Use Of Antibiotics Research Articles

Postoperative Antibiotics After Appendectomy for Acute Appendicitis: No Evidence of Benefit, Even with Intra-Abdominal Fluid.

To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis, particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections. Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation. A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1,539 patients with acute appendicitis (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis. Intra-abdominal fluid was present in 880 patients(57.2%), with 474 exhibiting sero-sanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid . The study identified three independent risk factors for postoperative infection: ASA score (HR=5.129,P=0.004), symptom duration>2 days (HR=2.290,P=0.029), and the presence of appendicolith (HR=2.204,P=0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes. Routine use of postoperative antibiotics for acute appendicitis, even with intra-abdominal fluid may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.

Novel Approaches for Treatment of Intraoral Microbial Infections.

Historically, broad-spectrum antibiotics have represented a major component of the therapeutic armamentarium used to treat common oral diseases associated with a bacterial etiology. The fact that these diseases are due to the accumulation of multispecies biofilms composed of ever-increasing numbers of resistant organisms has dramatically affected the efficacy of many of these drugs. Furthermore, it is now appreciated that repeated use of broad-spectrum antibiotics also affects the composition of the host commensal microbiota, which can have both local and systemic implications. In recognition of the limitations of classical antibiotics, alternative chemical, physical, and mechanical strategies are either in use or development. These include novel narrow-spectrum antimicrobials such as antitoxins, bacteriophages, and antibody-conjugated drugs that can target specific microbes while minimizing the emergence of resistant organisms and preserving eubiotic microbes. Other approaches, such as new broad-spectrum non-antibiotic strategies and probiotics, are aimed at disrupting or altering the composition of oral biofilms and their extracellular matrices to facilitate the elimination of overt pathogens by the host response and/or adjunctive antimicrobials. This critical review describes the use and limitations of broad- and narrow-spectrum strategies currently being used to treat common bacterially induced oral diseases as well as alternative methods in development.

Use of antibiotics in early life and development of diseases in childhood: nationwide registry study

ObjectiveTo investigate the association between the use of antibiotics in early life and the development of immune mediated diseases in children and adolescents.DesignNationwide registry study.SettingNational Danish registries: Danish Civil Registration...

Evaluating the impact of the ‘Antibiotic Guardian Schools Ambassadors’ programme on UK trainee pharmacists’ learning and development

Background: The Antibiotic Guardian Schools Ambassadors programme engages healthcare professionals and scientists with young people to educate them about antibiotic use and resistance. In 2022, the UK Health Security Agency (UKHSA) and a national pharmacy chain involved trainee pharmacists across the UK in this effort. This study aims to evaluate the impact of participating in the Antibiotic Guardian Schools Ambassadors programme on UK trainee pharmacists’ learning and development. Methods: Trainee pharmacists in the program received a digital toolkit to help plan and deliver educational lessons on antibiotic use and antimicrobial resistance to young people in their communities. Pre- and post-project questionnaires assessed changes in their knowledge, attitudes, and behaviours regarding these topics, as well as the impact of their participation on their learning and development. Results: The study included 195 trainee pharmacists from the UK, with a 67% participation rate. Only 45 post-project responses were received (23% response rate). The responses indicated that trainee pharmacists felt knowledgeable about antibiotic use and antimicrobial resistance, and they benefitted personally and professionally from the project. Conclusion: Trainee pharmacists took part in a national public health campaign, enhancing their knowledge, skills, and confidence while meeting General Pharmaceutical Council outcomes. Future improvements should focus on increasing post-project response rates and including pharmacy professionals from diverse organizations and sectors.

Exploring Antibiotic Use And Self-Medication Practices Among Medical Students At Rawalpindi Medical University

Introduction: The irrational use of antibiotics is a growing global concern, leading to increased resistance and treatment failures. Medical students, due to their academic exposure, are at high risk of self-prescription and misuse of antibiotics, which can have significant public health implications. Objectives: To find the platitude of antibiotic usage among the undergraduate medical professionals of Rawalpindi Medical University (RMU), Rawalpindi. Methodology: This cross-sectional study was undertaken in the Pharmacology Department of Rawalpindi Medical University, Rawalpindi. 250 undergraduate students (50 from each class) from all years of study were included in the study. A predesigned questionnaire was distributed to participants. IBM Version 25 was used for statistical analysis. Results: Out of 250 enrolled students, 239 responded to this project. Out of which 60% (n=30) of 1st year, 66% (n=33) of 2nd year, 74% (n=37) of 3rd year, 88% (n=44) of 4th year, and 64% (n=33) of 5th year participants used antibiotics since last 06 months. The percentage of self-prescription found was 23.3%(n=7), 33.3%(n=11), 40.5%(n=15), 16%(n=7), and 36.5%(n=12) in the first, second, third, fourth, and fifth professional years, respectively. Conclusion: As we moved from 1st year to 4th year students, the usage of antibiotics was increasing and so was the percentage of self-prescription from 1st year to 3rd year students. In the final year, students used antibiotics less and self-prescribed less. There was a significant difference among the participants considering the ill use of antibiotics nowadays.

Susceptibility of Aeromonas salmonicida subsp. salmonicida bacteria from French farmed trout to antibiotics commonly used in fish farming, and attempt to set epidemiological cut-off values

Aeromonas salmonicida subsp. salmonicida (ASS) is a bacterium that can cause opportunistic infections in humans and animals. In farmed rainbow trout it causes furunculosis, with more frequent outbreaks when water temperatures are higher, an additional consequence of global warming. When infections occur, antibiotics are sometimes required. However, data on ASS susceptibility is limited. The aim of this study was to determine the distribution of Minimum Inhibitory Concentrations (MICs) of eight antibiotics commonly used in fish veterinary medicine in a population of pathogenic ASS, and to calculate provisional epidemiological cut-off values (called COEpid). To date, only four epidemiological cut-off values (ECV) have been established by CLSI, and none by EUCAST. In this study, 406 bacterial strains of ASS were collected exclusively from diseased French farmed trout over a 10-year period (2012–2021). A combination of PCR, MALDI-TOF and specific characteristics of the bacterial culture was used to identify each isolate to species level. All MIC data were obtained by the broth dilution method according to CLSI recommendations. Our COEpid meets the CLSI defined ECV for florfenicol (4 mg/L) and oxytetracycline (1 mg/L). In the absence of a defined ECV, we proposed a COEpid of 1 mg/L for doxycycline. For sulfadiazine alone, all strains tested were non-wild-type (NWT) with very high MICs. The COEpid was calculated as 4.8/0.25 mg/L for sulfadiazine + trimethoprim (one two-fold dilution difference from the ECV established by CLSI for ormetoprim + sulfadimethoxine). For quinolones, COEpid were 4 mg/L, 4 mg/L and 0.5 mg/L for oxolinic acid, flumequine and enrofloxacin, respectively, with a cross-resistance mechanism. This COEpid for oxolinic acid far exceeds the CLSI defined ECV (0.125 mg/L). A total of 12 strains (3%) were classified as NWT for all antibiotics tested. Over the period studied, the proportion of bacteria susceptible to the different molecules remained stable, except for the tetracycline family. These data will be available to establish internationally agreed epidemiological cut-off values, which are lacking for some antibiotics. These cut-offs are essential to assess and monitor the emergence of bacterial populations with resistance traits, and to establish clinical breakpoints for better use of antimicrobials in fish.

Prevalence of the Antibiotic Resistance of Salmonella typhi and Salmonella paratyphi in Pakistan: A Systematic Review and Meta-Analysis

Abstract Background Antibiotic resistance to Salmonella is a significant threat to public health globally, particularly in low- and middle-income countries like Pakistan. This study reviews the existing literature to determine the pooled prevalence of antibiotic resistance among Salmonella typhi and Salmonella paratyphi strains across Pakistan in the past decade, including the emergence of extended-spectrum beta-lactamase (ESBL). Methods Six databases were searched for studies published from January 2014 to December 2024. Studies were screened for relevance, and data on antibiotic susceptibility among human S. typhi and S. paratyphi isolates were extracted. Their quality was assessed using the Joanna Briggs Institute checklist. The random-effects model was employed using the R statistical software (V 4.4) to calculate the pooled resistance rates. Results Thirty-one studies met the inclusion criteria after full-text screening. The analysis revealed significant resistance rates to commonly used antibiotics for S. typhi, including nalidixic acid (92%; confidence interval [CI]: 88–95%), ampicillin (80%; CI: 66–89%), ciprofloxacin (64%; CI: 48–77%), azithromycin (7%; CI: 3–16%), and meropenem (2%; CI: 1–3%), with notable variations across different cities, and for S. paratyphi, such as nalidixic acid (91%; CI: 82–96%), ampicillin (34%; CI: 21–50%), ciprofloxacin (51%; CI: 25–77%), azithromycin (4%; CI: 1–12%), and meropenem (2%; CI: 1–5%) resistance, respectively. In S. typhi, 29% and 25% of patients were found to have multidrug resistance (MDR; CI: 21–41%) and extensive drug resistance (XDR; CI: 12–44%), respectively. S. paratyphi with MDR (9%; CI: 2–28%) and XDR (2%; CI: 1–7%). Conclusion The findings revealed the alarming prevalence of antibiotic-resistant Salmonella in Pakistan and the need for updated treatment guidelines. Public health strategies must focus on improving antibiotic use and developing alternative treatment options to mitigate the rising threat of resistant Salmonella strains. Continued research, policy intervention, and national and international cooperation are essential to safeguard public health and ensure effective management of enteric fever.

Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance Among the General Adult Population in Riyadh Province, Saudi Arabia

Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance Among the General Adult Population in Riyadh Province, Saudi Arabia

Frequency of Culture-proven Bacterial Infection and Radiographic Pneumonia in Pediatric Heart Transplant Recipients

Background: Infection is a leading cause of death after pediatric heart transplants (PHTs). Understanding of common pathogens is needed to guide testing strategies and empiric antibiotic use. Methods: We conducted a 3-center retrospective study of PHT recipients ≤18 years old presenting to cardiology clinics or emergency departments (EDs) from 2010 to 2018 for evaluation of suspected infections within 2 years of transplant. Suspected infection was defined as (1) chief complaint of fever and/or (2) visit temperature ≥38 °C, and/or (3) blood culture obtained. The primary outcome was a culture-proven bacterial infection or radiographic pneumonia. Secondary outcomes included fluid-refractory septic shock, antibiotic resistance, respiratory viral infections and diagnostic testing. The unit of analysis was the encounter. Results: Of 193 children meeting inclusion criteria, 108 (56.0%) had ≥1 visit for suspected infection. Of 258 total encounters, 88.8% occurred in the ED and 52.8% resulted in admission. Culture-proven bacterial infection (4.3%) or radiographic pneumonia (11.6%) was documented in 15.5% of encounters; 1 (0.4%) had bacteremia. Antibiotics were administered in 33.7% of encounters, and 3 (1.2%) required inotropic support for fluid-refractory shock. Viral testing was sent in 162 encounters (62.8%), and 52% detected viral pathogens. Clinical characteristics and routinely obtained laboratory testing were similar in encounters with and without culture-proven bacterial infection or radiographic pneumonia. Conclusions: Over 15% of PHT recipients presenting with suspected infection had culture-proven bacterial infection or radiographic pneumonia. No single clinical or laboratory variable accurately identified these patients, potentially due to variability in testing. A more standardized approach could augment diagnostic and antimicrobial stewardship.

Environmental Risk Factors of Inflammatory Bowel Disease: Towards a Strategy of Preventative Health

Abstract The pathogenesis of inflammatory bowel disease (IBD) involves a complex interplay between genetic, environmental, and microbial factors. Many of these environmental determinants are modifiable, offering opportunities to prevent disease or delay its onset. Advances in the study of preclinical IBD cohorts offer the potential to identify biomarkers that predict individuals at high risk of developing IBD, enabling targeted environmental interventions aimed at reducing IBD incidence. This review summarizes findings from 79 meta-analyses on modifiable environmental factors associated with the development of IBD. Identified risk factors include smoking, Western diets, ultra-processed foods, and early-life antibiotic use, while protective factors include breastfeeding, Mediterranean diets rich in fiber, plant-based foods, and fish, along with an active physical lifestyle. Despite the promise shown by observational data, interventional or randomized controlled studies evaluating the efficacy of modifying environmental risk factors remain limited and mostly focus on dietary intervention. This review aims to inform the design of higher-quality interventional and randomized controlled studies for disease prevention while providing actionable guidance to healthcare providers on reducing the risk of developing IBD through environmental modifications.

Rapid Bacterial/Viral Infections Typing Strategy Using a Portable Dual-Channel Electrochemical Biosensor Based on One-Step Assembly of Immunomagnetic Beads.

Amidst multiple epidemics, a rapid, sensitive, economical, and portable infection diagnosis strategy is crucial for primary medical care, particularly through the analysis of pathogen sources to determine appropriate antibiotic use. C-reactive protein (CRP) and serum amyloid A (SAA) are host-related biomarkers, and their combined detection can effectively distinguish between bacterial and viral infections, which holds great significance for the diagnosis of unknown pathogens. In this work, a portable dual-channel electrochemical biosensor based on a one-step assembly of immunomagnetic beads was proposed for the on-site combined detection of plasma CRP and SAA, which streamlined the operation and shortened the minimum detection time to less than 3 min. The biosensor exhibited excellent linearity in the detection of 3.125-1250 ng/mL CRP and 31.25-1250 ng/mL SAA, with detection limits of 0.91 and 12 ng/mL, respectively, falling within the clinically relevant reference range. Through simulated sample tests, the biosensor effectively distinguished between bacterial infection, viral infection, and healthy plasma samples. The actual sample tests demonstrated a high correlation and comparable medical value to enzyme-linked immunosorbent assay. Overall, this proposed strategy showed potential to aid in infection diagnosis and enable rapid combined detection of multiple biomarkers.

Understanding the Potential of a Short-Term Participatory Video Project for Long-Term Change

Participatory video (PV) allows communities to explore issues of concern by making short videos. PV has been used in public health research by focusing the topic of video-making on a specific health issue in order to both raise awareness of this issue and to support communities to effect change with regard to this issue. Although evaluations of PV-in-health approaches yield positive findings in terms of community empowerment, it is difficult to measure changes in behaviour regarding the focal topic. This is important in the context of public health, as the impact of an intervention often determines its future usage. This study discusses a rare opportunity to consider the longer-term impacts of a PV project on the topic of antimicrobial resistance (AMR). Thematic analysis of a focus group discussion conducted with six PV participants demonstrates a retention of accurate knowledge about AMR over two years after original engagement. Participants reported changes in their own attitudes and practices around antibiotic and pesticide use, and described how they advocate for behaviour change in their wider communities. Findings also speak to the legacy of PV. While over time, videos may have impact through being viewed by others, participation in the project was also shown to have lasting legacy. Participants developed knowledge and changed attitudes on the topic, which continues to impact their behaviour. Beyond having co-produced the videos, participants are now experts in the video topic, and as such their opinions and actions represent a distinct, measurable impact of the PV process.

Antibiotic Utilization and Resistance According to the WHO AWaRe Classification in Intensive Care Units After COVID-19 Third Wave in Pakistan: Findings and Implications

Background and Objective: Irrational use and overuse of antibiotics is considered a major cause of antimicrobial resistance (AMR) among patients admitted to hospitals, especially in intensive care units (ICUs). ICUs are the most critical wards in healthcare settings, where the use of antibiotics is much higher compared to other wards. Therefore, the appropriate administration and monitoring of antibiotic usage in these units is a matter of concern. Materials and Methods: This retrospective study evaluated the types, utilization patterns, sensitivity, and resistance of various antibiotics used among patients admitted to the ICUs of different hospitals after the third wave of the coronavirus disease in 2019 (COVID-19) in Pakistan. Results: It was observed that more than 40% of the patients were given two antibiotics and 54.3% were given at least one antibiotic each day. A total of 768 antibiotics from different groups, based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification, were prescribed to 313 patients admitted to ICUs between April and August 2021. Among the types of antibiotics, amoxicillin/clavulanic acid was the most frequently used antibiotic (75 prescriptions). It was also observed that the majority of the bacterial isolates were more sensitive to carbapenems than the other antibiotics. The current study showed that antibiotic usage according to the AWaRe classifications was 31.8% in the Access category, 59.5% in the Watch category, and 8.7% in the Reserve category in ICUs of the studied hospitals after the third wave of COVID-19. Conclusions: The findings of the study also highlight the importance and continuous need for the implementation of antibiotic stewardship programs to optimize the appropriate utilization of antibiotics in the ICUs of the studied hospitals.

Consumers’ perspectives on antibiotic use and antibiotic resistance in food animals: a systematic review

Inappropriate antibiotic use in food animals is considered a significant contributor to increasing antibiotic resistance. Consumers can play a critical role in reducing it through purchasing choices, demand, and policy advocacy. This systematic review aimed to synthesize all published literature investigating consumers’ perspectives (i.e., knowledge, perceptions, and attitudes) on antibiotic use and antibiotic resistance in food animals. We conducted a comprehensive literature search in PubMed, Web of Science, Scopus, and Google Scholar on November 14, 2022, and an updated search on April 30, 2024. We limited findings to original peer-reviewed journal articles published up to 2023 (inclusive), were written in English, and focused on knowledge/perceptions/attitudes of antibiotic use and antibiotic resistance in food animals. Of the 3815 articles identified, 39 were included. The findings suggested that consumers were concerned about antibiotic use in food animals, thus they were willing to pay more for food products with antibiotic-free or reduced-antibiotic use. However, consumers lacked deep understanding of antibiotic use practice and antibiotic stewardship in food animals as well as transmission risks of antibiotic-resistant bacteria. These findings offer valuable insights for policymakers and livestock industries to implement policy and practice changes to ensure responsible antibiotic use in food animals.

Antimicrobial Stewardship Impact on Antibiotic Use in Three Tertiary Hospitals in Zambia: A Comparative Point Prevalence Survey

Introduction: Antimicrobial stewardship (AMS) can improve the rational use of antibiotics in hospitals. This study assessed the impact of a multifaceted AMS intervention on antibiotic use and prescribing patterns at three tertiary hospitals in Zambia. Methods: Point Prevalence Surveys (PPS) were conducted in three tertiary hospitals in August 2022 and in October 2023. It was part of a 3-year AMS demonstration project that aimed to optimize the use of antibiotics in treating urinary tract infections (UTIs) and bloodstream infections (BSIs) in various health sector settings in Zambia. Up to 170 medical records in 2022 and 265 in 2023 were included in the assessment. Results: Overall, the prevalence of antibiotic use in this PPS was 75%. Eighty-one percent (81%) and 71% of patients assessed were on at least one antibiotic in 2022 and 2023, respectively, indicating a decrease of 10%. Similarly, prescribing ceftriaxone, the most prescribed antibiotic, declined from an average of 48% in 2022 to 38% in 2023. Adherence to Standard Treatment Guidelines (STGs) slightly increased from 42% in 2022 to 45% in 2023. Additionally, antibiotic prescribing was reduced from 1.38 to 1.21. Conclusions: Antimicrobial stewardship had an early positive impact on antibiotic use and adherence to Standard Treatment Guidelines.

Development of an Information and Communication Technology (ICT) Tool for Monitoring of Antimicrobial Use, Animal Disease and Treatment Outcome in Low-Income Countries

Background/Objectives: Surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) is needed to understand risks and implement policies. Collecting AMU data in the context of disease prevalence and therapeutic outcomes has been suggested for improving AMU. We describe the process of developing an information and communication technology (ICT) system to monitor AMU, diseases and treatment outcomes in poultry in East Africa. Methods: A prototype system to register drug sales in veterinary pharmacies, a mobile application for farmers to report their AMU, and a database for monitoring was developed. Contact information for participating veterinarians was included as well as information about poultry diseases, husbandry, AMR and prudent use of antibiotics. The system was pilot-tested for a 6-month period in Kenya. Results: A total of 15,725 records were submitted by the 14 participating pharmacies and 91 records were entered by the 15 participating farmers. Overall, the participants were positive about the system and were able to use it. The information available was appreciated by the farmers. The pharmacy representatives appreciated getting an overview of their sales and stated that it had given them new insights. Conclusions: Despite some challenges, the concept of the developed ICT system could be useful for future monitoring of animal health and the use of pharmaceuticals in animals, and connecting farmers with veterinarians to improve animal health management. Our results underline the importance of close collaboration with stakeholders so that developed tools can be transferred to national ownership after the finalization of externally funded projects.

Implementation of Smart Triage combined with a quality improvement program for children presenting to facilities in Kenya and Uganda: An interrupted time series analysis.

Sepsis occurs predominantly in low-middle-income countries. Sub-optimal triage contributes to poor early case recognition and outcomes from sepsis. Improved recognition and quality of care can lead to improved outcomes. We evaluated the impact of Smart Triage using improved time to intravenous antimicrobial administration in a multisite interventional study. Smart Triage, a digital platform with a risk score and clinical dashboard, was implemented (with control sites) in Kenya (February 2021-December 2022) and Uganda (April 2020-April 2022). Children presenting to the outpatient departments with an acute illness were enrolled. A controlled interrupted time series was used to assess the effect on time from arrival at the facility to intravenous antimicrobial administration. Secondary analyses included antimicrobial use, admission rates and mortality (NCT04304235). During the baseline period, the time to antimicrobials decreased significantly in Kenya (132 and 58 minutes) at control and intervention sites. In Uganda, the time to antimicrobials marginally decreased (3 minutes) at the intervention site. Then, during the implementation period in Kenya, the time to antimicrobials at the intervention site decreased by 98 min (57%, 95% CI 81-114) but increased by 49 min (21%, 95% CI: 23-76) at the control site. In Uganda, the time to antimicrobials initially decreased but was not sustained and there was no significant difference between intervention and control sites. At both intervention sites, there was a significant reduction in antimicrobial utilization of 47% (Kenya) and 33% (Uganda) compared to baseline. There was a reduction in admission rates of 47% (Kenya) and 33% (Uganda) compared to baseline. Mortality reduced by 25% (Kenya) and 75% (Uganda) compared to the baseline period. We showed significant improvements in time to intravenous antibiotics in Kenya but not Uganda, likely due to COVID-19, a short study period and resource constraints. The reduced antimicrobial use and admission and mortality rates are remarkable and welcome benefits. The admission and mortality rates should be interpreted cautiously as these were secondary outcomes. This study underlines the difficulty of implementing technologies and sustaining quality improvement in health systems.

Evaluation of Antibacterial Activity of Different Porphyrins Containing Transition Metals at the Core: Unveiling the Potent Metalloporphyrins as Antimicrobial Agents

ABSTRACTThe foundation of healthcare has been the use of antibiotics to treat bacterial infections; however, the growing number of infections resistant to these drugs has raised serious concerns. Innovative antimicrobial strategies that are safe, minimally invasive, and able to act quickly and efficiently are needed to address this urgent problem and provide a substitute for conventional antibiotics in the fight against this growing health emergency. Metalloporphyrins are emerging photosensitizers, utilized in antimicrobial photodynamic therapy, using visible light and photosensitive compounds to cause oxidative damage to microbial organisms. Metalloporphyrins are minimally toxic molecules that can target microbial pathogens through a variety of distinct mechanisms. We synthesized an electronically activated and sterically protected catalyst, meso‐tetrakis(2,6‐dichlorophenyl‐β‐octabromo) porphyrins and inserted different metals into the porphyrin cavity. Evaluation of the antibacterial activity of our catalyst towards various Gram‐positive and Gram‐negative bacteria revealed bactericidal activity.

Antibiotic resistance of urinary pathogens after kidney transplantation: a 10-year single-center survey in Germany

Abstract Purpose Urinary tract infections (UTIs) are common complications after kidney transplantation (KT), often resulting in severe outcomes like acute graft failure and sepsis. Factors such as diabetes, age, sex, and type of transplantation significantly influence disease progression. Rising antibiotic resistance complicates treatment, emphasizing the importance of Antimicrobial Stewardship (AMS), particularly during the post-transplant immunosuppression phase. Recent changes in treatment protocols, including a shift away from treating asymptomatic bacteriuria and modifications in antibiotic prescribing, highlight the need for updated resistance trend analyses. Methods This retrospective study at the University Hospital Essen analyzed urine samples from kidney transplant outpatients from 2013 to 2022. Pathogen identification and resistance testing focused on common UTI pathogens, including Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Enterococcus faecium, and Enterococcus faecalis. Data on antibiotic prescriptions were sourced from the North Rhine Association of Statutory Health Insurance since 2017. Results Out of 10,508 urine samples collected from 6962 patients, bacterial growth was detected in 4126 samples (39%). Escherichia (E.) coli was the most frequent pathogen (41%). Klebsiella spp., which accounted for 11.7% of all pathogens, showed increasing resistance to piperacillin/tazobactam and ceftazidime. Resistance rates Enterococcus faecalis showing a significant decline in levofloxacin (100% resistance in 2014 in all isolates, compared to 2% in 2022). An increasing concern in our cohort is the prevalence of Extended Spectrum Beta-Lactamase (ESBL)-producing Gram-negative pathogens, particularly Klebsiella spp., which are being detected with greater frequency. In our center, we have observed a significant increase in the use of oral antibiotics recommended for first-line therapy. This shift is attributed to updated guidelines and therapeutic recommendations. Consequently, oral cephalosporins are now rarely used due to their low bioavailability. Conclusion The study highlights the importance of ongoing surveillance to address antibiotic resistance in KT recipients. Increasing resistance in pathogens like Klebsiella spp. necessitates new antimicrobial strategies. Findings should inform future guidelines to preserve antibiotic effectiveness and improve therapeutic outcomes in this vulnerable patient population.

Urinary microbiota changes among NMIBC patients during BCG therapy: comparing BCG responders and non-responders

The gold standard for treating high-risk non-muscle-invasive bladder cancer involves the transurethral removal of cancerous tissue followed by BCG immunotherapy. So far, there is no reliable biomarker for predicting BCG efficacy and identifying patients who will or will not respond to BCG treatment. Emerging evidence suggests that urinary microbiota may play a crucial role in BCG efficacy. This study aimed to explore (i) changes in urinary microbiota during the six induction cycles of BCG and (ii) its potential predictive role in determining the outcome of BCG treatment. To this end, catheterized urine samples were collected before each of the six BCG doses and bacterial composition was analyzed using 16S rRNA gene sequencing. Patient inclusion criteria were male gender, no previous history of urothelial cancer, no other malignancies, no active infection, and no antibiotic usage for at least 20 days before the first BCG dose. We observed a significant decrease in biodiversity, measured by the Shannon Index, during the first week of therapy in 10 out of 12 patients (p=0.021). Additionally, differences in microbiota composition before the start of BCG therapy were noted between responders and non-responders to BCG therapy. Non-responders exhibited a 12 times higher abundance of genus Aureispira (p<0.001), and, at the species level, a 27-fold lower abundance of Negativicoccus succinivorans (p<0.001). Throughout the treatment, the abundance of the genus Aureispira decreased, showing an eightfold reduction by the end of therapy among non-responders (p<0.001). Our findings suggest that urinary microbiota plays an active role before and during the course of BCG therapy. However, this is a preliminary study, and further research involving larger patient cohorts is needed.