Other specific DSP article suggested by Editorial Board
Diabetes Mellitus and Enhanced Vulnerability to Escherichia coli Catheter-Associated Urinary Tract Infections: Integrative Clinical and Molecular Analysis.
Authors: Parveen N, et al
Abstract
Catheter-associated urinary tract infections (CAUTIs) represent a substantial clinical burden, particularly in diabetes Mellitus (DM) patients, with extended duration of catheterization. Escherichia coli remains most prevalent uropathogen, often exhibiting virulence factors, robust biofilm formation, and multidrug resistance (MDR). This study investigates antimicrobial resistance patterns, virulence gene profiles, and biofilm production of E. coli isolates from CAUTI patients with and without diabetes mellitus. A total of 260 CAUTI patients were enrolled in this study, comprising 130 diabetic (HbA1c > 6.5%) and 130 non-diabetic (HbA1c < 5.7%) individuals admitted to various wards of DHQ Hospital, Jhang, between January 2023 and January 2024. From 183 urine culture-positive urine samples 123 E. coli isolates were analyzed. Antimicrobial susceptibility testing was performed by disk diffusion, Molecular profiling and virulence genes were conducted via polymerase chain reaction (PCR), and biofilm quantification was assessed by microtiter plate method. MDR (89.7%) and XDR (19.2%) phenotypes were significantly more common in diabetic isolates with increased resistance to ß-lactams, fluoroquinolones, carbapenems, and sulfonamides. The most prevalent genes were bla CTX-M, bla NDM and bla OXA-48. Virulence genes (fimH (78%), PapC (50%), FyuA (45%), and KpsMTII (33%) associated with enhanced biofilm formation. Diabetes mellitus (DM) substantially exacerbates CAUTIs caused by E. coli through increased multidrug resistance, virulence genes prevalence and biofilm production emphasizing the need for targeted antimicrobial stewardship and stringent infection control strategies in diabetic populations.
Other specific DSP article suggested by Editorial Board
Exploring Early Antifungal Activity of Rezafungin as a Stepping-Stone for Shorter Treatment Duration for Candidemia: Pooled Analysis of 2 Randomized Trials.
DOI: 10.1093/ofid/ofag143
Authors: Ostrosky-Zeichner L, et al
Abstract
Background: Guidelines recommend ≥2 weeks of antifungal therapy after candidemia clearance and for invasive candidiasis (IC). This post-hoc analysis evaluates Day 7 pooled data from the phase 2 STRIVE and phase 3 ReSTORE trials to explore early antifungal activity.
Methods: Adults with candidemia and/or IC received weekly rezafungin 400/200 mg or daily caspofungin 70/50 mg for ≤4 weeks. Efficacy was evaluated in the modified intent-to-treat population via all-cause mortality (ACM; primary endpoint; 20% noninferiority margin), mycological eradication, and time to negative blood culture (TTNBC) at days 7, 14, and 30 (TTNBC assessed only in patients with candidemia). Day 7 safety was evaluated in the safety population.
Results: Rezafungin was noninferior to caspofungin at each timepoint. Day 7 ACM rates were 7.9% (11/139) for rezafungin and 5.2% (8/155) for caspofungin (weighted difference [95% CI]: 3.0% [-3.7, 9.7]). Mycological eradication was similar between groups at all timepoints. Day 7 rates were 71.2% (99/139) and 65.2% (101/155), respectively (weighted difference [95% CI]: 6.6% [-4.0, 17.1]). Median (interquartile range) TTNBC was numerically shorter for rezafungin (22.3 [14.3-47.0] hours; caspofungin 26.3 [17.8-112.6] hours). Subgroup analyses suggested potential Day 7 benefits for rezafungin in patients with candidemia or C. albicans. Day 7 safety for rezafungin was consistent with previous reports.
Conclusions: Rezafungin was noninferior to caspofungin in candidemia and/or IC from Day 7, with shorter TTNBC in patients with candidemia. Subgroup analysis suggested a potential early benefit with rezafungin in some patients. Trials exploring shorter treatment durations for some patients are warranted.
Other specific DSP article suggested by Editorial Board
Clinical impact of a multidisciplinary remote-based hybrid antibiotic stewardship program in critically ill patients during COVID-19 pandemic in Korea: a prospective pilot implementation study.
Authors: Lee S, et al
Abstract
Background: Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use in intensive care units (ICUs); however, many institutions lack infectious disease specialists and pharmacy expertise for full implementation. The COVID-19 pandemic further disrupted conventional stewardship. While tele-stewardship models have shown promise, evidence for hybrid programs operating without infectious disease specialist leadership remains limited, particularly outside high-income countries. We developed a hybrid ASP (hASP) collaboratively led by an on-site intensivist and an off-site faculty clinical pharmacist to reduce inappropriate antibiotic use and improve outcomes in a resource-constrained ICU.
Methods: This prospective, single-center, pre-post study was conducted in the medical ICU of a 733-bed university teaching hospital in Seoul, South Korea. The pre-intervention period (August to October 2017) with no ASP was compared with the post-intervention period (August to October 2020) following hASP implementation. Stewardship activities were primarily performed off-site by trained clinical pharmacists via secured messaging, telephone, and video conferencing, with on-site rounds every other weekday. Key outcomes were inappropriate antibiotic prescriptions per 100 patient-days, 30-day all-cause mortality, ICU length of stay, preventable adverse drug events, and days of therapy, assessed using Delphi-derived appropriateness criteria.
Results: Thirty-three and 37 admissions were analyzed (364 and 251 patient-days). On-site activities were limited to three hours daily or less. Inappropriate prescriptions declined from 83.8 to 20.7 per 100 patient-days (p < 0.001), ICU length of stay from 14 to 6 days (p < 0.05), and preventable adverse drug events from 4.4 to 2.8 per 100 patient-days (p < 0.05). Thirty-day all-cause mortality was comparable (24.2% vs. 24.3%). The most frequent pharmacist interventions were dose optimization (47.8%) and antimicrobial discontinuation (40.6%), with an overall acceptance rate of 62.3%. Days of therapy for broad-spectrum antibiotics targeting multidrug-resistant organisms declined while those for narrower-spectrum agents increased, suggesting a shift toward targeted therapy.
Conclusion: The hASP, collaboratively led by an intensivist and a faculty clinical pharmacist with off-site pharmacist-led interventions via virtual communication, significantly reduced inappropriate prescribing, ICU length of stay, and preventable adverse drug events. Hybrid stewardship models may serve as a feasible alternative to on-site programs in resource-limited settings.”
Other specific DSP article suggested by Editorial Board
Interconnected reservoirs and escalating resistance in multidrug-resistant Pseudomonas aeruginosa : A One Health review.
Authors: Mohanty S, et al
Abstract
Multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) has emerged as a major global health threat due to its intrinsic resistance mechanisms, remarkable genetic adaptability, and ability to persist across interconnected human, animal, food, and environmental reservoirs. Increasing evidence indicates that antimicrobial resistance (AMR) in P. aeruginosa is not confined to clinical settings but is sustained through complex ecological interactions involving wastewater systems, agricultural environments, aquaculture, food production chains, and the built environment. This narrative review synthesizes current evidence on the emergence, molecular mechanisms, environmental reservoirs, and cross-sectoral transmission pathways of MDR P. aeruginosa within the One Health framework. The review further examines therapeutic challenges associated with intrinsic resistance, horizontally acquired resistance genes, adaptive tolerance mechanisms, and biofilm-mediated persistence. Emerging treatment strategies, including bacteriophage therapy, antimicrobial peptides, nanotechnology-based approaches, and predictive modeling for optimized antibiotic use, are also discussed. The findings highlight the convergence of resistance determinants across sectors and emphasize the role of environmental and anthropogenic drivers in sustaining AMR. Addressing MDR P. aeruginosa therefore requires integrated One Health strategies that combine antimicrobial stewardship, improved environmental management, strengthened surveillance systems, and responsible antimicrobial use across healthcare, agriculture, and environmental sectors. Coordinated interdisciplinary efforts will be essential to mitigate the growing global burden of MDR P. aeruginosa and preserve the effectiveness of current and future antimicrobial therapies.
Other specific DSP article suggested by Editorial Board
A clinically oriented antimicrobial resistance surveillance network 2 (ACORN2): results from three hospitals in Viet Nam.
Authors: Thi HN, et al
Abstract
Objectives: ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) integrates antimicrobial resistance (AMR) surveillance with clinical data in hospitals across low- and middle-income countries. We describe ACORN2 data from Viet Nam and compare findings with existing national surveillance data.
Methods: Hospitalised patients receiving intravenous antibiotics were enrolled from selected wards in three national hospitals. Infections were classified as community-acquired (CAI), healthcare-associated (HCAI), or hospital-acquired (HAI). Microbiological data were deduplicated to the first isolate per species per infection episode. Pathogen distribution and resistance patterns were analysed by hospital, infection origin, and sample type.
Results: Among 5,449 infection episodes, 2,817 were CAI, 1,615 HCAI, and 1,017 HAI. Escherichia coli and Staphylococcus aureus predominated in sterile samples, while Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were most frequent in non-sterile samples. A. baumannii and P. aeruginosa were common in HCAI and HAI. Resistance to third-generation cephalosporins and carbapenems was markedly higher in HCAI and HAI than CAI, with widespread carbapenem resistance in A. baumannii. Overall AMR levels exceeded those reported in previous national surveillance data.
Conclusion: ACORN2 demonstrates a high burden of AMR in Viet Nam, particularly in healthcare- and hospital-acquired infections, underscoring the value of clinically oriented surveillance to inform treatment and stewardship policies.”
Other specific DSP article suggested by Editorial Board
Diabetes Mellitus and Enhanced Vulnerability to Escherichia coli Catheter-Associated Urinary Tract Infections: Integrative Clinical and Molecular Analysis.
Authors:Parveen N, et al
Abstract
Catheter-associated urinary tract infections (CAUTIs) represent a substantial clinical burden, particularly in diabetes Mellitus (DM) patients, with extended duration of catheterization. Escherichia coli remains most prevalent uropathogen, often exhibiting virulence factors, robust biofilm formation, and multidrug resistance (MDR). This study investigates antimicrobial resistance patterns, virulence gene profiles, and biofilm production of E. coli isolates from CAUTI patients with and without diabetes mellitus. A total of 260 CAUTI patients were enrolled in this study, comprising 130 diabetic (HbA1c > 6.5%) and 130 non-diabetic (HbA1c < 5.7%) individuals admitted to various wards of DHQ Hospital, Jhang, between January 2023 and January 2024. From 183 urine culture-positive urine samples 123 E. coli isolates were analyzed. Antimicrobial susceptibility testing was performed by disk diffusion, Molecular profiling and virulence genes were conducted via polymerase chain reaction (PCR), and biofilm quantification was assessed by microtiter plate method. MDR (89.7%) and XDR (19.2%) phenotypes were significantly more common in diabetic isolates with increased resistance to ß-lactams, fluoroquinolones, carbapenems, and sulfonamides. The most prevalent genes were bla CTX-M, bla NDM and bla OXA-48. Virulence genes (fimH (78%), PapC (50%), FyuA (45%), and KpsMTII (33%) associated with enhanced biofilm formation. Diabetes mellitus (DM) substantially exacerbates CAUTIs caused by E. coli through increased multidrug resistance, virulence genes prevalence and biofilm production emphasizing the need for targeted antimicrobial stewardship and stringent infection control strategies in diabetic populations.
Other specific DSP article suggested by Editorial Board
Exploring Early Antifungal Activity of Rezafungin as a Stepping-Stone for Shorter Treatment Duration for Candidemia: Pooled Analysis of 2 Randomized Trials.
DOI: 10.1093/ofid/ofag143
Authors: Ostrosky-Zeichner L, et al
Abstract
Background: Guidelines recommend ≥2 weeks of antifungal therapy after candidemia clearance and for invasive candidiasis (IC). This post-hoc analysis evaluates Day 7 pooled data from the phase 2 STRIVE and phase 3 ReSTORE trials to explore early antifungal activity.
Methods: Adults with candidemia and/or IC received weekly rezafungin 400/200 mg or daily caspofungin 70/50 mg for ≤4 weeks. Efficacy was evaluated in the modified intent-to-treat population via all-cause mortality (ACM; primary endpoint; 20% noninferiority margin), mycological eradication, and time to negative blood culture (TTNBC) at days 7, 14, and 30 (TTNBC assessed only in patients with candidemia). Day 7 safety was evaluated in the safety population.
Results: Rezafungin was noninferior to caspofungin at each timepoint. Day 7 ACM rates were 7.9% (11/139) for rezafungin and 5.2% (8/155) for caspofungin (weighted difference [95% CI]: 3.0% [-3.7, 9.7]). Mycological eradication was similar between groups at all timepoints. Day 7 rates were 71.2% (99/139) and 65.2% (101/155), respectively (weighted difference [95% CI]: 6.6% [-4.0, 17.1]). Median (interquartile range) TTNBC was numerically shorter for rezafungin (22.3 [14.3-47.0] hours; caspofungin 26.3 [17.8-112.6] hours). Subgroup analyses suggested potential Day 7 benefits for rezafungin in patients with candidemia or C. albicans. Day 7 safety for rezafungin was consistent with previous reports.
Conclusions: Rezafungin was noninferior to caspofungin in candidemia and/or IC from Day 7, with shorter TTNBC in patients with candidemia. Subgroup analysis suggested a potential early benefit with rezafungin in some patients. Trials exploring shorter treatment durations for some patients are warranted.
Other specific DSP article suggested by Editorial Board
Clinical impact of a multidisciplinary remote-based hybrid antibiotic stewardship program in critically ill patients during COVID-19 pandemic in Korea: a prospective pilot implementation study.
DOI: 10.3310/mbva3675
Authors: Lee S, et al
Abstract
Background: Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use in intensive care units (ICUs); however, many institutions lack infectious disease specialists and pharmacy expertise for full implementation. The COVID-19 pandemic further disrupted conventional stewardship. While tele-stewardship models have shown promise, evidence for hybrid programs operating without infectious disease specialist leadership remains limited, particularly outside high-income countries. We developed a hybrid ASP (hASP) collaboratively led by an on-site intensivist and an off-site faculty clinical pharmacist to reduce inappropriate antibiotic use and improve outcomes in a resource-constrained ICU.
Methods: This prospective, single-center, pre-post study was conducted in the medical ICU of a 733-bed university teaching hospital in Seoul, South Korea. The pre-intervention period (August to October 2017) with no ASP was compared with the post-intervention period (August to October 2020) following hASP implementation. Stewardship activities were primarily performed off-site by trained clinical pharmacists via secured messaging, telephone, and video conferencing, with on-site rounds every other weekday. Key outcomes were inappropriate antibiotic prescriptions per 100 patient-days, 30-day all-cause mortality, ICU length of stay, preventable adverse drug events, and days of therapy, assessed using Delphi-derived appropriateness criteria.
Results: Thirty-three and 37 admissions were analyzed (364 and 251 patient-days). On-site activities were limited to three hours daily or less. Inappropriate prescriptions declined from 83.8 to 20.7 per 100 patient-days (p < 0.001), ICU length of stay from 14 to 6 days (p < 0.05), and preventable adverse drug events from 4.4 to 2.8 per 100 patient-days (p < 0.05). Thirty-day all-cause mortality was comparable (24.2% vs. 24.3%). The most frequent pharmacist interventions were dose optimization (47.8%) and antimicrobial discontinuation (40.6%), with an overall acceptance rate of 62.3%. Days of therapy for broad-spectrum antibiotics targeting multidrug-resistant organisms declined while those for narrower-spectrum agents increased, suggesting a shift toward targeted therapy.
Conclusion: The hASP, collaboratively led by an intensivist and a faculty clinical pharmacist with off-site pharmacist-led interventions via virtual communication, significantly reduced inappropriate prescribing, ICU length of stay, and preventable adverse drug events. Hybrid stewardship models may serve as a feasible alternative to on-site programs in resource-limited settings.”
Other specific DSP article suggested by Editorial Board
Interconnected reservoirs and escalating resistance in multidrug-resistant Pseudomonas aeruginosa : A One Health review.
Authors: Mohanty S, et al
Abstract
Multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) has emerged as a major global health threat due to its intrinsic resistance mechanisms, remarkable genetic adaptability, and ability to persist across interconnected human, animal, food, and environmental reservoirs. Increasing evidence indicates that antimicrobial resistance (AMR) in P. aeruginosa is not confined to clinical settings but is sustained through complex ecological interactions involving wastewater systems, agricultural environments, aquaculture, food production chains, and the built environment. This narrative review synthesizes current evidence on the emergence, molecular mechanisms, environmental reservoirs, and cross-sectoral transmission pathways of MDR P. aeruginosa within the One Health framework. The review further examines therapeutic challenges associated with intrinsic resistance, horizontally acquired resistance genes, adaptive tolerance mechanisms, and biofilm-mediated persistence. Emerging treatment strategies, including bacteriophage therapy, antimicrobial peptides, nanotechnology-based approaches, and predictive modeling for optimized antibiotic use, are also discussed. The findings highlight the convergence of resistance determinants across sectors and emphasize the role of environmental and anthropogenic drivers in sustaining AMR. Addressing MDR P. aeruginosa therefore requires integrated One Health strategies that combine antimicrobial stewardship, improved environmental management, strengthened surveillance systems, and responsible antimicrobial use across healthcare, agriculture, and environmental sectors. Coordinated interdisciplinary efforts will be essential to mitigate the growing global burden of MDR P. aeruginosa and preserve the effectiveness of current and future antimicrobial therapies.
Other specific DSP article suggested by Editorial Board
A clinically oriented antimicrobial resistance surveillance network 2 (ACORN2): results from three hospitals in Viet Nam.
Authors: Thi HN, et al
Abstract
Objectives: ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) integrates antimicrobial resistance (AMR) surveillance with clinical data in hospitals across low- and middle-income countries. We describe ACORN2 data from Viet Nam and compare findings with existing national surveillance data.
Methods: Hospitalised patients receiving intravenous antibiotics were enrolled from selected wards in three national hospitals. Infections were classified as community-acquired (CAI), healthcare-associated (HCAI), or hospital-acquired (HAI). Microbiological data were deduplicated to the first isolate per species per infection episode. Pathogen distribution and resistance patterns were analysed by hospital, infection origin, and sample type.
Results: Among 5,449 infection episodes, 2,817 were CAI, 1,615 HCAI, and 1,017 HAI. Escherichia coli and Staphylococcus aureus predominated in sterile samples, while Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were most frequent in non-sterile samples. A. baumannii and P. aeruginosa were common in HCAI and HAI. Resistance to third-generation cephalosporins and carbapenems was markedly higher in HCAI and HAI than CAI, with widespread carbapenem resistance in A. baumannii. Overall AMR levels exceeded those reported in previous national surveillance data.
Conclusion: ACORN2 demonstrates a high burden of AMR in Viet Nam, particularly in healthcare- and hospital-acquired infections, underscoring the value of clinically oriented surveillance to inform treatment and stewardship policies.”