Antimicrobial Stewardship Program: Reducing Antibiotic’s Spectrum of Activity Is not the Solution to Limit the Emergence of Multidrug-Resistant Bacteria

Abstract

Overconsumption of antibiotics in hospitals has led to policy implementation, including the control of antibiotic prescriptions. The impact of these policies on the evolution of antimicrobial resistance remains uncertain. In this work, we review the possible limits of such policies and focus on the need for a more efficient approach. Establishing a causal relationship between the introduction of new antibiotics and the emergence of new resistance mechanisms is difficult. Several studies have demonstrated that many resistance mechanisms existed before the discovery of antibiotics. Overconsumption of antibiotics has worsened the phenomenon of resistance. Antibiotics are responsible for intestinal dysbiosis, which is suspected of being the source of bacterial resistance. The complexity of the intestinal microbiota composition, the impact of the pharmacokinetic properties of antibiotics, and the multiplicity of other factors involved in the acquisition and emergence of multidrug-resistant organisms, lead us to think that de-escalation, in the absence of studies proving its effectiveness, is not the solution to limiting the spread of multidrug-resistant organisms. More studies are needed to clarify the ecological risk caused by different antibiotic classes. In the meantime, we need to concentrate our efforts on limiting antibiotic prescriptions to patients who really need it, and work on reducing the duration of these treatments.

Multifaceted Evaluation of Antibiotic Therapy as a Factor Associated with Candidemia in Non-Neutropenic Patients

“…TPN can alter the gut barrier function and contribute to Candida translocation from the gut, although lipid emulsions and glucose contained in TPN can promote Candida CRBSIs [ 9 , 29 , 30 , 31 ]. Most anti-pseudomonal BLs have an anti-anaerobic activity, which primarily affects the gut microbiota and can induce dysbiosis on gut microbiota [ 32 ]. Because these antibiotics also have broad-spectrum antibacterial activity, they may inhibit the subsequent bloom of low-abundance commensals, including Enterobacterales , providing additional spatial liberation of ecological niches for Candida species [ 21 ].…”

“…These findings may indirectly reflect the close association between antibiotic therapy and candidemia. Furthermore, among these factors, anti-anaerobic therapy is well known to be associated with candidemia originating from the gastrointestinal tract [ 16 , 32 ]. However, anti-anaerobic therapy was not an independent factor for candidemia in this study.…”

“…This result might be due to correlations with other antibiotic factors, especially anti-pseudomonal BLs. Furthermore, evaluating the impact of antibiotic therapy on the microbiota may require consideration not only of the antibacterial spectrum, but also the pharmacokinetics of the antibiotic, including routes of administration and excretion [ 32 ].…”

Rational Use of Antibiotics and Education Improved Aeromonas Necrotizing Fasciitis Outcomes in Taiwan: A 19-Year Experience

“…In period II, 84.9% of patients adjusted the definitive antibiotic regimen based on the ID physician’s suggestion using the HCAAS, monotherapy was more common, simpler, and rational than combination therapy. At the same time, we should limit antibiotic prescriptions to patients, and we should reduce the length of time these treatments are required [ 39 ].…”

Intestinal Microbiota Correction in the Treatment and Prevention of Urinary Tract Infection

“… 26 Thus, antimicrobial therapy significantly changes the IM, stimulates the virulence factor expression by uropathogens, and increases the risk of future UTIs. 51 , 52 Considering all of the above, non-antimicrobial methods of treatment and prevention may be of particular interest in this context ( Table 2 ).…”