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From access to reserve: antimicrobial resistance among etiological agents of central line-associated bloodstream infections in the view of WHO’s AWaRe antimicrobial spectrum.
DOI: 10.3205/dgkh000559
Authors:Anand G et al
Abstract
Aim: Central line-associated bloodstream infections (CLABSI) remain a major contributor to morbidity and mortality in critically ill patients. The rise of antimicrobial resistance (AMR) exacerbates treatment challenges, making it crucial to examine pathogen resistance patterns. This study analyses CLABSI-associated pathogens’ antimicrobial susceptibility using the WHO’s AWaRe antimicrobial framework, providing insights to guide targeted treatment and strengthen infection control strategies.
Methods: This observational study (2021-2024) assessed data from adult and pediatric ICUs to evaluate CLABSI incidence, microbial etiology, and antimicrobial susceptibility trends. We categorized antimicrobials based on the WHO’s AWaRe classification system, analysing their susceptibility to Access, Watch, and Reserve antimicrobials. Statistical analysis was performed using SPSS version 22.
Results: Among 5,398 patient records, 101 cases of CLABSI were confirmed. The predominant pathogens were Klebsiella (K.) pneumoniae (27.7%), Acinetobacter spp. (19.8%), and Candida spp. (17.8%). A worrying decline in susceptibility to Access- and Watch-category antimicrobials was observed in key pathogens. K. pneumoniae demonstrated a steep decline in susceptibility to Access-category agents, from 27.8% in 2021 to 16.7% in 2023. Conversely, Reserve-category antimicrobials maintained 100% efficacy across the study period. Acinetobacter spp. exhibited resistance to both Access- and Watch-category antimicrobials by 2024. Pseudomonas aeruginosa showed a drastic drop in Watch-category susceptibility, from 44.5% in 2021 to 0% in 2023, while Reserve-agents remained effective. These results underline the growing reliance on Reserve antimicrobials and the diminishing effectiveness of first-line agents. Furthermore, a fluctuation in CLABSI rates was also observed, with a significant reduction in infection rates in 2024 after the implementation of enhanced infection control practices.
Conclusion: This study highlights the escalating resistance patterns of CLABSI pathogens, with a consternating decline in Access- and Watch-category antimicrobial efficacy. The AWaRe framework proves invaluable in identifying critical resistance trends, demonstrating the need for targeted antimicrobial stewardship. Prioritizing Access antimicrobials as first-line therapies, guided by local resistance data, can preserve the effectiveness of Reserve agents. A strategic focus on the AWaRe classification, coupled with rigorous infection control and stewardship programs, is essential to combat the rising AMR threat and optimize patient outcomes in critical care settings.
Other specific DSP article suggested by Editorial Board
Evaluating chain-of-thought prompting in a GPT chatbot for BCID2 interpretation and stewardship: how does AI compare to human experts?
Authors:Tassone DM et al
Abstract
Background: Rapid molecular diagnostics, such as the BIOFIRE® Blood Culture Identification 2 (BCID2) panel, have improved the time to pathogen identification in bloodstream infections. However, accurate interpretation and antimicrobial optimization require Infectious Disease (ID) expertise, which may not always be readily available. GPT-powered chatbots could support antimicrobial stewardship programs (ASPs) by assisting non-specialist providers in BCID2 result interpretation and treatment recommendations. This study evaluates the performance of a GPT-4 chatbot compared to ASP prospective audit and feedback interventions.
Methods: This prospective observational study assessed 43 consecutive real-world cases of bacteremia at a 399-bed VA Medical Center from January to May 2024. The GPT-chatbot utilized “chain-of-thought” prompting and external knowledge integration to generate recommendations. Two independent ID physicians evaluated chatbot and ASP recommendations across four domains: BCID2 interpretation, source control, antibiotic therapy, and additional diagnostic workup. The primary endpoint was the combined rate of harmful or inadequate recommendations. Secondary endpoints assessed the rate of harmful or inadequate responses for each domain.
Results: The chatbot had a significantly higher rate of harmful or inadequate recommendations (13%) compared to ASP (4%, p = 0.047). The most significant discrepancy was observed in the domain of antibiotic therapy, where harmful recommendations occurred in up to 10% (p <0.05) of chatbot evaluations. The chatbot performed well in BCID2 interpretation (100% accuracy) but provided more inadequate responses in source control consideration (10% vs. 2% for ASP, p = 0.022).
Conclusions: GPT-powered chatbots show potential for supporting antimicrobial stewardship but should only complement, not replace, human expertise in infectious disease management.
Other specific DSP article suggested by Editorial Board
An antimicrobial stewardship intervention on antibiotic prophylaxis for transrectal prostate biopsies in a veteran population.
DOI: 10.1017/ash.2025.166
Authors: Bennett G et al
Abstract
This retrospective review describes changes in prophylactic antibiotic prescribing practices for Veterans undergoing transrectal ultrasound-guided prostate biopsy (TRUPB) and the incidence of post TRUPB infection-related hospitalizations before and after an antimicrobial stewardship intervention.
Other specific DSP article suggested by Editorial Board
Temporal trends in vaccination and antibiotic use among young children in the United States, 2000-2019.
Authors: Eiden AL et al
Abstract
Objective: Routine immunization programs may reduce antibiotic use, but few studies have comprehensively examined their impact on antibiotic utilization. The authors aimed to explore temporal trends in vaccination and antibiotic use among young children in the United States.
Design: Ecological study using the Merative® MarketScan Commercial Claims and Encounters database.
Methods: Data on pediatric vaccine uptake (pneumococcal conjugate, Haemophilus influenzae type b, diphtheria-tetanus-pertussis, and influenza) and antibiotic prescriptions and antibiotic-treated respiratory tract infections among US children <5 years during 2000-2019 was analyzed. Vaccination status was assessed annually, and children were categorized based on receipt of all four vaccines, 1-3 vaccines, or no vaccines. Antibiotic prescriptions were classified by spectrum and drug class. Respiratory infections included otitis media, pharyngitis, pneumonia, sinusitis, and viral infections.
Results: Among 6.7 million children, vaccine uptake increased from 32.5% receiving all four vaccines in 2004 to 66.8% in 2019. During this period, overall antibiotic prescriptions decreased from 1.89 to 1.01 per person-year, with the greatest reductions in macrolides (73.3%) and broad-spectrum antibiotics (57.0%). Antibiotic-treated respiratory tract infections declined from 2.43 to 1.61 episodes per person-year, with the largest decreases in sinusitis (64.7%) and pharyngitis (39.8%).
Conclusions: The findings suggest a temporal association between routine childhood immunization uptake and reduced antibiotic utilization. Although immunization programs are primarily aimed at protecting children from vaccine-preventable diseases, their potential role in complementing antimicrobial stewardship efforts and other factors influencing antibiotic reduction warrants further investigation through more rigorous study designs
Other specific DSP article suggested by Editorial Board
Tracking the Invisible War: Automated Profiling of Multidrug-Resistant Pathogens in a Tertiary Care Teaching Hospital in Central India.
DOI: 10.7759/cureus.85778
Authors: Mohod SV et al
Abstract
Background: Automated systems such as VITEK® 2 Compact have revolutionized microbial diagnostics by offering rapid identification and antimicrobial susceptibility testing (AST). This study aimed to evaluate the spectrum of bacterial and fungal isolates and their resistance profiles using the VITEK 2 system.
Material and methods: A retrospective cross-sectional analysis was conducted over one year (January 2024 to December 2024) in the Department of Microbiology of a tertiary care hospital in Central India. The present study included only those clinical specimens that were initially processed using conventional methods but proved difficult to identify based on biochemical reactions alone. These included blood, sputum, wound swab, pus, cervicovaginal swab, endotracheal aspirate, pleural fluid, bronchoalveolar lavage, stool, corneal scraping, and cerebrospinal fluid. Such samples were subsequently subjected to identification by the VITEK 2 Compact system to ensure rapid and accurate results. The resistance patterns of Gram-negative organisms including Enterobacterales and non-fermenters, gram-positive cocci, and yeasts were analyzed. These findings were entered into the Microsoft Excel Version 2010. Statistical analysis was carried out using SPSS Version 20 for Windows package (IBM Corp., Armonk, NY, USA). Observed association of multidrug resistant (MDR) isolates from ICU with observed multidrug resistance from non-ICU was tested by calculating the p-value using the chi-square test (p-value of 0.00055, i.e., p < 0.05 was considered significant).
Results: Out of 284 isolates, Klebsiella pneumoniae 35 (12%), Pseudomonas aeruginosa 24 (8%), Staphylococcus aureus 33 (11%), and Candida albicans 14 (5%) were predominant. Isolated organisms were found more in the ICU, 195 (69%), than non-ICU, 89 (31%), setting. The proportion of MDR isolates is significantly higher in the ICU (92.82%, 181/195) compared to the non-ICU setting (78.65%, 70/89). High resistance was noted among Enterobacterales against β-lactams (100%) and fluoroquinolones (87.5%). Non-fermenters such as Acinetobacter baumannii showed 100% resistance to multiple drugs, indicating pan-drug resistance in some strains. Among gram-positive organisms, penicillin, erythromycin, levofloxacin, ciprofloxacin, and chloramphenicol were tested for Enterococcus faecalis. Enterococcus faecalis showed 100% resistance to penicillin, erythromycin, and chloramphenicol. Yeasts exhibited varied resistance, with Candida tropicalis and Cryptococcus laurentii showing higher resistance to fluconazole, 4 (57%) and 1 (100%), respectively.
Conclusion: The study reveals a significant rising occurrence of multidrug-resistant organisms, particularly in critical care areas. The VITEK 2 Compact system enabled rapid and precise identification of resistance profiles, including rare and highly resistant strains. Its use is crucial for timely, targeted therapy and reinforces the need for robust diagnostic and antimicrobial stewardship practices.
Other specific DSP article suggested by Editorial Board
Antibiotic Misuse: An In-Depth Examination of Its Global Consequences and Public Health Challenges.
DOI: 10.7759/cureus.85941
Authors: Nammi J et al