiotic treatment decisions for neonates (ages 0–28 days) and young infants (ages 29–90 days), including those born prematurely. Methods: A targeted PubMed and MEDLINE search was conducted through July 2026. Studies reporting treatment outcomes, pharmacokinetic data, or antibiotic safety in infants aged 0–90 days were included. Broader pediatric data were incorporated where age-specific evidence was unavailable and are presented with explicit population caveats. Results:Escherichia coli is the predominant uropathogen across all age strata; extended-spectrum beta-lactamase (ESBL)-producing organisms account for a clinically important minority of community-acquired isolates. No comparative trial of empiric regimens existed for confirmed UTI in this age group. Shorter intravenous courses were not associated with higher 30-day recurrence rates for either nonbacteremic or bacteremic UTI after exclusion of meningitis. Intravenous-to-oral (IV-to-oral) transition with amoxicillin–clavulanate was pharmacokinetically supported and clinically safe in selected term neonates, based on indirect evidence from neonatal infection trials. Non-carbapenem therapy is appropriate for ESBL UTI without concomitant bacteremia in clinically improving infants. Exclusion of meningitis before shortening intravenous therapy or initiating oral step-down is essential, particularly in neonates ≤ 28 days of age. Conclusions: Short parenteral courses with timely transition to oral antibiotics are recommended in appropriately selected infants with UTI, consistent with antimicrobial stewardship principles and supported by observational evidence. The evidence base is limited, with key gaps in empiric regimen selection, management of premature infants, ESBL treatment in bacteremic patients, and optimal duration of parenteral and oral antibiotic therapy. Full article

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhoea and a marker of antimicrobial exposure and healthcare quality, yet Central Asia is almost absent from the indexed literature. We reviewed available evidence on CDI epidemiology, antimicrobial use and molecular typing across Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan and Turkmenistan, searching PubMed/MEDLINE, Google Scholar and accessible regional sources, and identified priorities for surveillance development. The retrievable evidence is sparse and fragmented. The strongest direct data came from Uzbekistan, where paediatric cohorts documented toxigenic C. difficile in up to 47% of the aetiological structure of antibiotic-associated diarrhoea in early-aged children. Nationwide surveys in Kazakhstan showed substantial antimicrobial use (38.2–40.2% of inpatients) and measurable healthcare-associated infection burdens (2.4–3.8%), indicating environments in which CDI may go unrecognised. No national CDI surveillance, ribotyping or resistance-gene data were identified for any of the five countries, whereas evidence from China, Thailand and other Asian settings indicates that ribotype 017 (sequence type 37) predominates in those countries. This absence appears more consistent with underdiagnosis, fragmented reporting and limited laboratory capacity than with true absence of disease. Sentinel surveillance, standardised diagnostic algorithms, integration with antimicrobial stewardship and infection prevention programmes, and regional typing collaborations are the practical priorities. Full article

Antimicrobial resistance (AMR) remains an ongoing and critical concern with substantial consequences for global public health. Although recent attention has focused on managing Gram-negative infections, Gram-positive pathogens contribute comparably to morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) Gram-positive infections has led to the widespread use of vancomycin and other next-line agents including linezolid, daptomycin, ceftaroline and dalbavancin. However, emerging resistance to these agents is increasingly reported, further limiting the available therapeutic options for Gram-positive infections. To this end, there is an urgent need for effective strategies to overcome resistance, including combination therapy, optimization of pharmacokinetic and pharmacodynamic parameters, and improved source control to reduce infection burden. Additionally, resistance surveillance, antimicrobial stewardship and the development of novel antimicrobials are warranted to address the rising threat of resistant Gram-positive infections. This review aims to provide an overview of resistance mechanisms in major Gram-positive pathogens and discuss existing and emerging approaches to overcome resistance to agents beyond vancomycin, incorporating recent evidence on combination therapies and providing a practical treatment algorithm. Full article

Background: Klebsiella pneumoniae is a leading cause of healthcare-associated infections and a major vehicle for the dissemination of antimicrobial resistance (AMR). Romania ranks among the most affected European countries for carbapenem-resistant K. pneumoniae (CRKP), yet data from specialized pulmonology–critical care settings remain limited. Objective: This study aimed to characterize the antimicrobial resistance profiles of K. pneumoniae clinical isolates—including MDR/XDR/PDR classification, carbapenem and colistin resistance rates, specimen and ward distribution, and category-specific resistance patterns—at a tertiary pulmonology–critical care institution in Bucharest, Romania. Methods: A retrospective, single-centre analysis of 203 K. pneumoniae clinical isolates from critical patients, which were collected at the Institute of Pneumology Marius Nasta, Bucharest, between July 2021 and May 2026. Susceptibility testing was performed using the VITEK^®2 system (bioMérieux), with results interpreted per EUCAST breakpoints. Results: Of 203 isolates, 112 (55.2%) were PDR, 36 (17.7%) XDR, six (3.0%) MDR, and 49 (24.1%) non-MDR. Carbapenem resistance was present in 134 isolates (66.0%); colistin resistance was present in 49 of 73 isolates tested (67.1%). Bronchial/tracheal aspirate was the dominant specimen source (61.1%), and intensive care units accounted for 61.1% of isolates. Resistance rates exceeded 75% for monobactams, first/second-generation cephalosporins, and fluoroquinolones. Conclusions: This cohort demonstrates severe AMR burden in this setting, consistent with the most concerning reports for K. pneumoniae in the literature. The findings underscore the urgent need for enhanced antimicrobial stewardship, strengthened infection control in ICU settings, and molecular surveillance of carbapenemase-producing high-risk clonal lineages in Romanian tertiary care. Full article

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly reported among gay, bisexual, and other men who have sex with men (GBMSM) engaging in chemsex, yet data remain limited. This ambispective cohort study conducted at Hospital Clínic of Barcelona (2018–2024) aimed to characterize CA-MRSA infections among GBMSM living with HIV. Methods: Epidemiological, behavioral, and clinical data were collected from medical records and standardized questionnaires. MRSA isolates from clinically indicated samples were identified by mass spectrometry and underwent antimicrobial susceptibility testing. Results: Among 446 participants, 62 (14%) were diagnosed with CA-MRSA, accounting for 109 infection episodes over a median follow-up of 3.21 years (IQR 1.39–5.05). All episodes involved skin and soft-tissue infections; 17% required hospitalization, 35% surgery, and 51% received non-active empirical antibiotics. Recurrent infections occurred in 32% of participants, and detectable HIV viral load was present in 28% of episodes. High levels of polydrug use were reported. Resistance to clindamycin (33%), cotrimoxazole (23%), and mupirocin (96%) was observed. Decolonization was attempted in 65% of participants. Conclusions: CA-MRSA infections were frequent, with substantial recurrence and antimicrobial resistance. These findings highlight challenges for infection control and antimicrobial stewardship and support further evaluation of preventive and decolonization strategies in this population. Full article

Agricultural subsidy policies have increasingly shifted from production-oriented support toward incentives that reward environmental stewardship and the provision of ecosystem services. Despite their rapid expansion, evidence regarding the environmental effectiveness, economic efficiency, market implications, and food-security consequences of these eco-centric agricultural subsidies remains fragmented across policy frameworks and regions. This review synthesizes current evidence on eco-centric agricultural subsidies by comparatively evaluating their environmental, economic, and policy outcomes across developed and developing economies. The review was conducted using a structured literature search following PRISMA-informed review procedures, drawing upon peer-reviewed articles, systematic reviews, policy evaluations, and international institutional reports retrieved from major scientific databases and policy sources. The evidence indicates that eco-centric subsidies generally improve biodiversity conservation, soil health, carbon sequestration, water quality, and reductions in chemical inputs when payments are appropriately targeted and supported by effective monitoring and institutional capacity. Performance-based and results-oriented payment schemes frequently demonstrate greater environmental additionality and cost-effectiveness than conventional practice-based payments; however, their broader implementation remains constrained by monitoring costs, verification requirements, administrative complexity, and regional institutional capacity. Economic outcomes are more heterogeneous, with benefits depending on program design, agroecological conditions, market structures, and farm characteristics. While these subsidies can enhance environmental returns on public investment, challenges including land-value capitalization, unequal benefit distribution, transaction costs, market distortions, and potential short-term productivity trade-offs remain important policy concerns. Evidence regarding food-security impacts is similarly context-dependent and varies across production systems and geographical regions. Overall, the review demonstrates that no single subsidy instrument is universally effective. Instead, the greatest environmental and economic benefits are achieved through integrated policy portfolios combining targeted incentives, outcome-based payments, robust monitoring systems, digital technologies, carbon-market integration, and equitable program design. The review also identifies important evidence gaps concerning developing-country experiences, long-term cost-effectiveness, and standardized evaluation frameworks, providing priorities for future research and policy development. Full article

Publicly funded rural-regeneration programs often deliver facilities, yet post-completion continuity depends on whether the outputs remain usable, active, and maintainable. This study examines Hsinchu City, Taiwan, through a five-year documentary trajectory (2020–2024) comprising five annual reports, one citywide achievement booklet, and four case evidence bundles. It asks how project delivery may support—or fail to support—everyday landscape stewardship. Using an abductive documentary case-study design and maximum-variation comparison of Haishan, Gangbei, Qiedong, and Xiangcun, the analysis develops conditional landscape stewardship around three interdependent conditions: material–spatial usability, functional continuity, and social-organizational maintenance. It identifies four indicative interruption modes: completed but underused space, event-dependent activation, responsibility and resource gaps, and livelihood value disconnected from shared maintenance. The weakest-link heuristic treats a pronounced weakness as a review trigger rather than proof of project failure. The study contributes a document-supported diagnostic framework and a proposed ex ante/ex post governance checklist. It identifies governance conditions and vulnerabilities; it does not directly measure long-term use, environmental performance, or sustainability outcomes. Full article