Overuse Of Antibiotics Research Articles

A Mucous Permeable Local Delivery Strategy Based on Manganese-Enhanced Bacterial Cuproptosis-like Death for Bacterial Pneumonia Treatment.

Bacterial pneumonia is one of the most challenging global infectious diseases with high morbidity and mortality. Considering the antibiotic abuse and resistance of bacterial biofilms, a variety of metal-based materials have been developed. However, due to the high oxygen environment of the lungs, some aerobic infection bacteria have high tolerance to oxygen and ROS, and most of the metal-based materials based on ROS may not achieve good therapeutic effects. Inspired by the sensitivity of cuproptosis to aerobic respiratory cells, we designed a copper composite antibacterial nanoparticle and found that it can effectively induce cuproptosis-like death in the aerobic bacteria of the lungs. To address the challenge of in vivo application of cuproptosis, manganese dioxide was first incorporated to deplete protective glutathione, which can interact with copper and thus hinder the interaction of copper with proteins and assist in antibacterial action through immune enhancement. Cuproptosis-like death also requires a large number of copper ions. To meet this demand, we deliver positively hydrophilic modified composite nanoparticles that effectively penetrate the lung mucus layer directly to the lungs through local administration, and the copper ions are further released rapidly by the acidic environment at the infected site, which can further destroy bacterial biofilms in synergy with manganese. This drug-delivery system can effectively treat pneumonia caused by aerobic bacteria and avoid systemic toxicity that can be caused by large doses of copper.

Data-Driven Approaches in Antimicrobial Resistance: Machine Learning Solutions

Background/Objectives: The emergence of antimicrobial resistance (AMR) due to the misuse and overuse of antibiotics has become a critical threat to global public health. There is a dire need to forecast AMR to understand the underlying mechanisms of resistance for the development of effective interventions. This paper explores the capability of machine learning (ML) methods, particularly unsupervised learning methods, to enhance the understanding and prediction of AMR. It aims to determine the patterns from AMR gene data that are clinically relevant and, in public health, capable of informing strategies. Methods: We analyzed AMR gene data in the PanRes dataset by applying unsupervised learning techniques, namely K-means clustering and Principal Component Analysis (PCA). These techniques were applied to identify clusters based on gene length and distribution according to resistance class, offering insights into the resistance genes’ structural and functional properties. Data preprocessing, such as filtering and normalization, was conducted prior to applying machine learning methods to ensure consistency and accuracy. Our methodology included the preprocessing of data and reduction of dimensionality to ensure that our models were both accurate and interpretable. Results: The unsupervised learning models highlighted distinct clusters of AMR genes, with significant patterns in gene length, including their associated resistance classes. Further dimensionality reduction by PCA allows for clearer visualizations of relationships among gene groupings. These patterns provide novel insights into the potential mechanisms of resistance, particularly the role of gene length in different resistance pathways. Conclusions: This study demonstrates the potential of ML, specifically unsupervised approaches, to enhance the understanding of AMR. The identified patterns in resistance genes could support clinical decision-making and inform public health interventions. However, challenges remain, particularly in integrating genomic data and ensuring model interpretability. Further research is needed to advance ML applications in AMR prediction and management.

Lignin-Derived Gold-Titanium Dioxide Nanophotocomposites as Potent Photoactivatable Probes for Microbial Inactivation.

The overuse of antibiotics has accelerated antibiotic resistance, and it is a significant global threat to public health. To combat the rising threat of drug-resistant microbes, antimicrobial photodynamic therapy (APDT) has emerged as a promising alternative therapeutic strategy. This study focuses on the synthesis of eco-friendly lignin-derived gold-titanium dioxide nanophotocomposites (L@Au-TiO2 NCs). Lignin was utilized as a sustainable precursor for the synthesis of L@Au-TiO2 NCs. The gold and TiO2 nanoparticles possess inherent photodynamic properties, and thus the developed L@Au-TiO2 NCs exhibit enhanced antimicrobial efficacy due to the synergistic combination of their attributes. The antimicrobial potential of the L@Au-TiO2 NCs was evaluated against various microbial strains (Escherichia coli, Bacillus megaterium, and Candida tropicalis) under dark and green light conditions. The outcome of this study highlights the promising potential of L@Au-TiO2 NCs for photodynamic antimicrobial applications. The L@Au-TiO2 nanophotocomposites could be explored in the fields of medicine and nanotechnology to introduce innovative ideas into the biomedical field.

Single-step hydrothermal synthesis of zinc oxide nanorods for potential use as nano-antibiotics without seeding or bases.

The alarming global rise in antibiotic resistance, driven by the widespread overuse of traditional antibiotics, has created an urgent demand for new antimicrobial solutions. This study presents zinc oxide (ZnO) nanorods as a potential nano-antibiotic agent. ZnO nanorods, with a 2:3 aspect ratio, were synthesized using an efficient one-step hydrothermal method at a low temperature of 100°C, reducing the synthesis time to just 5 hours. The synthesized ZnO nanorods' morphology, structure, and composition were characterized using scanning electron microscopy, x-ray diffraction, and energy dispersive x-ray spectroscopy. The potent antimicrobial activity of these nanorods against common bacterial strains such as Escherichia coli, Bacillus subtilis, and Vibrio parahaemolyticus was examined through optical density at 600 nm (OD600) measurements and inhibition zone analysis, demonstrating substantial inhibition of bacterial growth. In particular, at a concentration of 5 mg/mL, ZnO nanorods achieved a 96% reduction of B. subtilis bacteria in OD600 and an impressive 99.87% reduction in culturing assays within one day, showcasing bactericidal efficiency on par with tetracycline at 0.003 mg/mL. Furthermore, a predictive model of bacterial growth was developed and validated, providing insights into the time-dependent bactericidal efficiency of the synthesized nanorods. These results highlight the potential of ZnO-based composites as a promising solution to combat antibiotic resistance, paving the way for next-generation antimicrobial materials.

Probiotics in piglet: from gut health to pathogen defense mechanisms

Various problems and obstacles are encountered during pig farming, especially the weaning phase when switching from liquid to solid feed. Infection by pathogenic bacteria causes damage to the intestinal barrier function of piglets, disrupts the balance of the intestinal microbiota, and destroys the chemical, mechanical, and immune barriers of the intestinal tract, which is one of the main causes of gut inflammation or gut diseases in piglets. The traditional method is to add antibiotics to piglet diets to prevent bacterial infections. However, long-term overuse of antibiotics leads to bacterial resistance and residues in animal products, threatening human health and causing gut microbiota dysbiosis. In this context, finding alternatives to antibiotics to maintain pre- and post-weaning gut health in piglets and prevent pathogenic bacterial infections becomes a real emergency. The utilization of probiotics in piglet nutrition has emerged as a pivotal strategy to promote gut health and defend against pathogenic infections, offering a sustainable alternative to traditional antibiotic usage. This review introduces recent findings that underscore the multifaceted roles of probiotics in enhancing piglet welfare, from fortifying the gut barrier to mitigating the impacts of common bacterial pathogens. Meanwhile, this study introduces the functions of probiotics from different perspectives: positive effects of probiotics on piglet gut health, protecting piglets against pathogen infection, and the mechanisms of probiotics in preventing pathogenic bacteria.

A review of antibiotic misuse and bacterial resistance in Iraq

Background: Antimicrobial resistance poses a serious threat to healthcare globally. Reviewing current practice regarding antibiotic prescription and use is crucial to understanding antimicrobial resistance issues in Iraq and how to tackle them. Aim: To review and analyse studies addressing antimicrobial resistance as well as antibiotic prescription, dispensing and use in Iraq. Methods: In June 2023, we searched Google Scholar for, and reviewed, empirical studies related to antibiotic use and antimicrobial resistance in Iraq. Results: Thirty-seven eligible studies published between 2012 and 2023 were included in the review. Multi-drug-resistant bacteria, such as E. coli and P. aeruginosa, were commonly reported by the studies. Most physicians in public hospitals prescribed antibiotics frequently and empirically without relying on culture and sensitivity tests, and community pharmacists often dispensed antibiotics to patients without prescriptions, indicating self-medication and misuse of antibiotics in Iraq. Antibiotic residuals were found in raw meat and drinking water. Although there were antimicrobial resistance control regulations and plans, they were not fully implemented. Conclusion: This review shows that antimicrobial resistance and antibiotic misuse are serious problems in Iraq. The responsible authorities should work together to implement and enforce compliance to the antimicrobial resistance control plans using the One Health approach.

Frequency of Ceftazidime-Avibactam resistance in Pseudomonas aeruginosa: Experience at a Tertiary Care Hospital.

Objective: To isolate Pseudomonas aeruginosa from different clinical samples and determine the antimicrobial activity of Ceftazidime/avibactam against these isolates. Study Design: Prospective Cross-sectional study. Setting: Pathology Laboratory of Lahore General Hospital, Lahore. Period: July 2023 to June 2024. Methods: One hundred thirteen Pseudomonas aeruginosa were identified from different samples Bacterial identification was done by gram staining, bench tests, and API20NE. The antimicrobial sensitivity testing of the causative bacteria was conducted, using commercially available discs, by Kirby Bauer disc diffusion assay and reported in accordance with Clinical & Laboratory Standards Institute (CLSI) 2022. Results: Out of 113 resistant strains of Pseudomonas aeruginosa obtained from different clinical samples Ceftazidime/avibactam was only sensitive to 43.4% of strains and resistant to 56.6% of them. Conclusion: According to the findings of this study, Pseudomonas aeruginosa, a nosocomial organism is isolated from many different clinical samples. The findings of this study also indicate that even a new combination antibiotic fails to show sensitivity in more than half of the isolates. This is a frightening situation that places stress on avoiding the misuse of antibiotics and following anti-microbial stewardship.

Bacterial isolates and antibiotic sensitivity in canine bacterial keratitis in Korea.

To analyze bacterial isolates associated with canine bacterial keratitis and their antibiotic susceptibility patterns in Korea, focusing on multidrug resistance (MDR) and identifying effective antibiotic combinations for clinical treatment. A total of 146 dogs diagnosed with suspected bacterial keratitis between October 2022 and October 2023 in Korea, with 157 eye samples collected for analysis. Eye samples were cultured to isolate bacteria, and antibiotic susceptibility testing was performed using the minimum inhibitory concentration (MIC) method. Bacterial identification was conducted using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF). The study assessed the efficacy of individual antibiotics and combination therapies. Bacteria were isolated in 55.4% of the samples. The most common genera were Staphylococcus species (48.5%, 48/99), Streptococcus species (13.1%, 13/99), Pseudomonas species (9.1%, 9/99), and Escherichia coli (9.1%, 9/99). Amikacin (84.8%) showed the highest antibiotic susceptibility, while doxycycline exhibited the lowest (17.2%). The most effective antibiotic combinations were amikacin-moxifloxacin (93%). MDR isolates accounted for 52.5% (52/99) of the total bacterial samples. Staphylococcus species were the most common isolates, with 52.5% showing MDR, underscoring the need to curb antibiotic misuse. While antibiotics like amikacin demonstrated high susceptibility rates, their use should be reserved for resistant infections to prevent further resistance development. Rather than focusing solely on finding effective combinations of antibiotics, it is crucial to consider alternative treatment strategies that offer more sustainable solutions. Rather than relying on antibiotic combinations, attention should shift to sustainable alternatives to treat bacterial keratitis and reduce antibiotic dependence in clinical practice.

Nano Revolution: Harnessing Nanoparticles to Combat Antibiotic-resistant Bacterial Infections.

Nanoparticles, defined as particles ranging from 1 to 100 nanometers in size, are revolutionizing the approach to combating bacterial infections amid a backdrop of escalating antibiotic resistance. Bacterial infections remain a formidable global health challenge, causing millions of deaths annually and encompassing a spectrum from common illnesses like Strep throat to severe diseases such as tuberculosis and pneumonia. The misuse of antibiotics has precipitated the rise of resistant strains like methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Mycobacterium tuberculosis (MDR-TB), and carbapenem-resistant Enterobacteriaceae (CRE), underscoring the critical need for innovative therapeutic strategies. Nanotechnology offers a promising avenue in this crisis. Nanoparticles possess unique physical and chemical properties that distinguish them from traditional antibiotics. Their high surface area to volume ratio, ability to be functionalized with various molecules, and distinctive optical, electronic, and magnetic characteristics enable them to exert potent antibacterial effects. Mechanisms include physical disruption of bacterial membranes, generation of Reactive Oxygen Species (ROS), and release of metal ions that disrupt bacterial metabolism. Moreover, nanoparticles penetrate biofilms and bacterial cell walls more effectively than conventional antibiotics and can be precisely targeted to minimize off-target effects. Crucially, nanoparticles mitigate the development of bacterial resistance by leveraging multiple simultaneous mechanisms of action, which make it challenging for bacteria to adapt through single genetic mutations. As research advances, nanotechnology holds immense promise in transforming antibacterial treatments, offering effective solutions that address current infections and combat antibiotic resistance globally. This review provides a comprehensive overview of nanoparticle applications in antibacterial therapies, highlighting their mechanisms, advantages over antibiotics, and future directions in healthcare innovation.

Parents Perception on use of Antibiotics in Children

Objective: To determine parents’ perception on use of antibiotics in children. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Kharian Pakistan, from Jul 2022 to Mar 2023. Methodology: Fifty parents aged 18-50 years were included in the study. Their parity, education levels, knowledge and attitudes on antibiotic use, including basic concepts of antibiotics, indications of antibiotic, administration of antibiotics, Antimicrobial Resistance and other side effects; parental experiences and practices around buying antibiotics without a prescription and parental experiences regarding using antibiotics to treat their children themselves were noted. Result: Sixteen respondents (32%) were male and 34(68%) were female. It was found that most parents used Cefixime 28(56%), followed by Amoxicillin, and Azithromycin. Twenty-three (46%) participants stated that antibiotics could cure infections caused by viruses. Eighty-eight percent participants knew that antibiotics should only be taken according to doctor’s prescription. Almost half of parents believed that antibiotics should be withdrawn as soon as the symptoms disappear. About 26% of parents believed that antibiotics could prevent the common cold. Thirty-six (72%) parents agreed that overuse of antibiotics exists in Pakistan. Conclusion: Poor knowledge or understanding of antibiotic usage persists among parents in Pakistan. A doctor's prescription for antibiotics may have an impact on how parents use those medicines on their children.

Prevalence of Salmonella Typhi, its associated factors and antimicrobial susceptibility profile among patients attending Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia

IntroductionSalmonella Typhi infections cause significant morbidity and mortality worldwide, especially in developing countries including Ethiopia. This study aimed to determine the prevalence of Salmonella Typhi, its associated factors and antibiotic susceptibility profile among suspected typhoid patients.MethodsA cross-sectional study was conducted on 270 typhoid fever suspected patients at Hawassa University Comprehensive Specialized Hospital from June 2022 to September 2022. Data were collected using questionnaires by face-to-face interview. Stool samples for microbiological culture, blood samples for S. Typhi IgM/Entero-check WB rapid test and isolates for antimicrobial susceptibility tests were used through standard procedures and according to the reagents manufactures’ instructions. Hygiene implementation of patients was also assessed using interview. Sociodemographic and clinical characteristics of the patient’s were considered. Descriptive statistics were used to summarize the data, and logistic regression model analysis was performed to assess associations between S. Typhi infection and the associated sociodemographic and clinical factors.ResultsThe prevalence of S. Typhi IgM/Entero-check WB rapid test and stool culture results were 3.3%; (95% CI: 1.5–5.6) and 3.7%; (95% CI: 1.9–6.3) respectively. Not washing hands after latrine [AOR = 0.85, 95% CI (0.15–4.79), p = 0.05] is not significant but, not washing hands before meal [AOR = 0.053, 95% CI (0.08–0.36), p = 0.03], eating raw vegetables [AOR = 0.024, 95% CI (0.001–0.48), p = 0.015] and drinking water from a stream [AOR = 0.12, 95% CI (0.19–0.70), p = 0.001] were significantly associated with S. Typhi infection, but in terms of AOR, all are preventive. Susceptibility of isolates was 9/10 (90%), 8/10 (80%), and 8/10 (80%) to ciprofloxacin, ceftriaxone, and chloramphenicol, respectively. The majorities 100% and 80% of the isolates were resistant to ampicillin and cotrimoxazole, respectively. About 40% of the isolates were MDR.ConclusionThe prevalence of Salmonella Typhi with MDR has been observed. Therefore, health programmers and stakeholders should make efforts to improve the habit of sanitation, strengthen the capacity of laboratory diagnostic methods and increase awareness of the misprescription and misuse of antibiotics to reduce the impact of MDR bacteria.

Patterns of Viral Pathogens Causing Upper Respiratory Tract Infections in Children Under 13 Years Old: A Retrospective Analysis

Background: Respiratory viral infections strain healthcare globally, accounting for 15% of encounters in the UAE. However, seasonal prevalence in the region remains unclear. This hospitalbased study aims to understand viral causes of upper respiratory tract infections (URTIs) in children under 13, focusing on influenza and RSV. Methods: We conducted a retrospective chart review at Hatta Hospital in Dubai, collecting data from pediatric patients under 13 years old with URTI diagnoses from 2022 to 2023. Nasopharyngeal aspirate samples were analyzed using a multiplex chain reaction (mPCR) assay to identify viral pathogens. Data were collected from the hospital’s emergency department, walk-in clinic, and admitted patients. Results: During the study period, 2714 samples were analyzed, with 1870 (69%) testing positive for any respiratory pathogen. Most infected individuals were males (56.7%), aged between 1 and 3 years (37.9%). Single viral infections were predominant (85.3%), with 27.3% attributed to Human Enterovirus/Rhinovirus, 26.6% to Influenza A, and 10.2% to respiratory syncytial virus (RSV). The RSV season was observed to span from August to December, peaking in October, while Influenza A had semi-seasonal peaks in June and October. Hospital admissions varied significantly between single (21%) and multiple viral infections (27%). Of 340 children hospitalized with single viral infections, 28.2% were infected with Human Enterovirus/Rhinovirus, 16.7% with RSV, and 13.5% with Influenza A. Conclusion: The study provides insights into viral epidemiology among children in the UAE, highlighting the high prevalence and seasonal peaks of viral pathogens. Awareness of these trends can reduce unnecessary streptococcal testing and antibiotic overuse. Understanding the seasonal patterns aids in optimizing prophylactic measures and vaccination strategies for RSV and influenza, benefiting high-risk infants and children.

A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Pneumonia Caused by Gram-Negative Bacteria in Intensive Care Units (ICUs): Unit-Specific Combination Antibiograms Versus Patient-Specific Risk Factors

Abstract Background Guidelines suggest dual anti-pseudomonal therapy for empiric treatment of pneumonia caused by Gram-negative bacteria in ICU patients. Additionally, consideration of local susceptibility data and patient-specific risk factors for resistance is recommended for selecting optimal empiric regimens. However, data assessing how to best do this are lacking, and it is unclear whether a local susceptibility data-based or a patient specific risk factor-based approach will better drive appropriate empiric treatment. This study aims to compare these two strategies. Methods This retrospective study was divided into two periods. In period I, Gram-negative respiratory cultures from ICU patients were used to develop unit-specific combination antibiograms, and individual patient charts were reviewed to assess the impact of risk factors on antimicrobial susceptibility to develop a risk-factor based treatment algorithm. Optimal empiric regimens based on these two strategies were then defined. In period II, these regimens were hypothetically applied to patients to compare rates of appropriate empiric therapy and overuse by the two methods. Results Risk factor-based regimens had a higher appropriateness rate compared to regimens derived from antibiograms (89.9% vs 83.7%). Additionally, applying antibiogram based regimens resulted in a higher prevalence of antibiotic overuse than a patient-specific risk factor based approach (69.8% vs. 40.3%), with excess overuse driven by a higher frequency of unnecessary use of combination therapy. Conclusion Both strategies provided high rates of appropriateness in empiric antibiotic selection. However, the patient-specific risk factor-based approach demonstrated a higher rate of appropriate therapy and offered advantages in reducing rates of unnecessary combination therapy.

Computational prediction of a phage cocktail active against multidrug-resistant bacteria

Background Antibiotic misuse and overuse have contributed to the emergence of multi-drug resistant (MDR) bacteria, posing a serious public health problem across the globe. Phage cocktails, which combine multiple phages, provide an efficient method to combat multidrug-resistant bacterial infections. This study integrated a computational pipeline to design a phage cocktail against the bacterial strains Acinetobacter baumannii AB0057, Klebsiella pneumoniae subsp. pneumoniae HS11286, and Pseudomonas aeruginosa UCBPP-PA14. Methods The whole genome sequences of selected multidrug-resistant bacteria were accessed. Prophage sequences were identified from them which could be expressed to produce viable lytic phages against MDR bacterial strains, thereby reducing the severity of infection. Prophages were annotated for open reading frames (ORFs), putative promoters, virulence factors, transcriptional terminators, ribosomal RNAs, and transfer RNAs. A dot plot was also generated to investigate similar phages and phylogenetic analysis was performed. Results A total of 11 prophages were predicted from the bacterial genomes. About 472 open reading frames were predicted along with 3 transfer RNAs. Additionally, the presence of 754 putative promoters and 281 transcription terminator sequences was also detected. Comparative genomic and phylogenetic analyses provided insight into the diversity, relatedness, and lytic potential of the phages. The final designed phage cocktail consisted of five selected prophages including Acinetobacter baumannii prophages (2759376-2809756) and (3311844-3364667), and Klebsiella pneumoniae prophages (1288317-1338719), (1778306-1808606), and (2280703-2325555). Conclusion The phage cocktail designed in this study might be useful against MDR Acinetobacter baumannii and Klebsiella pneumoniae infections, especially where conventional antibiotics fail. Sequence similarity analysis suggested that the phage cocktail may also be effective against other carbapenemase-producing K. pneumoniae strains.

Prevalence and pattern of self-medication with antibiotics among residents of Abia State, Southeastern Nigeria: a call for action

Background: Antibiotic self-medication occurs worldwide, and it is a major driver of antibiotic misuse and antimicrobial resistance. In developing countries like Nigeria, antibiotics are frequently sold as over-the-counter medications. There is a need to explore this pattern, aiding stakeholders in informed decision-making. We assessed the prevalence and pattern of antibiotic self-medication among the residents of Abia State. Methods: A cross-sectional study was conducted among eligible adults in the State with respondents selected using the multistage sampling technique. An interviewer-administered questionnaire was used to obtain information from the respondents. Data analysis was done using SPSS version 26 and the level of significance was set at 5%. Results: A total of 1,491 respondents were surveyed. The mean age was 34.7±13.1 years and females constituted 55.7%. The overall prevalence of antibiotic self-medication was 46.5% (95%CI: 43.9-49.1). The majority of the respondents took self-medication for cough (48.6%) and ampicillin/cloxacillin was the major antibiotic used (30.1%). The reason for antibiotic self-medication mostly reported was the perception of minor illness (62.7%). Most (52.4%) of the respondents got the antibiotics from pharmacies without prescriptions. The predictors of antibiotic self-medication included residence (aOR=2.44, 95% CI: 1.12-5.30), retention of previous prescriptions (aOR=10.98, 95% CI: 4.40-27.47), storage of leftover antibiotics (aOR=4.13, 95% CI: 1.79-9.54) and perceived susceptibility of antibiotic self-medication (aOR=4.96, 95% CI: 1.71-14.39). Conclusions: Close to half of the residents practiced antibiotic self-medication with its pattern identified. We recommend tailored strategies including appropriate health education and enforcement of regulatory policies to promote community antibiotic stewardship.

Pattern of Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital of Bangladesh

Background: Surgical Site Infection (SSI) is a common form of hospital-acquired infection and major cause of postoperative illness accounting for approximately a quarter of all nosocomial infections. As a result, surgical antibiotic prophylaxis is now considered essential to conventional surgical procedure in order to reduce surgical site infections and improve postoperative recovery. The misuse and overuse of antibiotics has led to an increase in treatment costs and the emergence of antimicrobial resistance. The goal of the study is to identify the pattern of prophylactic antibiotic prescriptions for different surgical operations. Materials and methods: A retrospective observational study was conducted among 600 patients undergoing different surgeries in a tertiary care hospital of private setting in Dhaka, Bangladesh from July 2023 to December 2023. The demographic data, types of surgery, types of therapy, choice of antibiotic along with dosage formulations were collected. Results: Out of 600 patients, 245 (41%) were male and 355 (59%) were female. Highest bulk of patients were from Department of General Surgery (47.5%), followed by Department of Obstetrics & Gynecology (24.16%) and Department of Otolaryngology (16.7%). Surgical prophylactic antibiotic was used in all 600 patients, and all antibiotics were given in intravenous route (100%). Almost 505 patients (84.2%) had received ceftriaxone as antimicrobial agent. Ceftriaxone with metronidazole or gentamicin and Cefuroxime with metronidazole or amikacin drugs combination were given to 75 (12.5%) and Cefuroxime, Amikacin, Metronidazole drugs combination were given to 20 patients (3.3%). 3rd generation cephalosporin, Ceftriaxone, was the most commonly prescribed antibiotic as monotherapy (94.3%), followed by 2nd generation cephalosporin, cefuroxime (4%). Conclusion: Ceftriaxone was the preferred antibiotic for surgical prophylaxis. Existence of an antimicrobial guideline along with antibiotic stewardship program in every hospital could be helpful for prescribers to play role in containment of antimicrobial resistance. EWMCJ Vol. 12, No. 1&2, January-July 2024: 70-74

Extended Spectrum β-Lactamase: Tackling Antibiotic Resistance and Overcoming Treatment Challenges

Antibiotics, also known as antibacterials, kill or inhibit bacterial growth but are ineffective against viruses, fungi, or parasites, often leading to misuse. They are categorized by molecular structure, mode of action, and spectrum of activity. Antimicrobial Resistance (AMR) occurs when pathogens no longer respond to antimicrobial drugs, arising naturally or through acquisition. Resistance mechanisms include enzymatic (most common), genetic and physical. Bacteria produce various β-lactamases, such as Extended Spectrum β-lactamases (ESBLs), AmpC enzymes, and carbapenemase to exert resistance to Beta-Lactam (βL) class of antibiotics. ESBL families include TEM, SHV, and CTX-M, with E. coli being the most prevalent host. Any Gram-Negative Bacteria (GNB) can be an ESBL producer, but most common ones are the Enterobacteriaceae including Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis. ESBL-producing Enterobacteriaceae (ESBL-E) resist penicillin, aztreonam, and cephalosporins except cephamycins and carbapenems, posing a significant public health risk. Genetic resistance mechanisms involve random mutations and horizontal gene transfer through either of the following processes namely conjugation, transformation, transduction. Physical mechanisms include efflux pump production and decreased porin channels. In some microbiological laboratories, ESBL production are often not determined, rather resistance based on MIC values to third generation Cephalosporins are considered as resistance due to ESBL production. Antibiotic use in agriculture and medicine has increased Multi-drug resistant (MDR) ESBL-producing E. coli and evidenced in retail meat and among meat shop employees. Community-acquired ESBL-E infections are a growing concern, with hospital transmission primarily occurring among patients sharing rooms with ESBL carriers. Empirical and definitive therapies for ESBL-E infections must be adjusted based on Antibiotic Susceptibility Testing (AST). The MERINO trial identified urinary tract infections as the most common source of ESBL-E bacteremia, with E. coli being predominant. For critically ill patients with non-urinary tract infections, Meropenem or Imipenem-cilastatin are recommended. For uncomplicated UTIs, Nitrofurantoin, Cotrimoxazole, and Piperacillin-Tazobactam (Pip-Taz) are effective, while Cotrimoxazole, Fluoroquinolones, and Ceftolozane-tazobactam are suitable for complicated UTIs. New β-lactamase inhibitors like avibactam, vaborbactam, and relebactam are promising for treatment. Misuse of antibiotics, such as inappropriate dosing and duration, contributes to AMR, a growing global challenge. Deaths from AMR, estimated at 1.27 million in 2019, could reach 10 million by 2050. ESBLs drive the use of broad-spectrum antibiotics, accelerating resistance development. Inadequate therapy exacerbates infections, leading to prolonged hospital stays, complications, and increased mortality. Balancing new drug development with resistance emergence is crucial to combat AMR.

Antibiotic use and resistance: knowledge, attitudes and practices in Italian healthcare workers

Abstract Background Antimicrobial resistance (AMR) is one of the most significant public health challenges globally. The misuse or incorrect use of antibiotics has led to the emergence of resistant bacteria, making it increasingly difficult to treat infections. This study aims to identify knowledge, attitudes, and practices among Italian healthcare workers (HWs) - medical doctors (MDs) and nurses - regarding antibiotics, antibiotic use, and antibiotic resistance. Methods Cross-sectional study; a validated questionnaire from the European Centre for Disease Prevention and Control was distributed via web survey starting from April 2024 to a voluntary sample of healthcare workers employed in Italy. Descriptive analysis and multivariable logistic regression were performed to investigate predictors of knowledge regarding antibiotic use and AMR. Ethical approval was obtained from the local ethics committee. Results So far, 154 HWs were enrolled, of which 132 were nurses (85.7%). The average level of knowledge regarding AMR and antibiotic use was 6.8/7 (± 0.2) for MDs and 6.1/7 (± 0.2) for nurses, with an overall score, among HWs of 6.19 (± 0.99), compared to a European average of 6.35. The multivariable analysis highlighted that the medical profession reported higher knowledge regarding prudent antibiotic use and AMR (aOR 6.90; 95% CI 1.83-26.01, p-value = 0.004), while concerning professional practice, the unavailability and difficulty of access to guidelines seemed to increase the risk of reporting inadequate knowledge (aOR 2.04; 95% CI 1.01-4.13, p-value = 0.046). Conclusions Our preliminary results provide an insight into the importance of structuring and actively disseminating procedures/protocols and guidelines to deepen the issues of AMR and prudent antibiotic use. Also, there appears to be a need to enhance the delivery of refresher courses targeting HWs, with particular attention to settings at high infection transmission risk. EU funding: Project no. PE00000007, INF-ACT. Key messages • Although a higher knowledge about prudent antibiotic use and AMR, more efforts are needed to increase access to guidelines. • Constant updating of knowledge and practices is necessary to face the challenges of antibiotic resistance in public health.

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Visible light-activated dye-sensitized TiO2 antibacterial film: A novel strategy for enhancing food safety and quality

Antibacterial packaging holds promise in addressing food spoilage by inactivating bacteria, but current antimicrobial packaging solutions face challenges like depletion of antibacterials and concerns of antibiotic abuse. In response to these limitations of existing packaging materials, we developed a novel antibacterial packaging film by incorporating titanium dioxide (TiO2)- tetra(4-carboxyphenyl) porphyrin (TcPP) conjugates into cellulose nanofibrils (CNF) films. Unlike conventional antimicrobial packaging, this film harnesses visible light energy to excite electrons from TcPP to TiO2, generating reactive oxygen species (ROS) that inactivate bacteria without relying on antibiotics. Results demonstrated that the film reduced 4.5, 4.6, 4.1, and 4.7-log Escherichia coli, Pseudomonas fluorescens, Leuconostoc lactis, and Listeria innocua, respectively, in phosphate-buffered saline within 72h under 6000 lux light (3.13mW/cm2). The antimicrobial efficacy decreased as the light intensity decreased. Notably, it retains significant antimicrobial properties even under an extremely low light intensity of 600 lux (0.60mW/cm2). The analysis also revealed that singlet oxygen and hydrogen peroxide are the major generated ROS from the film under light exposure. When applied to cucumbers, the film reduced E. coli by 3.5 logs after 48-hour light exposure. The designed photocatalytic antibacterial film represents a major advancement in sustainable food preservation, reducing food waste by extending the shelf life of fresh produce.