3rd January 2024

Explore the latest Editors’ picks from Journal of Antimicrobial Chemotherapy (JAC) and JAC-Antimicrobial Resistance (JAC-AMR). Reviews in JAC focus on improving antibiotic access in low- and middle-income countries and reducing antimicrobial use in farming, while a survey of trust in molecular diagnostics shows a difference between theory and practice. In JAC-AMR, studies highlight the importance of nurses and pharmacists in antimicrobial stewardship and appropriate prescribing, and an update on nitrofurantoin resistance shows that nitrofurantoin-resistant E. coli are often multidrug resistant as well.

Himika Wasan and others, Strategies to improve antibiotic access and a way forward for lower middle-income countries. Journal of Antimicrobial Chemotherapy 2023; dkad291, https://doi.org/10.1093/jac/dkad291

In this review, Wasan et al. discuss the main barriers to antibiotic access and the models proposed and implemented to mitigate these issues, including market entry rewards, subscription models and transferable exclusivity vouchers. They also provide an overview of current global access programmes and proposals to improve access in LMICs.


João Sucena Afonso and others, Strategies to reduce antimicrobials in livestock and aquaculture, and their impact under field conditions: a structured scoping literature review. Journal of Antimicrobial Chemotherapy 2023; dkad350, https://doi.org/10.1093/jac/dkad350

Antimicrobial overuse in livestock and aquaculture fuels drug resistance, but limited understanding about replacements for antimicrobials can slow down efforts to change farming practices. Afonso et al. reviewed research on strategies to curb antibiotic use in these sectors. While no single solution emerged, options like bioactive peptides and feed management show promise in reducing antibiotic use while maintaining animal health, and these results can guide future cost-effectiveness assessments.


Sarah-Jane F Stewart and others, UK clinicians’ attitudes towards the application of molecular diagnostics to guide antibiotic use in ICU patients with pneumonias: a quantitative study. Journal of Antimicrobial Chemotherapy 2023; dkad355, https://doi.org/10.1093/jac/dkad355

Stewart et al. surveyed UK ICU prescribers about their views on using molecular diagnostics in patients with suspected hospital-acquired and ventilator-associated pneumonia. While most saw the potential of using molecular tests to tailor antibiotic treatment, they had concerns about stopping broad-spectrum antibiotics in critically ill patients even with negative test results, highlighting a tension between improving antibiotic use and ensuring patient safety.


Maria Bos and others, A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses’ activities in daily practice regarding antibiotic use. Journal of Antimicrobial Chemotherapy 2023; dlad123, https://doi.org/10.1093/jacamr/dlad123

This systematic review by Bos et al. highlights that most nurses already play a crucial role in appropriate antibiotic use through patient assessment, specimen collection, medication management, review prompting and patient education. Their patient advocacy fuels this involvement, making education and empowerment key to their vital contribution to antimicrobial stewardship.


Lily Rush and others, Impact of antibiotic allergy labels on timely and appropriate antibiotics for sepsis in the emergency department. JAC-Antimicrobial Resistance 2023; dlad120, https://doi.org/10.1093/jacamr/dlad120

In this retrospective study of sepsis patients admitted to an Australian emergency department, Rush et al. demonstrated that the presence of an antimicrobial allergy label did not impact on the time to first antimicrobial administration or mortality. Of note, including an Emergency Medicine pharmacist in the sepsis management response significantly improved both speed and appropriateness of empirical antimicrobial prescribing for all patients.


Rebecca L Guy and others, Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment of Escherichia coli urinary tract specimens in England, 2015–19. Journal of Antimicrobial Chemotherapy 2023; dlad122, https://doi.org/10.1093/jacamr/dlad122

Nitrofurantoin resistance in E. coli urinary isolates decreased slightly in England over 2015–19 and remains low (<3%), indicating that nitrofurantoin is still a good choice for first-line treatment of uncomplicated UTIs. However, nitrofurantoin-resistant isolates, especially those from male patients, also had high rates of resistance to other clinically relevant antibiotics. Clinicians should be aware that nitrofurantoin-resistant infections could also be multidrug resistant.


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