Antibiotic Prescribing Policies Research Articles

A Four-Year Trend of Ceftriaxone Resistance and Associated Risk Factors Among Different Clinical Samples in Wad Medani, Sudan: A Cross-Sectional Retrospective Study.

Introduction In sub-Saharan Africa, including Sudan, there is commonly no local data on the bacterial profile or antibiotic resistance pattern. Therefore, to bridge these gaps, this study aimed to evaluate ceftriaxone resistance patterns and associated risk factors among different clinical samples. Methods This study was a laboratory-based, retrospective,cross-sectional study. All clinical specimens were obtained from patients at Wad Medani and examined at the Pathology Center for Diagnosis and Research, Faculty of Medicine, University of Gezira, Sudan, from January 2020 to October 2023. Results Overall, 1784 specimens exhibited bacterial growth over four years. Of these, 1260 (70.6%) were females. Approximately one-third of the 588 (33%) studied patients were aged 30 to 44 years. Of the studied samples, 1108 (62.1%) were urine, and 465 (26.1%) were wound swabs. Staphylococcus aureus(697, 39.1%) and Escherichia coli(656, 36.8%) were the most frequently encountered bacteria. Generally, ceftriaxone resistance has been evaluated in 150 positive culture samples. The overall ceftriaxone resistance rate was 106 (70.7%). The greatest proportion of ceftriaxone resistance was observed in 4/4 (100%) of Klebsiella spp. and 66/82 (80.5%)of E. coli strains. The type of isolate (95% Cl, p-value; 0.006) and type of bacterial stain (95% Cl, p-value0.013) have been significantly associated with ceftriaxone resistance, in which Gram-negative bacteria had a greater resistance rate of 98/132 (74.2%)than Gram-positive bacteria 8/18 (44.4%). Conclusions This study revealed a high rate of ceftriaxone resistance. The most resistant bacteria were Klebsiella spp. and E. coli. The type of isolate and bacterial stain were significantly associated with ceftriaxone resistance. Therefore, hospitals should immediately and significantly modify their antibiotic prescription policy to give doctors a consistent strategy for the rational, safe, and effective administration of antibiotics.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation.

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.

Prescribing Pattern of Antibiotics in Paediatric Inpatients of Bakulahar Ratnanagar Hospital, Chitwan

INTRODUCTION: The rational use of antibiotics is crucial in paediatric healthcare settings to mitigate the risk of antimicrobial resistance. This study aimed to assess the prescription patterns of antibiotics among paediatric inpatients at Bakulahar Ratnanagar Hospital, Ratnanagar, Chitwan. MATERIALS AND METHODS: A cross-sectional study conducted over a 2-month period in May-June 2023 involved the analysis of 160 patient case sheets from the paediatric inpatient department. Patients with various infections were included, and data were analyzed using SPSS. RESULTS: The mean age of paediatric patients was 2.83 years. Each encounter involved an average of 3.4 drugs, with 1.86 antibiotics per patient. Pneumonia emerged as the most prevalent disease. Among antibiotics, the Cephalosporin group, particularly Ceftriaxone and Cefotaxime, were frequently prescribed. The combination antibiotic Ceftriaxone plus Tazobactam was widely used. CONCLUSIONS: Strict adherence to antibiotic prescription policies can significantly curb overuse and reduce antibiotic resistance development.

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance.

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

Prevalence of extended spectrum beta lactamase and molecular detection of blaTEM, blaSHV and blaCTX-M genotypes among Gram negative bacilli isolates from pediatric patient population in Gaza strip

BackgroundExtended-spectrum β lactamases (ESBLs), have the ability to hydrolyze and cause resistance to various types of the β-lactam antibiotics, including the extended-spectrum (or third-generation) cephalosporins (e.g., cefotaxime, ceftriaxone, ceftazidime) and monobactams (e.g., aztreonam). ESBL-producing Gram negative bacteria is still posing significant therapeutic challenges.ObjectivesTo assess the prevalence and molecular characteristics of ESBL producing Gram negative bacilli, isolated from a cohort of pediatric patients in Gaza hospitals.MethodsA total of 322 isolates of Gram-negative bacilli were collected from four referral pediatric hospitals in Gaza, namely: Al-Nasr, Al-Rantisi, Al-Durra and Beit Hanoun hospitals. These isolates were tested for ESBL production using the double disk synergy and CHROMagar phenotypic methods. Molecular characterization of the ESBL producing strains was performed using PCR targeting the CTX-M, TEM and SHV genes. Antibiotic profile was done using Kirby Bauer method according to Clinical and Laboratory Standard Institute.ResultsOut of 322 isolates tested by phenotypic methods, 166 (51.6%) were ESBL positive. The prevalence of ESBL production in Al-Nasr, Al-Rantisi, Al-Durra and Beit Hanoun hospitals was 54%, 52.5%, 45.5% and 52.8% respectively. The prevalence of ESBL production among Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., Proteus mirabilis, Enterobacter spp., Citrobacter spp., and Serratia marcescens is 55.3%, 63.4%, 17.8%, 57.1%, 33.3%, 28.5%, 38.4%, and 4% respectively.ESBL production among urine, pus, blood, CSF and sputum was 53.3%, 55.2%, 47.4%, 33.3%, and 25% respectively. Out of the 322 isolates, 144 were screened for CTX-M, TEM and SHV production. Using PCR, 85 (59%) had at least one gene. The prevalence rate of CTX-M, TEM and SHV genes was 60%, 57.6%, and 38.3% respectively.Meropenem and amikacin were highest rates of susceptibility antibiotics against ESBLs producers (83.1% and 82.5% respectively), while the least effective antibiotics were amoxicillin (3.1%) and cephalexin (13.9%). Moreover, ESBLs producers showed high resistance rate to cefotaxime, ceftriaxone and ceftazidime (79.5%, 78.9% and 79.5% respectively).ConclusionOur results show high prevalence of ESBL production among Gram negative bacilli isolated from children in different pediatric hospitals in Gaza strip. A substantial level of resistance to first and second generation cephalosporins was also observed. This ascertains the need for a rational antibiotic prescription and consumption policy.

Antimicrobial stewardship program: Fighting antimicrobial resistance in India

Antimicrobial resistance (AMR) is a significant concern in India, contributing to increased medical costs, prolonged hospital stays, and mortality. Antimicrobial stewardship programs (AMSP) are organizational strategies in health-care systems designed to promote, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness. The Indian council of medical research recognizes the need for AMS structures in healthcare institutions and has initiated actions to support this. These include developing an AMS curriculum, conducting workshops for increased awareness and education, and expanding surveillance of antimicrobial usage and resistance trends. However, many hospitals in India still lack structured processes for AMS, requiring a multidisciplinary approach involving various experts. AMSP contribute significantly to improving antibiotic use without compromising patient outcomes, such as optimal selection of agents, correct dosing, appropriate administration routes, and proper therapy duration. The aim is to enhance patient care and outcomes, reduce infection complications, and minimize the emergence of AMR. Key challenges faced in implementing AMS programs in India include lack of infrastructure and personnel, limited resources and funds, limited laboratory capability, absence of antibiotic prescription policy, irrational prescription and excessive use of broad-spectrum antibiotics, self-medication, inappropriate disposal of leftover antibiotics, lack of regulation, and treatment non-compliance. These challenges necessitate robust, collaborative, and multifaceted responses, including policy reform, investment in infrastructure development, expanded surveillance, improved professional practices, and public education.

Bacteriological Study on Surgical Site Infection in Rangpur Medical College and Hospital

Background: Surgical site infections (SSIs) is a major problem in both developed and developing countries. In developing countries like Bangladesh, infection in surgical patients has been appearing as a serious risk due to insurgence of drug resistance. Surgical site infections (SSIs) contribute significantly to increased health care costs in terms of prolonged hospital stay and lost working days. The problem was largely unexplored in Rangpur Medical College and Hospital, Rangpur.
 Objective: The aim of the study was to evaluate the bacteriological study on surgical site infections in Rangpur Medical College & Hospital.
 Methods: This cross-sectional observational study was conducted in the Department of Surgery at Rangpur Medical College Hospital. 72 patients of all ages, sex who developed surgical site infection were included through purposive sampling for observation and clinical follow up and wound swab was microbiologically evaluated.
 Results: Of the 72 cases, SSI developed 30.6% (22) following elective surgery and 69.4% (50) following emergency surgery. 7 cases were associated with co-morbid conditions like diabetes mellitus (2), malignancy (4) and tuberculosis (1). Most common organisms were Escherichia coli (30 /54) followed by Staphylococcous aureus (14/54), Pseudomonas (07/54) and Klebsiella (03/54).The antibiogram pattern of the organism isolated from wound swab of SSIs were analyzed with commonly used antibiotics. Resistance of Escherichia coli to Amoxycillin, Cotrimoxazole, Doxycycline and Nalidixic acid were 100%, 91.5%, 71.4% and 60.5% respectively. In case of, Staphylococcus aureus 87.5% were resistant to penicillin and Cotrimoxazole. Resistance of Pseudomonas spp. to Ciprofloxacin, Ceftazidime and Gentamicin were 31.2%. 6.3% and 50% respectively. In case of Klebsiella spp, it showed that 100% strains were resistant to Amoxycillin like Esch. coli but all strains were sensitive to both Ceftriaxon and Imipenem.
 Conclusion: The study emphasizes the need for the evidence-based infection control and antibiotic prescription policies in the hospital.
 J Rang Med Col. September 2022; Vol. 7, No. 2:12-19

The Antibiotics Susceptibility Profile of Acinetobacter spp Isolated from Clinical Specimens in University Teaching Hospital

The genus Acinetobacter currently contains 34 species, the vast majority of which are not regularly implicated in causing infection. However, Carbapenems have long been thought of as the agents of choice for serious Acinetobacter baumannii infections. The objective of this study is to determine the Antibiotics susceptibility profile of Acinetobacter spp Isolated from clinical specimen University of Ilorin Teaching Hospital, Ilorin. The descriptive cross-sectional study is conducted in UITH located in North Central Nigeria. 10 strains of Acinetobacter spp. were isolated from clinical samples between February to July 2018. The isolated strains were identified using standard microbiological methods, API20NE. Antimicrobial susceptibility was performed using the Modified Kirby Bauer method with the organism tested against Amoxicillin, Amoxicillin-Clavulanate, Ceftriaxone, Cefixime, Cefuroxime, Streptomycin, Perfloxacin, Gentamicin, Imipenem, Nitrofurantoin. Most of the antibiotics used in this study are mostly multi-drug resistant. Amoxicillin (100%), Cefixime, Amoxicillin Clavulanate (100%), Cefuroxime (100%), Gentamicin (100%), Nitrofurantoin (100%), Ceftriaxone (100%) but 80% are susceptible to Imipenem. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with a functional antibiotic prescription policy to avoid treatment failures. Continuous monitoring of resistance patterns is necessary to strengthen infection control policies.

Healthcare costs and mortality associated with serious fluoroquinolone-related adverse reactions.

The aim of this study was to estimate healthcare costs and mortality associated with serious fluoroquinolone‐related adverse reactions in Finland from 2008 to 2019. Serious adverse reaction types were identified from the Finnish Pharmaceutical Insurance Pool’s pharmaceutical injury claims and the Finnish Medicines Agency’s Adverse Reaction Register. A decision tree model was built to predict costs and mortality associated with serious adverse drug reactions (ADR). Severe clostridioides difficile infections, severe cutaneous adverse reactions, tendon ruptures, aortic ruptures, and liver injuries were included as serious adverse drug reactions in the model. Direct healthcare costs of a serious ADR were based on the number of reimbursed fluoroquinolone prescriptions from the Social Insurance Institution of Finland’s database. Sensitivity analyses were conducted to address parameter uncertainty. A total of 1 831 537 fluoroquinolone prescriptions were filled between 2008 and 2019 in Finland, with prescription numbers declining 40% in recent years. Serious ADRs associated with fluoroquinolones lead to estimated direct healthcare costs of 501 938 402 €, including 11 405 ADRs and 3,884 deaths between 2008 and 2019. The average mortality risk associated with the use of fluoroquinolones was 0.21%. Severe clostridioides difficile infections were the most frequent, fatal, and costly serious ADRs associated with the use of fluoroquinolones. Although fluoroquinolones continue to be generally well‐tolerated antimicrobials, serious adverse reactions cause long‐term impairment to patients and high healthcare costs. Therefore, the risks and benefits should be weighed carefully in antibiotic prescription policies, as well as with individual patients.

Bacterial Isolates and Their Antibiotic Susceptibility Pattern among Patients with Infected Wounds Admited in Orthopaedic and Trauma Ward in Tertiary Care Hospital North-Eastern Tanzania

The hospital environment contributes to wound infections. Effects of such infections include prolonged hospitalization, increased morbidity, potential for antibiotics resistance and mortality due to sepsis. An updated knowledge of antibiotics susceptibility profiles of clinical isolates will assist both in choosing the most appropriate antibiotic treatment for wound infections and help in curbing the escalation of drug resistance. Cross sectional hospital based study, analysis of 125 pus samples collected from January 2018 to December 2020 was conducted. Identification and characterization of isolates were performed on the basis of Gram staining, microscopic characteristics, colony characteristic, and biochemical tests using standard microbiological methods. Antibiotic susceptibilities of bacterial isolates were determined by Kirby Bauer disc diffusion. A total of 125 pus samples were studied, 94 (75%) were from male patients, mean age was 38.5 (SD ± 19) years. Single bacterial isolates were recovered from 120 (96%) samples, 67 (53.6%) shows Multiple Drug Resistance (MDR) pattern, 74 (59.2%) were gram negative, the predominant organism isolated was Staphylococcus aureus 46 (36.8%). Gram negative isolates showed high resistance to ampicillin and cephalosporins. Gram positive isolates showed high resistance to erythromycin. Both gram positive and negative were found to be highly susceptible to gentamicin, amikacin, clindamycin, ciprofloxacin and amoxicillin/clavulanic acid. The study showed that Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are the major bacteria isolated from pus samples. High proportion (53.6%) of the isolates was MDR. In the light of these findings, a change in antibiotic prescription policy is required at this hospital.

CHARACTERIZATION AND ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF NON LACTOSE FERMENTING GRAM-NEGATIVE BACTERIAL ISOLATES IN A TERTIARY CARE TEACHING HOSPITAL OF CENTRAL INDIA

Objectives: The non-lactose fermenting Gram-negative bacilli (NLF-GNB) are notorious pathogens reportedly acquiring multiple drug resistance alarmingly and emerging as a public health threat globally. This study was conducted to isolate and identify these pathogens from clinical samples received routinely in our Bacteriology Laboratory and to analyze their antibiotic susceptibility patterns. Methods: In this cross-sectional study, the first 100 NLF-GNB strains isolated consecutively from 1218 clinical samples were included through convenience sampling. The samples were processed using standard microbiological techniques. Results: The most common isolate was Pseudomonas aeruginosa followed by Acinetobacter spp, Proteus spp, Shigella spp, Salmonella typhi, Providencia spp., and Morganella spp. P. aeruginosa and Acinetobacter spp. isolates were found to exhibit high susceptibility toward Colistin and Imipenem. Proteus spp. exhibited high sensitivity toward Imipenem, Aminoglycosides, Ceftazidime, and Cefepime. All Providencia isolates were susceptible to Amikacin, Cefepime, and Ceftriaxone. The only isolate of Morganella spp. was found to be susceptible to Amikacin, Cefepime, Ceftazidime, Piperacillin tazobactam, Ciprofloxacin, Imipenem, and Aztreonam. Shigella isolates exhibited very high susceptibility toward Imipenem followed by Gentamicin and Ceftazidime. All the isolates of S. typhi exhibited susceptibility toward Imipenem, Piperacillin tazobactam, Ceftazidime, Ceftriaxone, Cefoperazone sulbactam, and Chloramphenicol. 24% of test isolates were found to be Multidrug resistant. Conclusion: Antimicrobial surveillance is needed to implement appropriate timely interventions to restrict the spread of multidrug-resistant clones. Strict infection prevention and control practices, with judicious antibiotic prescription policy, may help in tackling this problem by obviating the selection pressure.

Prevalence of urinary tract infection and sensitivity pattern amongst children less than 3 years of age with fever in a tertiary care hospital in South Karnataka

Background: Antimicrobial resistance is a major concern especially in urinary tract infections in children as improperly treated urinary tract infections (UTIs) on long term can cause renal scarring in young children, which leads to long term morbidities like hypertension, chronic renal disease and pre-eclampsia. The empirical therapy for UTI varies regionally due to their varied sensitivities and resistance pattern. This study aims to facilitate policy making in empirical antibiotic therapy of pediatric patients with urinary tract infections.Methods: A cross sectional study, which included a group of 140 children’s (6 months to 3 years) with fever were included in the study. All patients with colony count >1 lakh CFU/ml or colony count >50,000 CFU/ml, with leukocyturia (>5 WBCs/HPF in centrifuged urine) or colony count >1000 CFU/ml with urinary symptoms were diagnosed to be positive for urinary tract infection.Results: The prevalence of UTI in febrile children less than 3 years in our study was 0.1%. Out of 140 patients with fever, 35 were UTI positive. E. coli was the most commonly isolated organism (60%), followed by MRSA (14.2%) and Enterococci (11.4 %). E. coli was found to be most sensitive to nitrofurantoin (85.7%), followed by gentamicin (61.9%) and norfloxacin (38%). E. coli showed high resistance to cefuroxime (76.2%) and ceftriaxone (71.4%). MRSA was found to be most sensitive to linezolid and vancomycin, and resistant to norfloxacin.Conclusions: The data shows the increased resistance of E. coli to commonly prescribed antibiotics like cefuroxime and ceftriaxone. So, this study shows the empirical treatment of UTI in our region and the importance of having antibiotic prescription policies in every region.

Extended-Spectrum β-Lactamase (ESBL) Genotypes among Multidrug-Resistant Uropathogenic Escherichia coli Clinical Isolates from a Teaching Hospital of Nepal.

Urinary tract infections (UTI) represent the most common bacterial infections among patients visiting outpatient clinics of healthcare centers in Nepal. However, treatment of such infections is compounded by emergence and spread of multidrug-resistant uropathogens associated with extended-spectrum β-lactamases (ESBLs). In this study, we aimed to investigate the burden of antimicrobial resistance and occurrence of ESBL genes among clinical isolates of uropathogenic Escherichia coli at a tertiary care teaching hospital of Nepal. During the study period, we processed a total of 1,626 urinary tract specimens, isolated significant bacterial pathogens, and investigated their antimicrobial susceptibilities. Escherichia coli (n = 154), the predominant pathogen associated with UTI, was further investigated for the existence of ESBL enzymes by using conventional phenotypic as well as molecular approaches. Among suspected cases of UTI, we found that 15.2% were having UTI and female patients of the reproductive age group were more affected (p < 0.05). Escherichia coli (154, 62.1%) was the key uropathogen, and majority (∼64.9%) of them were multidrug resistant (MDR). Among MDR E. coli isolates, 40.3% were producing extended-spectrum β-lactamases (ESBLs). bla-TEM (83.8%), bla-CTX-M (66.1%), and bla-SHV (4.8%) were common ESBL genotypes. Nitrofurantoin, gentamycin, and imipenem were the most effective antibiotics for ESBL-producing Escherichia coli isolates. It indicates that the high rates of multidrug-resistant Escherichia coli are frequent causes of UTI in our hospital. Nitrofurantoin and aminoglycosides are the most useful first-line drugs to be used in the cases of UTI. We recommend the regular investigation of drug resistance among all isolates and develop a useful antibiotic prescription policy in our country.

Antibacterial Resistance Pattern of Acinetobacter baumannii in Burn Patients in Northeast of Iran

Background: Globally, Acinetobacter spp., most commonly, Acinetobacter baumannii, are one of the most common Gram-negative nosocomial infections, especially in Intensive Care units (ICUs) and burn wards. Because of the pathogens’ ability to survive for a long time, the eradication of the pathogen from these wards remains a great concern. Simultaneously, the remarkable increase in antibacterial resistance among A. baumannii strains in recent years has raised a great deal of concern. Objectives: The study assessed the prevalence and antibacterial resistance pattern of A. baumannii in the only academic-affiliated burn center in northeastern Iran. Methods: In this cross-sectional study, 5,080 samples from patients admitted to two burnt wards and one burn ICU were included in 2012-2014. The samples were from different sources including wound tissue, blood, bronchial secretion, and urine. The antibacterial resistance pattern was determined using relevant antibiotics based on the Clinical and Laboratory Standards Institut (CLSI) instructions. Results: Acinetobacter spp. were found in 39 of the acquired cultures (1,985 out of 5,080) and 51.9 of bacterial positive cultures (1985 out of 3823). The resistance rate of Acinetobacter spp. against antibiotics varied from 0.9 for colistin to 100 for piperacillin-tazobactam. All Acinetobacter spp. were multidrug-resistant (MDR) due to considerable resistance to fluoroquinolones (95), cephalosporins (93-98), penicillins (97), carbapenems (94-95), and beta-lactamase inhibitors (87-100). Conclusions: Given that infections are a major cause of mortality in burn wards, the high prevalence of MDR isolates of Acinetobacter spp. in this burn center suggests that local antibiotic prescription policies should be revised and infection control strategies should be improved. Also, antibiotic cycling and restrict infection control strategies should be implemented in high-risk wards such as burn units. © 2019, Author(s).

Study of genetic diversity, biofilm formation, and detection of Carbapenemase, MBL, ESBL, and tetracycline resistance genes in multidrug-resistant Acinetobacter baumannii isolated from burn wound infections in Iran

BackgroundAntimicrobial resistance in multidrug-resistant Acinetobacter baumannii (MDR-AB) isolated from burn wound infections is a major concern in intensive care or burns units worldwide, and molecular studies are considered critical strategies for control of MDR-AB outbreaks in this regard. Thus, in this study, antibiotic resistance, biofilm-forming ability, molecular epidemiology of MDR A. baumannii strains recovered from patients with burns were investigated in three major hospital centers of Iran.MethodsIn this cross-sectional research, 163 non-repetitive A. baumannii strains were tested for susceptibility to antimicrobial agents. Polymerase chain reaction (PCR) was performed to characterize ambler classes A, B, and D β-lactamases, ISAba1 and integrons, biofilm formation was also investigated. Clonal relatedness was analyzed using Pulsed-Field Gel Electrophoresis (PFGE).ResultsAmong 163 A. baumannii strains collected, 94.5% of them were Carbapenem-Non-Susceptible A. baumannii (CNSAB) and also 90.1 and 52.2% of them were Metallo-β-Lactamases (MBL) and Extended-Spectrum β-Lactamases (ESBL) producing isolates, respectively. Colistin and polymyxin B exhibited excellent activity against CNSAB strains. High prevalence of blaOXA − 23-like (85.1%), blaVIM (60.5%), blaPER − 1 (42.3%), tetB (67.8%), and Class 1 integrons (65.6%) were identified in CNSAB strains. ISAba1 element was associated with 42 (25.8%) and 129 (98.5%) of blaOXA-51-like and blaOXA-23-like genes, respectively. 6 clusters with the ability to form strong biofilms were found to be dominant and endemic in our entire areas.ConclusionsResults of the present study show that antimicrobial resistance in CNSAB isolates from burn wound infections in monitored hospitals in Iran is multifactorial, and also findings of the study suggested that local antibiotic prescription policies should be regularly reviewed, and efficient infection control measures should be observed. Therefore, further strengthening of surveillance of antimicrobial resistance is urgently needed in these regions.

Risk factors for community-acquired Escherichia coli bacteraemia: a systematic review protocol

Introduction: Rates of community-acquired Escherichia coli bacteraemia (ECB) have been consistently rising. As rates of antimicrobial resistance (AMR), particularly in Gram-negative bacteria, are also increasing, this is of concern both for management of individual patients and healthcare systems. There is currently little data on the risk factors for development of community-acquired ECB: this review aims to identify these risk factors in order to inform community interventions to reduce ECB as well as antibiotic prescribing policy. Methods and analysis: We will search Medline (Ovid), Embase (Ovid), Web of Science/Scopus and the Cochrane Central Register of Controlled Trials for published reports on observational and experimental primary research studies involving patients admitted to hospital with community-acquired ECB. Two reviewers will independently screen the studies for eligibility, perform data collection and assess study quality and risk of bias. Random effects meta-analyses will be performed if appropriate. Ethics and dissemination: No primary data will be collected for this study and so formal ethical approval is not required. We will publish the results of our review in relevant peer-reviewed medical journals, and will also seek to present them at relevant medical conferences. PROSPERO registration number: CRD42018104402

A systematic review and network meta-analysis of injectable antibiotic treatment options for naturally occurring swine respiratory disease

Based on an a priori protocol, a review of injectable antibiotic regimens to treat swine respiratory disease (SRD) in weaned swine was conducted to assess the first-treatment failure at 5 to 14 days post-treatment. Information sources included Cambridge Agricultural and Biological Index, MEDLINE, Food and Drug Administration New Animal Drug Approval summaries, Swine Information Library abstracts, and bibliographies of relevant studies and reviews. Two reviewers screened the records, extracted data, and assessed bias risk. From 1266 records screened, 25 relevant records described 41 relevant studies. Thirty-four relevant studies were included in a meta-analysis. The top 3 model-estimated SRD treatments based on mean rank were enrofloxacin (7.5 mg/kg once or 2.5-5 mg/kg once daily for 3-5 days; n = 5; rank = 2; 95% CI, 1-4), gamithromycin (6 mg/kg once, n = 2; rank = 5; 95% CI, 1-14), and marbofloxacin (8 mg/kg once, n = 1; rank = 6; 95% CI, 1-16). When treating SRD, this information should be combined with antibiotic treatment selection criteria including sensitivity testing results, the farm’s pathogen susceptibility monitoring data, local antibiotic prescribing policies, product label recommendations for use and warnings, cost, convenience, importance of the antibiotic to human health, and prudent antibiotic use guidelines.

Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus in patients at hospital admission in The Netherlands, 2010–2017: an observational study

ObjectivesWe determined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage upon hospital admission, among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. We also aimed to evaluate the prevalence of MRSA carriers without the standard risk factors. MethodsWe conducted an observational study to determine the prevalence of MRSA nasal carriage among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. Samples of cardiothoracic patients were tested by polymerase chain reaction (PCR), other samples were cultured using chromogenic agar plates. A Poisson regression model with robust error variance was used to assess whether there was a trend in the prevalence of MRSA over time. ResultsIn total, 31 093 nasal swabs were obtained from 25 660 patients. Three-hundred and seventy-five swabs (1.2%) had an invalid result. Therefore, 30 718 swabs (98.8%) were included in our analysis. Overall, S. aureus was detected in 7981/30 718 patients (26.0% 95% CI 25.5–26.5%) of whom 41 were MRSA (0.13% 95% CI 0.10–0.18%). The MRSA prevalence varied from 0.03% to 0.17% over the years without evidence of a changing trend over time (p = 0.40). Results of the questionnaire revealed that 30 of the 41 patients (73.2%) had no known risk factors for MRSA carriage (0.10%; 95% CI 0.07–0.14%). ConclusionOur study revealed a sustained low prevalence of MRSA carriage upon hospital admission over 7 years. This supports the effectiveness of the Dutch Search and Destroy policy, in combination with a restrictive antibiotic prescription policy.

Observational Study of Antibiotic Usage at the Children's Clinical University Hospital in Riga, Latvia.

Background and objectives: Many pediatric patients have been treated with antibiotics during their hospitalization. There is a need to improve antibiotic prescribing for pediatric patients because many of these prescriptions are inappropriate. Antibiotic consumption analysis was conducted at the Children’s Clinical University Hospital to identify targets for quality improvement. Materials and Methods: A one day cross-sectional point prevalence survey (PPS) was conducted in May and November 2011–2013 using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antibiotic treatment on the day of survey. Total consumption of systemic antibiotics belonging to the ATC J01 class (except amphenicols (J01B) and a combination of antibacterials (J01R)) was also analyzed by using a defined daily dose (DDD) approach and antibiotic drug utilization (90%DU) for the period 2006–2015. Results were compared with results in 2017 using the DDD and 90%DU methodology. Results: The most commonly used antibiotic group in all PPS, except in May and November 2011, was other β-lactam antibiotics (J01D): 42 (40%) prescriptions in May 2013 and 66 (42%) and November 2011. In 2006–2015 and also in 2017, the most commonly used antibiotic groups were penicillins (J01C) and other β-lactam antibiotics (J01D)—76% (90%DU) of the total antibiotic consumption registered in 2006, 73% in 2015 and 70% in 2017. Starting in 2008, amoxicillin was the most commonly used antibiotic at the hospital. The usage of ceftriaxone increased from 3% in 2006 to 13% in 2015, but decreased in 2017 (7%). Conclusions: Study results from 2006–2015 showed that there was a need to establish a stronger antibiotic prescribing policy in the hospital reducing the use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) and increasing the use of narrower spectrum antibiotics. It was partly achieved in 2017 with some reduction in ceftriaxone use.