26th June 2024

This month’s Editors’ picks in the Journal of Antimicrobial Chemotherapy (JAC) and JAC-Antimicrobial Resistance (JAC-AMR) shed light on the origins of antimicrobial resistance in war-related injuries in Ukraine and trends in worldwide carbapenemase resistance. Also this month: a simple reporting change reduced carbapenem prescribing in US hospitals, an example of how rapid susceptibility testing can improve patient outcomes, and real-world data on off-label dalbavancin use. And if you’re up for a challenge check out the review of AMR games and put your AMR knowledge to the test!

Dmytro Stepanskyi and others, Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine. JAC-Antimicrobial Resistance 2024, dlae090, https://doi.org/10.1093/jacamr/dlae090

Previous studies have reported antimicrobial-resistant bacteria in war wounds in Ukraine, but the origin of and transmission routes are unclear. Here, Stepanskyi et al. examined antibiotic resistance in Gram-negative bacteria isolated from war wounds at an intermediate evacuation hub in Dnipro, Ukraine. They found both susceptible and drug-resistant strains, demonstrating that resistant bacteria are spreading early during medical care for injured soldiers.

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Yu-Lin Lee and others, Global epidemiology and antimicrobial resistance of Enterobacterales harbouring genes encoding OXA-48-like carbapenemases: insights from the results of the Antimicrobial Testing Leadership and Surveillance (ATLAS) programme 2018–2021. Journal of Antimicrobial Chemotherapy, dkae140, https://doi.org/10.1093/jac/dkae140

Lee et al. report the global distribution and antimicrobial resistance of Enterobacterales carrying blaOXA-48-like genes worldwide in 2018–21. They found high levels of multidrug resistance and observed that prevalence of resistance genes was especially high in Asia and the Middle East. The proportion of K. pneumoniae isolates harbouring blaOXA-232 increased over the period, highlighting the need for better detection and antibiotic stewardship strategies.

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Lourdes R Menendez Alvarado and others, Impact of removing ESBL status labelling from culture reports on the use of carbapenems for non-bacteraemic patients diagnosed with ESBL-positive urinary tract infections. Journal of Antimicrobial Chemotherapy, dkae135, https://doi.org/10.1093/jac/dkae135

In this study, Menendez Alvarado et al. evaluated the rates of carbapenems prescribed to treat urinary tract infections and clinical outcomes before and after removing ESBL status labels from antibiotic susceptibility reports. They looked at data from adult patients in seven community hospitals in the USA and found that removing ESBL status labels significantly reduced carbapenem use but did not impact clinical cure rates, infection relapse, readmission or mortality.

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Muhammet Rıdvan Tayşi and others, Implementation of the EUCAST rapid antimicrobial susceptibility test (RAST) for carbapenemase/ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates, and its effect on mortality. Journal of Antimicrobial Chemotherapy, dkae125, https://doi.org/10.1093/jac/dkae125

Tayşi et al. used the EUCAST rapid antibiotic susceptibility test (RAST) for carbapenemase- or ESBL-producing E. coli and K. pneumoniae isolates without using an advanced identification system. Categorical agreement was over 95%. RAST allowed inappropriate empirical antibiotics to be changed to appropriate treatment within 8 h, compared with >24 h in historical controls, and patients who received faster appropriate treatment with RAST had lower mortality rates. RAST could be used in centres with high resistance rates to shorten the time to optimal treatment.

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Carolin Bresges and others, Three-years of dalbavancin use at a UK tertiary referral hospital serving a population with high numbers of people who inject drugs. JAC-Antimicrobial Resistance 2024, dlae066, https://doi.org/10.1093/jacamr/dlae066

Dalbavancin has been increasingly used off-label to treat complex infections in patients who may not be able to take other antibiotics. Bresges et al. looked at the use of dalbavancin in a group of patients at a hospital in the UK and found that dalbavancin was safe and effective for most patients. It may be a particularly useful treatment for people who inject drugs.

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Romita Trehan and others, The role of gaming for information, education and communication of AMR: full review of online education resources. JAC-Antimicrobial Resistance 2024, dlae080, https://doi.org/10.1093/jacamr/dlae080

In this educational resource review, Trehan et al. evaluated 12 games for their ability to teach the public about antibiotic resistance and responsible antibiotic use. They found games with clear rules and engaging challenges to be most effective. Recommendations to improve future games include having multiple difficulty levels—to sustain engagement and introduce complex AMR concepts while allowing players to have minimal prior knowledge—and ensuring that they offer a sense of reward.

 

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