Other specific DSP article suggested by Editorial Board
Ethical use of AI in infectious diagnostic decision and therapeutic stewardship.
Authors: Panda PK et al
Abstract
Artificial intelligence (AI) is rapidly reshaping healthcare, offering transformative potential in infectious diagnostics and antimicrobial stewardship through enhanced accuracy, efficiency, and predictive capabilities. However, its integration into clinical practice raises significant ethical challenges. These include transparency of decision-making, protection of patient privacy, algorithmic fairness, accountability, and the preservation of human oversight. Global and national bodies have developed guidance to address these concerns: the World Health Organization (WHO) emphasizes autonomy, inclusiveness, and equity; the U.S. Food and Drug Administration (FDA) regulates adaptive AI as medical devices; the European Union AI Act classifies medical AI as “high-risk”; and the Indian Council of Medical Research (ICMR) highlights accountability, data security, and cultural sensitivity. Drawing on these frameworks, this perspective discusses the ethical imperatives of deploying AI responsibly in infectious diagnostic and therapeutic stewardship. Best practices are outlined to ensure that innovation enhances patient trust, safety, and equity while mitigating risks of misuse or bias.
Other specific DSP article suggested by Editorial Board
The Impact of COVID-19 on the Epidemiology of Carbapenem Resistance.
Authors: Sakagianni A et al
Abstract
Background: The global COVID-19 pandemic has significantly disrupted healthcare systems, inadvertently influencing the epidemiology of antimicrobial resistance (AMR). Among the most critical AMR threats are carbapenem-resistant organisms (CROs), which include carbapenem-resistant Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa. This review explores the pandemic’s impact on carbapenem resistance patterns worldwide.
Objectives: This study aimed to assess the effects of the COVID-19 pandemic on carbapenem resistance trends, identify key drivers, and discuss implications for clinical practice and public health policy. Methods: A comprehensive review of peer-reviewed literature, national surveillance reports, and WHO/ECDC data from 2019 to 2025 was conducted, with emphasis on hospital-acquired infections, antimicrobial use, and infection control practices during the pandemic.
Results: The pandemic has led to increased use of broad-spectrum antibiotics, including carbapenems, often in the absence of confirmed bacterial co-infections. Overwhelmed healthcare systems and disruptions in infection prevention and control (IPC) measures have facilitated the spread of carbapenem-resistant organisms, particularly in intensive care settings. Surveillance data from multiple countries show a measurable increase in CRO prevalence during the pandemic period, with regional variations depending on healthcare capacity and stewardship infrastructure.
Conclusions: COVID-19 has accelerated the emergence and dissemination of carbapenem resistance, underscoring the need for resilient antimicrobial stewardship and IPC programs even during public health emergencies. Integrating pandemic preparedness with AMR mitigation strategies is critical for preventing further escalation of resistance.
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Use of a molecular syndromic panel for the etiological diagnosis of ventilator-associated bacterial pneumonia: impact on clinical outcomes and antibiotic use from a multicenter, prospective study.
Authors: Giacobbe DR et al
Abstract
Background: Ventilator-associated bacterial pneumonia (VABP) is a common infection in critically ill patients in intensive care units (ICU), with attributable mortality of up to 13%, and its etiological diagnosis remains challenging.
Materials and methods: A multicenter, prospective, observational study was conducted within the MULTI-SITA platform to assess the impact on relevant clinical and antimicrobial stewardship outcomes of the use of a molecular syndromic panel (BIOFIRE® FILMARRAY® Pneumonia plus), in addition to a standard approach based on culture. The primary outcome measure was 30-day mortality from VABP onset.
Results: Overall, 237 patients with VABP were included in the study. In multivariable analysis, SOFA score (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.04–1.22, p = 0.003), previous isolation of carbapenem-resistant Pseudomonas aeruginosa (HR 3.02, 95% CI 1.25–7.32, p = 0.015), and solid neoplasm (HR 2.15, 95% CI 1.12–4.14, p = 0.022) were associated with increased mortality, while no association was registered for the molecular syndromic panel performed (HR 1.07, 95% CI 0.59–1.93, p = 0.825). In secondary analyses, use of the molecular syndromic panel resulted in more events of either de-escalation or initiation of appropriate antibiotic therapy at day 1 from VABP onset in comparison with a standard approach based on culture only (41.3% vs. 27.8%, p = 0.041). Conclusion: The use of a molecular syndromic panel in patients with VABP was able to impact antibiotic decisions, without an unfavorable effect on mortality. Further study is necessary to assess the long-term effects in terms of antimicrobial stewardship of molecular syndromic panels-based antibiotic treatment decisions.
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Determinants of Implementation of Antimicrobial Stewardship Interventions for Managing Community Adult Acute Respiratory Infections: Qualitative Analysis from the OPTIMAS-GP Study Co-Design Phase.
Authors: Jordan M et al
Abstract
Background/objectives: Antimicrobial stewardship (AMS) interventions are critical to reducing inappropriate antibiotic prescribing for acute respiratory infections (ARIs) in primary care and mitigating antimicrobial resistance (AMR). While interventions are routinely employed in hospitals, implementation in general practice is nascent. This qualitative study, part of the OPTIMAS-GP project, explored determinants influencing the implementation of evidence-based AMS strategies in Australian general practice.
Methods: Using Experience-Based Co-Design, three rounds of online focus groups were conducted with ten healthcare professionals (GPs, pharmacists, microbiologist, practice staff) and ten adult patients who had experienced ARI management in primary care. Participants discussed the feasibility and acceptability of AMS interventions: shared decision-making (SDM) tools, delayed prescribing (DP) and point-of-care testing (PoCT) for C-reactive protein (CRP).
Results: Thematic analysis of focus group transcriptions identified four interrelated themes: ‘Patient acceptance and engagement’, ‘Practising within a system’, ‘Prescribing stewardship’, and ‘Diagnostic stewardship’. Patient engagement was dependent upon expectations, trust, and personalised care, while systemic factors such as continuity of care, practice culture, and resource availability influenced implementation. DP was viewed as a pragmatic but potentially confusing strategy, requiring clear patient guidance and interprofessional collaboration. SDM tools were conceptually supported but challenged by time constraints and poor health literacy. PoCT-CRP was cautiously welcomed for selective use, with concerns expressed about workflow integration and overreliance on testing. Findings were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to identify behavioural determinants and inform future implementation strategies. Recommendations include co-designing patient-centred AMS tools with clear instructions and red flags, enhancing GP-pharmacist collaboration, and addressing barriers to PoCT integration. Conclusions: These insights highlight the complexity of implementing AMS interventions in general practice and underscore the need for tailored, system-supported approaches to optimise antibiotic use and reduce AMR.
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Establishing a Practical Approach to Sewer Monitoring for Antimicrobial Resistance Genes and Organisms at Healthcare Facilities
Authors: Rachel S Poretsky
Abstract
Background: Surveillance of wastewater from healthcare facilities has the potential to identify the emergence of multidrug-resistance (MDR) genes of public health importance. Specifically, wastewater surveillance (WWS) can provide sentinel surveillance of novel MDR genes or organisms in healthcare facilities, helping to direct targeted prevention efforts and monitor longitudinal effects. Several knowledge gaps need to be addressed before WWS can be used routinely for MDR surveillance, including determining optimal approaches to sampling, processing, and testing wastewater.
Methods: To this end, we evaluated multiple methods for wastewater collection (passive, composite, and grab), concentration (nanoparticles, filtration, and centrifugation), and PCR quantification (real-time quantitative PCR vs. digital PCR) for Candida auris and 5 carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48-like) twice weekly for 6 months at a long-term acute care hospital in Chicago, IL. We also tested the effects of different transport and sample storage conditions on PCR quantification.
Results: All genes were detected in facility wastewater, with blaKPC being the most consistently abundant. Experiments were done in triplicate with gene copy, variance, and number of detections between triplicates used to determine method efficacy. We found that passive samples processed immediately by centrifugation followed by bead-beating and dPCR provided the most reliable results for detecting MDR genes and C. auris. We also present the tradeoffs of different approaches and use culture and metagenomics to elucidate clinical relevance.
Conclusions: This study establishes a practical approach for WWS as a potential tool for public health monitoring of MDR burden in healthcare facilities.”
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Investigating Azithromycin Activity Against ESBL-Producing Escherichia coli Under Physiologically Relevant Conditions
Authors: Sean Jung
Abstract
Abstract: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli are a major antimicrobial resistance threat. Although not standard therapy, azithromycin (AZM) displayed potent activity against ESBL E. coli in vitro, ex vivo, and in vivo. AZM demonstrated multi-fold reductions in MIC, bactericidal activity in supplemented mammalian tissue culture media, and enhanced dose-dependent activity with sodium bicarbonate (NaHCO3). AZM also augmented complement-mediated killing in human serum and improved survival by 50% in a murine bloodstream infection model. These findings underscore the need to revisit antibiotic susceptibility testing—incorporating host defense factors and NaHCO3—and suggest AZM merits further clinical evaluation for ESBL E. coli infections.
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Active screening and decolonization reduce the incidence of Staphylococcus aureus bacteremia and mortality in hemodialysis patients: An interrupted time series study in a hemodialysis unit
Authors: Han-Chuan Chuang
Abstract
Background: Hemodialysis (HD) patients with nasal Staphylococcus aureus carriage are at an increased risk of S. aureus infection.
Purpose: This study investigated the incidence of S. aureus bacteremia and associated mortality in HD patients receiving active screening and decolonization (ASD) program for nasal S. aureus carrier in a teaching hospital HD unit.
Methods: The ASD program was divided into five stages: 1: preintervention, 2: preparation, 3: intervention, 4: interruption, and 5: reintervention. Nasal screening was conducted every 3 months in stages 3 and 5. Patients colonized with S. aureus received decolonization with mupirocin to the nares and 4 % chlorhexidine gluconate body wash. S. aureus bacteremia and mortality were assessed. Whole-genome sequencing was conducted on S. aureus isolate in stage 3.
Results: In preintervention stage, the bacteremia incidence and mortality rate were 7.8 and 3.1 cases per 100 patient-years(PY). In the intervention stage, the incidence rate decreased to 1 case per 100 PY without mortality. In the reintervention stage, the incidence and mortality rates were 2.1 and 0.6 cases per 100 PY. The rates in stages 3, 4, and 5 were significantly lower than those in preintervention stage (p < 0.05). Genomic analysis of S. aureus isolates from stage 3 revealed genetically diversity. High-level mupirocin-resistant S. aureus isolates carrying mupA-bearing plasmids were identified.
Conclusions: ASD programs for S. aureus carrier may improve clinical outcomes in HD units. However, mupirocin resistance may emerge after decolonization, indicating a need for ongoing monitoring and alternative decolonization strategies.”
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Linezolid versus daptomycin for VRE bloodstream infections in patients with malignancy: The impact of neutropenia on outcomes
Authors: Ming-Tao Tsai
Abstract
Objectives: Vancomycin-resistant enterococcal bloodstream infections (VRE-BSIs) carry high mortality in patients with malignancy. While neutropenia is a known risk factor for mortality in patients with malignancy and BSI, its impact on the effectiveness of daptomycin and linezolid in VRE-BSI is not well defined.
Methods: We conducted a multicenter cohort study of hospitalized patients aged ≥18 years with malignancy and VRE-BSI between 2010 and 2021. Eligible patients received linezolid or high-dose daptomycin (≥8 mg/kg). Those with pneumonia or Enterococcus species other than E. faecium were excluded. Only the first VRE-BSI episode per patient was analyzed. The primary outcome was 14-day mortality, assessed using multivariable logistic regression.
Results: A total of 474 patients were included (linezolid, n = 90; daptomycin, n = 384); 128 (27.0 %) had neutropenia. The 14-day mortality was 32.9 % (156/474). Mortality was higher in neutropenic than non-neutropenic patients (45/128 [35.2 %] vs. 111/346 [32.1 %]; P = 0.005). Among neutropenic patients, mortality was 6/8 (75.0 %) with linezolid and 49/120 (40.8 %) with daptomycin; in non-neutropenic patients, mortality was 16/82 (19.5 %) and 85/264 (32.2 %), respectively. In multivariable analysis, linezolid use in neutropenic patients was associated with higher mortality (aOR 8.48; 95 % CI, 1.40–51.30; P = 0.02).
Conclusions: Neutropenia was associated with worse outcomes in patients with VRE-BSI, and linezolid-treated neutropenic patients showed higher mortality in this cohort. These findings should be interpreted cautiously given the small sample size and residual confounding. High-dose daptomycin may be considered, particularly in neutropenic patients, but confirmatory studies are needed.”