YouTube video by KetamineRx

YouTube video by KetamineRx

YouTube video by KetamineRx

YouTube video by KetamineRx

Importance  Understanding how neonatal unit colonization pressure, the proportion of infants carrying resistant bacteria on a unit, is associated with antibiotic-resistant bacterial acquisition risk can inform the design and implementation of effective infection prevention and control (IPC) interventions.Objectives  To describe resistant bacterial gene prevalence in European neonatal units and to assess the association between unit-level extended-spectrum β-lactamase (ESBL) colonization pressure and infant-level ESBL acquisition.Design, Setting, and Participants  Multicenter study in 24 tertiary neonatal units in 8 European countries (Estonia, Greece, Germany, Italy, Poland, Spain, Switzerland, and the United Kingdom) using repeated cross-sectional surveys collecting stool samples from infants over 4 surveys with 4-, 7-, and 14-day intervals, analyzed using real-time quantitative polymerase chain reaction (PCR) between January 2022 and June 2024 as part of the NeoIPC project. All infants present on the neonatal unit at 8:00 am on the day of the survey were eligible; infants could contribute to multiple surveys.Exposure  ESBL colonization pressure at previous survey.Main Outcome and Measure  Incident infant gut colonization with ESBL-harboring bacteria (ESBL-colonized). Bayesian hierarchical logistic regression modeling was used to assess the association between colonization pressure and infant-level acquisition risk on the neonatal unit.Results  Overall, 943 infants (547 of 943 male [58.0%]; median [IQR] gestational age, 34 [30-38] weeks, and median [IQR] birth weight, 2130 [1254-3084] g) contributed to 1847 infant-survey observations. Stool samples were collected and PCR results obtained in 1448 of 1847 infant surveys (78.4%). The most common genes detected were those encoding ESBLs (205 of 1448 samples [14.2%]), with high unit-level variation. In the colonization acquisition analysis, we included 829 samples from 533 infants hospitalized since birth who were either newly admitted since or not colonized at the previous survey time point; 90 of 533 infants (16.9%) became ESBL-colonized. Their median (IQR) gestational age was 34 (30-37) weeks, and median (IQR) length of stay at survey was 14 (5-32) days. Colonization pressure was associated with increased odds of becoming ESBL-colonized for all survey intervals (4-day interval: mean odds ratio [OR], 1.89; 95% credible interval [CrI], 1.22-2.94; 7-day interval: OR, 1.76; 95% CrI, 1.26-2.63; 14-day interval: OR, 1.73; 95% CrI, 1.15-2.52 per 10% increase of colonization pressure).Conclusions and Relevance  In this cross-sectional study, ESBL colonization pressure was associated with individual risk of acquiring ESBL on the neonatal unit. Unit-level interventions targeting colonization rather than infection may have important direct and indirect benefits in units with high colonization pressure.

New data from the PETERPEN trial suggest that piperacillintazobactam may be noninferior to meropenem for early clinical outcomes in select patients with ESBL bloodstream infections, but carbapenems re...

:Diabetic foot ulcers (DFUs) are often polymicrobial infections, necessitating antibiotic therapy. However, the high prevalence of antibiotic misuse and the growing issue of antibiotic resistance in low- and middle-income countries (LMICs) exacerbate the challenges in managing these ulcers, contributing to the risk of lower-limb amputations.Objectives:This systematic review reported the bacterial profile and antibiotic resistance patterns associated with DFUs in LMICs.Design:A systematic review and meta-analysis.Data sources and methods:A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science to retrieve relevant articles, which were screened according to predefined selection criteria. Publication bias was assessed with a funnel plot and Egger’s regression test. A meta-analysis was conducted in RStudio version 4.5.2, using the random-effects model. Meta-regression and sensitivity analysis were conducted to assess the sources of heterogeneity and robustness of the included studies, respectively.Results:The most frequently isolated bacteria were Staphylococcus aureus (22.64%), Escherichia coli (12.37%), Pseudomonas aeruginosa (8.49%), Klebsiella pneumoniae (5.19%), P. mirabilis (4.61%), and Coagulase-negative Staphylococci (4.86%). The prevalence of key antibiotic-resistant bacteria was as follows: Methicillin-resistant S. aureus (38.65%), Extended-spectrum beta-lactamase (ESBL)-producing E. coli (50.74%), and ESBL-producing K. pneumoniae (41.54%). S. aureus demonstrated the highest resistance to penicillin (96.87% (93.30; 99.32)), azithromycin (76.42% (64.54; 86.65)), and cefoxitin (68.19% (46.83; 86.67)). E. coli showed the highest resistance to ampicillin (86.60% (77.14; 94.18)) and cotrimoxazole (69.27% (57.35; 80.18)).Conclusion:Pathogenic bacteria isolated from DFUs in LMICs exhibit high rates of antibiotic and multidrug resistance. Alternative therapies, such as phage therapy, should be explored as potential treatments for DFUs to mitigate the impact of antibiotic resistance and decrease the rate of diabetes-related amputations.Trial registration:Open Science Framework (OSF) registry, available at https://doi.org/10.17605/OSF.IO/DPX9F.

Patients with bloodstream infections with antimicrobial resistant bacteria often receive ineffective empirical therapy. The implications are still uncertain.MethodsWe performed a retrospective, multicenter, study of patients with bloodstream infections caused by Extended-Spectrum Beta-Lactamase-producing gram-negative bacteria in southern Sweden from 2013 to 2022. Patients were categorized based on time to effective therapy: ≤24 h (effective empirical therapy) and >24 h (ineffective empirical therapy). Therapy was considered effective if the agent was active in susceptibility testing and administered intravenously at an appropriate dose.The primary outcome was 30-day mortality. Secondary outcomes were ICU admission and hospital length of stay.ResultsA total of 289/644 (44.9%) patients received ineffective empirical therapy within the first 24 hours after the index blood culture collection. No significant impact of ineffective empirical therapy on 30-day mortality was found in univariable (Hazard ratio 0.66; P=0.15) or multivariable Cox regression analysis (Hazard ratio 0.64; P=0.13). Patients receiving effective empirical therapy were more likely to receive intensive care (Odds ratio 0.38; P=0.008), but the association was non-significant after adjusting for severity of illness and comorbidities.Ineffective empirical therapy was not associated with a longer hospital stay in Fine–Gray competing risks regression analysis (univariable: sHR 1.15; P=0.082; multivariable: sHR 1.11; P=0.20).ConclusionIneffective empirical therapy was not associated with 30-day mortality, in patients with bloodstream infections with Extended-Spectrum Beta-Lactamase-producing Enterobacterales. If confirmed in prospective studies, our findings could support antimicrobial stewardship efforts by reducing unnecessary empirical carbapenem use without compromising short-term clinical outcomes, particularly in low-prevalence settings