Other specific DSP article suggested by Editorial Board
Multidrug resistance, biofilm formation, and genetic determinants in diabetic foot infections from Uttar Pradesh, India: a clinical-microbiological insight from a prospective study.
Authors: Saleem M et al
Abstract
This prospective cohort study systematically analyzed the demographic profile, clinical characteristics, spectrum of microorganisms, and antimicrobial resistance pattern in 248 patients with diabetic foot ulcer (DFU) over 2.7 years. Most patients were male (75.4%) and had a mean age of 56.1 years, and high comorbidity rates (81% neuropathy, 77% retinopathy, and 67.7% hypertension). A combined 439 bacterial isolates were obtained, with the dominance of Gram-negative pathogens, including Escherichia coli (16.6%) and Pseudomonas aeruginosa (15.3%). Staphylococcus aureus was also the dominant Gram-positive pathogen (12.8%). Polymicrobial infections were found in 43.1% of cases, and 71% of strains were biofilm-producing. The prevalence of multidrug-resistant (MDR) was alarmingly high (67%), particularly among Escherichia coli (97.3%), Staphylococcus aureus (83.9%), and Proteus mirabilis (90.5%). MDR infections were associated with tobacco use, biofilm formation, polymicrobial infection, and clinical complications. In specific, seven bacterial types, Pseudomonas aeruginosa, Staphylococcus aureus, Providencia rettgeri, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas flourescens, and Staphylococcus epidermidis, as described, were statistically associated with amputation. Beta-lactams (ampicillin, piperacillin) showed 100% resistance. Cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefepime) had resistance rates ranging from 25 to 96%. Amoxicillin-clavulanic acid showed 30 to 92.3% resistance, while piperacillin-tazobactam ranged from 7.7 to 71.4% resistance. Out of 338 Gram-negative isolates, 105 (31.1%) were ESBL producers, and molecular characterization shows blaCTX-M as the most predominant, 40 (38.1%), followed by blaSHV 20 (19.0%), and blaTEM 7 (6.7%) isolates. Methicillin and vancomycin resistance were common among Gram-positive isolates, particularly Methicillin-resistant Staphylococcus aureus (MRSA) (51.8%) and Vancomycin-resistant Enterococci (VRE) (33.3%). Despite widespread resistance, antibacterial drugs such as colistin (100%), polymyxin B (100%), linezolid (100%), and vancomycin (100%) retained efficacy. These data emphasize the significant burden of MDR infections in DFUs and emphasize the urgent actions needed for aggressive antimicrobial stewardship, early infection control, and personalized treatment approaches to prevent amputation and enhance patient outcomes.
Other specific DSP article suggested by Editorial Board
Management of invasive candidiasis in French ICUs: insights from a 2024 nationwide survey.
Authors: Esposito M et al
Abstract
Purpose: Invasive candidiasis (IC) is a major challenge in intensive care units (ICUs) given its high prevalence, mortality rate, and diagnostic complexity. This national survey aimed to evaluate the knowledge of French intensive care specialists, assess the available resources for IC management, and analyze current bedside practices in ICUs.
Methods: A cross-sectional survey was conducted among senior ICU physicians from 221 French ICUs. A structured questionnaire addressing organizational, diagnostic, and therapeutic approaches to IC management, including clinical cases, was distributed, achieving a participation rate of 54.7%.
Results: Of the 121 respondents, 75 provided complete data. Most respondents were experienced intensivists working in public centers and managing hematological oncology patients. Although 65 (74%) respondents reported organizing multidisciplinary staff meeting, mycologists were rarely involved. Despite the availability of rapid diagnostic tools such as serum (1,3)-β-D-glucan (BDG), which was accessible to 63 (75%) respondents, integrating them into patient management at the bedside remains challenging. Additionally, 55 (67%) respondents had access to antifungal therapeutic drug monitoring (TDM), with voriconazole being the most frequently monitored antifungal drug. However, only 5 (9.1%) respondents had access to TDM every day of the week.
Conclusion: This survey highlights the strengths of multidisciplinary teams, TDM and rapid diagnostic tools for managing IC. However, significant gaps remain in their practical application, particularly the integration of diagnostic tools into clinical algorithms to guide bedside decision-making. Optimizing antifungal stewardship through coordinated interventions is essential for accelerating the diagnosis of IC, improving clinical outcomes, reducing resistance and adverse events.
Other specific DSP article suggested by Editorial Board
Applying Antimicrobial Strategies in Wound Care Practice: A Review of the Evidence.
DOI: 10.1111/iwj.70684
Authors: Blackburn J et al
Abstract
Antimicrobial resistance is increasing due to an overreliance on antimicrobials to treat and manage infections. Chronic wounds are particularly vulnerable to infections and harbour complex microbial communities, increasing the risk of secondary infections caused by antimicrobial resistant bacteria. Accurate and early diagnosis of infection ensures appropriate treatment interventions and a reduction in the likelihood that antibiotic use is required. Despite this, the overuse of antibiotic treatment in wound care is still evident. Antimicrobial stewardship describes a structured approach to managing antimicrobial resistance through educating healthcare professionals about antimicrobial use to improve patient outcomes and minimise the spread of infections. However, the evidence suggests that healthcare professionals experience barriers when attempting to implement such strategies in their practice. It is essential that the principles of antimicrobial stewardship are embedded into wound care treatment and management. This review aimed to explore the current barriers to antimicrobial stewardship in wound care clinical practice and discuss the strategies that can be applied to successfully maximise infection prevention. There is a need to further educate wound care practitioners about antimicrobial stewardship and future research should concentrate on understanding how healthcare professionals can work collaboratively to implement such strategies in their practice.
Other specific DSP article suggested by Editorial Board
Evaluating the diagnostic utility of 16S ONT Sequencing in patients with Central Nervous System infections and its usefulness in Antimicrobial Stewardship.
Authors: Van Dong D et al
Abstract
Background: Central nervous system (CNS) infections pose a significant public health challenge in resource-limited settings. Traditional culture-based and targeted molecular diagnostic methods have limitations in sensitivity and speed. This study retrospectively analysed the data and CSF samples from the previous study to assess the diagnostic efficacy of untargeted 16S ONT sequencing compared to conventional CSF culture methods, with the goal of improving diagnostic accuracy, reducing time to treatment, and enhancing patient outcomes.
Material and methods: A total of 329 patients from four hospitals were enrolled in the study. CSF samples were collected and processed for both CSF culture and 16S ONT sequencing. DNA was extracted from CSF and amplified for 16S rRNA sequencing using the MinION platform. Descriptive analyses were conducted to assess pathogen detection rates and the potential impact of sequencing on antimicrobial stewardship.
Results: Of the 329 samples, 40 (12%) were positive for bacterial or fungal pathogens. 16S ONT detected pathogens in 28 samples (9%), while CSF culture identified pathogens in 23 samples (7%). 16S ONT sequencing identified 17 pathogens not detected by CSF culture, including Streptococcus suis and Acinetobacter baumannii. Based on 16S ONT findings, 61% of patients found to have received inappropriate empirical antibiotic therapy and could have benefited from improved antimicrobial management, including de-escalation in 11, escalation in five and adjustments in two cases.
Conclusion: 16S ONT sequencing showed higher sensitivity and diagnostic yield than CSF culture, providing clinical insights for managing CNS infections through targeted antibiotic use and enhanced antimicrobial stewardship in resource-limited settings.
Other specific DSP article suggested by Editorial Board
Antimicrobial resistance with a focus on antibacterial, antifungal, antimalarial, and antiviral drugs resistance, its threat, global priority pathogens, prevention, and control strategies: a review.
Authors: Belay WY et al
Abstract
Antimicrobial resistance (AMR) poses a significant global health threat by diminishing the effectiveness of once-powerful antimicrobial agents, leading to higher rates of illness and death, along with escalating healthcare costs. While bacterial resistance is a primary concern, resistance is also increasing against antifungal, antiparasitic, and antiviral drugs. Many of the last-resort drugs are becoming less effective due to AMR. Projections indicate that by 2050, AMR could cause up to 10 million deaths annually, making it the leading cause of death worldwide, a situation that could result in a post-antibiotic era with substantially increased morbidity and mortality. This review aims to raise awareness about the dangers of AMR and its potential to become a silent global pandemic. It begins by examining antimicrobial drugs, followed by a discussion on AMR, focusing on resistance to antibacterial, antifungal, antimalarial, and antiviral drugs, along with its effects on health, and the economy, and prioritized global pathogens. Finally, it explores preventive measures and innovative strategies to combat AMR.