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Antibiotics
Special Issues
Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy
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Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy

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

Deadline for manuscript submissions: 15 January 2025 | Viewed by 4655

Special Issue Editors

Prof. Dr. Xiaolin Wei

E-Mail Website
Guest Editor
Fellow of Canadian Academy of Health Sciences (FCAHS), Dalla Lana Chair in Global Health Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
Interests: AMR; implementation science; complex interventions; reviews; health system; policy; one health
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Xiaoxv Yin

E-Mail Website
Guest Editor
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Interests: rational antibiotic use; antimicrobial stewardship
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The growing global threat of antimicrobial resistance has become a significant concern for public health professionals and policymakers. The misuse and overuse of antimicrobial agents have accelerated the emergence of drug-resistant pathogens, compromising the effectiveness of our arsenal of antimicrobials. With the potential loss of effective antimicrobial treatment options, patients are at risk of experiencing severe health outcomes and increased mortality rates. Antimicrobial stewardship intervention has emerged as a crucial strategy aimed at addressing this issue.

This Special Issue focuses on the importance of antimicrobial stewardship intervention in promoting the responsible use of antimicrobial agents and preserving their effectiveness. We welcome the submission of original research articles, or review articles that explore antibiotic stewarship programs in both low- and middle-income countries (LIMCs) and high-income countries (HICs). We specifically welcome studies employing implementation science theories and frameworks that involved impacted real-world clinical practice and health policies. These activties may include guiding efforts in developing and implementing effective strategies that optimize antimicrobial use, preserving the therapeutic advancements, and ensuring the sustained management of infectious diseases.

Prof. Dr. Xiaolin Wei
Prof. Dr. Xiaoxv Yin
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

  • antimicrobial stewardship
  • antibiotic use
  • implementation science
  • interventions
  • clinical guidelines
  • health policy

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Published Papers (4 papers)

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Research

10 pages, 2031 KiB  
Article
A Five-Bundle Intervention to Improve Blood Culture Use in a Tertiary Hospital in Romania
by Alina-Ioana Popa, Daniela Tălăpan and Gabriel-Adrian Popescu
Antibiotics 2024, 13(11), 1040; https://doi.org/10.3390/antibiotics13111040 - 4 Nov 2024
Viewed by 618
Abstract
Objectives: The aims of this study were to evaluate the efficacy of a five-bundle intervention and to decrease the number of cases in which only one set of blood cultures is collected prior to starting antimicrobials. Methods: The study group consisted [...] Read more.
Objectives: The aims of this study were to evaluate the efficacy of a five-bundle intervention and to decrease the number of cases in which only one set of blood cultures is collected prior to starting antimicrobials. Methods: The study group consisted of the two hospital wards that have the highest collection rate (120 blood cultures/1000 patient days and 121.4 blood cultures/1000 patient days, respectively), and the control group consisted of the other three adult wards. The collection protocol was changed, and a bundle of five measures was introduced: one-on-one discussions with the nurses, 2% chlorhexidine in 70% alcohol for disinfection, ensuring the use of sterile gloves, sterile wipes, a checklist for the materials needed, and a copy of the collection protocol. The impact of these changes was followed over a 5-month period. Results: Prior to the intervention, the contamination rate was higher in the control group (6.5%) versus the study group (4%), p = 0.00578. The before–after analysis revealed a significantly reduced contamination rate in the control group (4.6% vs. 6.5% p = 0.0099), but it was above the one obtained in the study group (3.1% vs. 4%, p = 0.1635). The number of infectious episodes in which one blood culture set was collected decreased significantly in the study group (77/311 vs. 139/456, p = 0.041). Conclusions: The intervention decreased the contamination rate and the number of infectious episodes in which one blood culture set is collected. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy)
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12 pages, 931 KiB  
Article
Establishment of an Antimicrobial Stewardship Program to Spare the Use of Oral Fluoroquinolones for Acute Uncomplicated Cystitis in Outpatients
by Tomoyuki Kato, Masayuki Nagasawa, Ippei Tanaka, Yuka Seyama, Reiko Sekikawa, Shiori Yamada, Eriko Ishikawa and Kento Kitajima
Antibiotics 2024, 13(9), 886; https://doi.org/10.3390/antibiotics13090886 - 14 Sep 2024
Viewed by 812
Abstract
The increase in fluoroquinolone (FQ)-resistant Escherichia coli (EC) is a serious global problem. In addition, much of acute uncomplicated cystitis (AUC) cases are caused by EC. FQs have been selected for the treatment of cystitis in outpatients, and there is concern about treatment [...] Read more.
The increase in fluoroquinolone (FQ)-resistant Escherichia coli (EC) is a serious global problem. In addition, much of acute uncomplicated cystitis (AUC) cases are caused by EC. FQs have been selected for the treatment of cystitis in outpatients, and there is concern about treatment failure. It is therefore necessary to select appropriate antimicrobials to spare FQs. However, there are few reported effective antimicrobial stewardship programs (ASPs) for outpatients. We aimed to establish the effective ASP for outpatients diagnosed with AUC caused by EC, to spare the use of FQs, and to explore optimal oral antimicrobials for AUC. The study subjects were outpatients treated for AUC caused by extended-spectrum β-lactamase-non-producing EC (non-ESBL-EC). Based on the antibiogram results, we recommended cefaclor (CCL) as the initial treatment for AUC, and educated clinical pharmacists who also worked together to advocate for CCL or cephalexin (CEX) prescriptions. FQ usages decreased, and cephalosporin (Ceph) prescriptions increased in all medical departments. The Ceph group (n = 114; CCL = 60, CEX = 54) in the non-FQ group had fewer treatment failures than the FQ group (n = 86) (12.3% vs. 31.4%). Cephs, including CCL and CEX, were effective treatments for AUC caused by non-ESBL-EC. Antimicrobial selection based on antibiogram results and the practice of an ASP in collaboration with clinical pharmacists were useful for optimizing antimicrobial therapy in outpatients. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy)
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15 pages, 406 KiB  
Article
Knowledge, Attitudes, and Practices towards Antibiotics, Antimicrobial Resistance, and Antibiotic Consumption in the Population of Kazakhstan
by Yuliya Semenova, Laura Kassym, Assiya Kussainova, Ainur Aimurziyeva, Larissa Makalkina, Andrey Avdeyev, Aizhan Yessmagambetova, Manar Smagul, Bibigul Aubakirova, Zaure Akhmetova, Ademi Yergaliyeva and Lisa Lim
Antibiotics 2024, 13(8), 718; https://doi.org/10.3390/antibiotics13080718 - 31 Jul 2024
Cited by 3 | Viewed by 1320
Abstract
During the COVID-19 pandemic, a ban on inspections of small businesses, including pharmacies, was imposed in Kazakhstan, which relaxed law enforcement efforts regarding the prohibition of over-the-counter antibiotic (AB) sales. This study aimed to investigate how this affected the knowledge, attitudes, and practices [...] Read more.
During the COVID-19 pandemic, a ban on inspections of small businesses, including pharmacies, was imposed in Kazakhstan, which relaxed law enforcement efforts regarding the prohibition of over-the-counter antibiotic (AB) sales. This study aimed to investigate how this affected the knowledge, attitudes, and practices (KAP) related to AB and antimicrobial resistance (AMR), as well as to assess actual AB consumption at the community level. The study comprised two cross-sectional sub-studies: the first involved a KAP survey conducted in 2022 and 2024, utilizing the Special Eurobarometer questionnaire on AMR. The second sub-study analyzed AB consumption in 2021 and 2023, measured in defined daily doses per 1000 inhabitants. Results revealed an increase in the percentage of individuals reporting receipt of information about ABs and AMR in the past year (37.3% in 2022 vs. 52.9% in 2024, p < 0.001) and an increase in the percentage of individuals reporting AB use in the past year (49.0% in 2022 vs. 54.0% in 2024, p = 0.056). The most consumed ABs were from the Watch group, with azithromycin and ceftriaxone ranking highest. These findings support the hypothesis that the relaxation of law enforcement contributed to an increase in AB consumption and emphasize the need for public health policies to address this issue. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy)
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18 pages, 871 KiB  
Article
Adherence to Antibiotic Prescription Guidelines in Four Community Hospitals in Germany
by Joachim Peter Biniek, Frank Schwab, Karolin Graf and Ralf-Peter Vonberg
Antibiotics 2024, 13(7), 635; https://doi.org/10.3390/antibiotics13070635 - 10 Jul 2024
Viewed by 1222
Abstract
This retrospective study aimed to assess and compare guideline adherence and treatment costs in the management of urinary tract infections (UTIs) and bloodstream infections (BSIs) in German tertiary hospitals from January 2019 to December 2020. The study analyzed 586 patient records, with 65% [...] Read more.
This retrospective study aimed to assess and compare guideline adherence and treatment costs in the management of urinary tract infections (UTIs) and bloodstream infections (BSIs) in German tertiary hospitals from January 2019 to December 2020. The study analyzed 586 patient records, with 65% diagnosed with UTIs and 35% with BSIs. Antibiotic treatment was given to 98% of patients, but only 65% received microbiological diagnostics. Bacterial growth was observed in 86% of patients with cultures taken, with Escherichia coli being the leading pathogen. The treatment was intravenous in 63% of cases, with Ceftriaxone as the leading antibiotic agent. The guideline adherence was found to be low, at 33%. Multivariable logistic regression analysis revealed that patients with urogenital risk factors (OR = 1.589; p < 0.001) and increasing age (OR = 1.01; p = 0.007) were significantly more likely to receive guideline-concordant treatment for UTIs and BSIs. Additionally, complicating factors such as diabetes and renal dysfunction were associated with higher adherence rates, underscoring the importance of targeted antibiotic stewardship interventions. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Intervention: Importance for Clinical Practice and Health Policy)
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