The interaction between gut and oropharyngeal microbiota plays a significant role in the viral infections like SARS-CoV-2, but role of the lower respiratory tract microbiota remains unclear. Our study utilized metatranscriptomics and metagenomics to analyze the microbial composition of bronchoalveolar lavage fluid and sputum samples from 116 COVID-19 patients, categorized into mild, severe, and critical groups. Our analysis revealed significant differences in viral genotypes across disease stages. As disease severity increased, the Chao index also rose. The mild group was predominantly dominated by Firmicutes, while the severe group showed an increase in Bacteroidetes. The critical group was characterized by a higher abundance of Actinobacteria and Proteobacteria. Notably, the abundance of Streptococcus and Rothia decreased as the disease progressed. Additionally, the Shannon index correlated with mortality risk, while the Chao index was associated with ICU admission, mechanical ventilation, and patient survival. These findings highlight the strong link between microbial composition and COVID-19 severity, providing valuable insights for assessing disease progression.

Using sanitizer in food industry is an important mean of sterilization and biofilm eradication, but inappropriate operation may lead to resistance, posing a concealed risk to food safety. The purpose of this study was to assess the impact of sub-lethal sanitizers on the biofilm formed by adaptive Salmonella and to explore the variations in transcription within adaptive Salmonella biofilms when co-incubated with sublethal concentrations of sanitizers.

The microbroth dilution method was determined to measure the MIC of three sanitizers on Salmonella, and adaptation induction was conducted with steadily increasing sanitizer concentrations. The effect of sub-MIC sanitizers on the biofilm of Salmonella was investigated by crystal violet method, confocal laser scanning microscopy and transcriptomics.

The results indicated that the maximum growth concentration of the adapted strains was 1.69-43.25 times that of the original MIC, and the number of bacteria and matrix content were increased when re-exposed to sub-MIC benzalkonium chloride (BZK), and the expression of regulatory factors and various amino acid biosynthesis and metabolism-related genes showed an up-regulation trend.

This will be beneficial to clarify the correlation and mechanism between the sanitizer adaptation of salmonellae caused by improper sanitization and increased biofilm formation resulting from this adaptation. And it helps to adjust the appropriate dosage of sanitizer and optimize sanitation standard operating procedures (SSOP) in the foodstuff industry, thereby effectively promoting the bactericidal effect and eliminating foodborne pathogens' biofilm.

In recent years, the overuse of antibiotics has led to the emergence of antimicrobial-resistant (AMR) bacteria. To evaluate the spread of AMR bacteria, the reservoir of AMR genes (resistome) has been identified in environmental samples, hospital environments, and human populations, but the functional role of AMR bacteria and their persistence within individuals has not been fully investigated. Here, we performed a strain-resolved in-depth analysis of the resistome changes by reconstructing a large number of metagenome-assembled genomes from the gut microbiome of an antibiotic-treated individual. Interestingly, we identified two bacterial populations with different resistome profiles: extensively acquired antimicrobial-resistant bacteria (EARB) and sporadically acquired antimicrobial-resistant bacteria, and found that EARB showed broader drug resistance and a significant functional role in shaping individual microbiome composition after antibiotic treatment. Our findings of AMR bacteria would provide a new avenue for controlling the spread of AMR bacteria in the human community.

Understanding the effects of changes brought by the COVID-19 pandemic on antimicrobial resistance in P. aeruginosa (PA) is essential to inform clinical management.

This single-centre retrospective cohort study included adult inpatients with PA bacteraemia at the University Hospital Zurich between January 2014 and December 2023. The primary outcome was the association between the start of the COVID-19 pandemic and PA with multidrug resistance (MDR), defined as resistance to ≥3 of 5 antibiotic classes. We used logistic regression to adjust for age, sex and ICU treatment. Secondary outcomes included changes in resistance patterns, patient demographics and antimicrobial consumption.

A total of 493 instances of PA bacteraemia in 333 patients were observed during the study period. The proportion of MDRPA declined from 21% (62/291) pre-pandemic to 9% (19/202) post-pandemic (adjusted OR 0.38, 95% CI 0.18-0.79, p = 0.01). The occurrence of MDRPA during hospitalization following an initial instance of non-MDRPA bacteraemia was rare and unlikely to happen earlier than after 2 weeks. After the start of the pandemic, we observed no MDRPA cases involving cardiovascular or pulmonary diseases and marked reductions in patients with burn injuries or organ transplants. Furthermore, ciprofloxacin and tobramycin use significantly decreased after the start of the pandemic. Overall in-hospital mortality among patients with MDRPA bacteraemia remained high (28%), with no substantial differences between time periods.

We observed a decline in MDRPA occurrence after the start of the COVID-19 pandemic, possibly driven by intensified infection control measures, shifts in antimicrobial use and changes in patient populations.

The diffused and prolonged SARS-CoV-2 transmission lead to high levels of hospitalization. During this period, the focus of sanitary structures was to contain COVID-19 mortality and this may have reduced the application of health associated infection (HAI) and multidrug resistant microorganism (MDRO) prevention programs.

A search was performed in PubMed, Science Direct, and Google Scholar databases to identify clinical observational studies that reported the impact of COVID-19 pandemic on the prevalence or incidence on HAIs and/or MDROs from December 2019 to August 2024 in Italy. Studies were included if they reported a comparison with pre-pandemic period and had a full-text available. Eligible studies were assessed for risk of bias and quality with NHI Quality Assessment Tool by two researchers independently. Data were represented in tables and a narrative synthesis was made in the text.

Selected studies included 4 studies reporting data on HAI (1497 total patients) and 11 studies reporting data on MDRO (80388 total patients). The majority of the studies reported an increase in HAI prevalence (9-11.1 % range) and MDRO, in particular, gram negative MDRO had an increase range of 0.8 %-45.6 % and gram positive MDRO an increase range of 0.5 %-81.8 % from pre- to post-COVID-19 period in the different studies considered CONCLUSION: These findings underscore the critical need for active surveillance in hospital wards, the implementation of antibiotic stewardship and prescribing programs to mitigate the impact of such crises on healthcare-associated infections and antimicrobial resistance. Furthermore, permanent training of healthcare personnel is necessary.

Background: The COVID-19 pandemic in Romania exacerbated pediatric antimicrobial resistance (AMR). Overuse of broad-spectrum antibiotics may be related to increased multidrug-resistant bacteria. The main aim of this study was to assess pediatric AMR trends and phenotypes, while a secondary objective was to investigate the potential links with hospital abandonment. Methods: This retrospective study from the Children's Emergency Hospital "Louis Țurcanu", Timișoara, focused on AMR patterns in 2019 pre-pandemic, 2021 pandemic, and 2023 post-pandemic. The following phenotypes were assessed: MRSA, MRCoNS, VRE, ESBL, CRO, MDR, XDR, and PDR. Results: There were 3530 total patients and 6885 total samples. There were 69.92% of the total samples resistant to at least one antimicrobial class, (72.69% in 2019, 67.05% in 2021, 69.16% in 2023). Specifically, resistance towards penicillins remained high across the entire period (57.45-60.93%), while the following classes presented elevated resistance in the pandemic: cephalosporins (42.91%), combination therapies (40.95%), reserve antibiotics (38.89%), and cyclines (13.83%). As for resistance phenotypes, MRSA and MRCoNS peaked during the pandemic (36.08% and 81.43%, respectively) while VRE remained relatively constant. Overall ESBL declined in 2023 to 14.45%, while overall CRO peaked during the pandemic (8.81%). Overall MDR fell during the pandemic (64.47%), while overall XDR peaked in 2019 (9.87%). No PDR cases were observed. Pediatric abandonment was an increasing concern, with regional cases rising from 5.42% (2019) to 9.83% (2023). Compared to the general population, increased antimicrobial resistance in abandoned patients was observed for fluoroquinolones (50.00%), Aminogycolsides (60.00%), reserve antibiotics (70.00%), cephalosporins (60.00%), and urinary antibiotics (60.00%). Resistance to cephalosporins (OR = 5.17, p = 0.0304) and reserve antibiotics (OR = 5.64, p = 0.0049) were key predictors of abandonment risk. Conclusions: The COVID-19 pandemic influenced resistance trends, with notable peaks in MRSA, MRCoNS, and CRO. Post-pandemic patterns suggest continued escalation of resistance. The association between resistant infections and pediatric abandonment highlights the need for robust antimicrobial stewardship and social intervention policies.

Currently, carbapenem-resistant Klebsiella pneumoniae (CR-KP) strains, particularly those producing New Delhi metallo-beta-lactamase (NDM), are increasingly recognized as a significant threat to global health. The present study aimed to conduct a genomic analysis of an NDM-1-producing CR-KP strain isolated from patients with coronavirus disease of 2019 (COVID-19) admitted to the intensive care unit (ICU). The K. pneumoniae isolate was obtained from the bronchoalveolar lavage fluid of a 68 year-old male patient hospitalized in the ICU with COVID-19 at Besat Hospital in Sanandaj, Iran. The minimum inhibitory concentrations (MICs) for 15 antibiotics were determined using the VITEK 2 system. Genomic analysis of the isolate was performed using whole genome sequencing. The CRKP-51 strain was identified as an extensively drug-resistant (XDR) strain, exhibiting resistance to all tested antibiotics except tigecycline (MIC = 2 μg/mL). The highest resistance values were recorded against sulfamethoxazole-trimethoprim (SXT), nitrofurantoin (NIT), and piperacillin-tazobactam (TZP), with MICs of ≥ 320, 256 μg/mL, and ≥ 128 μg/mL, respectively. Multilocus sequence typing revealed that CRKP-51 belonged to sequence type 15 (ST15). The IncHI1B replicon type associated with this strain harbored several resistance genes, including bla NDM-1 , armA, msrE, mphE, BRP (MBL), bla OXA-1, aadA2, dfrA12, qnrB1, bla CTX-M-15, and cat1. High-risk K. pneumoniae clones, such as ST15, are increasingly associated with antimicrobial resistance and the emergence of XDR strains in ICUs. Additionally, the global dissemination of the NDM enzyme occurs through various plasmid replicon types. Therefore, monitoring local epidemiology is essential for the effectiveness of antimicrobial stewardship programs.

During the Coronavirus Disease 2019 (COVID-19) epidemic, the strain on intensive care units (ICUs) has increased, which made them more vulnerable to the threat of multidrug-resistant organism (MDRO).

This study aims to investigate an outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) infection in a general adult ICU of a tertiary hospital in China during the COVID-19 epidemic and evaluate the effectiveness of intervention measures.

Demographic and clinical data of 37 patients were collected, and 230 environmental samples were collected. Whole genome sequencing (WGS) analysis was performed on clinical and environmental isolates. An evolutionary tree was constructed based on the WGS data. The infection control team implemented a bundle of MDRO interventions, including a termination of COVID-19 infection control measures and implementation of 'three-step' cleaning and disinfection method.

There were 37 patients found to have CRAB infection or colonization in the ICU from December 2022 to April 2023, of whom 35 were hospital-acquired. 12 CRAB isolates were obtained from the environment and medical equipment. Through WGS analysis, the CRAB strains from the medical environment and bronchoscopes were found to be highly homologous to those from patients' clinical specimens. This demonstrated that the infection outbreak was caused by the lack of MDRO prevention and control measures. Following intervention, the CRAB detection rate gradually declined, with no positive samples for CRAB found in the ICU environment or on bronchoscopes.

The infection control measures for COVID-19 conflicted with basic MDRO prevention and control strategies, likely contributing to the outbreak. Therefore, established infection prevention and control measures should be consistently followed, as they represent the most effective approach to preventing MDRO.

Antibiotic resistance is a growing global health threat, and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship. The coronavirus disease 2019 (COVID-19) pandemic has introduced additional complexities, potentially influencing these patterns.

To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023, with a specific focus on the impact of the COVID-19 pandemic on these trends.

A retrospective analysis of microbiological data was conducted, covering the period from 2018 to 2023. The study included key bacterial pathogens such as Escherichia coli (E. coli), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus, among others. The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods. To contextualize the findings, the findings were compared with similar studies from other regions, including China, India, Romania, Saudi Arabia, the United Arab Emirates, Malaysia, and United States.

The study revealed fluctuating trends in the prevalence of bacterial isolates, with notable changes during the COVID-19 pandemic. For example, a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years, while the prevalence of E. coli showed a more variable pattern. Antibiotic resistance rates varied among the different pathogens, with a concerning rise in resistance to commonly used antibiotics, particularly among Klebsiella pneumoniae and E. coli. Additionally, the study identified an alarming increase in the prevalence of multidrug-resistant (MDR) strains, especially within Klebsiella pneumoniae and E. coli isolates. The impact of the COVID-19 pandemic on these trends was evident, with shifts in the frequency, resistance patterns, and the emergence of MDR bacteria among several key pathogens.

This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex, particularly in the context of the COVID-19 pandemic. The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance. Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.

During the COVID-19 pandemic, there was a significant decline in the number of patients with both non-urgent and urgent ophthalmologic conditions presenting to emergency departments, leading to concerns about the whereabouts of patients in need of care. We hypothesized that there was an actual decrease in microbial keratitis (MK) cases, due to reduced contact lens (CL) wear and improved hand hygiene, including alcohol-based hand disinfection. Besides, we questioned if non-pharmaceutical interventions would have a sustained effect after the COVID-19 pandemic.

Retrospectively, characteristics of patients presenting with MK at a large ophthalmic tertiary referral center were compared during 9 March-15 June of 2018 and 2019 ("pre-COVID"), 2020 ("COVID") and 2022 and 2023 ("post-COVID"). In an online cross-sectional survey among CL wearers, CL wear and hand hygiene habits were compared for the recall months February and April 2020.

Three hundred and one MK patients were included: 79 in 2018, 69 in 2019, 41 in 2020, 60 in 2022 and 52 in 2023. Presentation delay was ≥4 days in 38% during COVID, compared to 54% pre-COVID (p = 0.106). The proportion of CL related MK did not differ (p = 0.704). Fewer patients were admitted than pre-COVID (p = 0.026), without a difference in admission indications (p = 0.322). Pseudomonas aeruginosa and Staphylococcus aureus cases were not observed during COVID. Post-COVID, MK by Pseudomonas aeruginosa occurred more often than pre-COVID (p < 0.001). In the online survey with 791 respondents, hand washing before CL insertion and removal and hand disinfection were reported more often in April 2020 than February 2020 (respectively, p = 0.001, p < 0.001 and p < 0.001).

We found no evidence of MK patients facing barriers to accessing hospital care during the COVID-19 pandemic, as presentation delays were not longer and cases not more severe. Our data suggest that a decreased MK incidence may be due to improved hand hygiene practices, including alcohol-based hand disinfection.

Melioidosis caused by Burkholderia pseudomallei manifests as a variety of infectious symptoms. However, hemophagocytic lymphohistiocytosis (HLH) secondary to bacteraemic melioidosis is rarely documented in the literature. We report a series of fatal cases of melioidosis combined with HLH in one Chinese family.

Three cases of melioidosis with HLH were reported in a family with three children, two boys aged 4 and 6 years and a 12-year-old girl. The most common clinical presentation was fever. A blood culture confirmed B. pseudomallei, and bone marrow aspiration revealed hemophagocytosis. Despite the administration of antibiotics, glucocorticoids and other treatments, all the patients died, and their deaths were attributed to HLH.

Melioidosis complicating HLH is rare in occurrence, but the mortality rate is high. Clinicians should be aware of the risk of a B. pseudomallei bloodstream infection in children.

Bacterial keratitis (BK) is a severe ocular infection that can lead to vision loss, with antimicrobial resistance (AMR) posing a growing challenge. This study retrospectively analyzed 1071 bacterial isolates from corneal infections over a 10-year period (2014-2024) at a tertiary ophthalmic center in Beijing, categorizing them into three distinct phases: pre-COVID-19, during COVID-19, and post-COVID-19. The results indicated significant changes in pathogen distribution, including a marked decrease in Gram-positive cocci (from 69.8% pre-COVID-19 to 49.3% in post-COVID-19, p < 0.001), particularly in Staphylococcus epidermidis. In contrast, Gram-positive bacilli, particularly Corynebacterium spp., increased from 4.2% to 16.1% (p < 0.001). The susceptibility to gatifloxacin, moxifloxacin, and ciprofloxacin significantly declined in both Gram-positive cocci and bacilli during the COVID-19 period (all p < 0.01). Gatifloxacin resistance in Staphylococcus rose from pre-COVID-19 (15.2%) to COVID-19 (32.7%), remaining high post-COVID-19 (29.7%). A similar trend was observed in Streptococcus and Corynebacterium, where resistance rose sharply from 12.0% and 22.2% pre-COVID-19 to 42.9% during COVID-19, and remained elevated at 40.0% and 46.4% post-COVID-19, respectively (p < 0.01). These findings emphasize the rapid rise of fluoroquinolone resistance in several bacterial groups, underscoring the urgent need for continuous surveillance and improved antimicrobial stewardship to enhance treatment outcomes.

Introduction: A. baumannii and P. aeruginosa belong to the multidrug-resistant Gram-negative bacteria group, posing significant challenges in treatment. Colistin is considered the last-line antibiotic for treating this bacterium. It is essential to determine the minimum inhibitory concentration (MIC) to adjust the appropriate dosage. Method: A cross-sectional descriptive study using data from January 2020 to December 2024 was conducted. Results: The infections caused by A. baumannii and P. aeruginosa showed an increasing trend over the years, accounting for 17.4% and 9.6% of common multidrug-resistant Gram-negative bacteria, respectively. A. baumannii exhibited higher resistance rates than P. aeruginosa with multiple tested antibiotics. Although no Colistin-resistant strains were observed for either bacterium of interest during the observation period, both bacteria of interest showed a statistically significant change during the survey period (p < 0.05). In addition, the MIC value of ≤ 0.75 μg/mL was the most prevalent over 80% from 2020 to 2021, but its percentage declined strongly by 60%-65% in the next 3 years (p < 0.0001). Meanwhile, the MIC value of 1.0 μg/mL became the most common over 70% with a statistically significant difference (p < 0.0001). Regarding the MIC value based on infection types, the MIC value for P. aeruginosa causing septicemia was considerably concentrated at 1.0 μg/mL at 84.6%, while its percentage was lower in A. baumannii at 37.9% (p < 0.0001). Looking into MIC values based on carbapenem-resistant proportions, the MIC values from 1.0 to 2.0 μg/mL were higher in imipenem-resistant strains of both bacteria of interest compared with nonresistant strains (p < 0.0001). This difference was also observed in meropenem-resistant A. baumannii but was not demonstrated in P. aeruginosa. Conclusions: Although no colistin-resistant strains were observed, A. baumannii and P. aeruginosa showed statistically significant changes in the most prevalent colistin MIC values, which have been approaching the resistance threshold over the years. It is essential to implement control measures of colistin usage before bacteria become completely resistant.

During COVID-19 pandemic, use of antimicrobial has been shown to be reduced coupled with various respiratory infections. We investigated whether this effect on reduction of antibiotic prescription can be sustained after resumption of normalcy and lifting of public health measures.

We compared the wholesale supply of antimicrobials using mean annual Daily Defined Dose/1000 inhabitants (DID) in different sectors in pre-COVID-19 (2014-2019), COVID-19 (2020-2022) and post-COVID-19 (2023) periods. We grouped the data according to AWaRe categorisation namely Access, Watch and Reserve defined by WHO, and analysed the trends of the top 10 antibiotics and broad-spectrum antimicrobials. The trends in statutory notifiable diseases including scarlet fever, pneumococcal infections, chickenpox, tuberculosis, and pertussis and influenza-like-illness detected by sentinel surveillance system was analysed by negative-binominal regression.

Compared to baseline level, an overall reduction of 27.2% of antimicrobial utilization was observed during the pandemic years, with a rebound recorded in 2023, up to 89.5% of the pre-pandemic level. The access group of antimicrobials accounted for 57.9% in 2014 gradually increased to 60.2% in 2023 across the pandemic years. Concurrently, reduction in incidence of scarlet fever, pneumococcal infections, chickenpox, tuberculosis, pertussis and influenza-like-illness was observed during COVID-19 pandemic with statistical decreasing trend, p<0.05 for scarlet fever, pneumococcal infections and chickenpox. Rebound in all these infections was reported in 2023, except for chickenpox which showed continued decrease in incidence.

We demonstrated a substantial reduction of antibiotic use during the COVID-19 pandemic, which rebounded in 2023, likely due to increased incidence of respiratory diseases after lifting of public health and social measures. We urged for close monitoring of the antimicrobial resistance pattern of different bacteria due to the inter-connectiveness and global impact of these two pandemics.

This study analyzes the resistance and virulence profiles of Proteus mirabilis isolates obtained from patients admitted to the University Hospital of Londrina, Paraná, between 2019 and 2022. We evaluated the antimicrobial resistance phenotypes, genes associated with resistance, biofilm formation through a phenotypic assay, and the presence of specific virulence genes. When comparing the "pre-pandemic" (2019) and "pandemic" (2020-2022) periods, we observed an increase in resistance rates to all tested antimicrobials. Multidrug-resistant (MDR) pathogens producing extended-spectrum β-lactamase (ESBL) phenotypes were isolated in both periods, but their occurrence was significantly higher during the pandemic. We also observed an increase in the frequency of nearly all studied resistance genes. The virulence profiles remained largely unchanged. Analysis of patients' clinical and demographic data revealed that those hospitalized during the pandemic were older, required longer hospital stays, and had a higher usage of invasive devices. These findings suggest that the recent COVID-19 pandemic has impacted the antimicrobial resistance of P. mirabilis, a bacterium of significant clinical interest associated with urinary tract infections (UTIs) and healthcare-associated infections (HAIs).

Due to the outbreak of global public health emergency, antibacterial fabrics such as face masks are in great demand. However, common antibacterial fabrics cannot kill bacteria in minutes and they are easy to be contaminated and lost biological activity. In this work, omnipotent antibacterial cotton fabrics with superhydrophobic and photothermal properties are developed by the combination of dopamine with copper sulfide (CuS) and silver nanoparticles on cotton fabrics, and post-modification with PDMS. The prepared PDA/CuS/Ag/PDMS composite fabrics were characterized by FE-SEM, XRD, EDS, ATR-FTIR and water contact angle. The photothermal antimicrobial properties of the fabrics were evaluated with Staphylococcus aureus (S. aureus) and Escherichia coli (E. coil) under near-infrared light (NIR) illumination or not. The results showed that the obtained superhydrophobic PDA/CuS/Ag/PDMS composite fabrics had excellent water repellence and self-cleaning effect. Regardless of NIR irradiation or not, PDA/CuS/Ag/PDMS composite fabrics possessed high antibacterial activity against S. aureus and E. coil, which proves their omnipotent antibacterial property.

The Reyanning Mixture (RYN) is a Chinese patent medicine widely used in the treatment of respiratory inflammatory diseases in China and has potential in the treatment of bacteria-infected pneumonia.

The present study aimed to demonstrate the therapeutic potential of RYN in combination with linezolid for the treatment of MRSA-infected pneumonia and to explore the mechanisms of action and active components.

The pharmacodynamics of RYN alone and in combination with linezolid was investigated in a rat model of MRSA-induced pneumonia. Transcriptomics, ELISA, Western blot and qRT-PCR were used to explore and verify the pharmacological mechanism of the anti-inflammatory effect of RYN. UPLC-MS and molecular docking were used to explore the anti-inflammatory components of RYN for the treatment of MRSA-infected pneumonia.

In vivo, RYN reduced lung injury and inflammation in rats with pneumonia. In particular, the combination of RYN and linezolid enhanced the therapeutic effect compared to that of either treatment alone. Further research suggests that the synergistic therapeutic effect of the combination may be related to the inhibition of the inflammatory response by RYN and the enhancement of linezolid inhibition and clearance of MRSA in lung tissues by RYN. RYN plays an anti-inflammatory role in MRSA-infected pneumonia by inhibiting the TLR2/NF-κB/NLRP3 pathway, with 7 active components that may play a dominant role.

These results indicate that RYN may serve as an adjuvant drug to antibiotics for the treatment of MRSA-associated pneumonia. Exploration of its mechanisms and active components is conducive to the clinical application and quality improvement of RYN. More importantly, this study showed that the synergistic therapeutic effect of the combination of traditional Chinese medicine and antibiotics may be a valuable therapeutic strategy.

We investigated the drug resistance status of Pseudomonas aeruginosa (P. aeruginosa) focusing on its isolation sites and types of diseases.　Materials and methods: A microbiological laboratory database was searched to identify all clinical cultures positive for P. aeruginosa.　Clinicopathologic features and susceptibility of P. aeruginosa to any antibiotics were evaluated in patients admitted to the division of upper (Upper-GI group) or lower gastrointestinal surgery (Lower-GI group).　In addition, we investigated the susceptibility of P. aeruginosa to any antibiotics based on the isolation site.　Results:P. aeruginosa was frequently detected in the sputum and urine of the Upper-GI and Lower-GI groups, respectively.　Among P. aeruginosa isolates from drain discharge, a significantly higher rate of resistance to imipenem, amikacin, and ciprofloxacin was observed; among P. aeruginosa isolates from wounds, a substantially higher proportion had resistance to imipenem and cefozopran in the Upper-GI group.　However, there was no difference between the two groups in the drug resistance of P. aeruginosa isolated from urine, sputum, blood, and ascites.　P. aeruginosa isolated from sputum showed more resistance to imipenem and ciprofloxacin than those isolated from other sites.　Conclusion: There were significant differences in the drug resistance of P. aeruginosa based on the isolation sites and types of diseases.　.

Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed.

We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros.

126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57-0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89-0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06-1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman's coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID.

The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.

Breast cancer (BC) is yet a significant global health challenge across various populations including Ghana, though several studies on host-genome associated with BC have been investigated molecular mechanisms of BC development and progression, and candidate therapeutic agents. However, a little attention has been given on microbial genome in this regard, although alterations in microbiota and epigenetic modifications are recognized as substantial risk factors for BC. This study focused on identifying bacterial key genes (bKGs) associated with BC infections in the Ghanaian population and exploring potential drug molecules by targeting these bKGs through in silico analyses. At first, 16S rRNA bacterial sequence data were downloaded from NCBI database comprising 520 samples from BC patients and 442 from healthy controls. Analysis of 16S rRNA-Seq data showed significant differences in bacterial abundance between BC and healthy groups and identified 26 differential genera with the threshold values at |log2FC|>2.0 and p-value≤0.05. It was observed that two genera Prevotella and Anaerovibria are significantly upregulated in BC patients and others are downregulated. Functional analysis based on all differential genera identified 19 MetaCyc signaling pathways, twelve of which were significantly enriched in BC patients by containing 165 genes Top-ranked 10 genes mdh, pykF, gapA, zwf, pgi, tpiA, pgk, pfkA, ppsA, and pykA were identified as BC-causing bacterial key genes (bKGs) through protein-protein interaction network analysis. Subsequently, the bKG-guided top ranked 10 drug molecules Digitoxin, Digoxin, Ledipasvir, Suramin, Ergotamine, Venetoclax, Nilotinib, Conivaptan, Dihydroergotamine, and Elbasvir were identified using molecular docking analysis. The stability of top-ranked three drug-target complexes (Digitoxin-pykA, Digoxin-mdh, and Ledipasvir-pgi) were confirmed through the molecular dynamics simulation studies. Therefore, these findings might be useful resources to the wet-lab researchers for further experimental validation on bacterial therapies against BC.

Background/Objectives. Our study aimed to determine the development of antibiotic resistance during the peri-pandemic period in a regional secondary care hospital using an interrupted time series analysis. Methods. We analyzed data from seven years, accounting for 441,149 patient days. The incidence density of multidrug-resistant bacteria (MDR) burden and infection was reported per 1000 patient days. Results. During the COVID-19 period, a significant increase in the mean incidence density of the total MDR burden from 4.93 to 5.81 per 1000 patient days was observed (p = 0.007). On the other hand, the mean incidence density of MDR infections decreased from 1.61 to 1.29 per 1000 patient days (p = 0.019). Using the interrupted time series analysis, the same trends were observed, namely the overall increasing trend in MDR burden and the overall decreasing trend in MDR infections. This divergent trend is mainly due to similar trends in several Gram-negative MDR, namely ESBL-EC, ESBL-KP and CRE. Conclusions. Due to the increasing burden of MDR, it is necessary to strengthen AMR surveillance. In addition, strict infection prevention and control measures, and antimicrobial stewardship programs continue to be important components in the fight against resistant bacteria.

Hospital-acquired infections (HAIs) caused by multidrug-resistant organisms (MDROs) pose a significant challenge to healthcare systems. The present study aimed to evaluate the impact of the infection policy to COVID-19 on the incidence of HAIs caused by MDROs.

We conducted an eight-years retrospective analysis at a hospital in Shanghai, China. Bloodstream, sputum, and urinary tract cultures of MDROs obtained 48h after admission were collected monthly from January 2016 to Dec 2023. Occupied bed days (OBDs) were used to generate monthly HAI incidences per 10,000 OBDs. The study period was divided into pre-control, in-control, and post-control cohorts, in January 2020 and January 2022. The incidence was compared using interrupted time-series regression.

In total, 6763 MDRO cultures were identified, comprising 1058 bloodstream, 4581 sputum, and 1124 urine cultures derived from 4549 patients. The incidence rates of all HAIs were 8.68 per 10,000 OBDs in the pre-control cohort, 9.76 per 10,000 OBDs in the in-control cohort and 12.58 per 10,000 OBDs in the post-control cohorts, respectively. A downward trend in the incidence of HAI was observed in the post-control cohort (p<0.05).

This study demonstrates that while the COVID-19 pandemic poses a significant challenge to infection control within hospitals, it provides a unique opportunity to enhance infection control measures and evaluate their effectiveness. In addition, these findings highlight the need for more targeted prevention and control strategies against different pathogens in future epidemics.

Previous studies found that the coronavirus disease 2019 (COVID-19) pandemic had a variable impact on the consumption of antimicrobial drugs in human medicine, with trends in several European countries differing between community and inpatient prescribing.

This study analysed changes in the volumes and use density of antibacterial and antifungal drugs dispensed in acute care hospitals in Germany between 2019 and 2022.

Surveillance data for the four years available from 279 hospitals were expressed as the total volumes of daily doses or as use density (daily doses per 100 patient/occupied bed days) per year and analysed descriptively, using recommended hospital-adapted daily dose definitions (RDDs) and (as sensitivity analysis) WHO/ATC-defined daily dose definitions (DDD). Hospitals were stratified according to size (number of beds), university affiliation, and location (East, West, South).

There were significant decreases in both the total number of patient days and antibacterial drug volumes in 2020 through 2022 compared with 2019. The relative changes between 2019 and 2020, 2021, and 2022 were -12.8%, -13.5%, and -13.3% for patient days, and -9.7%, -11.0%, and -10.1% for antibacterial RDDs, respectively. Broad-spectrum betalactams, notably piperacillin-tazobactam and carbapenems, increased in volume, unlike most other drug classes. The resulting antibacterial drug use density was slightly but significantly increased, with pooled means (and medians) of 43.3 (40.0) RDD/100 in 2019 compared to 44.8 (41.7), 44.5 (40.80), and 44.9 (41.7) RDD/100 in the years 2020 through 2022, respectively. Antifungal drug volumes and use density increased after 2019 and peaked in 2021 (the difference between 2019 and 2021 for total volumes was +6.4%, and that for pooled mean use density values was +22.9%, respectively). These trends were similar in the different hospital strata and comparable when DDDs instead of RDDs were used.

Similar to what has been observed in a majority of European countries, the total volume of antibacterial drug use in German acute care hospitals decreased with the pandemic, without a rebound phenomenon in 2022. In association with restricted hospital capacities and presumably more immunocompromised general medicine patients, however, inpatient prescribing of (primarily broad-spectrum) antibacterials and of antifungal drugs increased.

The COVID-19 pandemic disrupted antimicrobial stewardship and infection prevention operations worldwide, raising concerns for an acceleration of antimicrobial resistance (AMR). Therefore, we aimed to define the scope of peer reviewed research comparing AMR in inpatient bacterial clinical cultures before and after the start of the COVID-19 pandemic.

We conducted a scoping review and searched PubMed, Scopus, and Web of Science through 15 June 2023. Our inclusion criteria were: (1) English language, (2) primary evidence, (3) peer-reviewed, (4) clinical culture data from humans, (5) AMR data for at least one bacterial order/species, (6) inpatient setting, (7) use of statistical testing to evaluate AMR data before and during the COVID-19 pandemic. Reviewers extracted country, study design, type of analysis, study period, setting and population, number of positive cultures or isolates, culture type(s), method of AMR analysis, organisms, and AMR results. Study results were organised by organism and antibiotic class or resistance mechanism. AMR results are also summarised by individual study and across all studies.

In total, 4805 articles were identified with 55 papers meeting inclusion criteria. Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were the most commonly studied organisms. There were 464 bacterial AMR results across all studies with 82 (18%) increase, 71 (15%) decrease, and 311 (67%) no change results.

The literature examining the impact of COVID-19 on AMR among inpatients is diverse with most results reflecting no change pre/post pandemic. Ongoing inquiry is needed into evolving patterns in AMR post COVID-19.

Early empiric antibiotics were prescribed to numerous patients during the Coronavirus disease 2019 (COVID-19) pandemic. However, the potential impact of empiric antibiotic therapy on the clinical outcomes of patients hospitalized with COVID-19 is yet unknown.

In this retrospective cohort study, early antibiotics use cohort was defined as control group, which was compared with no antibiotic use and delayed antibiotic use cohorts for all-cause mortality during hospitalization. The 1:2 propensity score matched patient populations were further developed to adjust confounding factors. Survival curves were compared between different cohorts using a Log rank test to assess the early antibiotic effectiveness.

We included a total of 1472 COVID-19 hospitalized patients, of whom 87.4% (1287 patients) received early antibiotic prescriptions. In propensity-score-matched datasets, our analysis comprised 139 patients with non-antibiotic use (with 278 matched controls) and 27 patients with deferred-antibiotic use (with 54 matched controls). Patients with older ages, multiple comorbidities, severe and critical COVID-19 subtypes, higher serum infection indicators, and inflammatory indicators at admission were more likely to receive early antibiotic prescriptions. After adjusting confounding factors likely to influence the prognosis, there is no significant difference in all-cause mortality (HR=1.000(0.246-4.060), p = 1.000) and ICU admission (HR=0.436(0.093-2.04), p = 0.293), need for mechanical ventilation (HR=0.723(0.296-1.763), p = 0.476) and tracheal intubation (HR=1.338(0.221-8.103), p = 0.751) were observed between early antibiotics use cohort and non-antibiotic use cohort.

Early antibiotics were frequently prescribed to patients in more severe disease condition at admission. However, early antibiotic treatment failed to demonstrate better clinical outcomes in hospitalized patients with COVID-19 in the propensity-score-matched cohorts.

The association between the COVID-19 pandemic and the incidence of invasive infections caused by multidrug-resistant organisms remains a topic of debate.

To analyse the national incidence rates of bloodstream infections (BSI) caused by Escherichia coli (EC) and Klebsiella pneumoniae (KP) with extended-spectrum cephalosporin resistance (ESCR) in two distinct regions in Switzerland, each exhibiting varying antimicrobial resistance patterns and that were impacted differently by the pandemic.

Data was analysed from positive blood cultures prospectively collected by the nationwide surveillance system (ANRESIS) from January 1st, 2015, to August 31st, 2022. To explore the potential relationship between COVID-19 patient occupancy and ESCR incidence rates, an in-depth analysis was conducted over the two-year pandemic period from April 1st, 2020, to March 30th, 2022, using Quasi-Poisson and logistic regression analyses.

During the study period, 40,997 EC-BSI and 8537 KP-BSI episodes were collected and reported to ANRESIS by the participating hospitals. ESCR was observed in 11% (N = 4313) of E. coli and 8% (N = 664) of K. pneumoniae, respectively. A significant reduction in ESCR-EC BSI incidence occurred during the pandemic in the region with the highest COVID-19 incidence. Conversely, ESCR-KP BSI incidence initially fell considerably and then increased during the pandemic in both regions, though this effect was not statistically significant. No association between hospital occupancy from COVID-19 patients and these trends was observed.

In the early phase of the COVID-19 pandemic, a decrease in ESCR rates was observed, particularly in ESCR-EC BSI within the most heavily impacted region.

The COVID-19 pandemic has significantly transformed the infection spectrum of various pathogens. This study aimed to evaluate the impact of the COVID-19 pandemic on Staphylococcus aureus (S. aureus) infections among pediatric patients with community acquired pneumonia (CAP). We retrospectively reviewed pediatric CAP admissions before (from 2018 to 2019) and during (from 2020 to 2022) the COVID-19 pandemic. The epidemiology and antimicrobial resistance (AMR) profiles of S. aureus isolates were examined to assess the pandemic's effect. As a result, a total of 399 pediatric CAP patients with S. aureus infections were included. The positivity rate, gender, and age distribution of patients were similar across both periods. There was a marked reduction in respiratory co-infections with Haemophilus influenzae (H. influenzae) during the COVID-19 pandemic, compared to 2019. Additionally, there were significant changes in the resistance profiles of S. aureus isolates to various antibiotics. Resistance to oxacillin and tetracycline increased, whereas resistance to penicillin, gentamicin, and quinolones decreased. Notably, resistance to erythromycin significantly decreased in methicillin-resistant S. aureus (MRSA) strains. The number of S. aureus isolates, the proportion of viral co-infections, and the number of resistant strains typically peaked seasonally, primarily in the first or fourth quarters of 2018, 2019, and 2021. However, shifts in these patterns were noted in the first quarter of 2020 and the fourth quarter of 2022. These findings reveal that the COVID-19 pandemic has significantly altered the infection dynamics of S. aureus among pediatric CAP patients, as evidenced by changes in respiratory co-infections, AMR patterns, and seasonal trends.

Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen.

Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex.

The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years.

The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.

Antimicrobial stewardship (AMS) programs have been differently implemented across Europe. This study primarily aimed to compare AMS in two European regions. Secondarily, the study explored the COVID-19 pandemic impact on surrogate outcome indicators of AMS.

A retrospective observational study was conducted in Piedmont (Italy) and Catalonia (Spain). AMS programs were compared through structure and process indicators in 2021. Changes in surrogate outcome indicators (antimicrobial usage; alcohol-based sanitizer consumption; antimicrobial resistance, AMR) from 2017 to 2021 described the pandemic impact.

Seventy-eight facilities provided structure and process indicators. Catalonia showed better structure scores (p < 0.001) and less dispersion in both indicators. The greatest areas to improve were accountability (Piedmont) and diversification of strategies (Catalonia). Overall, the regions reported consistent changes in outcome indicators. Antimicrobial usage decreased in 2020, returning to near-pre-pandemic levels in 2021. Alcohol-based sanitizer consumption surged in 2020, then dipped remaining above pre-pandemic levels. AMR trends were minimally affected.

The centralized approach of Catalonia ensured consistent attainment of quality objectives across all facilities, but it may limit facility-specific strategies. In Piedmont, accountability remain one of the most critical factors as in previous years. The pandemic did not substantially disrupt surrogate outcome measures of AMS. However, the data on AMR suggest that maintaining vigilance against this issue remains paramount.

Carbapenemases, a class of enzymes specialized in the hydrolysis of carbapenems, represent a significant threat to global public health. These enzymes are classified into different Ambler's classes based on their active sites, categorized into classes A, D, and B. Among the most prevalent types are IMI/NMC-A, KPC, VIM, IMP, and OXA-48, commonly associated with pathogenic species such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The emergence and dissemination of carbapenemase-producing bacteria have raised substantial concerns due to their ability to infect humans and animals (both companion and food-producing) and their presence in environmental reservoirs. Adopting a holistic One Health approach, concerted efforts have been directed toward devising comprehensive strategies to mitigate the impact of antimicrobial resistance dissemination. This entails collaborative interventions, highlighting proactive measures by global organizations like the World Health Organization, the Center for Disease Control and Prevention, and the Food and Agriculture Organization. By synthesizing the evolving landscape of carbapenemase epidemiology in Portugal and tracing the trajectory from initial isolated cases to contemporary reports, this review highlights key factors driving antibiotic resistance, such as antimicrobial use and healthcare practices, and underscores the imperative for sustained vigilance, interdisciplinary collaboration, and innovative interventions to curb the escalating threat posed by antibiotic-resistant pathogens. Finally, it discusses potential alternatives and innovations aimed at tackling carbapenemase-mediated antibiotic resistance, including new therapies, enhanced surveillance, and public awareness campaigns.

The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge.

This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital.

A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE).

Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.

To investigate the clinical distribution and changing trend of antibiotic resistance profiles of multidrug-resistant organisms (MDROs), a retrospective study was undertaken.

The characteristics of MDROs isolated from 2016 to March 2023 were retrospectively analysed. The detection rate of these MDROs was compared prior to COVID-19 (Period 1, 2016-2019), during the COVID-19 pandemic with restrictions (Period 2, 2020-2022), and after the end of zero-policy (Period 3, Jan-March, 2023). Antibiotic-resistant genes were detected.

The overall detection rates of CRPA, CRAB, CREC, CRKP, MRSA, and VREfm were 22.6%, 22.6%, 1.3%, 4.0%, 19.5%, and 3.1%, respectively. The detection rate of CRAB was significantly lower in Period 2 and 3 compared with Period 1 (P < 0.0001). The detection rate of CRPA and VREfm was significantly increased in Period 3 compared with Period 1 and 2 (P < 0.0001). The resistance rate to ticarcillin/clavulanic acid (TIM) and piperacillin/tazobactam (TZP) has gradually increased in CRPA since 2018. NDM and KPC were the most common carbapenemase genes identified in CREC (60.0%) and CRKP isolates (47.8%), respectively. All the 10 VREfm isolates carried the vanA gene.

The detection rate of CRAB has decreased since 2018, but a significantly increased prevalence of CRPA and VREfm was seen after the end of zero-policy. An increasing resistance rate to TIM and TZP was seen in CRPA. NDM, KPC, and vanA were the common genes harboured by CREC, CRKP, and VREfm, respectively. Ongoing surveillance after the COVID-19 era is suggested.

To report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022.

Reference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates.

Carbapenem-resistant Enterobacterales (CRE) detection increased (P < 0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions.

CRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.

There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa.

Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles.

Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4-51.7%; n = 14 studies), metronidazole (14.6-44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6-22.3%), and ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively.

The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.

This study aims to investigate the association between oral vancomycin consumption and intestinal vancomycin-resistant Enterococcus carriage in the pre- and COVID era in the clinical centre of the University of Szeged, Hungary.

This retrospective microbiological examination was carried out using electronically collected data, corresponding to the period between 1 January 2018 and 31 December 2022, at the Department of Medical Microbiology. Data included isolated species and the according antimicrobial susceptibility patterns. Annual consumption data for oral vancomycin consumption were exported from the database of the central pharmacy of the clinical centre. As a strain typing procedure, Fourier transform infrared spectroscopy analysis was used.

There was a significant increase in the number of faecal vancomycin-resistant Enterococcus isolates throughout the study. The prevalence increased significantly during the years of the pandemic. The use of orally administered vancomycin in the clinical centre increased significantly. A strong positive correlation existed between the two phenomena. Several strains with different resistance patterns spread in the clinical centre. Two of these occurred in greater numbers, differing in their high-level aminoglycoside resistance. However, the overall resistance of these strains was stagnating. FTIR analysis revealed that 59 of the 62 strains were also divided into 2 large clusters differing partially in their high-level aminoglycoside resistance.

During the pandemic, intestinal VRE carriage among clinical centre patients increased significantly, linked to increased oral vancomycin use. Different strains spread, with aminoglycoside resistance being the primary distinction. This highlights the negative impact of the pandemic on VRE carriage.

From 2019 (pre-COVID-19) to 2022 (COVID-19 years), three tertiary Greek hospitals monitored MDRO bloodstream infection (BSI) and hospital acquisition relying on laboratory data. Surveillance covered carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA), in intensive care units (ICUs) and non-ICUs. Non-ICUs experienced significant increases in CRE, CRAB and VRE during the pandemic. In ICUs, CRE increased in 2021, CRAB in 2020 and 2021, and VRE in 2021 and 2022. KPC predominated among CRE. MDRO BSI and hospital acquisition incidence rates increased, driven by CRE and CRAB.

To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic.

In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed.

Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60 years (IQR 51-72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications.

This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.

Patients hospitalized in ICUs with severe COVID-19 are at risk for developing hospital-acquired infections, especially infections caused by Pseudomonas aeruginosa. We aimed to describe the evolution of P. aeruginosa infections in ICUs at CHRU-Nancy (France) in patients with severe COVID-19 during the three initial waves of COVID-19. The second aims were to analyze P. aeruginosa resistance and to describe the antibiotic treatments. We conducted a retrospective cohort study among adult patients who were hospitalized for acute respiratory distress syndrome due to COVID-19 and who developed a hospital-acquired infection caused by P. aeruginosa during their ICU stay. Among the 51 patients included, most were male (90%) with comorbidities (77%), and the first identification of P. aeruginosa infection occurred after a median ICU stay of 11 days. Several patients acquired infections with MDR (27%) and XDR (8%) P. aeruginosa strains. The agents that strains most commonly exhibited resistance to were penicillin + β-lactamase inhibitors (59%), cephalosporins (42%), monobactams (32%), and carbapenems (27%). Probabilistic antibiotic treatment was prescribed for 49 patients (96%) and was subsequently adapted for 51% of patients after antibiogram and for 33% of patients after noncompliant antibiotic plasma concentration. Hospital-acquired infection is a common and life-threatening complication in critically ill patients. Efforts to minimize the occurrence and improve the treatment of such infections, including infections caused by resistant strains, must be pursued.