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Introduction: Infections are one of the most common complications of anti-cancer therapy and cancer patients rely on effective antibiotics to prevent and treat infections. 41% of UK oncologists saw a rise in drug-resistant infections in 2019 and 46% believe drug-resistant infections could make chemotherapy unviable.1 Antibiotic exposure to bacteria and overuse of antibiotics contribute to antibiotic resistance.2 The UK 5-year action plan for tackling antimicrobial resistance 2019–2024 has set the target to reduce antibiotic use by 15% by 2024.2 Objectives 1. To reduce antibiotic use (defined daily doses (DDD) per 1000 total admissions (inc. Day Cases)) in a cancer centre by 15% by 2024. 2. To identify interventions that reduce antibiotic use (DDD per 1000 total admissions (inc. Day Cases)) in cancer patients. 3. To gather data on antibiotic use (DDD per 1000 total admissions (inc. Day Cases)) in 2018 in a cancer centre to establish a baseline. Method: Retrospective antibiotic use data from April 2018 to March 2019 was collected from DEFINE RX Info and plotted on a statistical process control (SPC) chart to establish a baseline. Interventions to reduce antibiotic use were identified by the project stakeholders and implemented through six plan, do, study and act (PDSA) cycles. Antibiotic use data was collected from DEFINE RX Info monthly from April 2019 to March 2021 and plotted on an SPC chart to establish the impact of interventions. Discussion: Figure 1 shows antibiotic use decreased by 1% in 2019/20 and by 12% in 2020/21. Overall antibiotic consumption decreased by 13% from the 2018/19 baseline. The SPC chart shows a special cause improvement demonstrating a statistically significant reduction in antibiotic prescribing. The frequency of auditing adherence to the Start Smart – then Focus principles was increased from 6 monthly to once monthly during PDSA 1 and from once monthly to twice weekly during PDSA 4. These interventions enabled the poor prescribing practice to be promptly identified and education and training were provided to prescribers in real time to improve antibiotic stewardship. Ciprofloxacin neutropenic sepsis prophylaxis was removed from solid tumour anti-cancer therapy proformas in response to the MHRA Fluoroquinolone Drug Safety Alert in PDSA 2. Ciprofloxacin consumption decreased by 35% between 2018/19 and 2020/21 and unintentional negative patient impact has not been observed. The Antimicrobial Guidelines were moved from a large PDF document to a digital mobile application in PDSA 3. This enables quick and easy access to antibiotic guidance and course length to improve antibiotic stewardship. Twice weekly face-to-face antimicrobial stewardship ward rounds moved to video call in PDSA 5. This enabled ward rounds to continue throughout the Covid-19 pandemic. An additional benefit was it was easier to access patients’ electronic healthcare records over a video call, which was previously challenging due to limited computers. [ABSTRACT FROM AUTHOR]

Objectives: Urinary tract infections (UTIs) are a common reason for empirical treatment with broad-spectrum antibiotics worldwide. However, population-based antimicrobial resistance (AMR) prevalence data to inform empirical treatment choice are lacking in many regions, because of limited surveillance capacity. We aimed to assess the prevalence of AMR to commonly used antimicrobial drugs in Escherichia coli and Klebsiella pneumoniae isolated from patients with community- or healthcare-associated UTIs on two islands of Indonesia.Methods: We performed a cross-sectional patient-based study in public and private hospitals and clinics between April 2014 and May 2015. We screened patients for symptoms of UTIs and through urine dipstick analysis. Urine culture and susceptibility testing were supported by telemicrobiology and interactive virtual laboratory rounds. Surveillance data were entered in forms on mobile phones.Results: Of 3424 eligible patients, 3380 (98.7%) were included in the final analysis, and yielded 840 positive cultures and antimicrobial susceptibility data for 657 E. coli and K. pneumoniae isolates. Fosfomycin was the single oral treatment option with resistance prevalence <20% in both E. coli and K. pneumoniae in community settings. Tigecycline and fosfomycin were the only options for treatment of catheter-associated UTIs with resistance prevalence <20%, whilst the prevalence of resistance to meropenem was 21.3% in K. pneumoniae .Conclusions: Patient-based surveillance of AMR in E. coli and K. pneumoniae causing UTIs indicates that resistance to the commonly available empirical treatment options is high in Indonesia. Smart AMR surveillance strategies are needed to inform policy makers and to guide interventions. [ABSTRACT FROM AUTHOR]

Background: Early administration of appropriate antibiotic therapy in bacteraemia patients dramatically reduces mortality. A new method for RApid Molecular Antibiotic Susceptibility Testing (RAMAST) that can be applied directly to positive blood cultures was developed and evaluated. Methodology/Principal Findings: Growth curves and antibiotic susceptibility of blood culture isolates (Staphylococcus aureus, enterococci and (facultative) aerobic Gram-negative rods) were determined by incubating diluted blood cultures with and without antibiotics, followed by a quantitative universal 16S PCR to detect the presence or absence of growth. Testing 114 positive blood cultures, RAMAST showed an agreement with microbroth dilution of 96.7% for Gram-negative rods, with a minor error (false-susceptibility with a intermediate resistant strain) rate of 1.9%, a major error (false resistance) rate of 0.8% and a very major error (false susceptibility) rate of 0.6%. Agreement for S.aureus was 97.9%, with a very major error rate of 2.1%. Enterococcus species showed 95.0% agreement, with a major error rate of 5.0%. These agreements are comparable with those of the Phoenix system. Starting from a positive blood culture, the test was completed within 9 hours. Conclusions/Significance: This new rapid method for antibiotic susceptibility testing can potentially provide accurate results for most relevant bacteria commonly isolated from positive blood cultures in less time than routine methods. [ABSTRACT FROM AUTHOR]

Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study (NCT03226886) integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2-positive, 94 were symptomatic and 2 patients died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies, 82% had neutralizing antibodies against WT, whereas neutralizing antibody titers (NAbT) against the Alpha, Beta, and Delta variants were substantially reduced. Whereas S1-reactive antibody levels decreased in 13% of patients, NAbT remained stable up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment-specific, but presented compensatory cellular responses, further supported by clinical. Overall, these findings advance the understanding of the nature and duration of immune response to SARS-CoV-2 in patients with cancer.

Background. Pyogenic ventriculitis is a well-known complication of meningitis, brain abscesses and intraventricular drains. Primary pyogenic ventriculitis is a rare entity and few cases have been described so far. We report the first case of primary pyogenic ventriculitis in an adult caused by Neisseria meningitidis and present an overview of all reported adult primary pyogenic ventriculitis cases in the English literature. Methods. A PubMed search was performed using the terms ependymitis, ventricular empyema, pyocephalus and ventriculitis. Filter was set for adults and English. Articles in which pyogenic ventriculitis was a complication of well-known risk factors were excluded. A total of five cases of primary pyogenic ventriculitis were identified. Results. There were seven adult patients. Only one patient showed signs of meningeal irritation. Four patients had positive blood cultures with Escherichia coli (one patient), methicillin-resistant Staphylococcus aureus (one patient), one patient was bacteraemic with Enterococcus faecalis , Escherichia coli and Peptostreptococcus spp., and N. meningitidis (our patient). In four patients cerebrospinal fluid was sent for culture, which yielded methicillin-sensitive Staphylococcus aureus (one patient), Peptostreptococcus spp. (one patient), Streptococcus intermedius (one patient, identified via 16S PCR) and Listeria monocytogenes (one patient). Cerebrospinal fluid cell count was determined in four patients and showed pleocytosis in all four cases. Ventricular drainage was performed in four patients. Five patients survived. Discussion. We report the first case of pyogenic ventriculitis caused by N. meningitidis . Primary pyogenic ventriculitis is a rare entity with various clinical presentations caused by various bacterial species. Treatment consists of adequate antimicrobial therapy, and ventricular drainage may be necessary.