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Antibiotics
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Trends in Antibiotic Resistance in the Hospital Setting and Its...
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Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health

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

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 22330

Special Issue Editors

Dr. Gianluigi Franci

E-Mail Website
Guest Editor
Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”/DIPMED, Baronissi, Italy
Interests: peptides; microbial membranes; microbial drugs
Special Issues, Collections and Topics in MDPI journals
Dr. Giovanni Boccia

E-Mail Website
Guest Editor
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy
Interests: public health; occupational medicine; health economics; preventive medicine; epidemiology; environmental health and food control
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hospital-acquired infections (HAIs) have a notable impact on public health and economics worldwide. HAIs first appear 48 hours after hospitalization or within 3 days after a patient’s discharge. In Europe, approximately 8.9 million cases of HAIs are reported every year, with approximately 0.5 million episodes diagnosed within intensive care units. Frequently, these infections involve urinary and respiratory tracts, bloodstream, and surgical sites. About 80–87% of HAIs are caused by Staphylococcus aureus (S. aureus), Enterococcus species (Enterococcus spp.), Escherichia coli (E. coli), coagulase-negative Staphylococci (CoNS), Candida species (Candida spp.), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), Acinetobacter baumannii (A. baumannii), Enterobacter species (Enterobacter spp.), and Proteus mirabilis (P. mirabilis). Among these pathogens, 16–20% exhibit multidrug-resistant (MDR) phenotypes: methicillin-resistant S. aureus, vancomycin-resistant Enterococcus faecium, carbapenem-resistant P. aeruginosa, extended-spectrum cephalosporin-resistant K. pneumoniae, E. coli and Enterobacter spp., and carbapenem-resistant P. aeruginosa, K. pneumoniae, E. coli, Enterobacter spp., and A. baumannii. Development and selection of MDR strains, due to the extensive use of antibiotics, limit the treatment options for the patient, resulting in the development of serious clinical complications.

To prevent this phenomenon, beyond sanitizing the hospital environment and using more rigid hygiene procedures, monitoring of HAIs’ pathogenic and antibiotic susceptibility profiles is crucial to re-establish empirical therapy and improve the control and management of these infections.

The aim of this Special Issue is to gather information to evaluate the etiopathogenesis of nosocomial infectious diseases and monitor the epidemiological trend of both new and emerging infections. For this purpose, the Special Issue will collect original articles, reviews, brief communications, case reports, epidemiological studies, and retrospective analysis and evaluate and compare the different local realities and the relative approaches used to resolve this serious problem.

Prof. Dr. Gianluigi Franci
Prof. Giovanni Boccia
Guest Editors

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

  • Healthcare-related infections
  • Multidrug resistance
  • Hygiene procedure
  • Epidemiology
  • Public health

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Published Papers (6 papers)

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Research

15 pages, 2136 KiB  
Article
Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?
by Siegmund Lang, Astrid Frömming, Nike Walter, Viola Freigang, Carsten Neumann, Markus Loibl, Martin Ehrenschwender, Volker Alt and Markus Rupp
Antibiotics 2021, 10(11), 1410; https://doi.org/10.3390/antibiotics10111410 - 18 Nov 2021
Cited by 16 | Viewed by 3756
Abstract
Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, [...] Read more.
Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, causative pathogens, and antibiotic susceptibility. Methods: Cases of adult patients with VO treated at a German university orthopaedic trauma center between 2000 and 2020 were retrospectively reviewed. Patient history was used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens was assessed based on antibiograms of the isolated pathogens. Results: A total of 155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 ± 12.4 years) with VO were identified. In 74 (47.7%) patients, infections were deemed healthcare-associated. The most frequently identified pathogens were Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO cohort for mono-therapies with meropenem (36.4%), piperacillin–tazobactam (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest antimicrobial coverage was achieved with either a combination of piperacillin–tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + vancomycin (CAVO: 100.0%; HAVO: 95.5%). Conclusion: Healthcare association is common in VO. The susceptibility pattern of underlying pathogens differs from CAVO. When choosing an empiric antibiotic, combination therapy must be considered. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
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8 pages, 255 KiB  
Article
Antimicrobial Resistance Patterns in Diabetic Foot Infections, an Epidemiological Study in Northeastern Italy
by Giovanni Boschetti, Dino Sgarabotto, Marco Meloni, Marino Bruseghin, Christine Whisstock, Mariagrazia Marin, Sasa Ninkovic, Michela Pinfi and Enrico Brocco
Antibiotics 2021, 10(10), 1241; https://doi.org/10.3390/antibiotics10101241 - 13 Oct 2021
Cited by 15 | Viewed by 2194
Abstract
This study is a retrospective epidemiological assessment of bacterial species isolated from a cohort of out-patients with diabetic foot infections referred to our “Diabetic Foot Unit” over one year, with particular attention to index pathogens, as identified by the EARS Network. Staphylococcus aureus [...] Read more.
This study is a retrospective epidemiological assessment of bacterial species isolated from a cohort of out-patients with diabetic foot infections referred to our “Diabetic Foot Unit” over one year, with particular attention to index pathogens, as identified by the EARS Network. Staphylococcus aureus and Pseudomonas aeruginosa accounted for 33.5% and 11.9% of cases, respectively. MRSA was isolated in 27.1% of patients, with 14.06% showing additional resistance to three antimicrobial classes. Pseudomonas aeruginosa presented extensive resistance to fluoroquinolones (57.3%), which was associated with resistance to piperacillin in 17.6% or to carbapenems in 23.5% of cases. Other pathogens, such as methicillin resistantStaphylococcus epidermidis, Escherichia coli and Morganella morganii ESBL and Enterococcus faecium VRE, were also found. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
10 pages, 258 KiB  
Article
Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland
by Sławomir Poletajew, Katarzyna Pawlik, Anna Bonder-Nowicka, Artur Pakuszewski, Łukasz Nyk and Piotr Kryst
Antibiotics 2021, 10(10), 1232; https://doi.org/10.3390/antibiotics10101232 - 10 Oct 2021
Cited by 9 | Viewed by 2517
Abstract
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. [...] Read more.
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
11 pages, 6138 KiB  
Article
Prevalence and Antibiotic Resistance Profile of Bacterial Pathogens in Aerobic Vaginitis: A Retrospective Study in Italy
by Enrica Serretiello, Biagio Santella, Veronica Folliero, Domenico Iervolino, Emanuela Santoro, Roberta Manente, Federica Dell’Annunziata, Rossella Sperlongano, Valeria Crudele, Anna De Filippis, Massimiliano Galdiero, Gianluigi Franci and Giovanni Boccia
Antibiotics 2021, 10(9), 1133; https://doi.org/10.3390/antibiotics10091133 - 20 Sep 2021
Cited by 10 | Viewed by 3506
Abstract
Aerobic vaginitis (AV) is a vaginal infectious condition, characterized by a high inflammatory response and/or signs of epithelial atrophy, a decrease in the amount of Lactobacillus spp. and an increase in enteric origin bacteria. AV, often misdiagnosed, is difficult to treat due to [...] Read more.
Aerobic vaginitis (AV) is a vaginal infectious condition, characterized by a high inflammatory response and/or signs of epithelial atrophy, a decrease in the amount of Lactobacillus spp. and an increase in enteric origin bacteria. AV, often misdiagnosed, is difficult to treat due to the emerging spread of multi-drug resistant bacterial strains. The present study aimed to define the prevalence of AV, to detect causative bacteria and their antimicrobial resistance pattern. Women 10–95 years old, admitted to San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy (in the years 2015–2019) are included in the study. Bacterial identification and antibiotic susceptibility tests were carried out by VITEK® 2. Among 2069 patients, 1176 tested positive for microbial growth. A higher incidence of infection was found in the 55–64 age group. Among the pathogenic strains, 50.4% were Gram-negative, and 49.6% were Gram-positive. Escherichia coli (E. coli) (32.5%) was the most representative strain, followed by Enterococcus faecalis (E. faecalis) (29.4%), Klebsiella pneumoniae (K. pneumoniae) (7.8%) and Enterococcus faecium (E. faecium) (7.7%). E. coli showed high sensitivity to carbapenems and amikacin. K. pneumoniae carbapenems resistance was fluctuating over time. Alarming resistance to vancomycin was not recorded for Enterococci. Both strains were sensitive to teicoplanin, linezolid and tigecycline. Proper diagnosis and an effective therapeutic approach are needed to improve AV management. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
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12 pages, 1424 KiB  
Article
Lower Respiratory Tract Pathogens and Their Antimicrobial Susceptibility Pattern: A 5-Year Study
by Biagio Santella, Enrica Serretiello, Anna De Filippis, Veronica Folliero, Domenico Iervolino, Federica Dell’Annunziata, Roberta Manente, Francesco Valitutti, Emanuela Santoro, Pasquale Pagliano, Massimiliano Galdiero, Giovanni Boccia and Gianluigi Franci
Antibiotics 2021, 10(7), 851; https://doi.org/10.3390/antibiotics10070851 - 13 Jul 2021
Cited by 32 | Viewed by 5585
Abstract
Lower respiratory tract infections (LRTIs) are the most common infections in humans. It is estimated that 2.74 million deaths worldwide occur each year due to LRTIs. The aim of the study was to determine the frequency and antibiotic susceptibility pattern of microorganisms isolated [...] Read more.
Lower respiratory tract infections (LRTIs) are the most common infections in humans. It is estimated that 2.74 million deaths worldwide occur each year due to LRTIs. The aim of the study was to determine the frequency and antibiotic susceptibility pattern of microorganisms isolated from respiratory samples of patients with LRTIs. Between January 2015 and December 2019, a total of 7038 sputum and bronchoaspirate samples from suspected LRTI patients were collected. Among them, 2753 samples (39.1%) showed significant microbial growth on culture media. The LRTI rate was higher in patients with male gender (67.1%) and with age between 40–59 years (48.6%). The microorganism identification and antibiotic susceptibility testing were performed with Vitek 2. Out of 4278 isolates species, 3102 (72.5%) were Gram-negative bacteria, 1048 (24.5%) were Gram-positive bacteria, and 128 (3.0%) were Candida spp. Major microorganisms isolated were Acinetobacter baumannii (18.6%), Staphylococcus aureus (15.2%), Pseudomonas aeruginosa (14.2%), and Klebsiella pneumoniae (10.9%). In antimicrobial susceptibility testing, Staphylococcus aureus isolates were mostly resistant to Penicillin G (84.1%) and Oxacillin (48.1%), whereas they demonstrated maximum sensitivity to Tigecycline (100%) and Linezolid (99.5%). Among Gram-negative isolates, Acinetobacter baumannii showed maximum sensitivity to Colistin but was resistant to other antibiotics (95–99%). Klebsiella pneumoniae isolates were mostly resistant to Cefotaxime (72.7%) and sensitive to Gentamicin (54.3%), and Pseudomonas aeruginosa was resistant to Ciprofloxacin (40.3%) and sensitive to Amikacin (85.9%). Gram-negative bacteria represented the species most commonly isolated. A high rate of antimicrobial resistance was observed in this study. In conclusion, the correct identification of causative microorganisms and their susceptibility patterns to antibiotics is crucial for choosing targeted and effective antibiotic therapy in LRTIs, and to prevent the emergence of multidrug-resistant bacteria. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
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8 pages, 581 KiB  
Article
Antimicrobial Susceptibility Patterns and Resistance Trends of Staphylococcus aureus and Coagulase-Negative Staphylococci Strains Isolated from Ocular Infections
by Francesco Petrillo, Danilo Pignataro, Federica Maria Di Lella, Michele Reibaldi, Matteo Fallico, Niccolò Castellino, Guglielmo Parisi, Maria Consiglia Trotta, Michele D’Amico, Biagio Santella, Veronica Folliero, Maria Teresa Della Rocca, Michele Rinaldi, Gianluigi Franci, Teresio Avitabile, Marilena Galdiero and Giovanni Boccia
Antibiotics 2021, 10(5), 527; https://doi.org/10.3390/antibiotics10050527 - 3 May 2021
Cited by 24 | Viewed by 3280
Abstract
Ocular bacterial infections represent a serious problem that affecting people of all age and genders. These infections can lead to visual impairment and blindness if not properly treated. The current study evaluates the antimicrobial resistance profiles and the resistance trend of both Staphylococcus [...] Read more.
Ocular bacterial infections represent a serious problem that affecting people of all age and genders. These infections can lead to visual impairment and blindness if not properly treated. The current study evaluates the antimicrobial resistance profiles and the resistance trend of both Staphylococcus aureus (S. aureus) and coagulase-negative staphylococci (CoNS), the main pathogens involved in eye infections. A total of 322 isolates of S. aureus and CoNS, were collected from patients with bacterial conjunctivitis and keratitis at the “Luigi Vanvitelli” University Hospital of Campania in Naples, Italy, between 2017 and 2020. The isolated bacteria showed a high percentage of resistance to methicillin and other antibiotics commonly used for the treatment of ocular infections. Trends in antibiotic resistance were not encouraging, recording—especially among CoNS strains—an increase of more than 20% in resistance to methicillin and aminoglycosides during the study period. Instead, the resistance rates to tetracycline had a significant decrease in CoNS isolates while no changes in their susceptibility to fluoroquinolones and macrolides were observed. However, all isolates showed no resistance to trimethoprim/sulfamethoxazole and chloramphenicol. In this scenario, preventive identification of the infection causative agents and the evaluation of the antimicrobial susceptibility patterns are essential to set up an ocular infection effective drug treatment and also prevent antibiotic resistance. Full article
(This article belongs to the Special Issue Trends in Antibiotic Resistance in the Hospital Setting and Its Impact on Public Health)
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