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Antibiotics
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Antimicrobial Resistance in Humans: The Final Frontier
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Antimicrobial Resistance in Humans: The Final Frontier

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Mechanism and Evolution of Antibiotic Resistance".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 12030

Special Issue Editor

Dr. Matthaios Papadimitriou Olivgeris

E-Mail Website
Guest Editor
Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
Interests: antimicrobial resistance; bloodstream infections; critically ill patients; carbapenemases; VRE; MRSA
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The development of resistance after the discovery of a given antimicrobial is inevitable. The process of resistance development and its dissemination in the healthcare environment and the community are accelerated by misuse of such antimicrobials. The most important resistant bacterial pathogens are designated by the acronym “ESKAPE” that includes vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species. During the last two decades, some Gram-negative bacteria have acquired genes that confer resistance to carbapenems, further restricting our limited armamentarium. Another problematic is the fungi resistant to antifungals, some of which, such as the Candida auris, have the capacity to provoke nosocomial epidemics.

The constant rise of antimicrobial resistance constitutes one of the most important public health issues. According to some projections, in a matter of decades, infections due to antimicrobial-resistant pathogens will be responsible for more deaths than diabetes or cancer.

Therefore, this Special Issue seeks submissions concerning the mechanisms and evolution of resistance, the epidemiology and surveillance of resistance in the clinical setting, clinical applications of existing and newer antimicrobials, and strategies to control the emergence and dissemination of resistance and improve the control of antimicrobials’ use.

Dr. Matthaios Papadimitriou Olivgeris
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial resistance
  • MRSA
  • VRE
  • carbapenemases
  • infection control
  • antifungal-resistance

Published Papers (5 papers)

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Research

13 pages, 619 KiB  
Article
Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States
by Yuwei Vivian Tsai, Caroline Derrick, Ismaeel Yunusa, Sharon Weissman, Majdi N. Al-Hasan, Julie Ann Justo and Paul Brandon Bookstaver
Antibiotics 2022, 11(12), 1720; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11121720 - 29 Nov 2022
Cited by 2 | Viewed by 1309
Abstract
Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a positive NTM culture and [...] Read more.
Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a positive NTM culture and clinical suspicion of infection between 1 January 2010 and 30 June 2020. The primary objective was to identify predictors for favorable treatment outcomes. Key secondary objectives were characterization of NTM epidemiology, susceptibility profiles, and safety and tolerability of treatment, including the proportion of subjects with an antimicrobial change and the reasons for the change. Of 250 subjects diagnosed with NTM infection, the most prevalent NTM isolates were Mycobacterium avium intracellulare complex (66.8%) followed by Mycobacterium abscessus (17.6%). Antimicrobial susceptibility data were available for 52.4% of the cohort (45.8% slow growers; 54.2% rapid growers). Only 88 (35%) subjects received treatment with evaluable clinical outcomes. The proportion of subjects with a favorable outcome was 61.4%. More subjects in the unfavorable outcome group experienced a change in antimicrobial therapy (73.5% vs. 51.9%, p = 0.043). The most common reason for antimicrobial change was adverse drug events (n = 36, 67.9%). In the regression model, private insurance was associated with a favorable outcome, whereas having multiple antimicrobial changes was associated with an unfavorable outcome. The complexity of NTM treatment and high incidence of medication-related issues suggest the necessity of interdisciplinary collaboration to improve overall treatment outcomes in NTM infections. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Humans: The Final Frontier)
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10 pages, 1209 KiB  
Article
A Seven-Year Microbiological and Molecular Study of Bacteremias Due to Carbapenemase-Producing Klebsiella Pneumoniae: An Interrupted Time-Series Analysis of Changes in the Carbapenemase Gene’s Distribution after Introduction of Ceftazidime/Avibactam
by Matthaios Papadimitriou-Olivgeris, Christina Bartzavali, Eleftherios Karachalias, Anastasia Spiliopoulou, Ekaterini Tsiata, Georgios Siakallis, Stelios F. Assimakopoulos, Fevronia Kolonitsiou and Markos Marangos
Antibiotics 2022, 11(10), 1414; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11101414 - 14 Oct 2022
Cited by 3 | Viewed by 1185
Abstract
Background: Ceftazidime/avibactam (CZA) is a new option for the treatment of KPC-producing Klebsiella pneumoniae. The aim of this study was to determine resistance patterns and carbapenemase genes among K. pneumoniae (CP-Kp) bacteremic isolates before and after CZA introduction. Methods: K. pneumoniae from [...] Read more.
Background: Ceftazidime/avibactam (CZA) is a new option for the treatment of KPC-producing Klebsiella pneumoniae. The aim of this study was to determine resistance patterns and carbapenemase genes among K. pneumoniae (CP-Kp) bacteremic isolates before and after CZA introduction. Methods: K. pneumoniae from blood cultures of patients being treated in a Greek university hospital during 2015–21 were included. PCR for blaKPC, blaVIM, blaNDM and blaOXA-48 genes was performed. Results: Among 912 K. pneumoniae bacteremias: 725 (79.5%) were due to carbapenemase-producing isolates; 488 (67.3%) carried blaKPC; 108 (14.9%) blaVIM; 100 (13.8%) blaNDM; and 29 (4%) carried a combination of blaKPC, blaVIM or blaNDM. The incidence of CP-Kp bacteremias was 59 per 100,000 patient-days. The incidence of CP-Kp changed from a downward pre-CZA trend to an upward trend in the CZA period (p = 0.007). BSIs due to KPC-producing isolates showed a continuous downward trend in the pre-CZA and CZA periods (p = 0.067), while BSIs due to isolates carrying blaVIM or blaNDM changed from a downward trend in the pre-CZA to an upward trend in the CZA period (p < 0.001). Conclusions: An abrupt change in the epidemiology of CP-Kp was observed in 2018, due to the re-emergence of VIM-producing isolates after the suppression of KPC-producing ones via the use of CZA. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Humans: The Final Frontier)
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13 pages, 1172 KiB  
Article
Occurrence and Biological Cost of mcr-1-Carrying Plasmids Co-harbouring Beta-Lactamase Resistance Genes in Zoonotic Pathogens from Intensive Animal Production
by Tiago Lima, Dina Loureiro, Ana Henriques, Fernando Ramos, Constança Pomba, Sara Domingues and Gabriela Jorge da Silva
Antibiotics 2022, 11(10), 1356; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11101356 - 05 Oct 2022
Cited by 5 | Viewed by 2029
Abstract
Colistin is classified as a high-priority critical antimicrobial by the World Health Organization (WHO). A better understanding of the biological cost imposed by mcr-plasmids is paramount to comprehending their spread and may facilitate the decision about the ban of colistin in livestock. [...] Read more.
Colistin is classified as a high-priority critical antimicrobial by the World Health Organization (WHO). A better understanding of the biological cost imposed by mcr-plasmids is paramount to comprehending their spread and may facilitate the decision about the ban of colistin in livestock. This study aimed to assess the prevalence of mcr and ESBL genes from 98 Escherichia coli and 142 Salmonella enterica isolates from food-producing animals and the impact of the mcr-1 acquisition on bacterial fitness. Only mcr-1 was identified by multiplex PCR (mcr-1 to mcr-10) in 15.3% of E. coli. Colistin MICs ranged between 8–32 mg/L. In four isolates, blaTEM-1, blaCTX-M-1, and blaCTX-M-15 co-existed with mcr-1. The IncH12, IncHI1, IncP, IncN, and IncI plasmids were transferred by conjugation to E. coli J53 at frequencies of 10−7 to 10−2 cells/recipient. Growth kinetics assays showed that transconjugants had a significantly lower growth rate than the recipient (p < 0.05), and transconjugants’ average growth rate was higher in the absence than in the presence of colistin (1.66 versus 1.32 (p = 0.0003)). Serial transfer assay during 10 days demonstrated that plasmid retention ranged from complete loss to full retention. Overall, mcr-1-bearing plasmids impose a fitness cost, but the loss of plasmids is highly variable, suggesting that other factors beyond colistin pressure regulate the plasmid maintenance in a bacterial population, and colistin withdrawal will not completely lead to a decrease of mcr-1 levels. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Humans: The Final Frontier)
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11 pages, 250 KiB  
Article
A Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Public Acute Care Hospitals in Crete, Greece
by Petros Ioannou, Eirini Astrinaki, Efsevia Vitsaxaki, Emmanouil Bolikas, Despoina Christofaki, Apostolia Salvaraki, Eirini Lagoudaki, Eleni Ioannidou, Stamatis Karakonstantis, Stamatina Saplamidou, Christos Cleovoulou, Eleni Stamataki, Stavroula Ilia, Argyri Messaritaki, Michaela Avdi, Anthoula Chalkiadaki, Styliani Papathanasaki, Chrisanthi Markopoulou, Evagelia Magouli, Maria Moustaki, Vasileia-Athina Kataxaki, Panagiotis Skevakis, Nikolaos Spernovasilis, Georgios Chamilos and Diamantis P. Kofteridisadd Show full author list remove Hide full author list
Antibiotics 2022, 11(9), 1258; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11091258 - 16 Sep 2022
Cited by 6 | Viewed by 2616
Abstract
Background: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs [...] Read more.
Background: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals highlighted an HAI prevalence of 6.5%, while Greece had a higher HAI prevalence of 10%. The aim of this PPS was to record the prevalence of HAIs and antimicrobial use in all eight public acute care hospitals in Crete, Greece during the COVID-19 pandemic in order to highlight the types of infections and antimicrobial practices that need to be prioritized for infection control initiatives. Methods: The PPS was conducted between 30 March and 15 April 2022, according to the ECDC standardized relevant protocol (version 5.3). Statistics were extracted using the ECDC Helics.Win.Net application (software version 4.1.0). Results: A total of 1188 patients were included. The overall point prevalence of patients with at least one HAI was 10.6%. The most frequent types of infections were pneumonia (34.3%), bloodstream infections (10.5%), systemic infections and urinary tract infections (10.5% and 9.1%, respectively). In 14 (12.4%) cases, the pathogen responsible for HAI was SARS-CoV-2 following onsite spread, accounting for almost 10% of all HAIs. Microorganisms were identified in 60.1% of HAIs. Antimicrobials were administered in 711 (59.8%) patients, with 1.59 antimicrobials used per patient. Conclusion: The prevalence of HAI and antimicrobial use among hospitalized patients in Crete, Greece was similar to the national HAI prevalence in 2016 despite the enormous pressure on public hospitals due to the COVID-19 pandemic. Nevertheless, both HAI prevalence and antimicrobial use remain high, underlining the need to implement adequate infection control and antimicrobial stewardship interventions. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Humans: The Final Frontier)
16 pages, 2574 KiB  
Article
Metagenomics-Based Analysis of the Age-Related Cumulative Effect of Antibiotic Resistance Genes in Gut Microbiota
by Lei Wu, Xinqiang Xie, Ying Li, Tingting Liang, Haojie Zhong, Jun Ma, Lingshuang Yang, Juan Yang, Longyan Li, Yu Xi, Haixin Li, Jumei Zhang, Xuefeng Chen, Yu Ding and Qingping Wu
Antibiotics 2021, 10(8), 1006; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10081006 - 20 Aug 2021
Cited by 12 | Viewed by 3833
Abstract
Antibiotic resistance in bacteria has become a major global health problem. One of the main reservoirs of antibiotic resistance genes is the human gut microbiota. To characterise these genes, a metagenomic approach was used. In this study, a comprehensive antibiotic resistome catalog was [...] Read more.
Antibiotic resistance in bacteria has become a major global health problem. One of the main reservoirs of antibiotic resistance genes is the human gut microbiota. To characterise these genes, a metagenomic approach was used. In this study, a comprehensive antibiotic resistome catalog was established using fecal samples from 246 healthy individuals from world’s longevity township in Jiaoling, China. In total, 606 antibiotic resistance genes were detected. Our results indicated that antibiotic resistance genes in the human gut microbiota accumulate and become more complex with age as older groups harbour the highest abundance of these genes. Tetracycline resistance gene type tetQ was the most abundant group of antibiotic resistance genes in gut microbiota, and the main carrier of antibiotic resistance genes was Bacteroides. Antibiotic efflux, inactivation, and target alteration were found to be the dominant antimicrobial resistance mechanisms. This research may help to establish a comprehensive antibiotic resistance catalog that includes extremely long-lived healthy people such as centenarians, and may provide potential recommendations for controlling the use of antibiotics. Full article
(This article belongs to the Special Issue Antimicrobial Resistance in Humans: The Final Frontier)
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