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Antibiotics
Special Issues
Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance
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Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 12759

Special Issue Editor

Dr. Jesus Ruiz-Ramos

E-Mail Website
Guest Editor
Pharmacy Department, Hospital Santa Creu i Sant Pau. C/San Quintín 89, 08041 Barcelona, Spain
Interests: antimicrobial stewardship; carbapenems; antibiotic resistance; beta Lactamase; anti-bacterial agents

Special Issue Information

Dear Colleagues,

The emergence and spread of multidrug-resistant (MDR) pathogens continue to threaten our ability to treat common infections, being considered a major threat for global health. During the last few decades, the implementation of antimicrobial stewardship programs has become more widespread in health centers. The objectives of these programs are to reduce the use of antimicrobials, reduce the duration of broad-spectrum antibiotic treatments, and to optimize individualized antibiotic treatment for the patient with the best efficacy and safety results, to slow down the advance of MDR pathogens. Even though there is ample evidence that the application of these multidisciplinary programs reduces the consumption of antimicrobials globally, the heterogeneity of the practices used and the unequal impact on the selection and infection by MDR strains make it essential to continue studying which interventions have a greater impact within these programs. This Special Issue seeks manuscript submissions that further our understanding of antimicrobial stewardship programs’ impact on bacterial resistance. Submissions on the impact of antimicrobial stewardship over bacterial resistance are especially encouraged.

Dr. Jesus Ruiz-Ramos
Guest Editor

Manuscript Submission Information

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

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

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

Keywords

  • antimicrobial stewardship
  • antimicrobial cycling
  • antimicrobial resistance
  • decision support
  • antibiotic optimization
  • antibiotic therapy

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Published Papers (6 papers)

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Research

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21 pages, 995 KiB  
Article
Logistic Stewardship: Supporting Antimicrobial Stewardship Programs Based on Antibiotics Goods Flow
by Bianca Leistner, Dominic Rauschning, Ralf Matthias Hagen, Franziska Srečec, Nico Tom Mutters, Ruth Weppler, Christina Mutschnik and Manuel Döhla
Antibiotics 2025, 14(1), 43; https://doi.org/10.3390/antibiotics14010043 - 6 Jan 2025
Viewed by 704
Abstract
Background/Objectives: Antimicrobial resistance is a global threat to safe health care, and a reduction in antibiotic consumption seems to be an appropriate preventive measure. In Germany, the reporting of hospital antibiotics consumption to an independent institution is only voluntary. Although a high level [...] Read more.
Background/Objectives: Antimicrobial resistance is a global threat to safe health care, and a reduction in antibiotic consumption seems to be an appropriate preventive measure. In Germany, the reporting of hospital antibiotics consumption to an independent institution is only voluntary. Although a high level of willingness to improve can be assumed in the case of participation, the median consumptions of reporting hospitals change only slightly. This study examines the question of whether the logistical consumption figures adequately reflect real consumption, and if not, how to optimize the use of logistical data for clinical decisions. Methods: Four selected wards were analyzed during six months. A retrospective analysis of patient case files was performed to receive “prescribed daily doses” (PDDs). These were compared to “defined daily doses” (DDDs) from logistical data. Additional inventories were performed to calculated stored antibiotics. Antibiotics goods flows were presented via waterfall diagrams to identify logistic patterns that could explain PDD/DDD quotients. Antimicrobial stewardship (AMS) quality indicators were analyzed to give advice for optimized clinical AMS measures. Results: The total PDD/DDD quotient was 0.69. Four logistical patterns were identified. Optimized prophylaxis, AMS consultations and reevaluation of therapy seem to be the most useful measures to reduce PDDs. Conclusions: If AMS programs rely solely on DDDs, measures cannot be optimal. A complete consideration of antibiotic goods flows supports clinical decisions, but is very costly in terms of data collection. The consideration of logistical data can help to identify areas of focus for AMS programs. Therefore, specialists of antibiotics logistics should complement clinical AMS teams. Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)
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12 pages, 517 KiB  
Article
A Point Prevalence Survey of Antimicrobial Use in Second-Level Mexican Hospitals: A Multicenter Study
by German Alberto Venegas-Esquivel, María Guadalupe Berumen-Lechuga, Carlos José Molina-Pérez, Rodolfo Norberto Jimenez-Juarez, Enna Guadalupe Villanueva-Cabrera, David Vargas-González, Gonzalo Santos-González, Rebeca Pamela Velázquez Pérez, Mariana Hernández Navarrete, Celene Corral-Rico, Natali Robles-Ordoñez, Juan Manuel Lara-Hernández and Helen’s Irais Sánchez Mendoza
Antibiotics 2024, 13(11), 1065; https://doi.org/10.3390/antibiotics13111065 - 9 Nov 2024
Viewed by 1339
Abstract
In 2018, the WHO published a methodology for conducting a point prevalence survey (PPS) of antibiotic use in hospitals. The aim of this study is to report the use of antibiotics in six second-level hospitals in Mexico using this methodology. Methods: A multicenter [...] Read more.
In 2018, the WHO published a methodology for conducting a point prevalence survey (PPS) of antibiotic use in hospitals. The aim of this study is to report the use of antibiotics in six second-level hospitals in Mexico using this methodology. Methods: A multicenter cross-sectional study based on the 2021–2023 adaptation for Latin American hospitals was conducted in internal medicine, surgery, intensive care unit (ICU), obstetrics and gynecology and pediatrics departments of the IMSS in the western region of the state of Mexico. Results: The overall prevalence of antibiotic use was 61%; the services with the highest prevalence of prescription were general surgery (79%) and the ICU (78%). A total of 846 patients were surveyed; there were no differences in antibiotic use or non-use in terms of gender, surgical procedure and invasive devices, but there were differences in median age and comorbidities. Adherence to guidelines was 53.9%. The three main antibiotics used were third-generation cephalosporins (28%), carbapenems (13%) and glycopeptides (9%); for the type of indication, for CAI and prophylaxis, the rates of use of third-generation cephalosporins were 29.2% and 44.5%, respectively, while for healthcare-associated infections, carbapenems were used (23.9%). By AWaRe group, the watch group was predominant for all types (63.9%), for prophylaxis it was the access group (39.3%), and for HAIs it was the reserve group (4.9%). Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)
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18 pages, 1474 KiB  
Article
Examining Antimicrobial Resistance in Escherichia coli: A Case Study in Central Virginia’s Environment
by Chyer Kim, Allissa Riley, Shobha Sriharan, Theresa Nartea, Eunice Ndegwa, Ramesh Dhakal, Guolu Zheng and Claire Baffaut
Antibiotics 2024, 13(3), 223; https://doi.org/10.3390/antibiotics13030223 - 28 Feb 2024
Viewed by 2284
Abstract
While environmental factors may contribute to antimicrobial resistance (AMR) in bacteria, many aspects of environmental antibiotic pollution and resistance remain unknown. Furthermore, the level of AMR in Escherichia coli is considered a reliable indicator of the selection pressure exerted by antimicrobial use in [...] Read more.
While environmental factors may contribute to antimicrobial resistance (AMR) in bacteria, many aspects of environmental antibiotic pollution and resistance remain unknown. Furthermore, the level of AMR in Escherichia coli is considered a reliable indicator of the selection pressure exerted by antimicrobial use in the environment. This study aimed to assess AMR variance in E. coli isolated from diverse environmental samples, such as animal feces and water from wastewater treatment plants (WWTPs) and drainage areas of different land use systems in Central Virginia. In total, 450 E. coli isolates obtained between August 2020 and February 2021 were subjected to susceptibility testing against 12 antimicrobial agents approved for clinical use by the U.S. Food and Drug Administration. Approximately 87.8% of the tested isolates were resistant to at least one antimicrobial agent, with 3.1% showing multi-drug resistance. Streptomycin resistance was the most common (73.1%), while susceptibility to chloramphenicol was the highest (97.6%). One isolate obtained from WWTPs exhibited resistance to seven antimicrobials. AMR prevalence was the highest in WWTP isolates, followed by isolates from drainage areas, wild avians, and livestock. Among livestock, horses had the highest AMR prevalence, while cattle had the lowest. No significant AMR difference was found across land use systems. This study identifies potential AMR hotspots, emphasizing the environmental risk for antimicrobial resistant E. coli. The findings will aid policymakers and researchers, highlighting knowledge gaps in AMR–environment links. This nationally relevant research offers a scalable AMR model for understanding E. coli ecology. Further large-scale research is crucial to confirm the environmental impacts on AMR prevalence in bacteria. Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)
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27 pages, 919 KiB  
Article
Antimicrobial Activities of Aztreonam-Avibactam and Comparator Agents against Enterobacterales Analyzed by ICU and Non-ICU Wards, Infection Sources, and Geographic Regions: ATLAS Program 2016–2020
by Denis Piérard, Elizabeth D. Hermsen, Michal Kantecki and Francis F. Arhin
Antibiotics 2023, 12(11), 1591; https://doi.org/10.3390/antibiotics12111591 - 3 Nov 2023
Cited by 3 | Viewed by 1419
Abstract
Increasing antimicrobial resistance among multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacterales (CPE), in particular metallo-β-lactamase (MBL)-positive strains, has led to limited treatment options in these isolates. This study evaluated the activity of aztreonam-avibactam (ATM-AVI) and comparator antimicrobials against Enterobacterales isolates and key [...] Read more.
Increasing antimicrobial resistance among multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacterales (CPE), in particular metallo-β-lactamase (MBL)-positive strains, has led to limited treatment options in these isolates. This study evaluated the activity of aztreonam-avibactam (ATM-AVI) and comparator antimicrobials against Enterobacterales isolates and key resistance phenotypes stratified by wards, infection sources and geographic regions as part of the ATLAS program between 2016 and 2020. Minimum inhibitory concentrations (MICs) were determined per Clinical and Laboratory Standards Institute (CLSI) guidelines. The susceptibility of antimicrobials were interpreted using CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. A tentative pharmacokinetic/pharmacodynamic breakpoint of 8 µg/mL was considered for ATM-AVI activity. ATM-AVI inhibited ≥99.2% of Enterobacterales isolates across wards and ≥99.7% isolates across infection sources globally and in all regions at ≤8 µg/mL. For resistance phenotypes, ATM-AVI demonstrated sustained activity across wards and infection sources by inhibiting ≥98.5% and ≥99.1% of multidrug-resistant (MDR) isolates, ≥98.6% and ≥99.1% of ESBL-positive isolates, ≥96.8% and ≥90.9% of carbapenem-resistant (CR) isolates, and ≥96.8% and ≥97.4% of MBL-positive isolates, respectively, at ≤8 µg/mL globally and across regions. Overall, our study demonstrated that ATM-AVI represents an important therapeutic option for infections caused by Enterobacterales, including key resistance phenotypes across different wards and infection sources. Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)
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12 pages, 276 KiB  
Article
In Vitro Activity of Ceftaroline and Comparators against Bacterial Isolates Collected Globally from Patients with Skin and Soft Tissue Infections: ATLAS Program 2019–2020
by Alona Kuraieva, Guillermo Cabezas-Camarero, Pattarachai Kiratisin and Eric Utt
Antibiotics 2023, 12(8), 1237; https://doi.org/10.3390/antibiotics12081237 - 26 Jul 2023
Cited by 1 | Viewed by 1923
Abstract
The objective of this study was to assess the in vitro activity of ceftaroline and a panel of comparator agents against isolates causing skin and soft tissue infections (SSTIs) collected in Africa/Middle East, Asia–Pacific, Europe, and Latin America from 2019–2020. Minimum inhibitory concentrations [...] Read more.
The objective of this study was to assess the in vitro activity of ceftaroline and a panel of comparator agents against isolates causing skin and soft tissue infections (SSTIs) collected in Africa/Middle East, Asia–Pacific, Europe, and Latin America from 2019–2020. Minimum inhibitory concentrations (MIC) were determined using European Committee on Antimicrobial Susceptibility Testing criteria. All the methicillin-susceptible Staphylococcus aureus (MSSA) isolates were susceptible to ceftaroline. Across all regions, ceftaroline demonstrated potent activity against methicillin-resistant S. aureus (MRSA, susceptibility 89.5–93.7%) isolates. Susceptibility to vancomycin, daptomycin, linezolid, teicoplanin, trimethoprim sulfamethoxazole, and tigecycline was ≥94.1% in MSSA and MRSA isolates. Against β-hemolytic streptococci isolates, ceftaroline demonstrated very potent activity (MIC90 0.008–0.03 mg/L) across all regions. All β-hemolytic streptococci isolates were susceptible to linezolid, penicillin, and vancomycin (MIC90 0.06–2 mg/L). Among the extended-spectrum β-lactamases (ESBL)-negative Enterobacterales tested (E. coli, K. pneumoniae, and K. oxytoca), susceptibility to ceftaroline was high (88.2–98.6%) in all regions. All ESBL-negative Enterobacterales were susceptible to aztreonam. Potent activity was observed for amikacin, cefepime, and meropenem (94.1–100%) against these isolates. Overall, ceftaroline showed potent in vitro activity against isolates of pathogens causing SSTIs. Continuous surveillance of global and regional susceptibility patterns is needed to guide appropriate treatment options against these pathogens. Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)

Review

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15 pages, 1122 KiB  
Review
The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department
by Jesus Ruiz-Ramos, Laura Escolà-Vergé, Álvaro Eloy Monje-López, Sergio Herrera-Mateo and Alba Rivera
Antibiotics 2023, 12(10), 1522; https://doi.org/10.3390/antibiotics12101522 - 9 Oct 2023
Cited by 2 | Viewed by 4234
Abstract
Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge [...] Read more.
Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge to their implementation. The inclusion of rapid diagnostic tests, tracking microbiological results upon discharge, conducting audits with feedback, and implementing multimodal educational interventions have proven to be effective tools for optimizing antibiotic use in these units. Nevertheless, future multicenter studies are essential to determine the best way to proceed and measure outcomes in this scenario. Full article
(This article belongs to the Special Issue Optimizing Antimicrobial Use: Antimicrobial Stewardship and Surveillance)
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