Antimicrobial Stewardship Research Articles

Antimicrobial stewardship program in one primary care hospital, a snapshot analysis

Abstract Antimicrobic resistance (AMR) continues to rise, whereas development of new agents to counter it has slowed. A heightened need to maintain the effectiveness of currently available agents exists. Healthcare-associated infections (HAIs) are a significant cause of poor treatment outcomes and elevated healthcare and societal costs worldwide. At the beginning of 2024, we started a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in the Intensive Care Unit (ICU) and in the internal medicine ward of our hospital. The primary outcomes will be the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes will include the hospital mortality rate, the mean length of stay and the antibiotic expense. We conducted a snapshot analysis of the first three months to assess the efficacy our program. In the first three months we registered a global reduction in antibiotic expense (almost by half in comparison of 2023 first quarter) and consumption, particularly in the use of carbapenems: (change in level, CL: -51,26 DDD/1000 PD,) and third- generation cephalosporins (CL: -6 DDD/1000 PD). We registered a reduction in the use of hydroalcoholic gel, probably due to the reducted perception after the waning of risk perception towards Covid-19, although no big difference was observed in BSI incidence due to MDR Gram-negative organisms (CL: +1,2 events/1000 PD). Albeit partial, once again these findings demonstrated that implementation of an antimicrobial stewardship program, no matter the level of healthcare, is critical for fighting the AMR and to lessen the burden on Public Health; in particular our program induced a significant reduction in antibiotic consumption that lead to more funds at disposal to improve our clinical practice. Key messages • Once again our findings demonstrated that implementation of an antimicrobial stewardship, no matter the level of healthcare, is critical for fighting the AMR. • Our program induced a significant reduction in antibiotic consumption.

Wastewater surveillance of antibiotic resistant bacteria for public health action: Potential and Challenges.

Antibiotic resistance is an urgent public health threat. Actions to reduce this threat include requiring prescriptions for antibiotic use, antibiotic stewardship programs, educational programs targeting patients and healthcare providers, and limiting antibiotic use in agriculture, aquaculture, and animal husbandry. Wastewater surveillance might complement clinical surveillance by tracking time/space variation essential for detecting outbreaks and evaluating efficacy of evidence-based interventions; identifying high-risk populations for targeted monitoring; providing early warning of the emergence and spread of antibiotic resistant bacteria and identifying novel antibiotic resistant threats. Wastewater surveillance was an effective early warning system for SARS-CoV-2 spread and detection of the emergence of new viral strains. In this data-driven commentary we explore whether monitoring wastewater for antibiotic resistant genes and/or bacteria resistant to antibiotics might provide useful information for public health action. Using carbapenem resistance as an example, we highlight technical challenges associated with using wastewater to quantify temporal/spatial trends in antibiotic resistant bacteria (ARBs) and antibiotic resistant genes (ARGs) and compare with clinical information. While ARGs and ARBs are detectable in wastewater enabling early detection of novel ARGs, quantitation of ARBs and ARGs with current methods is too variable to reliably track space/time variation.

Pattern of Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital of Bangladesh

Background: Surgical Site Infection (SSI) is a common form of hospital-acquired infection and major cause of postoperative illness accounting for approximately a quarter of all nosocomial infections. As a result, surgical antibiotic prophylaxis is now considered essential to conventional surgical procedure in order to reduce surgical site infections and improve postoperative recovery. The misuse and overuse of antibiotics has led to an increase in treatment costs and the emergence of antimicrobial resistance. The goal of the study is to identify the pattern of prophylactic antibiotic prescriptions for different surgical operations. Materials and methods: A retrospective observational study was conducted among 600 patients undergoing different surgeries in a tertiary care hospital of private setting in Dhaka, Bangladesh from July 2023 to December 2023. The demographic data, types of surgery, types of therapy, choice of antibiotic along with dosage formulations were collected. Results: Out of 600 patients, 245 (41%) were male and 355 (59%) were female. Highest bulk of patients were from Department of General Surgery (47.5%), followed by Department of Obstetrics & Gynecology (24.16%) and Department of Otolaryngology (16.7%). Surgical prophylactic antibiotic was used in all 600 patients, and all antibiotics were given in intravenous route (100%). Almost 505 patients (84.2%) had received ceftriaxone as antimicrobial agent. Ceftriaxone with metronidazole or gentamicin and Cefuroxime with metronidazole or amikacin drugs combination were given to 75 (12.5%) and Cefuroxime, Amikacin, Metronidazole drugs combination were given to 20 patients (3.3%). 3rd generation cephalosporin, Ceftriaxone, was the most commonly prescribed antibiotic as monotherapy (94.3%), followed by 2nd generation cephalosporin, cefuroxime (4%). Conclusion: Ceftriaxone was the preferred antibiotic for surgical prophylaxis. Existence of an antimicrobial guideline along with antibiotic stewardship program in every hospital could be helpful for prescribers to play role in containment of antimicrobial resistance. EWMCJ Vol. 12, No. 1&2, January-July 2024: 70-74

Prevalence, Molecular Characterization and Antibiogram Pattern of Livestock Associated Methicillin Resistant Staphylococcus aureus in Livebird Markets Gusau, Zamfara State, Nigeria

Study’s Excerpt The prevalence and antibiotic resistance patterns of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in poultry markets within the Gusau metropolis was examined. Phenotypic and molecular (PCR) detection methods were combined to identify the LA-MRSA isolates. Multidrug resistance (MDR) phenotypes were observed in 72.2% of the isolates. Full Abstract Poultry farms have been identified as hotspots for the emergence and spread of antibiotic-resistant bacteria, especially livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA). In this study, a total of 320 swab samples were randomly collected from fecal litter, Hands of poultry handlers, Soil, Feed, and Water from five different poultry markets in the Gusau metropolis. The LA-MRSA isolates involved were detected culturally and identified phenotypically by the use of PCR assay. The pooled prevalence of the LAMRSA isolates in the samples was 22(100%). The chi-square test was used to compare the prevalence of LAMRSA among the samples collected at 95% confidence interval and 0.05 level of significance. There is no statistically significant difference in the prevalence of LAMRSA among the samples. Findings from the antibiogram study conducted revealed that all the 22(100%) LAMRSA isolates were resistant to Penicillin antibiotics, with resistance to other antibiotics following the order: Nitrofurantoin, 17(77.3%), Sulphamethoxazole, 13(59.1%), Chloramphenicol 6(27.28%), Ciprofloxacin 5(22.7%) and Erythromycin 4(18.2%). A total of 14 multidrug resistant phenotypes were identified from the 22 LAMRSA isolates with 16(72.2%) demonstrating cross resistant to ≥3 of the six different classes of antibiotics used. The MDR rate in soil samples was the highest (27.3%) (p<0.05) compared to other MDR isolates from the other sources. Of all the isolates, 22(100%) demonstrated a MAR Index ranging from 0.2-0.8. These are disturbing trends with significant risks to humans and animals. Suggesting a potential for inoculation of self and transmission to others, particularly through those who sell and make daily contact with live birds. Therefore, the government should awaken the consciousness of poultry farmers/handlers by way of sensitization on the need to improve water quality and practice routine personal and environmental hygiene as it relates to poultry management, with a focus on antibiotic stewardship within the one health framework so as to lower endemicity and equally break the chain of transmission of LA- MRSA across the farm to fork continuum.

Characterization and Prevalence of Antibiotic Resistance Staphylococcus aureus in Street Food: A Public Health Concern

Food samples containing Staphylococcus aureus pose a serious health risk. This study aimed to examine the prevalence of S. aureus strains in various food samples sourced from Mailsi and Multan. Many food samples including yogurt, bakery products, and raw and cooked food were examined for S. aureus. The isolated strains were confirmed through Mannitol agar fermentation, catalase, coagulase, and urease tests. Hemolysis on blood agar and biofilm formation were also assessed to determine toxin production. Antibiotic sensitivity testing was conducted using the Kirby Bauer method on MH agar, and multiple antibiotics were tested. Out of all samples, a total of 50 S. aureus strains were obtained, mainly from milk and milk-based products. Yellow colonies on mannitol salt agar confirmed S. aureus presence, with all isolates testing positive for coagulase, catalase, and urease. The presence of hemolysins: beta, gamma, and alpha were revealed by hemolysis assays. Biofilm assay results showed variation among the strains, with some categorized as strong, moderate, or weak biofilm formers. Regarding antibiotic sensitivity, most strains exhibited multidrug resistance, particularly against certain antibiotics. Vancomycin showed varying susceptibility patterns, some strains showed susceptibility and intermediate resistance, whereas only milk samples showed resistance. This study emphasizes the prevalence of MDR S. aureus strains in food samples. The study underscores the significance of antimicrobial stewardship programs and stringent food safety measures in preventing the spread of antibiotic-resistant strains and reducing foodborne illnesses. Further research is needed to explore the mechanisms behind antibiotic resistance and toxin production in S. aureus strains from food samples.

Distribution and Molecular Characterization of Antibiotic-Resistant Pseudomonas aeruginosa in Hospital Settings of Sulaymaniyah, Iraq.

Pseudomonas aeruginosa is a significant pathogen in hospital settings, notorious for its role in hospital-acquired infections and its ability to develop resistance to multiple antibiotics. This study investigates the prevalence, distribution, and antibiotic resistance gene profiles of P. aeruginosa in seven hospitals in Sulaymaniyah City. A total of 300 samples were collected from various hospital surfaces including mops, sinks, medical equipment, beds, desks, and floors. Using bacteriological, biochemical, and molecular methods, 66 isolates were confirmed as Pseudomonas species, with 26 identified as P. aeruginosa. Antibiotic susceptibility testing revealed resistance rates of 23.3% to streptomycin, 13.6% to tobramycin, 22.7% to moxifloxacin, 21.2% to levofloxacin, and 22.7% to norfloxacin. Furthermore, the antibiotic resistance gene detection showed the presence of the bla CTX-M, bla SHV, qnrB, and bla ACC-1 genes among the isolates. The study highlights a 22% contamination rate of hospital surfaces with Pseudomonas species, emphasizing the urgent need for enhanced infection control measures and targeted antimicrobial stewardship to manage and reduce the spread of multidrug-resistant P. aeruginosa.

Antimicrobial resistance trends in Italian hospitals: insights from two point prevalence surveys

Abstract Background Antimicrobial resistance (AMR) presents a critical challenge to global healthcare systems, necessitating vigilant surveillance efforts. The European Centre for Disease Prevention and Control (ECDC) conducts point prevalence surveys (PPSs) to monitor AMR trends across European hospitals. This study focuses on comparing AMR patterns in Italian hospitals using data from two surveys: PPS2 (2016-2017) and PPS3 (2022-2023). Methods A total of 140 hospitals enrolling 28991 patients participated in PPS2, while 325 hospitals with 58506 patients contributed data to PPS3. Microbiological samples were collected and tested for antimicrobial susceptibility. Prevalence ratios (PR) with corresponding 95% confidence intervals (CI) were calculated to assess changes in resistance patterns between PPS2 and PPS3. Statistical significance was determined with p-value <0.05. Results Staphylococcus aureus showed a trend towards decreased oxacillin resistance, (PR: 0.77, 95% CI: 0.60 - 0.99). Enterococcus faecalis exhibited a non-significant decrease in glycopeptide resistance. Pseudomonas aeruginosa and Acinetobacter baumannii maintained stable carbapenem resistance between the two surveys. Escherichia coli and Klebsiella pneumoniae showed a decreasing trend in resistance to carbapenems and third-generation cephalosporins, but only Klebsiella pneumoniae was found to be significant (PR: 0.69, 95% CI: 0.55 - 0.88, p 0.004 and PR: 0.78, 95% CI: 0.66 - 0.94, p 0.01, respectively). Conclusions These findings underscore the importance of surveillance in monitoring AMR trends. Observed decreases, especially in Klebsiella pneumoniae, suggest potential improvements. However, the overall stability of resistance highlights the ongoing challenge of combating AMR. A multifaceted approach, including antimicrobial stewardship and One Health initiatives, is crucial to address this global health threat effectively. Key messages • Surveillance efforts are crucial to understand antimicrobial resistance (AMR) trends, as demonstrated by comparing data from two surveys in Italian hospital. • Results highlight the need for data-driven interventions, guiding future strategies within a One Health framework to address antimicrobial resistance comprehensively.

Antimicrobial resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa isolates from bloodstream infections in Australian children, 2013-2021.

Gram-negative bloodstream infections are associated with significant morbidity and mortality in children. Increasing antimicrobial resistance (AMR) is reported globally, yet efforts to track pediatric AMR at a national level over time are lacking. The Australian Group on Antimicrobial Resistance (AGAR) surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for MIC interpretation and the AMR package in R for data analysis. Over a nine-year period, there were 3,145 bloodstream infections with 3,266 gram-negative isolates reported in hospitalized children aged <18 years; 21.0% were from neonates. The median length of stay was 9 days, and 30-day all-cause mortality was 5.2%. A greater odds of death was observed in those with a multi-drug resistant organism (aOR: 2.1, 95%CI: 1.3, 3.3, p: 0.001). Escherichia coli (44.5%) and Klebsiella pneumoniae complex (12.6%) were the two most frequently reported organisms. Overall resistance in Enterobacterales to gentamicin/tobramycin was 11.6%, to ceftazidime/ceftriaxone was 12.9%, and 13.2% to ciprofloxacin. Resistance increased over time.Of 201 Pseudomonas aeruginosa isolates reported, 19.7% were resistant to piperacillin-tazobactam, 13.1% resistant to cefepime/ceftazidime and 9.8% to ciprofloxacin. Of 108 Acinetobacter spp. isolates, one was resistant to meropenem, and two were resistant to ciprofloxacin. Resistance did not increase over time. AMR in gram-negative organisms causing bloodstream infections in Australian children is increasing which should be considered when updating guidelines and empiric treatment regimens. Ongoing pediatric-specific national surveillance with pediatric reporting must remain a priority to strengthen antimicrobial stewardship and infection control programs.

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Assessment of an Antimicrobial Stewardship Program for Enhancing Clinical Knowledge in Neonatal Care Settings With High Antimicrobial Resistance.

Antimicrobial resistance (AMR) is a global problem, which is particularly challenging in developing countries like India. This study attempts to determine the competencies of health care professionals and to update evidence-based policies to address AMR. A survey-based educational interventional study was conducted using a validated structured survey and knowledge questionnaire under 3 domains through an antimicrobial stewardship program. Pooled data were analyzed using SPSS version 16.0. Out of 58 participants, 53 (91%) have observed an increasing trend of multidrug-resistant infections over the last 5years. There is a significant difference between the overall pretest mean scores (8.12±2.10) and posttest mean scores (12.5±1.49) of clinicians' knowledge with a mean difference of 4.38±0.61, 95% CI of 5.003-3.92, t(57)=16.62, P <.001). The antimicrobial stewardship program was effective in improving the competencies of clinical physicians to improve antimicrobial prescribing and reduce AMR. Moreover, improving the knowledge and competencies among health care professionals will minimize neonatal morbidity and mortality.

Self-assessed levels of preparedness, engagement willingness and teaching preferences on antibiotic use of medical and pharmacy students in Romanian universities: a cross-sectional study

BackgroundTo effectively support health professionals in optimizing antibiotic prescribing and dispensing, policymakers need to understand how these professionals are trained, feel prepared and want to be educated. The study aimed to assess the current situation and explore potential improvements in antibiotic use among future health professionals in Romania by: (i) evaluating their self-assessed preparedness on antibiotic-related topics, (ii) understanding their perceptions of their role in antibiotic stewardship, and (iii) gathering their recommendations for optimizing antibiotic use.MethodsA survey of students’ self-assessment of technical preparedness, engagement willingness, expectations, teaching preferences, training received and evolution of situation in Romania. Overall, 41 and 38 questions were asked to medical and pharmacy students respectively. Scores were calculated for preparedness, engagement willingness and teaching preferences to enable various comparisons. Exploratory factor analysis was used to explore the questionnaire construct.ResultsA total of 479 participants completed the survey- 233 medical students from 7 universities and 246 pharmacy students from 4 universities. Median overall preparedness score indicated that most students felt prepared in at least 14 questions (out of 22 for medical students, and 19 for pharmacy students). Engagement scores for medical and pharmacy students were similar (2 and 3 out of 4). Overall, more than half reported that ‘yes, very likely’ they received adequate training to ensure the appropriate use of antibiotics in their professional areas (n = 254, 53.5%). Medical and pharmacy students with low preparedness scores expressed a need for more education. Most of both medical and pharmacy students considered the antibiotic situation in Romania ‘will get worse’ (n = 159, 33.5%).ConclusionsThe study’s findings have important implications for the education and training of future Romanian health professionals and highlight the need for further research on optimal and standardized tools to allow for periodic monitoring and evaluation of progress into preparedness, engagement willingness and teaching preferences on antibiotic use.

Risk factors associated with multidrug-resistant Klebsiella pneumoniae infections: a multicenter observational study in Lebanese hospitals

BackgroundKlebsiella pneumoniae is a significant global public health burden, especially in low-income countries and regions with fragile healthcare infrastructures, due to its ability to cause severe infections, increase mortality rates, and its rising antimicrobial resistance. This study aimed to estimate the proportion of multidrug-resistant (MDR) K. pneumoniae infections and identify associated risk factors.MethodsData were retrospectively collected from three academic hospitals in Beirut, Lebanon, between January 2021 and September 2023 using a standardized form. Binary logistic regression was used to determine risk factors associated with MDR, extended-spectrum beta-lactamase (ESBL)-producing, and carbapenem-resistant K. pneumoniae (CRKP) infections.ResultsOut of 2,655 K. pneumoniae cases, 410 met the inclusion criteria. The primary infection sources were the urinary tract (58.3%) and the respiratory tract (12.4%). Among the isolates, 61% were MDR K. pneumoniae, with 7.3% being extensively drug-resistant, and 0.5% pandrug-resistant. Additionally, 36.8% were ESBL-producing, while 6.3% were CRKP. Predictors significantly associated with MDR K. pneumoniae infections included male sex (adjusted odds ratio [AOR] = 3.46, 95% CI = 1.01–11.86, P = 0.04), recent antibiotics use (AOR = 4.52, 95% CI = 1.65–12.36, P = 0.003), and recent cancer chemotherapy (AOR = 3.43, 95% CI = 1.25–9.42, P = 0.01). ESBL-producing infections were associated with age ≥ 65 years, higher Charlson Comorbidity Index (CCI), and recent antibiotic use. CRKP infections were linked to male sex, prior antibiotic use, and longer hospital stays prior to infection (all P < 0.05).ConclusionsMDR K. pneumoniae infections are steadily rising in Lebanon, along with an increase in ESBL-producing and CRKP cases. The main risk factors for MDR K. pneumoniae infections were male sex, recent antibiotic use, and cancer chemotherapy. ESBL-producing infections were associated with advanced age, higher CCI, and recent antibiotic use, while CRKP infections were linked to male sex, prior antibiotic use, and prolonged hospital stays. This situation is further exacerbated by inadequate healthcare infrastructure and suboptimal national surveillance. Strengthening local surveillance and implementing effective antibiotic stewardship programs are critical to managing this growing threat..

Prevalence of extended-spectrum β-lactamase-producing Enterobacterales and carbapenemase-resistant Enterobacterales in British military cohorts

IntroductionTravel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated...

Point-of-care procalcitonin trends in suspected neonatal late-onset infection: a prospective observational study.

Procalcitonin-guided antimicrobial decision-making has been shown to be safe in adult intensive care settings. Most antimicrobial exposure in neonatal units is in culture-negative conditions. We hypothesise that Procalcitonin aids antimicrobial stewardship efforts in suspected Late-Onset Neonatal Sepsis. Neonates were enrolled if they were aged over 72 h and were placed on antibiotics for a suspected infection. Procalcitonin levels were taken at set timepoints for the duration of antimicrobial exposure. Three subgroups were created: non-infectious episodes, blood culture-negative infectious episodes, and bloodstream infections. Eighty-five suspected infectious episodes were recruited across two tertiary neonatal and paediatric intensive care units. There was a significant difference between the median PCT in bloodstream infections (BSI) compared to non-infectious episodes (2.13 versus 0.26 µg/L, p < 0.001). A cut-off of 0.5 µg/L had sensitivity 92.9% and specificity 68% for bloodstream infections at 24 h. The difference between median PCT values at 24 h was significant (0.27 vs 7.08; p < 0.001) for feed intolerance vs. NEC Grade IIIa-IIIb subgroups. Procalcitonin levels taken 24 h following evaluation for late-onset neonatal infection are useful in out ruling BSI or severe Necrotising Enterocolitis. Up to 30% of antimicrobial exposure could be avoided with the use of Procalcitonin levels in low-risk neonates. This study demonstrates the utility of serial Procalcitonin measurements in antimicrobial stewardship efforts in the Neonatal Unit. Procalcitonin can be used to aid in antimicrobial decision making in suspected Late-Onset neonatal infection. Procalcitonin testing at twenty-four hours in episodes of Gastrointestinal deterioration can out rule Bells Grade III Necrotising Enterocolitis.

Evaluation of the perspective of pharmacists on antimicrobial stewardship and the barriers to its consolidation in hospitals: a cross-sectional study.

Antimicrobial Stewardship Programs (ASPs) are associated with positive outcomes, but seem to be consolidated in few hospitals. This study aimed to evaluate ASPs in Brazilian hospitals and the barriers to their consolidation from the pharmacists' perspective. This is a cross-sectional study. Data were collected through an online questionnaire applied to hospital pharmacists. Data analysis was performed by descriptive statistics and Spearman's ordinal correlation test. A total of 83 pharmacists participated in the study and 45.8% stated that the hospital in which they worked had an ASP. The ASPs were predominantly implemented in public hospitals, with a greater number of beds in the intensive care unit and beds in general. The main barriers to the consolidation of ASPs were: reduced number of pharmacists, time allocated to other demands of the pharmacy, the ineffectiveness of the communication process with doctors, and lack of access to reliable information about antimicrobials in the hospital. Pharmacists that work in hospitals where ASPs were implemented were more confident (p = 0.000) and with a better perception of the barriers that prevent their consolidation (p = 0.003. The ASP was commonly adopted in public hospitals with a greater number of beds. The main obstacles to consolidation were infrastructure, economic, and educational resources.

Antimicrobial Stewardship in Healthcare: Exploring the Role of Nurses in Promoting Change, Identifying Barrier Elements and Facilitators-A Meta-Synthesis.

Antimicrobial stewardship (AMS) involves a coordinated set of actions aimed at promoting the appropriate use of antibiotics within healthcare settings. This systematic review of qualitative studies assessed nurses' knowledge and perceptions of the barriers and facilitators that impact their involvement in AMS programs. This meta-synthesis followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Relevant studies published between 2018 and 2023 were identified through searches on PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar. The studies were critically appraised using the CASP checklist, with 19 articles meeting the inclusion criteria from five continents. Six recurring themes emerged from the analysis of nurses' experiences and opinions regarding their roles in AMS programs. These themes included the organization of AMS programs, availability of resources, training and education, communication, and the evolving role of nurses in AMS. Nurses at every level of the profession might play a crucial role in antimicrobial stewardship. Although active involvement of nurses in antibiotic stewardship requires further exploration and research, this topic is being examined internationally. The literature on this subject primarily analyzes the phenomenon from a quantitative perspective rather than a qualitative one, and it is contextualized more within hospital settings rather than community settings.

Expanding the β-Lactamase Family in the Human Microbiome.

β-lactams, the most common antibiotics globally, have resistance primarily determined by β-lactamases. Human microbiota and β-lactams influence mutually; however, β-lactamase variety and abundance in the human microbiome remain partially understood. This study aimed to elucidate the diversity, abundance, and substrate spectrum of β-lactamases. 1369 characterized β-lactamases and 16204 putative sequences are collected from protein databases. Upon clustering analysis and biochemical assays, nine proteins exhibiting less than 35% identity to those previously characterized are confirmed as β-lactamases. These newly identified β-lactamases originated from eight distinct clusters comprising 1163 β-lactamases. Quantifying healthy participants (n = 2394) across 19 countries using functionally confirmed clusters revealed that Japan have the highest gut β-lactamase abundance (log2[reads per million (RPM)] = 6.52) and Fiji have the lowest (log2[RPM] = 2.31). The β-lactamase abundance is correlated with β-lactam consumption (R = 0.50, p = 0.029) and income (R = 0.51, p = 0.024). Comparing individuals with ailments with healthy participants, β-lactamase abundance in the gut is increased significantly in patients with colorectal cancer, cardiovascular diseases, breast cancer, and epilepsy. These outcomes provide insights into investigating antibiotic resistance, antibiotic stewardship, and gut microbiome-antibiotic interactions.

Insights into Acinetobacter baumannii AMA205's Unprecedented Antibiotic Resistance.

The rise of antibiotic-resistant bacteria in clinical settings has become a significant global concern. Among these bacteria, Acinetobacter baumannii stands out due to its remarkable ability to acquire resistance genes and persist in hospital environments, leading to some of the most challenging infections. Horizontal gene transfer (HGT) plays a crucial role in the evolution of this pathogen. The A. baumannii AMA205 strain, belonging to sequence type ST79, was isolated from a COVID-19 patient in Argentina in 2021. This strain's antimicrobial resistance profile is notable as it harbors multiple resistance genes, some of which had not been previously described in this species. The AmpC family β-lactamase blaCMY-6, commonly found in Enterobacterales, had never been detected in A. baumannii before. Furthermore, this is the first ST79 strain known to carry the carbapenemase blaNDM-1 gene. Other acquired resistance genes include the carbapenemase blaOXA-23, further complicating treatment. Susceptibility testing revealed high resistance to most antibiotic families, including cefiderocol, with significant contributions from blaCMY-6 and blaNDM-1 genes to the cephalosporin and carbapenem resistance profiles. The A. baumannii AMA205 genome also contains genetic traits coding for 111 potential virulence factors, such as the iron-uptake system and biofilm-associated proteins. This study underscores A. baumannii's ability to acquire multiple resistance genes and highlights the need for alternative therapies and effective antimicrobial stewardship to control the spread of these highly resistant strains.

Antimicrobial Stewardship Programmes: Healthcare Providers’ Perspectives on Adopted Hospital Policies That Combat Antibacterial Resistance in Selected Health Facilities in Uganda

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 &lt; 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 &lt; 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 &lt; 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.

Adult penicillin allergy programmes in Australian hospitals: a practical guide from the National Antibiotic Allergy Network.

Penicillin allergy is a significant burden on patient, prescribing and hospital outcomes. There has been increasing interest in the incorporation of penicillin allergy testing (i.e. delabelling) into antimicrobial stewardship (AMS) programmes to reduce the burden of penicillin allergy labels and improve prescribing. In particular, there has been a focus on point-of-care penicillin allergy assessment and direct oral challenge for low-risk phenotypes. The National Antibiotic Allergy Network has provided a guide to assist AMS clinicians with the incorporation of penicillin allergy programmes, in particular direct oral challenge, into Australian hospitals.