Guidelines For Antibiotic Therapy Research Articles

Attitudes, Beliefs, and Behaviors of Topical Antibiotic Prescribing among Primary Care Providers in Saudi Arabia: A Cross-Sectional Study.

The World Health Organization (WHO) estimates that 20-50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription.

Major evidence and guidelines for antibiotic therapy in implant dentistry: a systematic review

Major evidence and guidelines for antibiotic therapy in implant dentistry: a systematic review

Screening for Beta-Lactamases Producing Bacteria and Other Resistant Bacteria among Patients Admitted to the Emergency Unit at the Yaoundé University Teaching Hospital, Cameroon

Aims: This study aimed to screen for Beta Lactamases (BLs) and other resistant bacteria among patients admitted to the emergency unit of the Yaoundé University Teaching Hospital (YUTH).
 Study Design: This study was a cross-sectional hospital-based study.
 Place and Duration of Study: This study was conducted at the Bacteriology unit of the YUTH, Yaoundé- Cameroon between February to June 2020.
 Methodology: Seventy-Five urine samples were collected from newly admitted patients at the emergency unit of the YUTH and bacteria species were identified basis on their culture characteristics, Gram morphology, and biochemical tests. The isolates were screened from the production of extended-spectrum beta-lactamases (ESBLs) and AmpC BLs using the Double disk synergy method and Disk approximation methods respectively. These isolates were later subjected to antimicrobial susceptibility testing using the disk diffusion method.
 Results: Out of the 75 urine analyzed, 14 (18.7%) were found positive for Urinary Tract Infection. Fourteen bacteria species were isolated identified and enumerated as E. coli (5), Klebsiella species (4), Citrobacter species (2), Proteus species (2), and Enterobacter species (1). A high level of resistance was observed with Amoxicillin clavulanic acid, Cefuroxime, and Ceftazidime while a high level of sensitivity was observed among carbapenem antibiotics. Eight of 14 isolated bacteria were BLs producers, of which 5 were sorely ESBL producers, 2 co-producers (ESBL + AmpC), and 1 AmpC producer. The overall positive rate of BLs in the study population was 10.7%. Again, patient origin and previous antibiotic use were significantly associated with BLs prevalence p-value of .01 and .04 respectively.
 Conclusion: The high prevalence of the ß- lactamases in the Emergency unit emphasizes the need for continuous surveillance in the Emergency unit to detect resistant strains, strict guidelines for antibiotic therapy, and the implementation of infection control measures to reduce the increasing burden of antibiotic resistance.

Antibiotic prescription: Knowledge among physicians and nurses in western Sweden

Misuse and overuse of antibiotics are common in primary care. Guidelines for prescribing of antibiotics are often not followed We conducted a survey of 120 health centers in western Sweden to investigate to what extent physicians and nurses think they know and comply with the guidelines for prescribing of antibiotics. A large majority of the respondents answered that they know the guidelines well. However, many also believed that physicians/nurses in general know less about and are worse at following the guidelines than themselves, indicating optimism bias. According to the respondents the main reason for non-compliance with guidelines was patient expectations. The survey also showed that both physicians’ and nurses’ actual knowledge of when it is effective to prescribe antibiotics is incomplete. Interventions to reduce unnecessary antibiotic therapy in primary care should target the failing congruence between the perceived knowledge of guidelines for antibiotic therapy and actual knowledge.

Multidrug-Resistant ESBL-Producing E. coli in Clinical Samples from the UK.

Globally, cephalosporin therapy failure is a serious problem for infection control. One causative agent of cephalosporin-resistant infections is multidrug-resistant (MDR) E. coli producing extended-spectrum β-lactamases (ESBLs) and/or plasmid-encoded AmpC (pAmpC) β-lactamases. We evaluated the occurrence of ESBL/pAmpC genetic determinants in phenotypically MDR E. coli isolated from clinical samples of blood, faeces, ear effusion, urine and sputum from a UK hospital. Phenotypic resistance profiling for 18 antibiotics (from seven classes) showed that 32/35 isolates were MDR, with resistance to 4-16 of the tested antibiotics. Of the isolates, 97.1% showed resistance to ampicillin, 71.4% showed resistance to co-amoxiclav, cefotaxime, ceftazidime and ceftiofur, and 68.5% showed resistance to cefquinome. blaCTX-M, blaTEM and blaOXA-1 genes were detected in 23, 13 and 12 strains, respectively, and Intl1 was detected in 17 isolates. The most common subtypes among the definite sequence types were CTX-M-15 (40%) and TEM-1 (75%). No E. coli isolates carried pAmpC genes. Significant correlations were seen between CTX-M carriage and cefotaxime, ceftiofur, aztreonam, ceftazidime and cefquinome resistance; between blaCTX-M, blaTEM and blaOXA-1 carriage and ciprofloxacin resistance; and between Intl1 carriage and trimethoprim/sulfamethoxazole resistance. Thus, MDR phenotypes may be conferred by a relatively small number of genes. The level and pattern of antibiotic resistance highlight the need for better antibiotic therapy guidelines, including reduced use and improved surveillance.

Antibiotic Susceptibility Patterns of Bacteria Associated with Sepsis among Hospitalized Patients in the Yaoundé University Teaching Hospital—Cameroon

Background and Objective: In developing countries, the steep increase in septicaemia cases is a major health problem that creates the biggest challenge for clinicians in the selection of appropriate antimicrobial agents. This is further complicated by the development of resistance in organisms to antimicrobial agents, which is the mainstay of treatment. The aim of this study was to determine the antimicrobial resistance patterns of bacterial isolates associated with sepsis among hospitalized patients including the detection of Methicillin Resistance Staphylococcus aureus (MRSA) and Extended Spectrum Beta lactamases (ESBLs). Methods: A cross-sectional study was carried out for 5 months at the Yaounde University Teaching Hospital. Bacterial species were isolated from 150 blood samples collected from hospitalized patients. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer disc diffusion method. The isolates were tested for methicillin resistance and ESBLs. Results: The prevalence of septicaemia was 16% (24/150) among hospitalized patients. In our study, 75% (18/24) of infections were caused by Gram- negative and 25% (6/24) by Gram-positive bacteria. Klebsiella spp., Escherichia coli, and Staphylococcus aureus were the most common isolates. The antibiotic susceptibility patterns of the isolates showed that Gram-negative bacteria were highly resistant to Amoxicillin clavulanic acid and ceftriaxone while the Gram- positive bacteria were highly resistant to minocycline. Fifty percent (3/6) of the isolated S. aureus were methicillin-resistant and 27.8% (5/18) of the isolated Enterobacteriaceae were ESBLs producers. In multivariable logistic regression analysis, temperature above 37.9℃ (AOR = 4.455; 95% Cl = 1.458 - 15.693; p = 0.033) and being under respiratory assistance (AOR = 4.311; 95% Cl = 1.458 - 12.749; p = 0.008) were significantly associated with septicaemia. Conclusion: The Occurrence of multidrug-resistant strains in this study emphasizes the need for continuous surveillance in hospitals to detect resistant strains. Strict guidelines for antibiotic therapy and the implementation of infection control measures to reduce the increasing burden of antibiotic resistance are advocated.

TEM,CTX-M,SHV Genes in ESBL-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Clinical Samples in a County Clinical Emergency Hospital Romania-Predominance of CTX-M-15.

Background: CTX-M betalactamases have shown a rapid spread in the recent years among Enterobacteriaceae and have become the most prevalent Extended Spectrum Beta-Lactamases (ESBLs) in many parts of the world. The introduction and dissemination of antibiotic-resistant genes limits options for treatment, increases mortality and morbidity in patients, and leads to longer hospitalization and expensive costs. We aimed to identify the beta-lactamases circulating encoded by the genes blaCTX-M-15, blaSHV-1 and blaTEM-1 in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains. Furthermore, we established the associated resistance phenotypes among patients hospitalized in the Intensive Care Unit (ICU) from County Clinical Emergency Hospital of Craiova, Romania. Methods: A total of 46 non-duplicated bacterial strains (14 strains of E. coli and 32 strains of K. pneumoniae), which were resistant to ceftazidime (CAZ) and cefotaxime (CTX) by Kirby–Bauer disk diffusion method, were identified using the automated VITEK2 system. Detection of ESBL-encoding genes and other resistance genes was carried out by PCR. Results. E. coli strains were resistant to 3rd generation cephalosporins and moderately resistant to quinolones, whereas K. pneumoniae strains were resistant to penicillins, cephalosporins, and sulfamides, and moderately resistant to quinolones and carbapenems. Most E. coli strains harbored blaCTX-M-15 gene (13/14 strains), a single strain had the blaSHV-1 gene, but 11 strains harbored blaTEM-1 gene. The mcr-1 gene was not detected. We detected tet(A) gene in six strains and tet(B) in one strain. In K. pneumoniae strains we detected blaCTX-M-15 in 23 strains, blaSHV-1 in all strains and blaTEM-1 in 14 strains. The colistin resistance gene mcr-1 was not detected. The tetracycline gene tet(A) was detected in 11 strains, but the gene tet(B) was not detected in any strains. Conclusions. The development in antibiotic resistance highlights the importance of establishing policies to reduce antibiotic use and improving the national resistance surveillance system in order to create local antibiotic therapy guidelines.

Development of the first edition of African treatment guidelines for common bacterial infections and syndromes.

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines – including drug selection, route of administration, formulation, dosage, and therapy duration – and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.

Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan.

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19. Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results. Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague ( n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy. Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Infekční artritidy nativních kloubů u dospělých: výskyt v našem souboru pacientů a doporučení antibiotické léčby

Infekční artritidy nativních kloubů u dospělých: výskyt v našem souboru pacientů a doporučení antibiotické léčby

Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteriuria

This study aimed to evaluate the practicality and advantage of Global Antimicrobial Resistance Surveillance System (GLASS) for surveillance of urine culture samples collected from patients with bacteriuria. GLASS has been implemented at a tertiary care university hospital in Thailand by using the web application program to collect clinical data and urine culture data from patients with positive urine culture. There were 5085 urine samples from 3545 patients that were sent to our microbiology laboratory during June-December 2017. Bacteriuria was found in 1944 patients. Of those, 952 had urinary tract infection (UTI), and 1161 had colonization. Among UTI patients, hospital-acquired infection (HAI) was observed in 74.2 %, and community-acquired infection (CAI) was found in 28.7 %. E. coli and S. agalactiae were more frequently observed in CAI, but P. aeruginosa, P. mirabilis, E. faecium, and A. baumannii were more prevalent in HAI. UTI isolates demonstrated less resistance to antibiotics than colonized isolates. Non-duplicate isolates of bacteria demonstrated less resistance than duplicate isolates. E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, E. faecalis, and E. faecium causing HAI were more resistant to antibiotics than those causing CAI. GLASS is feasible to implement and more beneficial than laboratory-based surveillance. This study collects additional information beyond GLASS including causative bacteria and colonizing bacteria; types of UTI; and more specific criteria to distinguish HAI from CAI so that such data can be used for developing more valid local guidelines for selecting antibiotic therapy in UTI patients in addition to AMR surveillance in urine samples.

Antibiotic Molecules Involved in Increasing Microbial Resistance

Over the past two decades, the resistance to antibiotics, especially for Gram-negative bacteria, has increased at an alarming rate, requiring constant concern for resolving and controlling this extremely important therapeutic aspect in any medical department but in particular, in Anaesthesia and Intensive Care Units, in units of neonatology, paediatrics, neurosurgery, burned patients and immunosuppressed. Specialists note a particular concern for the resistance of Enterobacteriaceae to third-generation cephalosporins and aztreonam, with a resistance profile frequently associated with the expression of extended-spectrum �-lactamases (ESBL). The Enterobacter genus comprises 14 species, but two are of medical interest, Enterobacter aerogenes and E. cloacae, which are involved in inducing healthcare-associated infections such as urinary tract infections, pneumonia associated with mechanical ventilation, bacteremia, septicemia, etc. The purpose of the study was to highlight the antibiotic molecules in which microbial resistance of some circulating strains of enterobacteria was detected. A descriptive and retrospective study was conducted between 2012-2017, on a batch of 35 patients, admitted to the Sf. Maria Emergency Clinical Hospital for Children of Iasi, from whom various pathological products were collected to highlight the Enterobacter sp strains involved in the production of infections associated with the inpatient medical care. The antimicrobial sensitivity of each strain was determined by diffusimetric method, while the interpretation criteria were considered to be those of the laboratory standards. Most cases were reported in 2017 (31.42%). The majority were registered in new-borns (42.85%) and infants (25.71%). The Anaesthesia and Intensive Care Units and Neonatology Anaesthesia and Intensive Care Units departments were the most involved. Microbial antibacterial resistance of Enterobacter sp isolates showed that all manifested resistance to ampicillin, amoxicillin and clavulanic acid, 48.57% were resistant to Cefuroxime, 42.85% resistant to Ceftazidime and Ceftriaxone, 14.28% to ciprofloxacin, 11.42% to ertapenem, 5.71% to Meronem. Although it showed relatively few cases with infections associated with healthcare in which strains of Enterobacter sp. were isolated our study, which was carried out over a period of 5 years, provides useful indications regarding the prevalence of healthcare associated infections with Enterobacter sp in paediatric patients and guidelines for antibiotic therapy.

Cross-sectional Survey on Antibiotic Prescription Practices Among Health Care Providers in Rombo District, Northern Tanzania

Irrational and inappropriate antibiotic prescription is a worldwide phenomenon - increasing the threat of serious antibiotic resistance. A better understanding of health care providers' knowledge, attitudes, and prescription practices related to antibiotics is essential for formulating effective antibiotics stewardship programmes. The aim of the present study was to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers.A descriptive cross-sectional study was conducted between March and June 2017 to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers in the Rombo district of northern Tanzania. A total of 217 health care providers were interviewed using a structured questionnaire.Over half of health care providers (n=111, 51.2%) strongly agreed that the inappropriate prescription of antibiotics puts patients at risk. More than half (n=112, 51.6%) reported that their decision to start antibiotic therapy was influenced by a patient's clinical condition, while 110 (50.7%) reported they were influenced by positive microbiological results in symptomatic patients. Almost two-thirds of the health care providers (n=136, 62.7%) reported that they had access to and used antibiotic therapy guidelines. Less than a quarter (n=52, 24.0%) received regular training and education in antibiotic prescription practice in their work place.Knowledge and prescription practice of antibiotics among health care providers was generally unsatisfactory. Training and education for health care providers is needed in the area of prescribing antibiotics.

Cross-sectional Survey on Antibiotic Prescription Practices Among Health Care Providers in Rombo District, Northern Tanzania

Background:Irrational and inappropriate antibiotic prescription is a worldwide phenomenon – increasing the threat of serious antibiotic resistance. A better understanding of health care providers' knowledge, attitudes, and prescription practices related to antibiotics is essential for formulating effective antibiotics stewardship programmes. The aim of the present study was to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers.Methods:A descriptive cross-sectional study was conducted between March and June 2017 to assess knowledge, attitudes, and prescription practices toward antibiotics among health care providers in the Rombo district of northern Tanzania. A total of 217 health care providers were interviewed using a structured questionnaire.Results:Over half of health care providers (n=111, 51.2%) strongly agreed that the inappropriate prescription of antibiotics puts patients at risk. More than half (n=112, 51.6%) reported that their decision to start antibiotic therapy was influenced by a patient's clinical condition, while 110 (50.7%) reported they were influenced by positive microbiological results in symptomatic patients. Almost two-thirds of the health care providers (n=136, 62.7%) reported that they had access to and used antibiotic therapy guidelines. Less than a quarter (n=52, 24.0%) received regular training and education in antibiotic prescription practice in their work place.Conclusion:Knowledge and prescription practice of antibiotics among health care providers was generally unsatisfactory. Training and education for health care providers is needed in the area of prescribing antibiotics.

Guidelines for Antibiotic Therapy of Urinary Tract Infection in Acute Pyelonephritis, Bacteriuria in Adolescents

Guidelines for Antibiotic Therapy of Urinary Tract Infection in Acute Pyelonephritis, Bacteriuria in Adolescents

National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands.

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the scientific impact and the possibility of detecting outbreaks may be amplified by merging the AMR surveillance database with databases from selected pathogen-based surveillance programmes containing patient data and genotypic typing data.

Categorical Risk Perception Drives Variability in Antibiotic Prescribing in the Emergency Department: A Mixed Methods Observational Study.

Adherence to evidence-based antibiotic therapy guidelines for treatment of upper respiratory tract infections (URIs) varies widely among clinicians. Understanding this variability is key for reducing inappropriate prescribing. To measure how emergency department (ED) clinicians' perceptions of antibiotic prescribing risks affect their decision-making. Clinician survey based on fuzzy-trace theory, a theory of medical decision-making, combined with retrospective data on prescribing outcomes for URI/pneumonia visits in two EDs. The survey predicts the categorical meanings, or gists, that individuals derive from given information. ED physicians, residents, and physician assistants (PAs) who completed surveys and treated patients with URI/pneumonia diagnoses between August 2014 and December 2015. Gists derived from survey responses and their association with rates of antibiotic prescribing per visit. Of 4474 URI/pneumonia visits, 2874 (64.2%) had an antibiotic prescription. However, prescribing rates varied from 7% to 91% for the 69 clinicians surveyed (65.2% response rate). Clinicians who framed therapy-prescribing decisions as a categorical choice between continued illness and possibly beneficial treatment ("why not take a risk?" gist, which assumes antibiotic therapy is essentially harmless) had higher rates of prescribing (OR 1.28 [95% CI, 1.06-1.54]). Greater agreement with the "antibiotics may be harmful" gist was associated with lower prescribing rates (OR 0.81 [95% CI, 0.67-0.98]). Our results indicate that clinicians who perceive prescribing as a categorical choice between patients remaining ill or possibly improving from therapy are more likely to prescribe antibiotics. However, this strategy assumes that antibiotics are essentially harmless. Clinicians who framed decision-making as a choice between potential harms from therapy and continued patient illness (e.g., increased appreciation of potential harms) had lower prescribing rates. These results suggest that interventions to reduce inappropriate prescribing should emphasize the non-negligible possibility of serious side effects.

MICROFLORA OF THE RESPIRATORY TRACT IN PATIENTS WITH CYSTIC FIBROSIS AND SENSITIVITY TO ANTIBIOTICS BASED ON A 15-YEAR FOLLOW-UP (2000–2015 YEARS)

Chronic lower respiratory tract infection in patients with cystic fibrosis (CF) is the major factor determining the severity of the clinical course and prognosis of the disease. The purpose of the study was to investigate the prevailing respiratory microflora in patients with CF and changes in the activity of antibacterial medicines (ABM) during the period 2000–2015 in order to optimize guidelines for antibiotic therapy. Bronchial secretion was evaluated in CF patients from 2000 till 2015. 9774 samples were studied, 16.703 microbial strains were obtained. In 2000–2015, P. aeruginosa (smooth and mucoid morphological types) was the most widespread gram-negative strain. Typical strains of P. aeruginosa were isolated more often than mucoid morphotypes. In 2000–2015, isolation rates for P. aeruginosa decreased from 41.2 to 20.0% (p <0.001). The proportion of B. cepacia complex increased from 1.1 to 7.3%, up to 11.3% in 2008–2011, and a rise in the proportion A. xylosoxidans was registered from 2.9 to 4.9% (p <0.001). During the follow-up period, the diversity of isolated species has grown. ABM such as colistin (active against 100% of strains), carbapenems (imipenem is active against 70.3–72.2% of strains, and meropenem against 75.8 and 78.9%) remain active against P. aeruginosa. The effect of piperacillin/tazobactam is similar to that of carbapenems. Cefepime is less effective than ceftazidime. Fluoroquinolones and tobramycin also remian active.

Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat Health Center, Riyadh City, KSA.

Background. Antibiotics are responsible for most dramatic improvement in medical therapy in history. These medications contributed significantly to the decreasing mortality and morbidity when prescribed based on evidence of microbial infection. Objective. The aim of this study was to determine the prevalence and predictors of self-prescription with antibiotics in Al Wazarat Health Center, Riyadh City, Kingdom of Saudi Arabia. Material and Methods. Cross-sectional study was conducted in Al Wazarat Health Center between February 2014 and November 2014. Respondents were randomly selected using a multistage clustered random sampling technique. Data was entered into SPSS version 21 and analyzed. Descriptive statistics and multiple logistic regression models were applied. Results. A total of 681 patients have participated in this study with a response rate of 92%. The prevalence of self-prescription with antibiotics in Al Wazarat Health Center was 78.7%. Amoxicillin was the most used self-prescribed antibiotic with prevalence of (22.3%). Friend advice on self-prescription of antibiotics use (p = 0.000) and pharmacy near to the participants (p = 0.002) were the most common predictors for self-prescription with antibiotics. Conclusion. The level of self-prescribing antibiotics is relatively high among participants. Health education on the appropriate use of antibiotics is highly recommended. The proper use of treatment guidelines for antibiotic therapy will significantly reduce self-prescription with antibiotics.

Pneumonia in the neutropenic cancer patient.

Pneumonia is the leading cause of death among neutropenic cancer patients, particularly those with acute leukaemia. Even with empiric therapy, case fatality rates of neutropenic pneumonias remain unacceptably high. However, recent advances in the management of neutropenic pneumonia offer hope for improved outcomes in the cancer setting. This review summarizes recent literature regarding the clinical presentation, microbiologic trends, diagnostic advances and therapeutic recommendations for cancer-related neutropenic pneumonia. Although neutropenic patients acquire pathogens both in community and nosocomial settings, patients' obligate healthcare exposures result in the frequent identification of multidrug-resistant bacterial organisms on conventional culture-based assessment of respiratory secretions. Modern molecular techniques, including expanded use of galactomannan testing, have further facilitated identification of fungal pathogens, allowing for aggressive interventions that appear to improve patient outcomes. Multiple interested societies have issued updated guidelines for antibiotic therapy of suspected neutropenic pneumonia. The benefit of antibiotic medications may be further enhanced by agents that promote host responses to infection. Neutropenic cancer patients have numerous potential causes for pulmonary infiltrates and clinical deterioration, with lower respiratory tract infections among the most deadly. Early clinical suspicion, diagnosis and intervention for neutropenic pneumonia provide cancer patients' best hope for survival.