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Antibiotics
Special Issues
Antimicrobial Stewardship and Use in Healthcare Setting
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Antimicrobial Stewardship and Use in Healthcare Setting

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

Deadline for manuscript submissions: 28 February 2025 | Viewed by 8044

Special Issue Editors

Dr. Colin S. Brown

E-Mail Website
Guest Editor
HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, London, UK
Interests: AMR; HCAI; emerging infection; TB; HIV
Dr. Donna M. Lecky

E-Mail Website
Guest Editor
Primary Care & Interventions Unit, UK Health Security Agency, Gloucester, UK
Interests: antimicrobial stewardship; antimicrobial resistance; professional education and training; behavioural science; qualitative research; public health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is a leading cause of death worldwide. Antibiotic misuse, including under-use, overuse, and inappropriate use, has been identified as a major driver of AMR. Antibiotic stewardship campaigns and interventions have been employed across the healthcare sector to help facilitate appropriate prescribing, with varying degrees of success.

This Special Issue aims to showcase a variety of stewardship initiatives undertaken across the healthcare setting including stewardship campaigns, interventions and programmes. We welcome original research, review articles, case studies and opinion papers. Topics of particular interest include:

  • Antimicrobial stewardship across various healthcare settings including general practice, care home, dentistry, hospital settings and private practice;
  • The landscape of antimicrobial stewardship post-COVID-19;
  • Implementing antimicrobial stewardship strategies at a local, regional, national or global level;
  • Antimicrobial stewardship integration with electronic medical records;
  • Multidisciplinary approaches to antimicrobial stewardship in healthcare settings;
  • The impact of antimicrobial stewardship;
    • hospital prevalence of multi-drug resistant organisms/resistance trends
    • adverse events e.g., CDI
    • other novel markers of success
  • Antmicrobial stewardship and behavioural change;
  • Antimicrobial stewardship and the general public;
  • Embedding antimicrobial stewardship across the healthcare setting;
  • Antimicrobial stewardship approaches including diagnostic stewardship, education and training, prescribing strategies, and point of care tests;
  • Syndrome-/organism-based antibiotic stewardship;
  • Novel approaches to antibiotic stewardship;
  • Antimicrobial stewardship—what is a success?

Dr. Colin S. Brown
Dr. Donna M. Lecky
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
  • behavior
  • decision support
  • antimicrobial resistance
  • knowledge
  • education
  • impact
  • implementation

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Published Papers (5 papers)

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13 pages, 245 KiB  
Article
Antimicrobial Stewardship Programmes: Healthcare Providers’ Perspectives on Adopted Hospital Policies That Combat Antibacterial Resistance in Selected Health Facilities in Uganda
by Isaac Magulu Kimbowa, Moses Ocan, Mary Nakafeero, Celestino Obua, Cecilia Stålsby Lundborg, Joan Kalyango and Jaran Eriksen
Antibiotics 2024, 13(11), 999; https://doi.org/10.3390/antibiotics13110999 - 23 Oct 2024
Viewed by 603
Abstract
Background: This study aimed to determine healthcare providers’ perspectives on adopted hospital policies that support establishing antimicrobial stewardship programmes (ASPs) in selected health facilities in Uganda. Results: In this study, 63.1% of healthcare providers had a low-level perspective regarding adopting hospital [...] Read more.
Background: This study aimed to determine healthcare providers’ perspectives on adopted hospital policies that support establishing antimicrobial stewardship programmes (ASPs) in selected health facilities in Uganda. Results: In this study, 63.1% of healthcare providers had a low-level perspective regarding adopting hospital policies to facilitate the establishment of ASPs. The low-perspective was significantly associated with females (aOR: 17.3, 95% CI: 1.28–2.34, p < 0.001), healthcare practitioners aged 50 + years (aOR: 1.92, 95% CI: 1.22–3.01, p = 0.004), individuals in the Obstetrics and Gynaecology department (aOR: 1.73, 95% CI: 1.03–2.90, p < 0.037), and Uganda’s Eastern (aOR: 1.47, 95% CI: 1.03–2.09, p = 0.034) and Northern regions (aOR: 2.97, 95% CI: 1.63–5.42, p < 0.001). Methods: We conducted a cross-sectional study where 582 healthcare providers (response rate (76%) were interviewed using a questionnaire to assess their perspectives on hospital policies that support ASP in 32 selected health facilities. We performed ordinal logistic regression on factors associated with adopted policies, and these were reported with odds ratios (ORs) and 95% confidence intervals (CIs). Conclusions: there was a low-level perspective on adopted hospital policies to support ASPs, which were significantly associated with the sex of healthcare providers, departments, age, and region of the country. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Use in Healthcare Setting)
12 pages, 754 KiB  
Article
Risk Factors for 30-Day Mortality in Nosocomial Enterococcal Bloodstream Infections
by Verena Zerbato, Riccardo Pol, Gianfranco Sanson, Daniel Alexandru Suru, Eugenio Pin, Vanessa Tabolli, Jacopo Monticelli, Marina Busetti, Dan Alexandru Toc, Lory Saveria Crocè, Roberto Luzzati and Stefano Di Bella
Antibiotics 2024, 13(7), 601; https://doi.org/10.3390/antibiotics13070601 - 27 Jun 2024
Cited by 1 | Viewed by 1003
Abstract
Enterococci commonly cause nosocomial bloodstream infections (BSIs), and the global incidence of vancomycin-resistant enterococci (VRE) BSIs is rising. This study aimed to assess the risk factors for enterococcal BSIs and 30-day mortality, stratified by Enterococcus species, vancomycin resistance, and treatment appropriateness. We conducted [...] Read more.
Enterococci commonly cause nosocomial bloodstream infections (BSIs), and the global incidence of vancomycin-resistant enterococci (VRE) BSIs is rising. This study aimed to assess the risk factors for enterococcal BSIs and 30-day mortality, stratified by Enterococcus species, vancomycin resistance, and treatment appropriateness. We conducted a retrospective cohort study (2014–2021) including all hospitalized adult patients with at least one blood culture positive for Enterococcus faecalis or Enterococcus faecium. We included 584 patients with enterococcal BSI: 93 were attributed to vancomycin-resistant E. faecium. The overall 30-day mortality was 27.5%; higher in cases of BSI due to vancomycin-resistant E. faecium (36.6%) and vancomycin-sensitive E. faecium (31.8%) compared to E. faecalis BSIs (23.2%) (p = 0.016). This result was confirmed by multivariable Cox analysis. Independent predictors of increased mortality included the PITT score, complicated bacteremia, and age (HR = 1.269, p < 0.001; HR = 1.818, p < 0.001; HR = 1.022, p = 0.005, respectively). Conversely, male gender, consultation with infectious disease (ID) specialists, and appropriate treatment were associated with reduced mortality (HR = 0.666, p = 0.014; HR = 0.504, p < 0.001; HR = 0.682, p = 0.026, respectively). In conclusion, vancomycin-resistant E. faecium bacteremia is independently associated with a higher risk of 30-day mortality. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Use in Healthcare Setting)
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12 pages, 1518 KiB  
Article
Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes
by Ana Belén Guisado-Gil, Marta Mejías-Trueba, Germán Peñalva, Manuela Aguilar-Guisado, Jose Molina, Adelina Gimeno, Rocío Álvarez-Marín, Julia Praena, Claudio Bueno, José Antonio Lepe, María Victoria Gil-Navarro and José Miguel Cisneros
Antibiotics 2024, 13(4), 356; https://doi.org/10.3390/antibiotics13040356 - 12 Apr 2024
Cited by 1 | Viewed by 2223
Abstract
We aimed to define a novel indicator for monitoring antimicrobial use specifically in the Emergency Department Observation Unit (EDOU) and to assess the long-term impact of an institutional education-based antimicrobial stewardship program (ASP) on the antimicrobial prescribing pattern and clinical outcomes in this [...] Read more.
We aimed to define a novel indicator for monitoring antimicrobial use specifically in the Emergency Department Observation Unit (EDOU) and to assess the long-term impact of an institutional education-based antimicrobial stewardship program (ASP) on the antimicrobial prescribing pattern and clinical outcomes in this setting. A quasi-experimental interrupted time-series study was performed from 2011 to 2022. An educational ASP was implemented at the EDOU in 2015. To estimate changes in antimicrobial use, we designed an indicator adjusted for patients at risk of antimicrobial prescribing: defined daily doses (DDDs) per 100 patients transferred from the Emergency Department to the Observation Unit (TOs) per quarter. The number of bloodstream infections (BSIs) and the crude all-cause 14-day mortality were assessed as clinical outcomes. Antimicrobial use showed a sustained reduction with a trend change of −1.17 DDD per 100 TO and a relative effect of −45.6% (CI95% −64.5 to −26.7), particularly relevant for meropenem and piperacillin-tazobactam, with relative effects of −80.4% (−115.0 to −45.7) and −67.9% (−93.9 to −41.9), respectively. The incidence density of all BSIs increased significantly during the ASP period, with a relative effect of 123.2% (41.3 to 284.7). The mortality rate remained low and stable throughout the study period, with an absolute effect of −0.7% (−16.0 to 14.7). The regular monitoring of antimicrobial use in the EDOU by using this new quantitative indicator was useful to demonstrate that an institutional education-based ASP successfully achieved a long-term reduction in overall antimicrobial use, with a low and steady BSI mortality rate. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Use in Healthcare Setting)
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20 pages, 623 KiB  
Article
Trends in Antibiotic Use in a Large Children’s Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys
by Kevin Meesters, Faye Chappell and Alicia Demirjian
Antibiotics 2024, 13(2), 172; https://doi.org/10.3390/antibiotics13020172 - 9 Feb 2024
Viewed by 2065
Abstract
Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic [...] Read more.
Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016–April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation’s AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20–44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8–70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Use in Healthcare Setting)
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10 pages, 259 KiB  
Brief Report
Assessing Clinical Outcomes of Vancomycin Treatment in Adult Patients with Vancomycin-Susceptible Enterococcus faecium Bacteremia
by Hiroshi Sasano and Kazuhiko Hanada
Antibiotics 2023, 12(11), 1577; https://doi.org/10.3390/antibiotics12111577 - 29 Oct 2023
Cited by 1 | Viewed by 1422
Abstract
Purpose: Enterococcal bacteremia is associated with high mortality and long-term hospitalization. Here, we aimed to investigate the clinical outcomes and evaluate the risk factors for mortality in adult patients treated with vancomycin (VCM) for vancomycin-susceptible Enterococcus faecium (E. faecium) bacteremia. Methods: [...] Read more.
Purpose: Enterococcal bacteremia is associated with high mortality and long-term hospitalization. Here, we aimed to investigate the clinical outcomes and evaluate the risk factors for mortality in adult patients treated with vancomycin (VCM) for vancomycin-susceptible Enterococcus faecium (E. faecium) bacteremia. Methods: This is a retrospective, record-based study. The data were collected from inpatients at a single university hospital between January 2009 and December 2020. The area under the curve (AUC) of VCM was calculated using the Bayesian approach. The primary outcome was a 30-day in-hospital mortality. Results: A univariate analysis showed significant differences in the concomitant use of vasopressors, history of the use of no clinically relevant activity antimicrobial agents against E. faecium, VCM plasma trough concentration, and renal dysfunction during VCM administration between the 30-day in-hospital mortality and survival groups. However, the groups’ AUC/minimum inhibitory concentration (MIC) were not significantly different. A multivariate analysis suggested that concomitant vasopressors may be an independent risk factor for 30-day in-hospital mortality (odds ratio, 7.81; 95% confidence interval, 1.16–52.9; p = 0.035). The VCM plasma trough concentrations and the AUC/MIC in the mortality group were higher than those in the surviving group. No association between the AUC/MIC and the treatment effect in E. faecium bacteremia was assumed, because the known, target AUC/MIC were sufficiently achieved in the mortality group. Conclusions: There may be no association between the AUC/MIC and the treatment effect in E. faecium bacteremia. When an immunocompromised host develops E. faecium bacteremia with septic shock, especially when a vasopressor is used in a patient with unstable hemodynamics, it may be difficult to treat it, despite efforts to ensure the appropriate AUC/MIC and therapeutic vancomycin concentration levels. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship and Use in Healthcare Setting)
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