Other specific DSP article suggested by Editorial Board
A targeted stewardship intervention improves the adequacy of antipseudomonal therapy after implementation of the EUCAST 2019 clinical category redefinitions.
Authors: Pesaresi LM, et al
Abstract
Objectives: To evaluate the adequacy of antipseudomonal therapy in hospitalised patients following implementation of the 2019 EUCAST clinical category redefinitions through a multidisciplinary strategy.
Methods: A mixed-design study was conducted in a university hospital. Adult inpatients with documented Pseudomonas aeruginosa infection and available antimicrobial susceptibility and treatment data were included. Two study periods were defined: a pre-intervention retrospective/training period and a post-intervention period. Primary outcome was adequacy of antimicrobial therapy. Secondary outcomes included clinical and microbiological variables.
Results: A total of 169 patients were included (78 pre-intervention and 91 post-intervention). Median age was 69 years (IQR 60-79), Charlson comorbidity index 5 (IQR 3-7) and SOFA score 3 (IQR 2-5). Analyses were adjusted for baseline differences between groups. Adequacy of antipseudomonal therapy increased significantly after the intervention (25/78 vs 79/91, p < 0.001). Interrupted time analysis (ITS) showed the intervention was associated with a marked and statistically significant immediate increase in the adequacy of antipseudomonal therapy (OR, 13.13; 95% CI, 1.73-113.25; p=0.015) after adjustment for time, SOFA score and infection type; without increased meropenem use. No significant differences were observed in mortality, readmissions or survival. Despite higher baseline severity in the post-intervention group, length of hospital stay was significantly shorter (OR = 0.98, p < 0.05). A non-significant trend toward fewer acquired resistance mutations was observed, consistent with improved local antipseudomonal susceptibility.
Conclusions: Implementation of the 2019 EUCAST clinical category redefinitions, supported by coordinated interventions from Microbiology and Infectious Diseases specialists, was associated with a marked improvement in adequate antipseudomonal therapy without increased meropenem use or adverse clinical outcomes. The trend toward reduced resistance emergence suggests this strategy is ecologically safe and sustainable.
Other specific DSP article suggested by Editorial Board
MRSA Knowledge, Infection-Prevention Practices, and Antibiotic Use Without Clinician Consultation Among Hajj Pilgrims Arriving in Madinah, Saudi Arabia: A Cross-Sectional Study.
Authors: Aloufi A, et al
Abstract
Background: Hajj is an international mass gathering in which infection prevention and antimicrobial stewardship intersect. Methicillin-resistant Staphylococcus aureus (MRSA) was selected as the organism-specific focus because it is a clinically important antimicrobial-resistant pathogen associated with skin and soft-tissue infections, wound care, and transmission through close contact and sharing of personal items. Hajj studies have also documented MRSA-related carriage and broader antimicrobial-resistance concerns among pilgrims and other mass-gathering populations. However, the relation between general infection awareness, MRSA-specific knowledge, and self-reported antibiotic-use behaviour remains less well described. This study assessed these three domains among Hajj pilgrims arriving in Madinah, Saudi Arabia.
Methods: A questionnaire-based cross-sectional study was conducted during Hajj 1446H (2025). The study dataset comprised 342 completed questionnaires. Item-level descriptive analyses were used because no validated composite scoring algorithm was documented in the available study records. The primary exploratory outcome was an undated, self-reported history of taking antibiotics without consulting a doctor. Modified Poisson regression with robust variance estimated adjusted prevalence ratios (aPRs), with sex, age group, education, healthcare employment, and MRSA awareness entered simultaneously as prespecified covariates.
Results: Among 342 respondents, 213 (62.3%) were male, 155 (45.3%) were aged 46-60 years, 181 (52.9%) reported postgraduate education, and 51 (14.9%) worked in healthcare. General awareness of crowding-related bacterial-infection risk was high (256/342, 74.9%), whereas MRSA-specific knowledge was lower: 110 (32.2%) had heard of MRSA, 137 (40.1%) identified personal-item sharing as a transmission route, and 124 (36.3%) recognised that MRSA can cause serious or fatal infection. Handwashing ≥ 3 times/day was reported by 310 respondents (90.6%), and 327 (95.6%) reported not sharing personal items. However, 143 respondents (41.8%) reported taking antibiotics without consulting a doctor. In the adjusted model, the prevalence of this outcome was higher among participants aged > 60 years than among those aged < 46 years (aPR 1.86, 95% CI 1.35-2.56) and among those who had not heard of MRSA (aPR 3.60, 95% CI 2.10-6.18) or did not know whether they had heard of MRSA (aPR 3.40, 95% CI 1.84-6.30), compared with those who had heard of MRSA.
Conclusions: Among pilgrims arriving in Madinah, general infection-prevention awareness and self-reported hygiene practices coexisted with limited MRSA-specific knowledge, and a substantial proportion of respondents reported taking antibiotics without consulting a doctor. The observed associations are cross-sectional and non-causal; they neither establish the timing or appropriateness of antibiotic use nor demonstrate that an education intervention would change behaviour. They identify a hypothesis for prospective evaluation of multilingual Hajj education linking MRSA transmission, wound care, and antibiotic stewardship.
Other specific DSP article suggested by Editorial Board
Burden of bacterial antimicrobial resistance associated with modifiable human antibiotic consumption: An observational study.
Authors: Singer BJ, et al
Abstract
Background: Human antibiotic use is widely believed to contribute to the evolution and maintenance of antimicrobial resistance (AMR) in bacterial pathogens. While antibiotic stewardship should thus discourage use in situations where AMR-related harms outweigh clinical benefit, evidence to inform this assessment of tradeoffs is lacking, most notably in low-resource settings where gaps in antibiotic access persist. Quantitative understanding of use-resistance relationships is thus necessary as countries navigate commitments from the 2024 UN General Assembly resolution to reduce AMR burden by 2030.
Methods and findings: We used global surveillance data on AMR prevalence from 2000 to 2018 representing over 30 million bacterial isolates from 114 countries, along with antibiotic consumption estimates for each country and year, to estimate elasticity relationships between AMR and antibiotic exposure. Our analyses addressed 16 bacterial pathogens and antibiotic consumption across 7 drug classes, controlling for country-level health and development indicators via weighted regression models. Across pathogens, evidence that AMR is associated with population-level antibiotic exposure is strongest for Acinetobacter spp., Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. In a modeled counterfactual scenario, we estimate that 10% lower levels of antibiotic use, in comparison to current levels, across classes, would be associated with 38,000 (95% confidence interval: 36,000-41,000) fewer annual deaths attributable to AMR globally. Although substantial, this total represents only 0.50% of estimated bacterial disease mortality. In sub-Saharan Africa, where risk of death due to bacterial disease is greatest, the modeled avertible burden of AMR-attributable deaths comprises only 0.34% of bacterial disease mortality. Key limitations of the study include reliance on ecological relationships to infer modifiable burden, and under-representation of low-resource settings in surveillance data on antibiotic consumption and AMR.
Conclusions: Our findings suggest near-term achievable reductions in AMR-attributable deaths may be modest relative to the persisting burden of bacterial disease mortality. These estimates should inform assessments of the potential benefits and harms of restrictive versus permissive antibiotic use paradigms in epidemiologically distinct settings.