Antimicrobial Stewardship Research Articles

Genomic Epidemiology of Antimicrobial Resistance: Tracking the Global Spread of Resistant Pathogens

The rapid development and spread of antimicrobial resistance have been one of the most prominent health crises globally, which significantly challenges treating infectious diseases. This paper will address the contribution that genomic epidemiology makes to track and understand the global spread of antimicrobial-resistant pathogens. Genomic epidemiology, an area combining pathogen genomics with epidemiological data, allows for an extremely powerful approach in the identification of resistance mechanisms and tracing transmission routes for guiding public health interventions. This review Emphasizes major bacterial pathogens, such as Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae, which harbor major resistance genes: blaCTX-M, mecA, and blaKPC. These genes contribute to the worldwide dissemination of resistance, mainly through mechanisms involving horizontal gene transfer and selective antibiotic pressure. Thus, genomic surveillance, phylogenetic analysis, and bioinformatics approaches allow for the pinpointing of transmission hotspots, mapping of resistance gene distribution, and tracking of emerging resistant strains in real time. It also provides information on how genomic data are being used to improve antimicrobial stewardship programs and inform clinical treatment decisions. Public health responses can further be tailored by recognizing regional resistance patterns, hence enhancing interventions. However, several challenges persist—for example, the need for standardized sharing of data, interpretation of genomic data, and integration of these insights into public health systems, especially in low-resource settings. This abstract highlights the transformative impact of genomic epidemiology in the management of the AMR crisis while emphasizing the continued need for global cooperation, enhanced data infrastructures, and policy initiatives to ensure the effective use of genomic data in public health.

Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes.

The widespread dissemination of carbapenem-resistant Gram-negative bacteria poses a significant threat to global public health. This study aimed to investigate the prevalence of carbapenem resistance in Gram-negative bacteria isolated from patients at the Children's Medical Center Hospital, Tehran, Iran, to understand the molecular mechanisms underlying this resistance. During the period spanning from June 2019 to June 2020, 777 Gram-negative bacterial strains were isolated. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute. Polymerase chain reaction was used to detect carbapenem resistance genes including bla OXA23, bla OXA24, bla OXA48, bla OXA51, bla OXA58, bla OXA143, bla KPC, bla IMP, bla VIM, and bla NDM. Among the total bacterial isolates, 141 (18.1%) exhibited carbapenem resistance. Escherichia coli was the most prevalent (57.4%), followed by Klebsiella pneumoniae (11.3%) and Acinetobacter baumannii (10.6%). Other notable contributors included Enterobacter spp. (5.7%), Salmonella spp. (3.5%), and Stenotrophomonas maltophilia (2.8%). Citrobacter spp., Proteus mirabilis, and Pseudomonas aeruginosa contributed to the distributions of two, one, and three isolates, respectively. Notably, bla OXA48 showed the highest prevalence (33%), followed by bla OXA143 and bla OXA58 (27% and 24%, respectively). In addition, bla OXA24 was present in 11% of the total isolates, bla OXA23 in 10%, and bla NDM in 10%, whereas bla KPC, bla VIM, and bla IMP were not detected. Our study highlights the prevalence of carbapenemase-producing Gram-negative isolates among pediatric patients. Notable resistance patterns, especially in K. pneumoniae and E. coli, underline the urgent need for proactive interventions, including appropriate antibiotic prescription practices and strengthening of antibiotic stewardship programs.

Trends in Urinary Tract Infection Management in Women.

Urinary tract infections (UTIs) are a common cause of health care utilization in the United States. The coronavirus disease 2019 (COVID-19) pandemic accelerated virtual care for UTIs. This retrospective cohort study analyzes more than 1.2 million encounters for UTI based on diagnosis codes, examining temporal trends focusing on virtual compared with in-person encounters, antibiotic dispensation rates, and culture-confirmed UTIs. From 2015 to 2022, UTI encounters increased by 325.9%, with a majority occurring at virtual visits. The rate of UTI encounters per 1,000 adult female patients increased by 241.6%. Antibiotic dispensation rates increased, surpassing the rise in rate of positive urine cultures, suggesting increasing use of empiric antibiotics. Our findings underscore the importance of balancing telemedicine's accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines.

Impact of a hub-and-spoke approach to hospital antimicrobial stewardship programmes on antibiotic use in Zambia.

Antimicrobial stewardship programmes (ASPs) aim to optimize antibiotic use and prevent antimicrobial resistance. This study assessed the impact of ASPs, initiated using a hub-and-spoke approach, on antibiotic use in Zambian public hospitals. A pre-post study was conducted in 10 ASP-naive hospitals across Zambia using the Centers for Disease Control and Prevention (CDC)'s hospital-based ASP core elements (i.e. leadership, accountability, pharmacy expertise, stewardship actions, tracking progress, reporting and education) checklist and the global point prevalence survey methodology. The intervention involved technical staff from a national 'hub' hospital with an established ASP providing on-site orientation and mentorship to multidisciplinary teams of healthcare workers at 10 'spoke' hospitals to build capacity in antimicrobial stewardship. ASP core elements and inpatient antibiotic use prevalence (AUP) were assessed before and 12 months after ASP implementation. Data were statistically analysed. The adoption of ASP core elements improved significantly (P = 0.001, 95% CI: -17.8 to -5.42). AUP decreased from 50.1% (±5.8, n = 1477) to 44.3% (±4.6, n = 1400) after 12 months, though the reduction was not statistically significant (P = 0.442; 95% CI: -9.8 to 21.6), with 'Watch' list antibiotics remaining the most commonly prescribed across the hospitals. The hub-and-spoke approach successfully catalysed ASPs in public hospitals in Zambia, demonstrating the potential for improving antibiotic use practices over time, provided structural challenges are addressed. This approach and insights can guide stakeholders in Zambia and similar settings in enhancing hospital ASPs.

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years.

Antibiotics are the most prescribed drugs for children worldwide, but overuse and misuse have led to an increase in antibiotic resistance. Antimicrobial stewardship programmes (ASPs) have proven feasible in reducing inappropriate antimicrobial use. The study aimed at evaluating the impact and sustainability of an ASP with multiple interventions over 8 years. This quasi-experimental study was conducted between 2014 and 2022 in the paediatric acute care unit of Padua University Hospital. Demographic and clinical data were retrieved from the electronic clinical records. Daily prescriptions were collected and analysed based on the AWaRe classification and using days of therapy (DOT) out of 1000 patient days (DOT/1000PDs). The primary outcome was to assess the change in overall antibiotic consumption and of access and watch antibiotics, stratifying patients with and without comorbidities. Trends in antibiotic consumption (DOTs/1000PD) were assessed using joinpoint regression analysis. A total of 3118 children were included. Total antibiotic consumption remained stable and low in patients without comorbidities, ∼300 DOT/1000PDs, whereas a statistically significant constant reduction was observed in children with comorbidities, from almost 500 DOT/1000PPDs to <400 DOT/1000PDs. Access consumption increased in both groups of patients, whereas watch consumption constantly decreased, although statistically significant only in children with comorbidities. Implementing a multistep ASP has proven feasible and sustainable in improving antibiotic prescriptions for previously healthy and fragile children. All the implemented interventions were low cost, and with efficient use of resources, ensuring an ASP that was effective, practical, and easily replicable and implementable in various healthcare settings.

Impact of Antibiotic Stewardship on Treatment of Hospitalized Children with Skin and Soft-Tissue Infections

Background: Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. Methods: We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014–September 2015), post-implementation (October 2015–March 2020), and COVID-19 (April 2020–August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. Results: The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. Conclusions: The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance.

Characterization of bla NDM in two Escherichia coli ST1193 clinical isolates in the Gulf region.

Escherichia coli ST1193 is an emerging high-risk clone associated with the production of plasmid-mediated CTX-type extended-spectrum β-lactamases. However, this clone has seldom been found to contain plasmids carrying carbapenemase genes. We report two epidemiologically unlinked multidrug-resistant (MDR) clinical isolates of E. coli ST1193 with plasmids harbouring NDM-type carbapenemase genes from the Gulf region. The isolates were identified by MALDI-TOF MS and antibiotic susceptibility testing was performed using the VITEK 2/Phoenix system. A conjugation experiment was performed to assess the transferability of the resistance plasmids. Genomic DNA of both isolates was subject to Illumina sequencing; one isolate was also sequenced using Oxford Nanopore technology. Bioinformatics analyses were performed to detect antimicrobial resistance genes, and to annotate the genetic context of the NDM genes. Both isolates were resistant to carbapenems using phenotypic tests. Conjugation experiment confirmed that NDM-5-encoding plasmids of both strains could be transferred to the recipient cells. The completed NDM-5-encoding plasmid of E. coli isolate FQ71 was highly similar to several plasmids from ST410 isolates in the NCBI database. Genomic analysis revealed the presence of transposase genes and transposons in the flanking regions of the NDM genes in the plasmids. Since carbapenems constitute first-line agents for the treatment of serious infections caused by ESBL producers, E. coli ST1193 isolates co-producing ESBL and NDM-type carbapenemases represent a serious challenge for antimicrobial stewardship and infection control programmes.

Multifaceted implementation strategy to improve the evaluation of penicillin allergies in perioperative patients: a pre-post feasibility implementation study.

The U.S. Centers for Disease Control and Prevention encourages nurses to evaluate penicillin allergies as part of hospital-based antibiotic stewardship programs. We evaluated the feasibility of an implementation strategy to improve nurses' comprehensive documentation of penicillin allergies. We defined feasibility as the uptake and acceptability of documentation procedures. Six-month pre-post feasibility implementation study. Outpatient surgical areas of an academic medical center located in the U.S. The implementation strategy was guided by the Capability, Opportunity, Motivation Model for Behavior Change and included, building an interdisciplinary coalition to iteratively evaluate the implementation effort, educational meetings with surgical prescribers and perioperative nurses, the development and distribution of educational pocket cards, and structured communication messages in the electronic medical record. A total of 426 patients with 487 penicillin allergy records (216 records pre-implementation period, 271 records post-implementation period) were analyzed. Penicillin allergy documentation contained the following information in the pre- versus post-implementation period: symptoms of the reaction (87% vs 87%), timing/years since reaction (8% vs 26%), onset of reaction in relation to taking penicillin (0% vs 21%), how symptoms resolved (0% vs 21%), and penicillin re-exposure (3% vs 21%). Focus groups revealed nurses perceived documentation procedures as highly acceptable. Major drivers of acceptability included the perceived effectiveness of a detailed allergy history and self-efficacy in conducting a detailed allergy history. Nurses perceived the comprehensive documentation of penicillin allergy history intervention as acceptable, and uptake improved following a theory-informed implementation strategy. We offer implementation strategy components to facilitate nurses' engagement in penicillin allergy evaluation.

Operationalizing an adverse event detection surveillance system to support antimicrobial stewardship activities: perceptions and insights from the SHEA research network.

A surveillance system for measuring patient-level antimicrobial adverse drug events (ADE) may support stewardship activities, however, design and implementation questions remain. In this national survey, stewardship experts favored simple, laboratory-based ADE definitions although there were tensions between feasibility, ability to identify attribution without chart review, and importance of specific ADE.

Capturing the complexity of veterinarians' antibiotic prescribing practices in the livestock sector: a meta-ethnography across contexts: Veterinarians' antibiotic prescribing in different contexts.

Strategies and policies to tackle the global public health threat of antimicrobial resistance are increasingly addressing antimicrobial use prescribing practices in both the human and animal health sectors. Veterinarians' antibiotic prescribing practices are influenced by different factors and conditioned by the context within which antibiotic prescribing decisions are made, complexifying the implementation of behaviour change interventions. A better understanding of these factors could therefore help in the design and application of such interventions. Meta-ethnography was used to explore the antibiotic prescribing behaviour of veterinarians in different contexts and to construct a new conceptual framework. A search was conducted in PubMed, Web of Science Core Collection and SciELO Citation Index between 2016 and 2024. The final sample consisted of 29 articles, 27 of which were selected from the 561 articles identified in the search and 2 of which were added by the authors. The results were synthesized and presented through four contextual situations influencing antibiotic prescribing by livestock veterinarians: priorities and pressures, uncertain field conditions, systemic challenges and an enabling environment. The results are presented as a conceptual framework that views veterinarians' antibiotic prescribing behaviour as dynamic, adapting in response to the different contextual situations they encounter. The findings provide an integrated and contextualized understanding of veterinarians' antibiotic prescribing behaviours, which could be implemented to facilitate the development and application of future antimicrobial stewardship interventions.

A global investigation into antimicrobial knowledge in medicine, pharmacy, nursing, dentistry and veterinary undergraduate students: A scoping review to inform future planetary health multidisciplinary education

BackgroundInappropriate use of antimicrobials can push the environment out of balance, and cause unnecessary waste that can contaminate our soil, animals and waterways. Health professional education is committed to preparing students for antimicrobial stewardship (AMS) and supporting planetary health, but a more multidisciplinary action is needed to curb the expansion of antimicrobial resistance (AMR). The aim of this scoping review is to showcase the current antimicrobial knowledge of undergraduate students across the disciplines of medicine, pharmacy, nursing, dentistry and veterinary. This will consequently showcase the gaps and trends across the different disciplines and countries to help inform planetary health multidisciplinary undergraduate curriculums.MethodsA search of the existing literature published prior to December 2023 was conducted using CINAHL, EMBASE, MEDLINE, SCOPUS, and ERIC databases. Studies were excluded if they included postgraduate students or discussed the knowledge, attitude and practice (KAP) of students towards antimicrobial prescribing, AMR and AMS related to a specific learning activity.ResultsA total of 144 articles were included. The most represented countries were India and Pakistan accounting for 17% and 8% of the studies, respectively. Single-disciplinary research accounted for approximately 80% of the studies. Medicine was the most represented discipline in both single-disciplinary and multidisciplinary research, appearing in approximately 62% of the studies, followed by pharmacy appearing in approximately 30% of the studies and dentistry appearing in approximately 18% of the studies. Three major priority themes were identified: students are more familiar with the term AMR compared to AMS; inappropriate use of antimicrobials is seen as the main driver of AMR; and the need for more training and education in the field of appropriate antimicrobial prescribing, AMR and AMS.ConclusionThis review has highlighted that there is a need for more AMS interprofessional education (IPE) activities in all five disciplines, and especially within the disciplines of nursing, veterinary and dentistry, as shown by a lack of multidisciplinary research in this area. Most of the knowledge assessments have just touched the surface of AMS and focused on inappropriate antimicrobial use alone. Interdisciplinary planetary health education needs to go beyond these skills and broaden the understanding of other factors that can contribute to AMR such as inappropriate disposal, environmental contamination, monitoring and surveillance, one health, false allergies, and more importantly, how each health professional can contribute to a team.

Towards Wiser Prescribing of Antibiotics in Dental Practice: What Pharmacists Want Dentists to Know

Antibiotics have various indications for treatment and prophylaxis in dental practice. While only a handful of antibiotics are typically prescribed in dentistry, unlike in medicine, clear indications and appropriate dosing and duration remain controversial among antibiotic-prescribing dentists, which may result in inappropriate or excessive antibiotic prescriptions. This practice can increase the risk of antibiotic resistance and expose patients to unnecessary side effects. Moreover, the concept of antibiotic stewardship in dental practice remains in its early stages. This review was developed by pharmacists (general and infectious disease pharmacists) in collaboration with a periodontist and a maxillofacial surgeon to provide an antibiotic prescription guide for dentists who frequently prescribe antibiotics. It also sheds light on antibiotic stewardship. The review discusses in detail antibiotic indications for treatment and prophylaxis in dental practice and provides tables that can be used by dentists in their everyday practice. It also discusses the concept of antibiotic stewardship and provides recommendations that can be applied to the practice of antibiotic prescribing in dentistry. Antibiotic prescribing in dental practice should be limited to cases with documented infections or when indicated for prophylaxis. Every dentist can act as an antibiotic steward by prescribing antibiotics wisely and only when necessary, using their discernment to identify appropriate cases and exclude those that do not meet infection criteria. Collaboration with pharmacists is encouraged to provide such recommendations and implement antibiotic stewardship interventions, such as developing antibiotic prescription protocols.

Audit of antibiotic utilization patterns and practice for common eye infections at the ambulatory clinic of a teaching hospital in Ghana: Findings and implications

Background Antimicrobial resistance (AMR) is a serious public health issue which is exacerbated by increased inappropriate use of antibiotics for common eye infections. This cross sectional survey was to assess the appropriate use of antibiotics for eye infections in an ambulatory clinic in Ghana and possible determinants. Method The medical records of all patients who sought eye care between January 2022 to December 2022 and were prescribed antibiotics were extracted from the hospital’s electronic database. Descriptive, bivariate and multivariate analyses were then conducted. Results A total of 1925 patient medical records were extracted, whose median age was 40 years (IQR 26–69), and were mostly females (58.91%, n = 1134/1925). The eye condition commonly treated with antibiotics was bacteria conjunctivitis (33.51%, n = 645/1925). The most prescribed antibiotic was gentamycin (22.96%, n = 442/1925) followed by ciprofloxacin (16.78%, n = 321/1925). These were mostly topical dosage forms (82.13%, n = 1581/1925). Systemic antibiotics prescribed were mostly from the WHO ‘Access’ class (83.33%, n = 280/338). The appropriate choice of antibiotic prescribed was 42.44% (n = 817/1925) and this was positivity associated with age (p&lt;0.001), number of antibiotics prescribed (p &lt;0.001), the prescription of topical dosage forms (p &lt;0.001), and WHO ‘Access’ antibiotic class (p &lt;0.034). Conclusion The level of appropriateness of antibiotic prescriptions for eye infections was sub-optimal. Antimicrobial stewardship programs, including prescriber education on guidelines and prescription audit to address associated factors, must now be instigated in this hospital to improve future antibiotic use and prevent the rise of AMR.

Over-the-counter antibiotics compromising aminoglycoside activity.

Antimicrobial resistance (AMR) is a global issue that needs addressing. While antibiotic stewardship has improved often by restricting antibiotic use, some antibiotics that are still sold legally over the counter (OTC), notably in sore throat medications. Recent findings suggest OTC antibiotics could trigger cross-resistance to antibiotics used in clinical treatments, whether systemic or topical. Here we investigated the impact of three antibiotics contained in OTC sore throat medicines on emerging AMR in vitro. Bacterial pathogens were exposed to a bactericidal concentration of an aminoglycoside in the presence or absence of a during-use concentration of bacitracin, gramicidin or tyrothricin in a time-kill assay. Damage to the bacterial membrane was also investigated by measuring potassium leakage and membrane potential alteration post-OTC antibiotic exposure. Gramicidin (15 µg/mL) significantly decreased the bactericidal activity of amikacin, tobramycin or gentamicin in Acinetobacter baumannii. It also decreased gentamicin bactericidal activity in Enterobacter cloacae, Escherichia coli and Klebsiella pneumoniae, while tyrothricin decreased the aminoglycoside efficacy in E. cloacae and E. coli. Gramicidin significantly decreased bacterial membrane potential and caused significant potassium leakage. Gramicidin and to some extent tyrothricin impacted aminoglycoside efficacy by affecting membrane potential, which is essential for aminoglycosides uptake. Thus, some OTC antibiotics can interfere with aminoglycoside activity, which could in turn affect treatment efficacy. Although the likelihood of OTC antibiotics and aminoglycosides being used at the same time might not be common, this research highlights one potential reason for OTC antibiotics' usage to result in treatment failure and their contribution to AMR development.

Carbapenem-Resistant Infections in Neonates and Children in Latin America: A Literature Review.

Carbapenems are broad-spectrum beta-lactam antibiotics that are increasingly being used worldwide to treat multidrug-resistant infections, but since their introduction, carbapenem resistance has emerged. This phenomenon has been well documented in the adult population, but there is a paucity of evidence from the neonatal and pediatric populations. A literature search of carbapenem-resistant infections in Latin American neonates and children was conducted via PubMed/Medline and SCOPUS: 551 titles were screened, and 17 articles were included in the review. The most commonly reported predominant isolate was Klebsiella pneumoniae (11 of 17 studies). Genotypic data were available in 10 of 17 studies, and the KPC gene was the most commonly reported resistance gene. The mortality rate ranged from 13% to 52.6%. Carbapenem-resistant infections are prevalent in children and neonates in Latin America and are associated with high rates of mortality, highlighting the need for enhanced antimicrobial stewardship and surveillance within these populations.

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

Unraveling antibiotic resistance in Achromobacter mucicolens IA strain: genomic insights, structural analysis, and prospects for targeted therapeutics

ABSTRACT The mortality rate of infectious diseases caused by Achromobacter mucicolens is increasing. The enhanced antibiotic resistance among bacterial species through genetic transfer and mutations in the efflux mediating genes has made the treatment quite challenging. A. mucicolens is an aerobic, gram-negative, and non-fermenting opportunistic pathogen found in immunocompromised patients. A. mucicolens shows resistance against beta-lactams and other antibiotics through intrinsic resistance mechanisms, including multi-drug efflux pumps and beta-lactamases. In this study, the clinical isolate whole genome sequencing of A. mucicolens data was analyzed to identify the genes and mutations responsible for antimicrobial resistance. The identified genes and their mutants were then subjected to structural analysis to better understand the impact of mutations on the protein structure, and domain analysis was performed to investigate the role of domains in antibiotic resistance. A total of 4 genes, acrR, macB, msbA, and tolC , were identified with significant mutations, whereas macB was shortlisted for further analysis based on the conserved regions, sequence alignment, and the maximum number of mutations. All the mutants of the macB gene contain the two common domains, the ABC transporter-like ATP-binding domain and the AAA + ATPase domain. These domains are crucial in efflux mediating drug transport and can be targeted to design novel drugs for treating infections caused by A. mucicolens . IMPORTANCE Achromobacter species represent a significant threat as opportunistic pathogens, particularly in healthcare settings. Their resilience to antibiotics, demonstrated by strains like A. mucicolens , poses a serious challenge in treating infections, especially in immunocompromised patients. This study emphasizes the critical need for heightened vigilance among healthcare professionals regarding Achromobacter infections. By analyzing the whole genome sequencing data of A. mucicolens , the study sheds light on the genetic basis of antimicrobial resistance, aiding in more targeted treatment strategies. Furthermore, structural and domain analyses offer insights into how mutations impact protein structure and function, crucial for developing effective interventions. Ultimately, implementing rigorous sanitation measures and antibiotic stewardship protocols is needed to mitigate the spread of Achromobacter and safeguard vulnerable patient populations.

Prevalence and pattern of self-medication with antibiotics among residents of Abia State, Southeastern Nigeria: a call for action

Background: Antibiotic self-medication occurs worldwide, and it is a major driver of antibiotic misuse and antimicrobial resistance. In developing countries like Nigeria, antibiotics are frequently sold as over-the-counter medications. There is a need to explore this pattern, aiding stakeholders in informed decision-making. We assessed the prevalence and pattern of antibiotic self-medication among the residents of Abia State. Methods: A cross-sectional study was conducted among eligible adults in the State with respondents selected using the multistage sampling technique. An interviewer-administered questionnaire was used to obtain information from the respondents. Data analysis was done using SPSS version 26 and the level of significance was set at 5%. Results: A total of 1,491 respondents were surveyed. The mean age was 34.7±13.1 years and females constituted 55.7%. The overall prevalence of antibiotic self-medication was 46.5% (95%CI: 43.9-49.1). The majority of the respondents took self-medication for cough (48.6%) and ampicillin/cloxacillin was the major antibiotic used (30.1%). The reason for antibiotic self-medication mostly reported was the perception of minor illness (62.7%). Most (52.4%) of the respondents got the antibiotics from pharmacies without prescriptions. The predictors of antibiotic self-medication included residence (aOR=2.44, 95% CI: 1.12-5.30), retention of previous prescriptions (aOR=10.98, 95% CI: 4.40-27.47), storage of leftover antibiotics (aOR=4.13, 95% CI: 1.79-9.54) and perceived susceptibility of antibiotic self-medication (aOR=4.96, 95% CI: 1.71-14.39). Conclusions: Close to half of the residents practiced antibiotic self-medication with its pattern identified. We recommend tailored strategies including appropriate health education and enforcement of regulatory policies to promote community antibiotic stewardship.

Results of a 5 year Antimicrobial Stewardship program in a North Italian Hospital

Abstract Issue A National Action Plan (PNCAR) to fight antimicrobial resistance has been launched in Italy in 2017, further revised in 2022. In order to reduce inappropriate exposure to antibiotics and infections from multidrug resistant bacteria, a structured system of surveillance and monitoring according to PNCAR standards has been set up in all Italian regions. In the Hospital of Cittadella (District of Padua, Veneto region), special focus has been given to the reduction of antibiotic consumption, in particular quinolones, third generation cephalosporins, carbapenems and macrolides. Description Multidisciplinary meetings have been monthly organized by the hospital Antimicrobial Stewardship Group, with the aim of coordinating the implementation of specific stewardship actions. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Regional data warehouse from 2019 to 2023 regarding all classes of antibiotics. Results Between 2019 and 2023 a clear decrease in the consumption of quinolones (from 8 to 5,8 DDD, -28%) and carbapenems (from 2,5 to 1,3 DDD, -48%) was observed but, at the same time, an increase in the consumption of third generation cephalosporins (from 9 to 15,7 DDD, +74%) has been reported. This can be explained as a direct consequence of the correct application of therapy guidelines, which in several cases suggest the use of ceftriaxone instead of meropenem. Finally, after an increase in the consumption of macrolides during the first COVID-19 pandemic wave, the consumption of this class of antibiotics has returned to pre-pandemic level. Lessons Constant monitoring of antimicrobial consumption and the identification of warning situations that may need to implement specific actions are the cornerstone of Antimicrobial Stewardship programs. Targets must be defined analyzing data of bacterial resistance rates and infections from multidrug resistant bacteria. Key messages • In Antimicrobial Stewardship programs it is important to adopt constant monitoring of antimicrobial consumption. • Antimicrobial stewardship programs need to be adapted according to the characteristics of each hospital.

Dispensing of antibiotics in community pharmacies before, during, and after the COVID-19 pandemic

Abstract Background Antibiotic resistance threatens our capability to successfully treat bacteriological infections, becoming a major threat to public health. Therefore, measures must be taken to minimize de incidence of multi-drug resistant bacterial infections. Antimicrobial Stewardship is a systemic healthcare approach devised to foster, enhance, oversee, and assess the judicious application of antimicrobials, aiming to safeguard their efficacy in the future, whilst advocating and safeguarding public health. In the initial phase, a correct diagnosis of antimicrobial utilization is pivotal for the proper implementation of an Antimicrobial Stewardship Program. Methods A cross-sectional study encompassing the Alentejo region, Portugal, with a specific focus on central Alentejo, was conducted to analyze the dispensing of antimicrobials in community pharmacies, alongside the examination of the prescribing locations, before, during, and after the COVID-19 pandemic, from 2019 to 2023. Results The number of antibiotic packages dispensed decreased, as expected, during the COVID-19 pandemic, but returned to pre-pandemic levels after its conclusion. In several prescribing locations, the proportion of cephalosporins and quinolones exceeded the maximum expected value. Conclusions The implementation of an appropriate Antimicrobial Stewardship Program in this region is necessary to ensure the correct prescription of antimicrobials, decreasing the risk that antibiotic resistance pose to public health. Emphasis on the application of the Clinical Practice Guidelines issued by the Portuguese Directorate-General of Health regarding the proper approach to bacterial infections should be intensified so that all prescribing locations exhibit proportions of cephalosporins and quinolones below the maximum expected value. Key messages • Antimicrobial resistance poses a threat to public health. • Stewardship is crucial for appropriately safeguarding public health by reducing antimicrobial resistance emergence.