Antimicrobial Stewardship Research Articles

Optimizing antibiotic stewardship and reducing antimicrobial resistance in Central Asia: A study protocol for evidence-based practice and policy.

Antimicrobial resistance (AMR) poses a significant global health challenge, prompting the World Health Organization (WHO) to stress the importance of monitoring antibiotic consumption and sales to address AMR effectively. This study protocol aims to optimize antibiotic stewardship and combat AMR in Central Asia through evidence-based practices and policies. The protocol includes objectives such as conducting systematic reviews of interventions to promote judicious antibiotic use, assessing antibiotic consumption trends, and investigating antibiotic overuse practices among healthcare providers. The study aims to raise awareness among stakeholders to enhance appropriate antibiotic prescribing practices. By establishing regulatory frameworks, monitoring policies' effectiveness, and providing training programs for healthcare professionals, this study seeks to contribute to the global efforts in combating AMR and promoting prudent antibiotic use.

The appropriateness of self-care policy for urinary tract infections among women from racialised minorities and low-income households in the United Kingdom: A qualitative study.

Urinary tract infections (UTIs) can negatively impact quality of life, especially when recurring. Patients often seek medical advice to relieve painful symptoms. UTIs are also the second most common reason antibiotics are prescribed in English primary care. However, overuse and long-term use of antibiotics for suspected UTIs in women can lead to antibiotic-resistant bacteria, making future treatments less effective. The UK's 2019-24 Antimicrobial Resistance National Action Plan aims to raise public awareness about the risks of overusing antibiotics and encourages self-care for minor infections, like uncomplicated UTIs. We explored how feasible and appropriate this approach is. The transcripts from four online focus groups and 19 one-to-one online interviews involving 25 racialised minority and/or low-income women were analysed thematically. Meetings with lay members of the public with similar socio-demographics and experiences to those we planned on recruiting for the research helped to orientate the study, refine its materials and enhance its recruitment strategies. All participants spoke about UTI-related anxieties, which they experienced differently depending on the frequency and the course of UTI episodes, and how knowledgeable they were about the symptoms. Participants often practised self-care for UTIs before seeking professional advice. They saw consultations with health care professionals as valuable for managing the symptoms of UTIs and navigating self-care options. Those with recurrent UTIs felt they could recognise when they required antibiotics and, therefore, they felt they could take responsibility for minimising overprescribing. Barriers to self-care included high pressure working days and not being able to take time off work to recover. Participants in our study were often able to self-diagnose and assess the severity of their symptoms, which makes them partners in efforts to improve antibiotic stewardship. They still valued consulting professionals for advice and support about their UTIs, irrespective of whether they received a prescription.

Biomarker-guided antibiotic stewardship in neonatology: time for implementation?

Biomarker-guided antibiotic stewardship in neonatology: time for implementation?

Critical care services in Bagmati province of Nepal: A cross sectional survey

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone survey. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Molecular Epidemiological Characteristics of Staphylococcus pseudintermedius, Staphylococcus coagulans, and Coagulase-Negative Staphylococci Cultured from Clinical Canine Skin and Ear Samples in Queensland.

Background/Objectives: Infections in dogs caused by methicillin-resistant staphylococci (MRS) present limited treatment options. This study's objective was to investigate the molecular epidemiology of Staphylococcus spp. cultured exclusively from clinical canine skin and ear samples in Queensland, Australia, using whole-genome sequencing (WGS). Methods: Forty-two Staphylococcus spp. isolated from clinical canine skin and ear samples, from an unknown number of dogs, were sourced from two veterinary diagnostic laboratories between January 2022 and May 2023. These isolates underwent matrix-assisted laser desorption ionisation- time of flight bacterial identification, minimum inhibitory concentration testing using SensititreTM plates and WGS. Phylogenetic trees and core genome multilocus sequence typing (cgMLST) minimum spanning trees (MSTs) were constructed. Results: The isolates included methicillin-resistant and -sensitive S. pseudintermedius (MRSP: 57.1%, 24/42; and MSSP: 19.1%, 8/42), methicillin-resistant and -sensitive S. coagulans (MRSC: 14.3%, 6/42; and MSSC: 2.4%, 1/42) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS: 7.1%, 3/42). Thirty-nine isolates were included after WGS, where all MRS harboured the mecA gene. Eighteen sequence types (STs) were identified, including three novel MRSP and six novel MSSP STs. MRSP ST496-V-VII (23%; 9/39) and MRSP ST749-IV-(IVg) (12.8%; 5/39) were commonly isolated. Phylogenetic analysis of single nucleotide polymorphisms showed that MRSP, MRSC and MSSC were similar to globally isolated staphylococci from canine skin and ear infections. Using cgMLST MSTs, MRSP isolates were not closely related to global strains. Conclusions: Our findings revealed a genotypically diverse geographical distribution and phylogenetic relatedness of staphylococci cultured from clinical canine skin and ear samples across Queensland. This highlights the importance of ongoing surveillance to aid in evidence-based treatment decisions and antimicrobial stewardship.

Phenotypic Antibiotic Resistance Patterns of Escherichia coli Isolates from Clinical UTI Samples and Municipal Wastewater in a Grenadian Community.

Antimicrobial resistance (AMR) is a growing global health threat. This study investigated antibiotic resistance in E. coli isolates from municipal wastewater (86 isolates) and clinical urinary tract infection (UTI) cases (34 isolates) in a Grenadian community, using data from January 2022 to October 2023. Antibiogram data, assessed per WHO guidelines for Critically Important antimicrobials (CIA), showed the highest resistance levels in both clinical and wastewater samples for ampicillin, followed by amoxicillin/clavulanic acid and nalidixic acid, all classified as Critically Important. Similar resistance was observed for sulfamethoxazole-trimethoprim (highly important) in both groups, with nitrofurantoin showing resistance in the important category. According to the WHO AWaRe classification, ampicillin (ACCESS group) had the highest resistance, while nitrofurantoin had the lowest across all samples. The WATCH group antibiotics, cefuroxime and cefoxitin, showed comparable resistance levels, whereas aztreonam from the RESERVE group (tested only in wastewater) was 100% sensitive. Multiple Antibiotic Resistance (MAR) index analysis revealed that 7% of wastewater and 38.2% of clinical samples had MAR values over 0.2, indicating prior antibiotic exposure in clinical isolates. These parallel patterns in wastewater and clinical samples highlight wastewater monitoring as a valuable tool for AMR surveillance, supporting antibiotic stewardship through ongoing environmental and clinical assessment.

Breaking the monotony: Exploring the approach of game-based learning in students’ understanding of antimicrobials and antimicrobial resistance

Objectives: The primary objective of the study was to evaluate students’ understanding of the subject through GBL compared to traditional didactic lectures. The secondary objective was to evaluate the perception and feedback of students regarding the GBL. Materials and Methods: After didactic lectures over a month, a pre-test was conducted for the whole batch. Following this, GBL was conducted for the entire batch. A virtual board numbered from 1 to 100 was prepared and played with virtual dice and game pieces. The board had colour-coded antibiotics (blue in colour), microorganisms (yellow in colour) and mutated organisms (red in colour). The player had to move either ahead or back based on the block he landed on. A set of questions were prepared, which varied from lower-order questions to higher-order thinking. The lower order questions included drug of choice, mechanism of action, uses and adverse effects, WhatsApp emoji-based questions, match the following, word puzzle and image-based questions. The higher-order questions included case scenarios with irrational antibiotic prescriptions and drug-resistant cases. The students had to analyse the treatment given and comment upon it. Furthermore, questions related to antimicrobial stewardship were asked so that students were able to understand the importance of the antimicrobial stewardship programme as well. After every question, a brief discussion about the condition and different options was done so that the students understand the subject and learn to critically evaluate the antimicrobials prescribed. After this activity, a post-test was conducted. Results: On comparing the pre-test (14.46 ± 0.29) and post-test scores (17.55 ± 0.26*), it was noted that students performed better in the post-test (*P < 0.0001). Students’ feedback regarding GBL revealed that this innovative teaching learning method was enjoyable. It helped them to interact and understand the concepts better. Conclusion: Therefore, virtual board game on antimicrobials is easy, affordable and can be implemented at every institution, especially in developing countries where there is rampant usage of antimicrobials.

Postoperative prophylactic antibiotics were not associated with decreased surgical site infections following hemilaminectomy in dogs: a retrospective study.

To compare hemilaminectomy surgical site infection (SSI) rates in dogs treated with or without postoperative prophylactic antibiotics. Medical records of 275 client-owned dogs from 1 tertiary referral hospital were retrospectively reviewed for dogs treated with thoracolumbar hemilaminectomy for intervertebral disk herniation between 2018 and 2023. Dogs were grouped according to whether they were treated with prophylactic postoperative antibiotics (group A) or not (group B). Relevant case details including dog signalment, duration of anesthetic procedure, method of incision closure, perioperative and prophylactic postoperative antibiotic prescription, and diagnosis of postoperative SSI (as defined by the CDC) were recorded. Wilson binomial CIs were calculated for SSI rates. Surgical site infection rates between dogs given or not given antibiotics were analyzed with a Fisher exact test. The overall SSI rate was 3% (8 of 275; 95% CI, 1% to 6%). The SSI rate in group A was 3% (5 of 147; 95% CI, 1% to 8%), which was not statistically different from the 2% SSI rate (3 of 128; 95% CI, 1% to 7%) in group B (P = .728). There was not a statistical difference in SSI rates between closure methods (intradermal absorbable, 1% [1 of 79]; cutaneous staples, 4% [7 of 184]; cutaneous nylon, 0% [0 of 12]; P = .611). Overall hemilaminectomy SSI rates in this study were low, and prescription of prophylactic antibiotics was not associated with a decreased SSI rate. Practicing antimicrobial stewardship through avoidance of antimicrobial prophylaxis in clean surgical procedures may not be clinically detrimental to outcomes in hemilaminectomy dogs.

Home visit survey on outpatient antibiotic use: Assessing leftover medications and factors influencing appropriate use by community Pharmacists.

This cross-sectional study investigated the prevalence and factors associated with leftover antibiotics in Japanese households through pharmacist home visits. The research, conducted in collaboration with pharmaceutical associations in Kyoto and Hirakata, included 37 cases analyzed from October 2023 to March 2024. Participants had a median age of 81 years and received a median of two antibiotic prescriptions in the past year. Leftover antibiotics were found in 18.9% of cases, with 5 out of 7 cases resulting from prophylactic prescriptions. Levofloxacin was the most common leftover antibiotic. Notably, 27.0% of participants reported a history of reusing leftover antibiotics. Logistic regression analysis revealed that frequent pharmacist visits (≥2/month) were significantly associated with decreased leftover antibiotics (adjusted OR: 0.02, 95% CI: 0.00-0.48, p=0.015), whereas a history of antibiotic reuse increased the likelihood of leftovers (adjusted OR: 20.32, 95% CI: 1.78-231.33, p=0.015). Other factors, including the number of antibiotic prescriptions and the presence of medication support, did not show statistically significant associations. This study highlights the potential role of community pharmacists in promoting appropriate antibiotic use and managing leftover medications through home healthcare engagement. The findings suggest that regular pharmacist interventions could significantly improve medication management and contribute to antimicrobial stewardship efforts. Future research should replicate these findings in larger, more diverse populations to enhance generalizability and further explore the long-term impact of pharmacist interventions on antibiotic use patterns.

Influence of Sequencing Technology on Pangenome-level Analysis and Detection of Antimicrobial Resistance Genes in ESKAPE Pathogens.

This study provides a comprehensive comparison of short-read (Illumina) and long-read (Oxford Nanopore Technologies, ONT) sequencing technologies in the context of antimicrobial resistance (AMR) detection in ESKAPE pathogens. By analyzing a large dataset of 1,385 whole genome sequences, the research offers valuable insights into the strengths and limitations of each approach, as well as the benefits of the novel approach of hybrid assembly. These findings have broad utility across microbiology, genomics, and infectious disease research. In particular, they apply to the work of researchers and clinicians dealing with AMR surveillance, investigation into outbreaks, and bacterial genome analysis. Given the nuance with which technological differences in genomic completeness, pangenome structure, and AMR determinant detection have been explored in this study, it is a good basis for informed method selection for future research. While the output represents an incremental advance, its significance lies in its practical implications. It thus enables researchers to take more reasonable decisions in designing genomic studies of bacterial pathogens by showing the complementarity of various sequencing approaches and their specific strengths. This could lead to more accurate and comprehensive detection of AMR, which would contribute ultimately to improved antibiotic stewardship and public health strategies. The authors confirm all supporting data, code and protocols have been provided within the article or through supplementary data files. All the sequences used for this study are publicly accessible from GenBank, and their individual IDs are disclosed in Supplementary Table 1.

The Role of ChatGPT and AI Chatbots in Optimizing Antibiotic Therapy: A Comprehensive Narrative Review.

Background/Objectives: Antimicrobial resistance represents a growing global health crisis, demanding innovative approaches to improve antibiotic stewardship. Artificial intelligence (AI) chatbots based on large language models have shown potential as tools to support clinicians, especially non-specialists, in optimizing antibiotic therapy. This review aims to synthesize current evidence on the capabilities, limitations, and future directions for AI chatbots in enhancing antibiotic selection and patient outcomes. Methods: A narrative review was conducted by analyzing studies published in the last five years across databases such as PubMed, SCOPUS, Web of Science, and Google Scholar. The review focused on research discussing AI-based chatbots, antibiotic stewardship, and clinical decision support systems. Studies were evaluated for methodological soundness and significance, and the findings were synthesized narratively. Results: Current evidence highlights the ability of AI chatbots to assist in guideline-based antibiotic recommendations, improve medical education, and enhance clinical decision-making. Promising results include satisfactory accuracy in preliminary diagnostic and prescriptive tasks. However, challenges such as inconsistent handling of clinical nuances, susceptibility to unsafe advice, algorithmic biases, data privacy concerns, and limited clinical validation underscore the importance of human oversight and refinement. Conclusions: AI chatbots have the potential to complement antibiotic stewardship efforts by promoting appropriate antibiotic use and improving patient outcomes. Realizing this potential will require rigorous clinical trials, interdisciplinary collaboration, regulatory clarity, and tailored algorithmic improvements to ensure their safe and effective integration into clinical practice.

Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey.

Early detection, standardized therapy, adequate infrastructure and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute hospitals. A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives in hospitals. 1023 hospitals in 69 countries were included. Most of them, 835 (81.6%) were from Europe. Sepsis screening was used in 54.2% of emergency departments(EDs), 47.9% of wards, and 61.7% of intensive care units(ICUs). Sepsis management was standardized in 57.3% of EDs, 45.2% of wards and in 70.7% of ICUs. The implementation of comprehensive quality improvement initiatives(QIIs) was associated with increased screening (EDs +33.3%; wards +44.4%; ICUs +23.8% absolute difference) and increased standardized sepsis management (EDs +33.6%; wards +40.0%; ICUs: +17.7% absolute difference) compared to hospitals without QIIs. 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regards to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

From Cure to Crisis: Understanding the Evolution of Antibiotic-Resistant Bacteria in Human Microbiota.

The growing prevalence of antibiotic-resistant bacteria within the human microbiome has become a pressing global health crisis. While antibiotics have revolutionized medicine by significantly reducing mortality and enabling advanced medical interventions, their misuse and overuse have led to the emergence of resistant bacterial strains. Key resistance mechanisms include genetic mutations, horizontal gene transfer, and biofilm formation, with the human microbiota acting as a reservoir for antibiotic resistance genes (ARGs). Industrialization and environmental factors have exacerbated this issue, contributing to a rise in infections with multidrug-resistant (MDR) bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae. These resistant pathogens compromise the effectiveness of essential treatments like surgical prophylaxis and chemotherapy, increase healthcare costs, and prolong hospital stays. This crisis highlights the need for a global One-Health approach, particularly in regions with weak regulatory frameworks. Innovative strategies, including next-generation sequencing (NGS) technologies, offer promising avenues for mitigating resistance. Addressing this challenge requires coordinated efforts, encompassing research, policymaking, public education, and antibiotic stewardship, to safeguard current antibiotics and foster the development of new therapeutic solutions. An integrated, multidimensional strategy is essential to tackle this escalating problem and ensure the sustainability of effective antimicrobial treatments.

Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial.

Procalcitonin is a rapid response biomarker specific for bacterial infection, which is not routinely used in the UK National Health Service. We aimed to assess whether using a procalcitonin-guided algorithm would safely reduce the duration of antibiotic therapy compared with usual care, in which C-reactive protein is the commonly used biomarker. The BATCH trial was a pragmatic, multicentre, open-label, parallel, two-arm, individually randomised, controlled trial conducted in 15 hospitals in England and Wales. Children aged 72 h to 18 years who were admitted to hospital and were being treated with intravenous antibiotics for suspected or confirmed bacterial infection and who were expected to remain on intravenous antibiotics for more than 48 h were enrolled. Participants were randomly assigned (1:1) to receive either current clinical management alone (usual care group) or clinical management with the addition of a procalcitonin test guided algorithm (procalcitonin group). Participants were randomly assigned by minimisation, with site and age group (0-6 months, 6 months to 2 years, 2-5 years, and older than 5 years) as minimisation factors and a random element to reduce predictability. Participants were randomly assigned remotely using a secure 24 h web-based randomisation programme. The coprimary outcomes were duration of intravenous antibiotic use, assessed for superiority, and a composite safety measure, assessed for non-inferiority (non-inferiority margin 5%). The primary analysis sample for each coprimary endpoint included all randomly assigned participants with available outcome data. This trial is registered with the International Standard Randomised Controlled Trial Number registry, ISRCTN11369832. Between June 11, 2018, and Oct 12, 2022, 15 282 children were screened for eligibility, 1949 of whom were randomly assigned to receive procalcitonin-guided antibiotic therapy (n=977) or usual care (n=972). The median intravenous antibiotic duration was 96·0 h (IQR 59·5-155·5) in the procalcitonin group and 99·7 h (61·2-153·8) in the usual care group (hazard ratio 0·96 [95% CI 0·87-1·05]). 78 (9%) of 917 participants in the procalcitonin group and 85 (9%) of 904 participants in the usual care group had at least one event covered by the composite safety outcome measure (estimated adjusted risk difference -0·81% [95% CI upper bound 1·11]). In children with suspected or confirmed bacterial infection admitted to hospitals in England and Wales for intravenous antibiotic treatment of at least 48 h, the introduction of a procalcitonin-guided algorithm did not reduce duration of intravenous antibiotics treatment and is non-inferior to usual care for safety outcomes. Therefore, evidence does not support the use of procalcitonin-guided algorithms where robust effective paediatric antibiotic stewardship programmes are established. National Institute for Health and Care Research.

Viability assessment of Chlamydia trachomatis in men who have sex with men using molecular and culture methods.

Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection (STI) worldwide. Diagnosis relies on nucleic acid amplification techniques, such as PCR, which does not distinguish between viable pathogens and residual bacterial DNA, leading to potential overdiagnosis and overtreatment. PCR with confirmation of pathogen viability has not been widely explored in the STI field. Our aim was to establish a C. trachomatis viability PCR (V-PCR) and to apply it to anorectal swabs from men who have sex with men (MSM). We performed validation of a published V-PCR protocol by preparing artificial samples with known ratios of viable and non-viable C. trachomatis. Mock samples were treated with propidium monoazide (PMAxxTM) before DNA extraction and quantitative PCR (qPCR) to detect C. trachomatis. The V-PCR was then applied to C. trachomatis PCR-positive anorectal swabs from MSM. Viability was expressed as the difference in C. trachomatis (CT) copies between PMAxxTM untreated and treated samples (ΔLog10 CT/mL). The anorectal samples were inoculated in cell culture for isolation. Genotyping was performed by examining the ompA gene sequence. Of 236 anorectal swabs, 69 (29.2%) were C. trachomatis PCR-positive, and we obtained V-PCR data from 54. There were 7/54 (12.9%), samples with <1% viable CT (>2.52 ΔLog10 CT/mL) 4/54 (7.4%) samples with 1%-10% viable CT (1.59-2.52), 16/54 (29.6%) with 10.01-50% viable CT (0.86-1.59) and 27/54 (50.0%) with 50.01%-100% viable CT (<0.35-0.86). C. trachomatis was isolated successfully from 39/69 (56.5%) samples in cell culture. Genotypes based on ompA were obtained for 62/69 (89.9%) samples: G (n=15/62), D/Da (n=15/62), J (n=15/62), E (n=11/62), L1 (n=4/62) and L2 (n=2). We successfully implemented a viability test based on PCR, which can distinguish, detect and quantify viable C. trachomatis in anorectal swabs from MSM. Rapid, reliable assessment of C. trachomatis viability could help to improve antimicrobial stewardship.

Evaluating an urgent care antibiotic stewardship intervention: a multi-network collaborative effort.

Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs. A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention. Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site. Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association. The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation. Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33-0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55-0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged. This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.

Logistic Stewardship: Supporting Antimicrobial Stewardship Programs Based on Antibiotics Goods Flow.

Antimicrobial resistance is a global threat to safe health care, and a reduction in antibiotic consumption seems to be an appropriate preventive measure. In Germany, the reporting of hospital antibiotics consumption to an independent institution is only voluntary. Although a high level of willingness to improve can be assumed in the case of participation, the median consumptions of reporting hospitals change only slightly. This study examines the question of whether the logistical consumption figures adequately reflect real consumption, and if not, how to optimize the use of logistical data for clinical decisions. Four selected wards were analyzed during six months. A retrospective analysis of patient case files was performed to receive "prescribed daily doses" (PDDs). These were compared to "defined daily doses" (DDDs) from logistical data. Additional inventories were performed to calculated stored antibiotics. Antibiotics goods flows were presented via waterfall diagrams to identify logistic patterns that could explain PDD/DDD quotients. Antimicrobial stewardship (AMS) quality indicators were analyzed to give advice for optimized clinical AMS measures. The total PDD/DDD quotient was 0.69. Four logistical patterns were identified. Optimized prophylaxis, AMS consultations and reevaluation of therapy seem to be the most useful measures to reduce PDDs. If AMS programs rely solely on DDDs, measures cannot be optimal. A complete consideration of antibiotic goods flows supports clinical decisions, but is very costly in terms of data collection. The consideration of logistical data can help to identify areas of focus for AMS programs. Therefore, specialists of antibiotics logistics should complement clinical AMS teams.

REVIEW OF PHARMACOLOGICAL STRATEGIES FOR REDUCING ANTIBIOTIC RESISTANCE IN HEALTHCARE SETTINGS

Background: Antibiotic resistance is a significant global health challenge, jeopardizing the efficacy of antibiotics and leading to increased healthcare costs, patient morbidity, and mortality. Objectives: This review explores key pharmacological strategies to combat antibiotic resistance, highlighting their effectiveness, challenges, and potential for application in healthcare settings. It also identifies gaps in current practices and proposes future research directions. Methods: A narrative synthesis of recent literature was conducted, focusing on strategies such as antimicrobial stewardship programs, combination therapies, personalized medicine, rapid diagnostics, and novel treatments. Results: Antimicrobial stewardship programs were found to be central to optimizing antibiotic use and reducing resistance. Combination therapies and personalized medicine further enhance treatment precision and efficacy. Emerging innovations, including artificial intelligence and advanced materials like nanoparticles, offer promising solutions. However, implementation gaps, particularly in resource-limited settings, and high costs of novel technologies remain significant barriers. Conclusions: This review underscores the importance of integrating evidence-based pharmacological strategies with emerging technologies to address antibiotic resistance. Future research should prioritize scalable, cost-effective interventions and a greater focus on community and outpatient settings to complement hospital-based efforts.

Antibiotic Stewardship in Silkworms: Navigating the Pros and Cons

To safeguard against microbial diseases and maintain optimal silk yields, the sericulture industry relies on antibiotics to promote the health, well-being, and vitality of silkworms (Bombyx mori). Antibiotics are commonly incorporated into synthetic diets for rearing silkworms or included as key components in bed disinfectant formulations. The silkworm-rearing industry’s reliance on antibiotics has led to concerns about the development of antibiotic-resistant bacteria. Previous research has uncovered a dual role for antibiotics: not only do they prevent disease, but they also promote silkworm growth by reshaping the gut microbiome and enhancing nutrient absorption, highlighting the need for judicious use. Therefore, there is a critical need for prudent management and further exploration of alternative growth-promoting strategies to minimize resistance risks. This study investigates the relationship between antibiotic administration and silkworm growth, shedding light on the mechanisms underlying antibiotic-induced effects and assessing the risk of antimicrobial resistance (AMR) emergence and dissemination.

Human and Veterinary Medicine Collaboration: Synergistic Approach to Address Antimicrobial Resistance Through the Lens of Planetary Health.

Antimicrobial resistance (AMR) represents a critical threat to human, animal, and environmental health, challenging global efforts to maintain sustainable ecosystems and public health systems. In this review, the complex, cross-disciplinary issues of AMR are explored within the framework of planetary health, emphasizing the interconnectedness of human and veterinary medicine with broader environmental and social systems. Specifically, it addresses the social, economic, environmental, and health dimensions of AMR under the planetary health framework. The social aspects consider how public awareness, education, and healthcare practices shape antimicrobial use (AMU) and resistance patterns. The economic impact evaluates the cost burdens of AMR, including healthcare costs, loss of productivity, and the implications for the livestock and food production industries. The environmental dimension highlights the role of pharmaceutical waste, agricultural runoff, and industrial pollution in contributing to the spread of antimicrobials and resistant pathogens in ecosystems. To illustrate these challenges, a comprehensive literature review using the PubMed and Web of Science databases was conducted, identifying 91 relevant articles on planetary health and AMR. In this review, the knowledge from these studies and additional references is integrated to provide a holistic overview of the AMR crisis. By applying the four pillars of planetary health-social, economic, environmental, and health knowledge-in this manuscript, the necessity is underscored of collaborative strategies across human and veterinary medicine to combat AMR. Ultimately, this synergistic approach aims to shape the policies and practices that safeguard public health, protect ecosystems, and promote a sustainable future by implementing antimicrobial stewardship programs and encouraging prudent AMU.