30th January 2024

Explore the latest Editors’ picks from Journal of Antimicrobial Chemotherapy (JAC) and JAC-Antimicrobial Resistance (JAC-AMR). This month, learn about optimizing penicillin allergy de-labelling; why comparing human and animal antimicrobial usage needs a rethink; the high risk of antibiotic-resistant infections after organ transplants; and a simple change that improves detection of carbapenemase producers. Plus, two different success stories involving Streptococcus swab testing.

Neil Powell and others, Penicillin allergy de-labelling by non-allergists: a comparison of testing protocols. JAC-Antimicrobial Resistance 2023, dlad134, https://doi.org/10.1093/jacamr/dlad134

In this review, Powell et al. compare penicillin allergy de-labelling protocols, revealing differences in definitions and risk tolerance. They recommend standardizing terminology and eligibility criteria, as this is crucial for safe and effective de-labelling by non-allergists. To ensure global applicability, studies must also report ethnicity data and prioritize diversity when validating protocols.

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Pim Sanders and others, Comparing human and animal antimicrobial usage: a critical appraisal of the indicators used is needed. JAC-Antimicrobial Resistance 2024, dlae005, https://doi.org/10.1093/jacamr/dlae005

Sanders et al. warn that current measures of antimicrobial usage in humans and animals could lead to biased comparisons. Production-based indicators for animal usage do not consider the time at risk of antimicrobial treatment and can underestimate usage in animals. Using more accurate measures, like defined daily doses based on a denominator that includes time at risk, will help to ensure fair comparisons.

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Max W Adelman and others, Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016–21). JAC-Antimicrobial Resistance 2024, dlad158, https://doi.org/10.1093/jacamr/dlad158

A study of over 2000 solid organ transplant patients by Adelman et al. found that 8.5% developed bloodstream infections, with a high prevalence of MDR organisms (45.5%). Infections were most common after multi-organ and liver transplants. VRE and ESBL-producing and carbapenem-resistant Enterobacterales were the most frequent MDR organisms, and VRE was independently associated with mortality. Used alongside local resistance patterns, these findings can inform antibiotic choices and stewardship practices for transplant patients.

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Belén Fernández-Caso and others, Usefulness of inclusion of ertapenem and temocillin screening breakpoints in the EUCAST rapid antimicrobial susceptibility testing (RAST) for rapid detection of OXA-48-producing Klebsiella pneumoniae directly from positive blood cultures. Journal of Antimicrobial Chemotherapy 2023, dkad406, https://doi.org/10.1093/jac/dkad406

Fernández-Caso et al. assessed the EUCAST rapid antimicrobial susceptibility testing method to identify OXA-48-producing Klebsiella pneumoniae in positive blood cultures. Adding ertapenem and temocillin tests to the standard method improved detection, even after only a 4 h incubation. This is an easy and inexpensive modification that could enable earlier implementation of targeted antimicrobial therapy and infection control measures in patients with these infections

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Max Bloomfield and others, Effect of directive laboratory comments on prescribing response to positive throat swab cultures. Journal of Antimicrobial Chemotherapy 2023, dkad384, https://doi.org/10.1093/jac/dkad384

Adding comments to throat swab reports recommending shorter antibiotic courses reduced prescribing of unnecessary 10 day courses in patients without ethnicity risk factors for acute rheumatic fever. The median course duration decreased from 10 to 7 days for group A Streptococcus and from 7 to 0 days for Streptococcus dysgalactiae subsp. equisimilis. Giving clear, direct advice to prescribers can improve antibiotic use.

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Efi Mantzourani and others, A pharmacy-led sore throat test and treat (STTT) service: antigen testing and antibiotic supply rates during the period of heightened public awareness of Group A Streptococcus infections. Journal of Antimicrobial Chemotherapy 2023, dkad388, https://doi.org/10.1093/jac/dkad388

Community pharmacies in Wales effectively managed a surge in sore throat consultations during a winter with high rates of invasive group A Streptococcus (iGAS) infections. Although consultations increased sharply after media reports about iGAS, pharmacists ensured appropriate antibiotic use and absorbed a large workload that would otherwise have gone to other healthcare settings.

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