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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 December 2021) | Viewed by 30757

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Dr. Gabriella Orlando

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Infectious Disease Clinic, University Hospital Policlinico Modena, Modena, Italy
Interests: antimicrobial stewardship; infection control and prevention

Special Issue Information

Dear Colleagues,

In this Special Issue of Antibiotics we would like to review the main acquired knowledge about the great advantages of combining antimicrobial stewardship (AS) and infection prevention and control (IPC) strategies, especially in settings like hematology-oncology, solid organ transplant (SOT), and hematopoietic cell transplant (HCT), and in the new scenario created by the SARS-CoV-2 pandemic. AS and IPC are a perfect combination of interventions aiming to optimize the clinical outcome of patients receiving antibiotics along the continuum of care (hospital, long-term care facilities, community). The former focuses on minimizing the unintended consequences of antimicrobial agent use (by the right drug, dose, duration, and route of administration when antibiotics are needed), such as toxicity, selection of resistant organisms, Clostridioides difficile infection (CDI), invasive mycoses, etc. The latter involves preventing the transmission of infectious agents (especially multi-drug-resistant organisms, MDROs) from patient-to-patient, patient-to-staff, staff-to-patient, visitor-to-patient, visitor-to-staff, etc. It is therefore intuitive that the activities of AS and IPC programs cannot be performed independently, and that an interdependent and coordinated action across different disciplines and clinical settings is required to maximize results (1). This idea has also been strongly endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) that some years ago published guidelines for the management of IPC measures to reduce transmission of MDR Gram-negative bacteria in hospital inpatients (2).

Papers to be included in this supplement should be focused on these aspects not only in general, but also in different settings in order to provide a comprehensive picture of what is known, what has been done, and what needs to be implemented.

REFERENCES

Manning ML, Septimus EJ, Ashley ESD, Cosgrove SE, Fakih MG, Schweon SJ, Myers FE, Moody. Antimicrobial Stewardship and Infection Prevention-Leveraging the Synergy: A Position Paper Update. Am J Infect Control. 2018 Apr;46(4):364-368
Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 (suppl): 1–55

Dr. Gabriella Orlando
Guest Editor

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Keywords

Antimicrobial Stewardship
Infection Prevention and Control
Haematology-oncology
Solid-Organ Transplant
Hematopoietic Cell Transplant
Covid-19

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Published Papers (8 papers)

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Research

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10 pages, 857 KiB

Open AccessArticle

Combined Resistance to Ceftolozane-Tazobactam and Ceftazidime-Avibactam in Extensively Drug-Resistant (XDR) and Multidrug-Resistant (MDR) Pseudomonas aeruginosa: Resistance Predictors and Impact on Clinical Outcomes Besides Implications for Antimicrobial Stewardship Programs

by Marianna Meschiari, Gabriella Orlando, Shaniko Kaleci, Vincenzo Bianco, Mario Sarti, Claudia Venturelli and Cristina Mussini

Antibiotics 2021, 10(10), 1224; https://doi.org/10.3390/antibiotics10101224 - 8 Oct 2021

Cited by 7 | Viewed by 2478

Abstract

A retrospective case-control study was conducted at Modena University Hospital from December 2017 to January 2019 to identify risk factors and predictors of MDR/XDR Pseudomonas aeruginosa (PA) isolation with resistance to ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T), and of mortality among patients infected/colonized. Among 111 PA isolates from clinical/surveillance samples, 60 (54.1%) were susceptible to both drugs (S-CZA-C/T), while 27 (24.3%) were resistant to both (R-CZA-C/T). Compared to patients colonized/infected with S-CZA-C/T, those with R-C/T + CZA PA had a statistically significantly higher Charlson comorbidity score, greater rate of previous PA colonization, longer time before PA isolation, more frequent presence of CVC, higher exposure to C/T and cephalosporins, longer hospital stay, and higher overall and attributable mortality. In the multivariable analysis, age, prior PA colonization, longer time from admission to PA isolation, diagnosis of urinary tract infection, and exposure to carbapenems were associated with the isolation of a R-C/T + CZA PA strain, while PA-related BSI, a comorbidity score > 7, and ICU stay were significantly associated with attributable mortality. C/T and CZA are important therapeutic resources for hard-to-treat PA-related infections, thus specific antimicrobial stewardship interventions should be prompted in order to avoid the development of this combined resistance, which would jeopardize the chance to treat these infections. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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11 pages, 285 KiB

Open AccessArticle

Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

by Andrea Cona, Alessandro Tavelli, Andrea Renzelli, Benedetta Varisco, Francesca Bai, Daniele Tesoro, Alessandro Za, Caterina Biassoni, Lodovica Battaglioli, Marina Allegrini, Ottavia Viganò, Lidia Gazzola, Teresa Bini, Giulia Carla Marchetti and Antonella d’Arminio Monforte

Antibiotics 2021, 10(9), 1031; https://doi.org/10.3390/antibiotics10091031 - 24 Aug 2021

Cited by 9 | Viewed by 2516

Abstract

With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

12 pages, 1817 KiB

Open AccessArticle

Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic

by Santiago Grau, Sergi Hernández, Daniel Echeverría-Esnal, Alexander Almendral, Ricard Ferrer, Enric Limón, Juan Pablo Horcajada and on behalf of the Catalan Infection Control Antimicrobial Stewardship Program (VINCat-PROA)

Antibiotics 2021, 10(8), 943; https://doi.org/10.3390/antibiotics10080943 - 4 Aug 2021

Cited by 43 | Viewed by 6345

Abstract

Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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13 pages, 548 KiB

Open AccessArticle

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

by Nurul Adilla Hayat Jamaluddin, Petrick Periyasamy, Chee Lan Lau, Sasheela Ponnampalavanar, Pauline Siew Mei Lai, Ramliza Ramli, Toh Leong Tan, Najma Kori, Mei Kuen Yin, Nur Jannah Azman, Rodney James, Karin Thursky and Isa Naina-Mohamed

Antibiotics 2021, 10(5), 531; https://doi.org/10.3390/antibiotics10050531 - 4 May 2021

Cited by 18 | Viewed by 4819

Abstract

Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients’ notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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7 pages, 892 KiB

Open AccessArticle

Effect of Restriction of Fluoroquinolone Antibiotics on Clostridioides difficile Infections in the University Hospital Hradec Králové

by Kristýna Vaverková, Martin Kracík, Lenka Ryšková, Pavla Paterová, Rudolf Kukla, Lenka Hobzová, Roman Špánek and Helena Žemličková

Antibiotics 2021, 10(5), 519; https://doi.org/10.3390/antibiotics10050519 - 2 May 2021

Cited by 3 | Viewed by 2046

Abstract

Clostridioides difficile is the most common pathogen responsible for hospital-acquired diarrhea. This complication of antibiotic treatment mainly endangers the health of elder patients. Preventing the development of C. difficile infections (CDI) is still a challenge that needs to be addressed. In our study, the results of 872 C. difficile positive stool samples were used to describe the epidemiological situation affected by a change in the prescription of fluoroquinolone antibiotics. In a total, 93 of strains were typed by polymerase chain reaction (PCR) and capillary gel electrophoresis. Between years 2014 and 2018 the decline in the fluoroquinolones consumption was 69.3 defined daily dose (DDD) per 1000 patient-days (from 103.3 to 34.0), in same period CDI incidence declined by 1.3 cases per 10,000 patient-bed days (from 5.6 to 4.3). Results of epidemiologic and statistical analysis shows that decline in fluoroquinolones consumption has significant influence on CDI incidence and prevalence of hypervirulent strains. In the University Hospital Hradec Králové properly managed antibiotic stewardship policy has reduced CDI incidence by 23.2% and lowered rate of hypervirulent ribotypes 001 and 176. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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11 pages, 280 KiB

Open AccessArticle

Impact of Treating Asymptomatic Bacteriuria in Kidney Transplant Recipients: A Prospective Cohort Study

by Sara Fontserè, Carmen Infante-Domínguez, Alejandro Suárez-Benjumea, Marta Suñer-Poblet, Carmen González-Corvillo, Guillermo Martín-Gutiérrez, Gabriel Bernal, Jerónimo Pachón, María Eugenia Pachón-Ibáñez and Elisa Cordero

Antibiotics 2021, 10(2), 218; https://doi.org/10.3390/antibiotics10020218 - 22 Feb 2021

Cited by 6 | Viewed by 2588

Abstract

This study aims to define the epidemiologic, clinical, and microbiological features of asymptomatic bacteriuria (AB) and cystitis in kidney transplantation recipients (KTRs), and to determine the impact of antimicrobial therapy of AB and the risk factors of cystitis. We conducted a prospective observational study of AB and cystitis in KTRs from January to June 2017. One-hundred ninety seven KTRs were included: 175 (88.8%) with AB and 22 (11.2%) with cystitis. The most frequent etiologies were Escherichia coli, Klebsiellapneumoniae, Enterococcusfaecalis, and Pseudomonas aeruginosa. No differences were observed regarding the etiologies, antimicrobial susceptibility patterns, and microbiologic outcomes in AB vs. cystitis. The treatment of AB diminished the microbiological cure and increased the rates of microbiologic relapses and reinfections; in addition, treated AB patients showed a trend of developing symptomatic urinary tract infection in the following six months. The analysis of the data identified the following independent risk factors for cystitis during the six months of follow-up: AB treatment, thymoglobulin induction, previous acute pyelonephritis, and time since transplantation < 1 year. In summary, considering the lack of clinical benefits of treating AB and its impact on cystitis development in the follow-up, we support the recommendation of not screening for or treating AB. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

Review

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15 pages, 1106 KiB

Open AccessReview

Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions

by Nesrine A. Rizk, Rima Moghnieh, Nisrine Haddad, Marie-Claire Rebeiz, Rony M. Zeenny, Joya-Rita Hindy, Gabriella Orlando and Souha S. Kanj

Antibiotics 2021, 10(11), 1320; https://doi.org/10.3390/antibiotics10111320 - 29 Oct 2021

Cited by 30 | Viewed by 5088

Abstract

The COVID-19 pandemic is expected to worsen the global problem of antimicrobial resistance (AMR). There is a heightened interest in understanding this effect and to develop antimicrobial stewardship (AMS) interventions accordingly to curb this threat. Our paper aims to evaluate the potential magnitude of COVID-19 on AMR and AMS with a focus on the countries of the Arab league, given the social, political, and economic environments. We also evaluate obstacles in applying the rational use of antibiotics, monitoring resistance trends in the midst of the pandemic, and evaluating the impact of the economic crisis in some countries. We aim to raise awareness about the potential effects of antibiotic overuse during the pandemic and to propose practical approaches to tackle this issue. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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10 pages, 697 KiB

Open AccessBrief Report

Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients

by Sonia Luque, Adela Benítez-Cano, Leire Larrañaga, Luisa Sorlí, María Eugenia Navarrete, Nuria Campillo, Jesús Carazo, Isabel Ramos, Ramón Adalia and Santiago Grau

Antibiotics 2021, 10(6), 666; https://doi.org/10.3390/antibiotics10060666 - 3 Jun 2021

Cited by 1 | Viewed by 3544

Abstract

Background: Pathophysiological changes such as extreme body weights in critically ill patients with severe infections may alter the pharmacokinetics (PK) of antimicrobials, leading to treatment failure or toxicity. There are almost no PK data on meropenem in critically ill patients with low body weight (LwBW) and therefore information is lacking on the most appropriate dosing regimens, especially when administered by extended infusion. Objectives: To assess if the current administered doses of meropenem could lead to supratherapeutic concentrations in LwBW patients and to identify the factors independently associated with overexposure. Methods: A matched case-control 1:1 study of surgical critically ill patients treated with meropenem administered by extended or continuous infusion and undergoing therapeutic drug monitoring was conducted. Cases (patients with LwBW (body mass index (BMI) < 18.5 kg/m²)) were matched with normal body weight controls (NBW) (patients with BMI ≥ 18.5 kg/m² and ≤30 kg/m²)) by age, gender, baseline renal function and severity status (APACHE II score). A 100% fT > MIC was considered an optimal pharmacokinetic/pharmacodynamic (PK/PD) target and 100% fT > 10 × MIC as supratherapeutic exposure. Results: Thirty-six patients (18 cases and 18 controls) were included (median (range) age, 57.5 (26–75) years; 20 (55.6% male)). Meropenem was administered by 6 h (extended) or 8 h (continuous) infusion at a median (range) daily dose of 5 (1–6) g/day. Similar median meropenem trough plasma concentrations (Cmin,ss), measured pre-dose on day three to four of treatment) were observed in the two groups (19.9 (22.2) mg/L vs 22.4 (25.8) mg/L, p > 0.999). No differences in the proportion of patients with an optimal or a supratherapeutic PKPD target between cases and controls were observed. A baseline estimated glomerular filtration rate (eGFR) < 90 mL/min was the only factor independently associated with a supratherapeutic PK/PD target. Conclusions: LwBW seems not to be a risk factor for achieving a supratherapeutic PK/PD target in critically ill patients receiving meropenem at standard doses by extended or continuous infusion. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Infection Control)

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