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Antibiotics
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Healthcare-Associated Infection, Antibiotic Resistance and Treatment
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Healthcare-Associated Infection, Antibiotic Resistance and Treatment

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 14412

Special Issue Editor

Prof. Dr. Ljiljana Markovic-Denic

E-Mail Website
Guest Editor
Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Interests: Hospital epidemiology; infection control; communicable diseses; immunization; prevention

Special Issue Information

Dear Colleagues,

Healthcare-associated infections (HAI) occur in every healthcare facility worldwide, and they are considered a major threat to patient safety. These infections contribute to a prolonged hospital stay, an increased need for additional medical interventions, and higher morbidity and mortality. HAIs have economic consequences for society as a whole, not only in developing and less developed countries but in developed ones, as well. Therefore, the estimations of incidence, prevalence, and risk factors for HAIs are key factors of their prevention. In addition to the lack of infection control measures, the inappropriate prescription of antibiotics for HAI treatment can contribute to antimicrobial resistance (AMR). Generally, antibiotics represent the most prescribed group of drugs in most countries in the world. If appropriate measures are not taken, it is estimated that the consumption of antibiotics by the end of 2030 will increase to 200% compared to 2015, of which the important percentage is related to prescription occuring in hospitals. The non-rational use of antibiotics can lead to a higher rate of infections such as Clostridioides difficile.

Reducing the use of antibiotics is the most important measure for controlling the silent pandemic of antimicrobial resistance, but it must be balanced in terms of the availability of life-saving drugs. In recent times, the World Health Organization has identified 12 bacterial species and their accompanying AMR profiles as the most considerable threats to public health. These AMR bacteria have been divided into three priority classes, e.g., carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacterales (priority “critical”) or vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus (priority “high”) based on their impact on human health and the urgency for developing new antibiotics to treat resistant infections. The dramatic increase in resistant bacteria in healthcare settings has led to difficulties in HAI treatment. Close monitoring of AMR is important for detecting and responding to emerging trends and patterns of resistance and thus to effectively control and treat HAIs. 

This Special Issue of Antibiotics is seeking research articles, review articles, and short notes focused on the prevention and control HAIs, antibiotics used for their treatment, and the antimicrobial resistance of bacterial pathogens.

Prof. Dr. Ljiljana Markovic-Denic
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

  • healthcare-associated infections
  • antimicrobial resistance
  • antibiotics
  • prevention
  • control
  • therapy

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Published Papers (6 papers)

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Research

12 pages, 1435 KiB  
Article
Intestinal Colonization of Preterm Neonates with Carbapenem Resistant Enterobacteria at Hospital Discharge
by Vera Mijac, Snezana Brkic, Marija Milic, Marina Siljic, Valentina Cirkovic, Vladimir Perovic, Milos Markovic, Ivana Cirkovic and Maja Stanojevic
Antibiotics 2023, 12(2), 284; https://doi.org/10.3390/antibiotics12020284 - 1 Feb 2023
Cited by 7 | Viewed by 2011
Abstract
Our aim was to investigate gut colonization with carbapenem-resistant Enterobacterales (CRE) in the population of preterm neonates at discharge from a tertiary care center in Serbia. The study included 350 randomly selected neonates/infants discharged in the period April 2018–May 2019. CRE colonization was [...] Read more.
Our aim was to investigate gut colonization with carbapenem-resistant Enterobacterales (CRE) in the population of preterm neonates at discharge from a tertiary care center in Serbia. The study included 350 randomly selected neonates/infants discharged in the period April 2018–May 2019. CRE colonization was present in 88/350 (25.1%) of patients. Klebsiella pneumoniae producing KPC and OXA-48 carbapenemase were detected in 45 and 42 subjects, respectively, while NDM producing Escherichia coli was identified in one patient only. All OXA-48 strains harbored blaCTX-M-15, while both blaTEM and blaSHV were present in all but one KPC-producing strain. CRE isolates exhibited a multidrug resistance pattern with uniform fluoroquinolone resistance, universal susceptibility to colistin, and variable susceptibility to aminoglycosides. Administration of carbapenems was common (~50%) and it was strongly associated with colonization, as well as the combinational therapeutic regimens that included meropenem, contrary to ampicillin–sulbactam/colistin therapy and prolonged course of the initial therapy (ampicillin/amikacin ≥ 7 days). Other risk factors for CRE carriage were level of immaturity, admission to neonatal intensive care unit, prolonged hospitalization and invasive procedures. Although the rate of clinically and/or laboratory proven systemic infections was significantly higher among colonized patients, CRE infection was confirmed in one patient only (1.1%) that was colonized with NDM E. coli. Clonal relatedness of CRE isolates was high, with seven and eight clusters detected among KPC (N = 30) and OXA-48 (N = 37) producing strains, respectively. The follow up of the 31 KPC-colonized patients after discharge from hospital revealed common decolonization within one month (~68%). In conclusion, our results demonstrated a high rate of CRE colonization that is most likely related to carbapenem consumption and lack of screening as important infection prevention practice. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
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15 pages, 1031 KiB  
Article
Enhancing Antibiotics Efficacy by Combination of Kuraridin and Epicatechin Gallate with Antimicrobials against Methicillin-Resistant Staphylococcus aureus
by Ben Chung-Lap Chan, Nilakshi Barua, Clara Bik-San Lau, Ping-Chung Leung, Kwok-Pui Fung and Margaret Ip
Antibiotics 2023, 12(1), 117; https://doi.org/10.3390/antibiotics12010117 - 8 Jan 2023
Cited by 2 | Viewed by 1901
Abstract
Background: Staphylococcus aureus is an opportunistic pathogen and a major cause of nosocomial and community-acquired infections. The alarming rise in Methicillin-resistant S. aureus (MRSA) infection worldwide and the emergence of vancomycin-resistant MRSA strains have created an urgent need to identify new and alternative [...] Read more.
Background: Staphylococcus aureus is an opportunistic pathogen and a major cause of nosocomial and community-acquired infections. The alarming rise in Methicillin-resistant S. aureus (MRSA) infection worldwide and the emergence of vancomycin-resistant MRSA strains have created an urgent need to identify new and alternative treatment options. Triple combinations of antimicrobials with different antimicrobial mechanisms may be a good choice to overcome antimicrobial resistance. Methods: In this study, we combine two natural compounds: kuraridin from Sophora flavescens and epicatechin gallate (ECG) from Camellia sinensis (Green tea), which could provide the best synergy with antibiotics against a selected panel of laboratory MRSA with known resistant mechanisms and clinical community-associated (CA) and hospital-associated (HA) MRSA as well. Results: The combined use of ECG and kuraridin was efficacious in inhibiting the growth of a panel of tested MRSA strains. The antibacterial activities of gentamicin, fusidic acid and vancomycin could be further enhanced by the addition of ECG and kuraridin. In time-kill study, when vancomycin (0.5 μg/mL) was combined with ECG (2 μg/mL) and kuraridin (2 μg/mL), a very strong bactericidal growth inhibition against 3 tested strains ATCC25923, MRSA ST30 and ST239 was observed from 2 to 24 h. ECG and kuraridin both possess anti-inflammatory activities in bacterial toxin-stimulated peripheral blood mononuclear cells by suppressing the production of inflammatory cytokines (IL-1β, IL-6 and TNFα) and are non-cytotoxic. In a murine pneumonia model infected with ATCC25923, MRSA ST30 or ST239, the combined use of ECG and kuraridin with vancomycin could significantly reduce bacterial counts. Conclusions: The present findings reveal the potential of ECG and kuraridin combination as a non-toxic herbal and antibiotics combination for MRSA treatment with antibacterial and anti-inflammatory activities. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
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15 pages, 278 KiB  
Article
Knowledge, Attitudes and Practices of Parents and Pediatricians Regarding Antibiotic Use among Children: Differences in Relation to the Level of Education of the Parents in the Republic of Srpska Bosnia and Herzegovina
by Biljana Mijović, Jela Aćimović, Jelena Đaković Dević, Julija Kralj, Vesna Lučić Samardžija, Mirjana Djermanović, Marija Milić, Vesna Vujić-Aleksić, Snežana Perić Simić and Bojan Joksimović
Antibiotics 2022, 11(10), 1325; https://doi.org/10.3390/antibiotics11101325 - 28 Sep 2022
Cited by 5 | Viewed by 3257
Abstract
Antibiotics are often misused, especially for the treatment of upper respiratory tract infections (URTIs) in children, where their use is unnecessary and leads to antimicrobial resistance. This study sought to explore the knowledge, attitudes and practices (KAP) of parents and pediatricians on the [...] Read more.
Antibiotics are often misused, especially for the treatment of upper respiratory tract infections (URTIs) in children, where their use is unnecessary and leads to antimicrobial resistance. This study sought to explore the knowledge, attitudes and practices (KAP) of parents and pediatricians on the use of antibiotics among children and whether the level of education of parents has an impact on their KAP. The research was carried out among 1459 parents of children under 6 years of age and among 18 pediatricians. Sixty percent of pediatricians (61.1%) were prescribed antibiotics daily in their practice. Most of the surveyed parents (98.4%) state that doctors are their main source of information when deciding on the use of antibiotics in the treatment of their children. Parents with a higher level of education use television less often as a source of information when making this decision compared to parents with a lower level of education (p = 0.039, i.e., p = 0.003). The majority of parents (80.7%) knew that Panklav (amoxicillin/clavulanic acid) is an antibiotic, while 52.5% identified Pancef (cefixime) as an antibiotic. Parents with a higher level of education correctly identified antibiotics significantly more often (p < 0.001). This study shows that in the Republic of Srpska, parents have adequate knowledge about antibiotics, especially those with a higher level of education, who show better KAP when it comes to antibiotic use. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
11 pages, 673 KiB  
Article
Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina
by Dragana Sokolović, Dragana Drakul, Bojan Joksimović, Nenad Lalović, Nada Avram, Marija Milić, Dajana Nogo-Živanović and Biljana Mijović
Antibiotics 2022, 11(10), 1319; https://doi.org/10.3390/antibiotics11101319 - 28 Sep 2022
Cited by 7 | Viewed by 2103
Abstract
The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the [...] Read more.
The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the consumption of antibiotics for systemic use in outpatients in the Republic of Srpska (RS), before and during the first year of the COVID-19 pandemic, as well as the association between antibiotic consumption and the rate of incidence and mortality of COVID-19. The total consumption of the antibiotics for systemic use (J01) in outpatients in the Republic of Srpska during 2019 was 19.40 DDD/TID, with an increase to 30.80 DDD/TID in 2020.Significantly higher use of penicillin (10.58 ± 11.01 DDD/TID in 2019 vs. 17.10 ± 13.63 DDD/TID in 2020), cephalosporins (2.68 ± 1.90 DDD/TID in 2019 vs. 5.93 ± 2.77 DDD/TID in 2020) and macrolides (2.14 ± 2.22 DDD/TID in 2019 vs. 3.40 ± 3.44 DDD/TID in 2020) was observed during the pandemic period. It is necessary to improve the prescribing practice of antibiotics at the primary health care level, public awareness about rational use of antibiotics, as well as the current antibiotic stewardship programs and control their implementation. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
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15 pages, 1645 KiB  
Article
Association between Antibiotic Use and Hospital-Onset Clostridioides difficile Infection in University Tertiary Hospital in Serbia, 2011–2021: An Ecological Analysis
by Aneta Perić, Nemanja Rančić, Viktorija Dragojević-Simić, Bojana Milenković, Nenad Ljubenović, Bojan Rakonjac, Vesna Begović-Kuprešanin and Vesna Šuljagić
Antibiotics 2022, 11(9), 1178; https://doi.org/10.3390/antibiotics11091178 - 31 Aug 2022
Cited by 6 | Viewed by 2117
Abstract
This ecological study is the largest to date examining the association between rates of antibiotic use (AU) and hospital-onset (HO) Clostridioides difficile infection (CDI) in a tertiary university hospital in Serbia. There was no clear trend in the incidence of HO-CDI over time. [...] Read more.
This ecological study is the largest to date examining the association between rates of antibiotic use (AU) and hospital-onset (HO) Clostridioides difficile infection (CDI) in a tertiary university hospital in Serbia. There was no clear trend in the incidence of HO-CDI over time. Total utilization of antibacterials for systemic use increased from 38.57 DDD/100 bed-days (BD) in 2011 to 56.39 DDD/100 BD in 2021. The most commonly used antibiotics were third-generation cephalosporins, especially ceftriaxone, with maximum consumption in 2021 (19.14 DDD/100 BD). The share of the Access group in the total utilization of antibiotics ranged from 29.95% to 42.96% during the observed period. The utilization of the Reserve group of antibiotics indicated a statistically significant increasing trend (p = 0.034). A statistically significant difference in the consumption of medium-risk antibiotics from 2011 to 2021 was shown for penicillins and a combination of sulfamethoxazole and trimethoprim. The consumption of cefotaxime showed a statistically significant negative association with the rate of HO-CDI (r = −0.647; p = 0.031). Ampicillin and the combination of amoxicilline with clavulanic acid have shown a negative statistically significant correlation with the ID of HO-CDI (r = −0.773 and r = −0.821, respectively). Moreover, there was a statistically significant negative correlation between consumption of “medium-risk antibiotics” and the rate of HO-CDI (r = −0.677). The next challenging step for the hospital multidisciplinary team for antimicrobials is to modify the antibiotic list according to the Access, Watch, and Reserve classification, in such a way that at least 60% of the AU should be from the Access group, according to the World Health Organization recommendation. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
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12 pages, 1502 KiB  
Article
Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia
by Ivana Ćirković, Ljiljana Marković-Denić, Milica Bajčetić, Gorana Dragovac, Zorana Đorđević, Vesna Mioljević, Danijela Urošević, Vladimir Nikolić, Aleksa Despotović, Gordana Krtinić, Violeta Rakić, Ivana Janićijević and Vesna Šuljagić
Antibiotics 2022, 11(9), 1161; https://doi.org/10.3390/antibiotics11091161 - 28 Aug 2022
Cited by 5 | Viewed by 2213
Abstract
Millions of patients acquire healthcare-associated infections (HAIs) every year, putting them at risk for serious complications and prolonged hospitalization. Point prevalence surveys (PPS), guided by the European Centre for Disease Prevention and Control framework, are one of the primary methods by which countries [...] Read more.
Millions of patients acquire healthcare-associated infections (HAIs) every year, putting them at risk for serious complications and prolonged hospitalization. Point prevalence surveys (PPS), guided by the European Centre for Disease Prevention and Control framework, are one of the primary methods by which countries in the European Union conduct surveillance of HAIs. Serbia, though not in the EU, implemented this approach in its national PPS. The microbiological and antimicrobial resistance (AMR) analyses comprised patients in 61 out of 65 hospitals included in the fourth PPS conducted in November 2017. A total of 515/12,380 (4.2%) of the adult patients included in the PPS had at least one HAI, with intensive care units carrying the highest prevalence of 15.9%. Urinary tract and surgical site infections were the most frequently identified types of HAIs (23.9% and 23.0%, respectively). Enterobacterales comprised almost half (47.0%) of all causative agents, most notably Klebsiella spp. (16.7%). AMR was very high for most pathogens—80.5% of nonfermentative Gram-negative bacilli were resistant to carbapenems whereas 62.9% of Enterobacterales were resistant to third generation cephalosporins. The calculated AMR index of 61% is one of the highest in Europe. Further efforts are needed to reduce the burden of HAIs in Serbia that carry very high resistance rates to antibiotics currently used in clinical practice. Full article
(This article belongs to the Special Issue Healthcare-Associated Infection, Antibiotic Resistance and Treatment)
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