Other specific DSP article suggested by Editorial Board
Antibiotic optimization in hospitalized children with non-severe community-acquired pneumonia: lessons from an antimicrobial stewardship intervention (2022-2024).
Authors: Attaianese F, et al
Abstract
Background and objectives: Community-acquired pneumonia (CAP) is a leading cause of hospitalization and antibiotic use in children. Despite guidelines recommending narrow-spectrum regimens and shorter treatment durations, prescribing practices remain inconsistent. This study assessed the impact of a newly implemented diagnostic and therapeutic clinical pathway (CP) as part of an antimicrobial stewardship (AMS) intervention in a tertiary care pediatric hospital. Methods: A single-center, retrospective observational study was conducted on children aged 28 days to 18 years hospitalized with non-severe, uncomplicated CAP from January 2022 to December 2024. The CP was implemented on January 1st, 2024. Antibiotic prescribing patterns, clinical outcomes, and predictors of short-course therapy (≤5 days) were compared between pre- and post-CP periods. Multivariate logistic regression identified predictors of intravenous (IV) therapy ≤48 h, total therapy ≤5 days, and ampicillin use as first-line agent. Results: The study included 263 CAP episodes in 250 children. Following the implementation of CP, the use of ampicillin as a first-line IV antibiotic significantly increased [19/99 (19%) vs. 1/164 (0.6%); p < 0.001]. A higher proportion of post-CP patients received IV antibiotics for ≤48 h [25/99 (25%) vs. 20/164 (12%); p = 0.006], reflecting an increased rate of early IV-to-oral switch. However, total antibiotic duration and hospital length of stay (LOS) remained unchanged. Viral detection in respiratory samples predicted antibiotic courses of ≤5 days. Conclusions: CP implementation improved adherence to evidence-based antibiotic prescribing, reduced broad-spectrum use, and increased early IV-to-oral transitions without compromising outcomes. However, unchanged therapy duration and LOS highlight the need for further AMS interventions, clinician education, and integration of viral and bacterial diagnostics to support optimal antibiotic use.
Other specific DSP article suggested by Editorial Board
Multiplex Polymerase Chain Reaction (PCR) and Conventional Methods for Diagnosing Ventilator-Associated Pneumonia in ICU Settings: A Systematic Review.
DOI: 10.7759/cureus.94852
Authors: Fadel Yosif AS,et al
Abstract
Ventilator-associated pneumonia (VAP) is a prevalent and serious infection in intensive care units (ICUs), with timely and accurate diagnosis being crucial for patient outcomes. Conventional diagnostic methods, primarily culture-based, are hampered by long turnaround times and limited sensitivity. Multiplex polymerase chain reaction (PCR) (mPCR) offers rapid detection of multiple pathogens and resistance genes, potentially revolutionizing VAP diagnosis and antimicrobial stewardship. This systematic review aims to compare the diagnostic performance and clinical impact of mPCR versus conventional methods for diagnosing VAP in ICU settings. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library was performed for studies published between 2020 and 2025. Eligible studies compared mPCR with conventional culture in ICU patients with suspected VAP and reported diagnostic accuracy metrics. Study quality was assessed using the QUADAS-2 tool. A qualitative synthesis was performed due to significant heterogeneity among the included studies. Fifteen studies were included. mPCR demonstrated high pooled sensitivity and specificity, with a consistently high negative predictive value (NPV) frequently approaching 100%. This high NPV provides a strong rationale for discontinuing unnecessary antibiotics when results are negative. However, positive predictive value (PPV) was more variable and often lower, reflecting the challenge of differentiating true infection from colonization. The most significant advantage of mPCR was its drastically reduced turnaround time compared to conventional culture. This rapidity facilitated earlier antibiotic modifications, including de-escalation and targeted therapy, as demonstrated in several studies. mPCR represents a significant advancement for the rapid microbiological diagnosis of VAP, offering high NPV and dramatically faster results than conventional culture. These attributes make it a powerful tool for enhancing antimicrobial stewardship in ICUs. However, its optimal use requires integration into clinical practice with careful interpretation of positive results within the context of clinical signs to distinguish infection from colonization. mPCR should be viewed as a complementary diagnostic tool that augments, rather than replaces, conventional microbiology. Limitations include potential omission of relevant studies due to database restrictions, language barriers, and paywalled articles, which may have influenced the comprehensiveness of study retrieval. Future research should focus on measuring its impact on hard clinical outcomes and conducting formal cost-effectiveness analyses.
Other specific DSP article suggested by Editorial Board
Adapting International Evidence-Based Guidelines to Local Challenges: A Lebanese perspective on the latest American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) Community-Acquired Pneumonia Antibacterial Therapy Recommendations.
Authors: Attieh R ,et al
Abstract
Community-acquired pneumonia (CAP) remains a major global health concern, particularly in regions with rising antimicrobial resistance (AMR). In Lebanon, increasing resistance among respiratory pathogens complicates management, limiting treatment options and worsening clinical and economic outcomes. This expert panel review assessed recent national AMR data to adapt CAP treatment recommendations to the Lebanese context. The 2019 ATS/IDSA guidelines and their 2025 update were reviewed; while most recommendations were retained, empiric antibiotic choices were adjusted for key pathogens based on local resistance patterns. The proposed management algorithm stratifies patients by disease severity, care setting, and AMR risk, integrating pathogen-specific risk factors into clinical decisions. By contextualizing international guidance to local epidemiology and healthcare infrastructure, these recommendations aim to optimize targeted therapy, support antimicrobial stewardship, and preserve antibiotic efficacy in Lebanon’s evolving resistance landscape.
Other specific DSP article suggested by Editorial Board
Impact of a persuasive antimicrobial stewardship program on antibiotic use in patients admitted to emergency department for urinary tract infections: a multicentre prospective study
Authors: Margherita Macera
Abstract
Background: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.
Methods: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.
Results: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58–79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.
Conclusions: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.”
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Carbapenem-resistant Enterobacterales (CRE) acquisition and molecular characterization following colistin monotherapy and colistin-meropenem combination therapy: findings from the AIDA randomized trial
Authors: Amir Nutman
Abstract
Background: Colistin-carbapenem combination therapy is frequently used for carbapenem-resistant Gram-negative infections, but its impact on subsequent acquisition of carbapenem-resistant Enterobacterales (CRE) requires further investigation. We evaluated the incidence of CRE acquisition and performed molecular characterization of recovered isolates following treatment with colistin–meropenem versus colistin monotherapy.
Methods: This analysis addressed a pre-specified secondary aim of the AIDA multicenter randomized controlled trial, which compared colistin monotherapy to colistin–meropenem combination therapy for carbapenem-resistant Gram-negative infections at six hospitals in Israel, Greece, and Italy. Rectal swabs were obtained at enrollment and weekly until day 28 or discharge. Swabs were processed centrally by plating onto MacConkey agar supplemented with imipenem to selectively isolate CRE. Recovered colonies were identified using MALDI-TOF mass spectrometry, and meropenem minimum inhibitory concentrations (MICs) were determined by broth microdilution. Clinical cultures were obtained as indicated and processed locally, and CRE isolates were sent to the central laboratory for confirmation and characterization. Whole-genome sequencing was used to determine sequence types and resistance genes. Patients were excluded if they had CRE detected at baseline, either by rectal culture or as the index clinical isolate, or if no follow-up rectal cultures were available.
Results: Among 197 eligible patients (99 colistin; 98 colistin–meropenem), CRE acquisition occurred in 6 (3.0%): 1/99 (1.0%, 95% CI 0.03–5.5%) in the monotherapy arm and 5/98 (5.1%, 95% CI 1.7–11.5%) in the combination arm (p = 0.12). Two patients in the combination arm developed clinical infections caused by CRE (bacteremia and pneumonia); none occurred in the monotherapy arm. Carbapenemase genes were detected in four of the six acquired CRE isolates: one in the monotherapy arm (blaVIM) and three in the combination arm (all blaKPC). Identified species included Klebsiella pneumoniae and Escherichia coli belonging to established and emerging high-risk, multidrug-resistant clones.
Conclusions: Patients treated with colistin-meropenem had a higher, though not statistically significant, rate of CRE acquisition. Early detection of high-risk CRE clones highlights the need to weigh potential unintended consequences when selecting combination regimens for multidrug-resistant infections.
Other specific DSP article suggested by Editorial Board
Emergency department-initiated outpatient parenteral antimicrobial therapy in Taiwan: A retrospective cohort study on clinical outcomes and cost analysis
Authors: Yu-Kai Chen
Abstract
Background: ED-initiated outpatient parenteral antimicrobial therapy (OPAT) aims to reduce admissions and relieve ED boarding. In practice, however, OPAT may be used as a “middle-ground” alternative to oral therapy, complicating assessment of its true value. Because studies using matched inpatient and outpatient comparators with longitudinal endpoints are scarce, we evaluated the effectiveness, safety, and medical costs of an ED-initiated OPAT program in Taiwan.
Methods: This retrospective cohort study analyzed ED-initiated OPAT patients from two teaching hospitals (2017–2019). Using coarsened exact matching, we created two comparison groups: inpatient-matched (assessing effectiveness) and outpatient-matched (assessing safety). The primary outcome was net hospital days saved over 30 days, derived from daily hospital-prevalence trajectories. Secondary outcomes were 14-day cumulative incidence of ED revisits/readmission and a stratified cost analysis over the treatment course.
Results: Of 1409 OPAT patients, 986 were matched. In the inpatient-matched cohort (n = 416), OPAT saved a net 8.9 hospital-days per patient over 30 days. In the outpatient-matched cohort (n = 570), OPAT showed a transiently higher risk of return visits at day 7 (risk difference +5 %; p = 0.008) without increases in severe adverse events or 14-day readmissions. OPAT reduced costs by NT$34,367 per patient when substituting for hospitalization but increased costs when compared with standard outpatient care.
Conclusions: For appropriately selected patients requiring admission-level care, ED-initiated OPAT can be a cost-saving substitute for hospitalization. Given limited safety data, benefits remain conditional on rigorous patient selection to avoid overuse and on structured early reassessment to mitigate early revisit risks.”
Other specific DSP article suggested by Editorial Board
Aspergillus-specific immunoglobulin G seropositivity and lung function decline in patients with chronic lung diseases: A prospective cohort study
Authors: Jung-Yien Chien
Abstract
Background: Aspergillus-specific immunoglobulin G (IgG) positivity typically indicates exposure to Aspergillus species, but its clinical significance among chronic lung diseases remains uncertain.
Methods: This prospective study enrolled patients with bronchiectasis, chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD) in Taiwan between July 2019 and June 2023. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured at baseline and repeated 1 year later. Lung function rapid decline was defined as FEV1 decline ≥ 60 mL/year or FVC decline ≥ 10 % predicted/year based on previous literature.
Results: A total of 97 patients were enrolled, including 75 (77.3 %) with bronchiectasis, 42 (43.3 %) with COPD, 26 (26.8 %) with asthma, and 6 (6.2 %) with ILD. Higher Aspergillus-specific IgG levels were significantly associated with greater FEV1 decline (r = 0.34, P < 0.001) but not with greater FVC decline (r = 0.10, P = 0.327). Multivariable analysis demonstrated that higher Aspergillus-specific IgG levels were an independent risk factor for rapid FEV1 decline (odds ratio = 1.04; 95 % confidence interval [CI]: 1.01–1.08; P = 0.007). The area under the receiver operating characteristic curve of Aspergillus-specific IgG for predicting FEV1 rapid decline was 0.72 (95 % CI: 0.61–0.82). A cutoff of 30 mgA/L provided a sensitivity of 63.64 % and specificity of 71.43 % in predicting rapid FEV1 decline.
Conclusions: Higher Aspergillus-specific IgG levels may be associated with rapid FEV1 decline in patients with chronic lung diseases, although this association requires further validation in larger, disease-specific cohorts.”