Journal of Antimicrobial Chemotherapy

BackgroundHospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP), particularly those caused by multi-drug resistant organisms (MDROs), often require newer antibiotic treatment. The efficacy and safety of newer antibiotics compared to generic antibiotics in randomized controlled trials (RCTs) have not been evaluated before. MethodsIn this systematic review, we searched RCTs in the United States National Library of Medicine (PubMed), Cochrane Central Reg...

Background: Emerging third generation cephalosporin-resistant Enterobacteriaceae (3GCR-EB) pose a global healthcare concern. We assessed excess mortality in patients infected with 3GCR-EB compared to patients infected with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCS-EB). Methods: The study cohort comprised all inpatients with a community-onset or healthcare-associated infection caused by Enterobacteriaceae in three tertiary-care public hospitals in 2017. Excess in-hospita...

BackgroundSystematic evidence on antimicrobial selection for antimicrobial resistance (AMR) is scarce. We estimated the effect of prescribing key antibiotic classes on AMR across U.S. Veterans Affairs Medical Centres (VAMC). MethodsWe analysed clinical isolates of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa from 138 VAMC from Feb 1, 2007 to Dec 31, 2021. Antimicrobial prescribing was measured as inpatient days of therapy per 1000 patient-days; mult...

ObjectivesThe SARS-CoV-2 pandemic has impacted healthcare use, with mixed reports about the impact on antimicrobial resistance. This work aimed to identify changes in healthcare utilisation and antibiotic prescribing in relation to the COVID-19 pandemic and quantify any subsequent impact on antibiotic resistance in clinical Escherichia coli isolates across a complete geographical population in Scotland. MethodsData including [~]490,000 people from January 2018 to March 2022 were accessed via th...

BackgroundThere is debate on whether cefazolin or antistaphylococcal penicillins should be the first-line treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Ongoing trials are investigating whether cefazolin is non-inferior to (flu)cloxacillin, but it remains uncertain whether these findings would apply to other antistaphylococcal penicillins. ObjectiveWe conducted a systematic review and meta-analysis comparing cefazolin to each of the individual antistaphylococcal ...

ObjectivesTo provide real-world evidence on piperacillin exposure and outcomes in critically ill patients following the implementation of pharmacokinetic (PK)/pharmacodynamic (PD)-guided dosing in routine care. MethodsThis retrospective observational study included critically ill adults who received continuous piperacillin/tazobactam infusion between 2011 and 2019. Empiric doses were individualized using dosing software based on renal function and subsequently adjusted according to therapeutic ...

IntroductionAntimicrobial resistance (AMR) poses a critical global health threat, with projections of 10 million annual deaths by 2050 if left unaddressed. Antimicrobial stewardship (AMS) initiatives, such as the UKHSA Start Smart - Then Focus (SSTF) framework, are vital for optimising antibiotic use. However, the COVID-19 pandemic significantly disrupted AMS practices, leading to increased empirical prescribing and reduced opportunities for timely antibiotic review. MethodsThis retrospective c...

Carriage duration of carbapenemase-producing Enterobacteriaceae (CPE) is uncertain. We followed 21 CPE carriers over one year. Mean carriage duration was 86 (95%CrI= [60, 122]) days, with 98.5% (95%CrI= [95.0, 99.8]) probability of decolonization in one year. Antibiotic consumption was associated with prolonged carriage. CPE-carriers status should be reviewed yearly.

BackgroundStaphylococcus aureus bloodstream infection (SAB) is treated with at least 14 days of intravenously administered antimicrobials. We assessed the efficacy and safety of an early oral switch therapy in patients at low risk for SAB-related complications. MethodsIn an international non-inferiority trial, we randomized patients with SAB after 5 to 7 days of intravenous antimicrobial therapy to either switch to an oral antimicrobial or to continue with intravenous standard therapy. Main exc...

ObjectivesLinezolid is highly valuable for treating infections caused by Gram-positive bacteria that are resistant to first-line agents. Severe infections require empirical therapy, where treatment is initiated before the pathogen and its susceptibility are identified. This evaluation aims to compare different dosing strategies for empirical dosing of linezolid in an intensive care unit (ICU) setting, with the goal of optimising pathogen eradication while minimising toxicities. MethodsThree dos...

BackgroundCOVID-19 and antimicrobial resistance (AMR) are two intersecting global public health crises. ObjectiveWe aim to describe the impact of the COVID-19 pandemic on AMR across healthcare settings. Data SourceA search was conducted in December 2021 in World Health Organizations COVID-19 Research Database with forward citation searching up to June 2022. Study EligibilityStudies evaluating the impact of COVID-19 on AMR in any population were included and influencing factors were extracted....

BackgroundIn many European hospitals, ampicillin-resistant Enterococcus faecium (ARE) is endemic, while outbreaks of vancomycin-resistant E. faecium (VRE), belonging to the same genetic lineage, are increasingly reported. We studied the attributable mortality due to vancomycin resistance in patients with E. faecium bacteremia and evaluated whether this is mediated by a delay in appropriate antibiotic therapy. MethodsIn a retrospective matched cohort study, patients with VRE bacteremia occurring...

BackgroundAntimicrobial resistance (AMR) is a multifaceted global challenge, partly driven by inappropriate antibiotic prescribing. The COVID-19 pandemic impacted antibiotic prescribing for common bacterial infections. This highlights the need to examine risk of hospital admissions related to common infections, excluding COVID-19 infections during the pandemic. MethodsWith the approval of NHS England, we accessed electronic health records from The Phoenix Partnership (TPP) through OpenSAFELY pl...

ObjectivesSeveral recent studies highlight the high prevalence of resistance to multiple antibiotic classes used in current treatment regimens for neonatal sepsis and new treatment options are urgently needed. We aimed to identify potential new combination antibiotic treatment regimens by investigating the drug-resistance and genetic profiles of the most frequently isolated Gram-negative bacteria causing neonatal sepsis in low- and middle-income countries (LMICs) in the NeoOBS study. Material a...

BackgroundThere is currently a paucity of data describing bacterial coinfections, related antibiotic prescribing patterns, and the potential role of antimicrobial stewardship in the care of patients infected with SARS-CoV-2. MethodsThis prospective, observational study was conducted from March 10, 2020 to April 21, 2020 in admitted patients with confirmed COVID-19. Patients were included if [≥] 18 years old and admitted to the hospital for further treatment. Data was collected via chart revi...

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackgroundC_ST_ABSResearch has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged [≥]65 years in primary care. MethodsWe analysed primary care records from patients aged [≥]65 years in England with community-onset UTI using the Clinical Practice Research Datali...

A 2019 nationwide study in Japan revealed the predominant methicillin-resistant Staphylococcus aureus (MRSA) types in bloodstream infections (BSIs) to be sequence type (ST)8-carrying SCCmec type IV (ST8-MRSA-IV) and clonal complex 1-carrying SCCmec type IV (CC1- MRSA-IV). However, detailed patient characteristics and how these MRSA types evolve over time remain largely unknown. In this long-term single-center study, MRSA strains isolated from blood cultures at Nagasaki University Hospital from 2...

BackgroundCurrent FDA-approved label recommends polymyxin B dosing should be adjusted according to renal function, despite several studies proved poor correlation between polymyxin B PK and creatinine clearance. The study aims to assess the impact of renal function on polymyxin B metabolism and identify an alternate dosing strategy by population analysis. MethodsBlood samples from adult patients were collected at steady state during routine therapeutic drug monitoring. Nonlinear mixed effects m...

BackgroundEscherichia coli bloodstream infections (BSIs) have been under mandatory surveillance in the UK for fifteen years, but cases continue to rise. Systematic searches of all features present within electronic healthcare records (EHRs), described here as an EHR-wide association study (EHR-WAS), could potentially identify under-appreciated factors that could be targeted to reduce infections. MethodsWe used data from Oxfordshire, UK, and an EHR-WAS method developed for use with large-scale C...

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a persistent nosocomial pathogen that poses a significant threat to global public health. A three-month cross-sectional observational study was conducted in a 28-bed ICU in Hangzhou, China. The same ICU was sampled for the same duration and with a similar methodology in 2019, 20 months prior to the outset of this study. Following COVID-19-associated delays, a series of IPC measures targeting patients, staff and the ICU environment were imple...