Health commissioner, ahead of European Day dedicated to the issue, calls on civil society to join the policy to reduce the 35,000 preventable yearly deaths.
Brussels – The numbers have not changed. There is no news, then. Worse, there is no good news—because the phenomenon of antibiotic resistance persists and continues to be a problem that the European Commission intends to solve. The Commissioner for Health, Stella Kyriakides, ahead of the European Antibiotic Awareness Day, wants to keep the focus on what is the real scourge of the contemporary era.
“Antimicrobial resistance is one of the greatest threats to the health of our times, with an unacceptably high human cost,” Kyriakides points out. “It is responsible for about 35 thousand deaths each year in the European Economic Area area,”—meaning the EU countries plus Iceland, Norway, and Lichtenstein—of about 4.95 million deaths globally, and “without urgent action, it could cause nearly 40 million deaths worldwide by 2050.”
The EU is determined to do its part. The goal, recalls the Health Commissioner, is “to lead efforts for a UN commitment to reduce global deaths related to antimicrobial resistance by 10 per cent by 2030. An international commitment that, if fulfilled, would mean saving the lives of 495,000 people.
The review identifies key epidemiological trends, including geographic variations and risk factors associated with carbapenem-resistant Enterobacteriaceae. Mechanisms of resistance are elucidated, focusing on carbapenemase production and other related factors. Current treatment options are assessed, with an emphasis on newer antibiotic combinations such as ceftazidime/avibactam, meropenem/vaborbactam, ceftolozane/tazobactam, and cefepime/enmetazobactam. This review also highlights emerging therapeutic approaches, including novel antibiotics and non-traditional approaches like phage therapy, faecal microbiota transplantation, probiotics, antimicrobial peptides, vaccines, and herbal drugs. Additionally, the review also reflects on effective infection prevention and control strategies. While research efforts to explore newer combinations and alternate approaches to treat carbapenem-resistant Enterobacteriaceae infections are crucial, the importance of stringent infection prevention and control strategies cannot be overstated.
The present paper reviews the currently available antimicrobial strategies in the management of orthopaedic infections, highlighting their clinical use related to the occurrence of microbial resistance. Some approaches for reducing antibiotic resistance emergence in orthopaedics are also presented. The use of antibiotics tailored to the microorganism’s sensitivity profile, patient factors, and pharmacokinetic profile in terms of monotherapy or combinations, the understanding of microbial pathogenicity and resistance patterns, strict control measures in healthcare facilities, the development of new antimicrobial therapies (drugs, devices, technologies), and patient education for improving compliance and tolerance are some of the most important tools for overcoming microbial resistance.
Although treatment guidelines generally recommend antimicrobial therapy for acute complicated diverticulitis, they do not specify treatment pathways according to local or national resistance profiles. This study seeks to address these issues and determine how often and what types of MDR bacteria occur in patients undergoing emergency surgery. Authors prospectively enrolled patients admitted between 2020–2023 and who underwent emergency surgery for complicated acute diverticulitis. they analysed the inflammatory response parameters at admission, the type of surgery employed for source control, identified pathogens in the peritoneal samples, their antimicrobial susceptibility, the efficacy of antimicrobial empiric therapy, and mortality. Gram-negative bacteria were identified most often, with E.coli being mostly MDR (43.9%) or extended-spectrum beta-lactamase producing (ESBL +ve) (24.4%), while most strains of K.pneumoniae were extended-spectrum beta-lactamase positive (ESBL +ve) (80%) and MDR (80%). Of the Enterococcus spp., 57.14% were vancomycin-resistant (VRE) strains. Patients with Hinchey III/IV (classification of acute diverticulitis) were significantly more associated with MDR. Patients with multiple pathogens were significantly associated with ESBL+/VRE strains. Age, leucocytosis, and procalcitonin levels at admission were good indicators for mortality prediction, which occurred in four cases.
Surveillance is crucial for monitoring the prevalence of opportunistic nosocomial Multidrug-resistant K.pneumoniae infections. Eighty-four KPC K. pneumoniae strains (2019–2022) were collected from patients admitted in Fondazione Policlinico Universitario Campus Bio-Medico. Strains were identified by MALDI-TOF and tested for antimicrobial susceptibility, and gene amplification was performed to identify the different blaKPC variants. Phylogenetic reconstructions were carried out using Bayesian methods. In total, 84 K. pneumoniae isolates were classified as multidrug-resistant (MDR), characterized by resistance to three or more antibiotic classes, including carbapenems, and testing positive for KPC gene presence, and were included in the study. The Bayesian evolutionary tree for K. pneumoniae showed strongly supported branches but no genetic structure related to sampling dates or hospital departments. Overall, the study found no genetic structure correlating with sampling date or hospital department, suggesting significant variability in pathogen introduction during the pandemic. The increase in multidrug-resistant K. pneumoniae was linked to the influx of severe COVID-19 cases, prolonged hospitalizations, and heightened broad-spectrum antibiotic use, which likely facilitated resistance development and transmission amidst altered infection control practices.
While National Guidelines serve as the gold standard on which to base SSTI treatment decisions, an Advisory Panel of experts convened by the ASHP Foundation, as a part of Medication-Use Evaluation Resources initiative, (for an approach to antibiotic stewardship in the treatment of SSTIs, with a focus on oral AB in the emergency department setting for patients who will be treated as outpatients), stressed that institutional guidelines must be regularly updated and grounded in local antimicrobial resistance patterns, patient-specific factors, and logistical considerations. SSTI treatment considerations for antibiotic selection in the ED supported by current, evidence-based guidelines, including guidance on optimal oral antibiotic selection for patients discharged for outpatient treatment, are a useful tool to improve the quality and efficiency of care, enhance patient-centric outcomes and satisfaction, decrease healthcare costs, and reduce overuse of antibiotics.
Empirical antibacterial therapy for febrile neutropenia reduces mortality due to Gram-negative blood stream infections (BSIs). Authors evaluated the changes in the proportions of resistance of beta-lactam monotherapies vs. their combination with amikacin, and the possible impact on ICU admission or death in 797 BSIs due to Gram-negative bacteria in 685 paediatric cancer patients included. Combination therapies with amikacin had a lower percentage of isolates resistant to one or to both drugs compared with the respective monotherapy. The highest OR for ICU admission was observed when both drugs of the combination of meropenem–amikacin were resistant. Mortality was significantly associated with relapse or the progression of the underlying malignancy, and resistance to both drugs of the combinations of cefepime–amikacin or meropenem–amikacin. In paediatric cancer patients with suspected or confirmed Gram-negative BSIs that are not-improving or deteriorating under monotherapy, escalation to meropenem may represent the best option. Amikacin should be preferred when combination therapy is considered with ciprofloxacin as an alternative in the case of impaired renal function.