Choice Of Antibiotic Treatment Research Articles

Antimicrobial Prescription Practices and Stewardship in Washington State Small and Mixed Animal Veterinary Medicine.

Judicious antimicrobial use is essential for the continued treatment of infections in small and mixed animal veterinary medicine. To better support Washington (WA) State veterinarians in antimicrobial stewardship, we surveyed licensed small and mixed animal veterinarians and led group conversations regarding antimicrobial prescription practices. Survey questions included demographic information, factors influencing prescription practices and clinical cases. Responses were summarised and logistic regressions were performed to identify factors associated with antibiotic treatment choices. Group conversations, led by a licensed veterinarian, focused on resource gaps for veterinarians, management of clinical scenarios and interpretation of minimum inhibitory concentrations (MICs) and breakpoints. A systematic qualitative analysis of conversation transcripts identified key themes such as common barriers to stewardship. Among 53 responses to clinical scenarios, veterinarians selected the most appropriate treatment choice, according to a veterinary microbiologist, 62% of the time. Variability was observed in culture and susceptibility practices and antibiotic choices. Survey respondents reported an influence of the client ability to medicate (92%), considerations of resistance (91%), client finances (75%) and availability of antimicrobials (75%) on their prescription decisions. There were no significant associations between opinions about contributing factors to antimicrobial resistance (AMR) or guidelines used and treatment choices in clinical scenarios. Among 15 veterinarians interviewed in group conversations, a systematic qualitative analysis of conversation transcripts revealed key themes, including reliance on human medicine as a resource and a lack of support for veterinarians in interpreting MICs and breakpoints. The variability in veterinary antibiotic treatment decisions in this study suggests a need for further dissemination of standardised antimicrobial stewardship resources for veterinarians. Client-related challenges and the cost of culture and susceptibility are major barriers to stewardship. To address these barriers, it is necessary to provide standardised, easy-to-access guidance for veterinarians in interpreting MICs and breakpoints, as well as develop antimicrobial use resources for clients.

Sepsis Stewardship: The Puzzle of Antibiotic Therapy in the Context of Individualization of Decision Making.

The main recent change observed in the field of critical patient infection has been universal awareness of the need to make better use of antimicrobials, especially for the most serious cases, beyond the application of simple and effective formulas or rigid protocols. The increase in resistant microorganisms, the quantitative increase in major surgeries and interventional procedures in the highest risk patients, and the appearance of a significant number of new antibiotics in recent years (some very specifically directed against certain mechanisms of resistance and others with a broader spectrum of applications) have led us to shift our questions from "what to deal with" to "how to treat". There has been controversy about how best to approach antibiotic treatment of complex cases of sepsis. The individualized and adjusted dosage, the moment of its administration, the objective, and the selection of the regimen are pointed out as factors of special relevance in a critically ill patient where the frequency of resistant microorganisms, especially among the Enterobacterales group, and the emergence of multiple and diverse antibiotic treatment alternatives have made the appropriate choice of antibiotic treatment more complex, requiring a constant updating of knowledge and the creation of multidisciplinary teams to confront new infections that are difficult to treat. In this article, we have reviewed the phenomenon of the emergence of resistance to antibacterials and we have tried to share some of the ideas, such as stewardship, sparing carbapenems, and organizational, microbiological, pharmacological, and knowledge tools, that we have considered most useful and effective for individualized decision making that takes into account the current context of multidrug resistance. The greatest challenge, therefore, of decision making in this context lies in determining an effective, optimal, and balanced empirical antibiotic treatment.

Rapid characterization of carbapenem-resistant Enterobacterales by multiplex lateral flow assay and detection of ceftazidime-avibactam-aztreonam synergy

PurposeThe choice of antibiotics for treatment of Carbapenem-Resistant Enterobacterales (CRE) is increasing becoming limited due to co-expression of Metallo-beta-lactamases (MBL) along with other carbapenemases in these isolates. The study aimed to investigate the occurrence of CRE and to determine the in-vitro synergy and clinical outcomes of Ceftazidime-Avibactam and Aztreonam combination in CRE infections in adult Intensive Care Units (ICUs). Methods79 CRE isolates recovered from adult ICUs during January to March 2023 were tested by O.K.N.V.I. RESIST-5, a lateral flow multiplex assay for rapid detection of OXA-48-like, NDM, IMP, VIM, and KPC carbapenemases. Ceftazidime-Avibactam MIC was determined by microbroth dilution method and in vitro synergy between Ceftazidime-Avibactam and Aztreonam was assessed by Modified E-test/disc diffusion method for these isolates. ResultsThe study revealed 7.5 % occurrence of CRE in our hospital, with high occurrence of NDM (n = 42, 53.1 %) and OXA-48-like (n = 63, 79.7 %) carbapenemase. Production of more than one type of carbapenemases was found in 44 isolates. A total of 57 isolates (72 %) had Ceftazidime-Avibactam resistance and 44 of them displayed Ceftazidime-Avibactam and Aztreonam in-vitro synergy. Successful clinical outcome was observed in two patients who received Ceftazidime-Avibactam and Aztreonam combination therapy for 7 days or more. ConclusionsDespite the preponderance of Ceftazidime-Avibactam resistant CRE expressing NDM and OXA-48-like carbapenemase in our hospital, 77.2 % of them displayed in-vitro synergy of Ceftazidime-Avibactam with Aztreonam. It emphasizes the potential therapeutic utility of this combination in CRE strains showing coproduction of MBL and serine carbapenemases. Greater therapeutic potential of Ceftazidime-Avibactam and Aztreonam combination was observed with extended duration of therapy. However, further clinical evidence is needed to establish the efficacy of this combination and consider other factors that influence treatment outcomes.

Antibiotic-Resistant Strains of Helicobacter pylori in 50 Antibiotic Treatment-Naive Children in Northeast Poland Diagnosed by Gastric or Duodenal Biopsy Between February 2019 and May 2022.

BACKGROUND In recent years, an increasing prevalence of Helicobacter pylori resistance to antibiotics has been observed. The aim of this study was to assess antibiotic resistance of Helicobacter pylori in previously untreated children from northeast Poland. MATERIAL AND METHODS Inclusion criteria comprised suspicion of Helicobacter pylori infection based on the presence of Helicobacter pylori antigen in the stool and/or characteristic macroscopic lesions seen on esophagogastroduodenoscopy. Samples of the gastric and/or duodenal mucosa were collected from 82 children with a median age of 13 years (range 3-17) during esophagogastroduodenoscopy between February 2019 and May 2022. The material was cultured, and positive Helicobacter pylori strains were tested for drug resistance to amoxicillin, metronidazole, and clarithromycin using the quantitative antibiotic concentration gradient stripe method E-test. RESULTS Based on biopsy culture, Helicobacter pylori infection was confirmed in 50 (61%) children. Helicobacter pylori resistance was most common to clarithromycin (n=19; 38%), followed by metronidazole (n=15; 30%), and the least frequent to amoxicillin (n=13; 26%). The resistance to 1 antibiotic was found in 14 children (28%). Double-drug resistance was noted in 3 children (6%) and triple drug resistance in 9 children (18%). In the whole group, 24 children (48%) were susceptible to all 3 antibiotics. CONCLUSIONS In this study, conducted for the first time in treatment-naïve children in northeast Poland, we found a high proportion of Helicobacter pylori strains resistant to at least 1 antibiotic. Our results may help in the appropriate choice of antibiotics for treatment of Helicobacter pylori in our region.

Antimicrobial Resistance Profile of Different Clinical Isolates against Augmentin, Imipenem and Ceftriaxone

Background: Antibiotic resistance is a growing global public health concern because it jeopardizes the effective control and treatment of bacterial infections. The purpose of this study was to determine the bacterial profiles and susceptibility patterns to Imipenem, Augmentin, and Ceftriaxone in various clinical specimens from Al Saleem laboratory in Benghazi, Libya.
 Methods: Two separate studies were carried out. Each experiment lasted three months. The patients' clinical samples included wound swabs, urine, sperm, blood, high vaginal swabs, and cerebrospinal fluid. Bacterial species were isolated and identified using standard microbiological methods in each study. Kirby-Bauer disc diffusion was used to conduct antimicrobial susceptibility tests from September 2020 to November 2020.
 Results: There were 711 isolates obtained from 535 female and 503 male patients. The most common organisms isolated from specimens were E. coli spp, Klebsiella spp, and Staph aureus.
 Conclusion: Bacterial resistance levels to various antibiotics varied greatly. We found that Augmentin has less activity against gram negative bacteria isolated from clinical specimens, whereas Imipenem has a much stronger effect on isolates than Augmentin. Appropriate monitoring of prevalent pathogenic organisms and their sensitivities will assist clinicians in making appropriate antibiotic treatment choices to avoid the spread of antimicrobial resistance.

Prevalence and Antibiotic-Resistance Indices of Bacterial Pathogens of Otitis Media among Patients Attending a Tertiary Hospital in Calabar, Nigeria

Background: Otitis media is linked to middle ear inflammation and sequelae, frequently occurring in infants and early childhood dealing with the accumulation of fluid behind the eardrum. It is often associated with the absence of timely and appropriate antibacterial interventions.
 Aim: To investigate the identity and antibiogram of bacterial agents of otitis media among patients attending a tertiary health facility in Calabar, Nigeria.
 Methods: Ear specimens collected from a total of 70 subjects were processed by conventional bacteriological methods for isolation and identification of pathogens. Antibiotic susceptibility testing was carried out on all the isolates using the Kirby-Bauer disk diffusion method. Multiple antibiotic resistance (MAR) indices of the isolates were evaluated.
 Results: The prevalence of bacterial otitis media was 72.9% in the study population. A total of 51 bacterial isolates including Pseudomonas aeruginaosa (26), Staphylococcus aureus (17), Proteus mirabilis (6), and Klebsiella pneumoniae (2) were found. Isolates of P. aeruginosa and S. aureus showed high susceptibility to amoxicillin-clavulanate (92.3%) and ciprofloxacin (88.3%), respectively. The prevalence of multidrug resistant (MDR) isolates was 25.4%. MDR percentages such as 100%, 33.3%, 30.7% and 29.4% were reported for isolates of K. pneumoniae, P. mirabilis, P. aeruginosa and S. aureus respectively. MAR indexing revealed high values ranging from 0.4 to 0.87 for all the isolates.
 Conclusion: High susceptibility of the predominant isolates to amoxicillin-clavulanate and ciprofloxacin may underscore the drugs’ potential as antibiotics of choice for prompt treatment of otitis media in the population. However, the overall high drug-resistance indices of the isolates would suggest dire implications for empiric antibacterial therapy in the population. Choice of antibiotics for treatment of bacterial infections in this population should be driven by results of microbiological drug-susceptibility tests.

Approach to multidrug resistant bacterial infections

Several bacterial pathogens have evolved into multidrug resistant (MDR) forms both in developed and developing countries at an expanding rate. The World Health Organization has identified antimicrobial resistance as one of the three most important problems facing human health. It was estimated that 4·95 million deaths were associated with bacterial AMR globally in 2019.1 Three infectious syndromes dominated the global burdens attributable to AMR: lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections. Some of the most important MDR pathogens that currently cause infection in hospital and in the community are the so-called “ESKAPE” pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species), emphasizing their capacity to “escape” the effects of routine antibiotics. Most of the MDR studies were heterogeneous in terms of study design, patient population, site of infection, choice of antibiotic treatment, duration of followup period, and the outcome definitions, making it difficult to compare the different treatments and combinations of antibiotics used. Current recommendations in Europe and USA are based on systematic reviews that suggest different methods to prevent and control MDR infections, but provide little data on new and alternative antibiotic treatment options and therefore provide little firm guidance on specific treatment choices and algorithms. Attempts are ongoing to overcome antibacterial resistance by using new agents and combinations of new plus old agents. For example, both old (clavulanic acid, tazobactam) and new (avibactam, vaborbactam, relebactam) BLIs are being used in treatment algorithm for critically ill patients in the ICU according to MDR pathogen. There were still controversies regarding microbiological success for single agent compared with combinations of multiple agents. Many bacteria have the ability to produce biofilms, comprising organized congregations of bacteria adhering to each other making complex condition where antibiotic failed to wipe out bacteria despite of retaining in vitro susceptibility. It is also not always possible to conduct randomized controlled studies involving the required number of patients in a timely manner. So a requirement with the increasing choice of highly effective antimicrobial drugs, with dosages based on pharmacokinetic analysis of drug disposition, selection of the appropriate drug based on clinical microbiological data and pharmacodynamic indices. Rational antimicrobial therapy is more applicable today than in the history of antimicrobial therapy. Exploring newer modalities such as phage therapy and lytic antibiotics as well as obtaining a deeper understanding of the pathways involved in MDR mechanisms in order to engineer targeted drugs. Besides, rapid and comprehensive diagnostics are the key factor for the future management of antimicrobial resistance. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 195-196

An expectation-maximization algorithm for estimating proportions of deletions among bacterial populations with application to study antibiotic resistance gene transfer in Enterococcus faecalis.

The online version contains supplementary material available at 10.1007/s42995-022-00144-z.

The Prevalence of Extended Spectrum Beta-Lactamase Producing Uropathogenic Escherichia coli from Mouau Female Hostel Students

Aim: The study is aimed at determining the antimicrobial susceptibility pattern and production of Extended-spectrum Βeta-Lactamase (ESBLs) among Escherichia coli isolates from urine samples.
 Methods: A total of 35 samples of early morning mid-stream urine samples of about 10-15 ml were collected from Michael Okpara University of Agriculture Umudike (MOUAU) female hostel students; using sterile plastic containers. Each urine sample was inoculated on MacConkey Agar (MCA). Isolates were identified based on morphological features, Gram staining, and biochemical characterization. The antibiotic susceptibility test was done by the Kirby Bauer Disc diffusion method on Muller Hinton agar. ESBL detection was done as per Clinical and Laboratory Standard Institute (CLSI) guidelines, using the double disc synergy test method.
 Results: The study reviewed a total of 12 isolates of Escherichia coli of which is (34.29%) of which were obtained from urine samples. The susceptibility test results showed that most isolates were susceptible to Ofloxacin with 83.3% susceptibility, followed by Levofloxacin (66.7%), whereas gentamicin, nalidixic acid, cefuroxime, and cefotaxime exhibited a susceptibility rate of 33.3%. On the other hand, the highest resistance rate was to imipenem (96.7%), followed by Amoxicillin and ampiclox with 83.3%, while the least percentage resistance was observed in Ofloxacin with (8.3%) and Levofloxacin with (16.7%). Extended-spectrum Βeta-Lactamase (ESBLs) production among E. coli isolates was detected in 25.0% of the potential ESBL producers. The result of the multiple antibiotic resistance index showed that the isolate (E20) was significantly higher than other isolates with p<0.05, whereas E3, E7, E10 and E12 had same resistance pattern.
 Conclusion: So drug resistance due to ESBL production is a severe threat in UTIs, narrowing down the choice of antibiotics for treatment. So, there is a need to introduce routine screening for ESBL production for all uropathogenic Escherichia coli, causing urinary tract infections.

The Susceptibility to Antibiotics of Isolated Bacteria and the Suitability of Antibiotic Regimens to Drugs Susceptibility Test for Patients with Community-acquired Pneumonia at National Hospital 74

Abstract: Community-acquired pneumonia (CAP) is a common infectious disease in clinical practice. The objective of the study was to describe the susceptibility to antibiotics of isolated bacteria and to analyze the suitability of antibiotics regimens for treatment after having a drugs susceptibility test (DST) to bacteria in CAP patients. A retrospective study was conducted at National Hospital 74, after screening the medical records of CAP patients hospitalized in the first 6 months of 2021, 32 patients with isolated pathogenic bacteria were included in the study. The results revealed that the percentage of CAP patients who isolated pathogenic bacteria was low. There were 9 isolations of isolated bacteria, in addition to the common bacteria in CAP, also including isolations of bacteria that commonly cause hospital-acquired pneumonia such as P. aeruginosa and S. aureus. Different strains were tested with different antibiotics and had different antibiotic susceptibility despite the same isolations of bacteria. Some physicians have not noticed the role of DST results in the choice of antibiotics for treatment, such as treatment regimens are not suitable for the results of DST, accounting for a high percentage.
 Keywords: Community-acquired pneumonia, drugs susceptibility test.

Prevalence, etiology and antibiotic resistance patterns of community-acquired urinary tract infections in Dhaka, Bangladesh.

Urinary tract infection (UTI) accounts for a significant morbidity and mortality across the world and is a leading cause for antibiotic prescriptions in the community especially in developing countries. Empirical choice of antibiotics for treatment of UTI is often discordant with the drug susceptibility of the etiologic agent. This study aimed to estimate the prevalence of community-acquired UTI caused by antibiotic resistant organisms. This was a cross-sectional study where urine samples were prospectively collected from 4,500 patients at the icddr,b diagnostic clinic in Dhaka, Bangladesh during 2016–2018. Urine samples were analyzed by standard culture method and the isolated bacteria were tested for antibiotic susceptibility by using disc diffusion method and VITEK-2. Descriptive statistics were used to estimate the prevalence of community acquired UTI (CA-UTI) by different age groups, sex, and etiology of infection. Relationship between the etiology of CA-UTI and age and sex of patients was analyzed using binary logistic regression analysis. Seasonal trends in the prevalence of CA-UTI, multi-drug resistant (MDR) pathogens and MDR Escherichia coli were also analyzed. Around 81% of patients were adults (≥18y). Of 3,200 (71%) urine samples with bacterial growth, 920 (29%) had a bacterial count of ≥1.0x105 CFU/ml indicating UTI. Women were more likely to have UTI compared to males (OR: 1.48, CI: 1.24–1.76). E. coli (51.6%) was the predominant causative pathogen followed by Streptococcus spp. (15.7%), Klebsiella spp. (12.1%), Enterococcus spp. (6.4%), Pseudomonas spp. (4.4%), coagulase-negative Staphylococcus spp. (2.0%), and other pathogens (7.8%). Both E. coli and Klebsiella spp. were predominantly resistant to penicillin (85%, 95%, respectively) followed by macrolide (70%, 76%), third-generation cephalosporins (69%, 58%), fluoroquinolones (69%, 53%) and carbapenem (5%, 9%). Around 65% of patients tested positive for multi-drug resistant (MDR) uropathogens. A higher number of male patients tested positive for MDR pathogens compared to the female patients (p = 0.015). Overall, 71% of Gram-negative and 46% of Gram-positive bacteria were MDR. The burden of community-acquired UTI caused by MDR organisms was high among the study population. The findings of the study will guide clinicians to be more selective about their antibiotic choice for empirical treatment of UTI and alleviate misuse/overuse of antibiotics in the community.

The Spread of 𝛽-Lactamases and Extended Spectrum 𝛽-Lactamase Enzymes among Bacteria: A Threat to Effective Health Care Delivery

Antibiotic discovery continue to play a critical role in disease containment. Misuse and overuse of these drugs are the main drivers in the development of drug resistant pathogens. The World Health Organisation has declared that Antimicrobial resistance is one of the top 10 global public health threats facing humanity. There is the fears that if nothing is done, it might end the antibiotic era soon. In 2017 alone, over 9000 human deaths were caused by ESBL-producing Enterobacteriaceae in the USA. The ability of bacteria to develop newer strategies to acquire and disseminate resistance, can be traced as far back to 1940s when (R-factor) plasmid mediated antibiotic resistance was observed. They become resistant via the production of 𝛽-Lactamases and ESBLs enzymes which inactivate or modify antibiotics. Extended Spectrum 𝛽-Lactamases are enzymes whose rates of hydrolysis of the extended-spectrum 𝛽-Lactam antibiotics are >10 % than that for benzylpenicillin. Some bacteria may produce multiple ß-lactamases, which may reduce the effectiveness of ß-lactam/ ß-lactamase inhibitor combinations. These enzymes are susceptible to inhibition by 𝛽-Lactam inhibitors such as clavulanic acid, tazobactam, or sulbactam but have no hydrolytic activity against cephamycins and carbapenems. The production of acquired 𝛽-Lactamase and ESBL makes the choice of antibiotic treatment of infections caused by Gram-negative bacteria very limited, these have been the major causes of treatment failures, outbreaks of both community and hospital acquired infections, surgical failures, long hospital stay and huge economic losses, which continue to claim uncountable lives, especially in Nigeria and Africa where the health system are weak. The emergence of drug resistannt strains may be minimized by maintaining high levels of the drug in the tissues to inhibit mutants, administering two drugs that do not give cross-resistance, and by limiting the use of valuable second line ‘reserve drugs’ such .....

THE USE OF MICROBIOLOGICAL AND LABORATORY DATA IN THE CHOICE OF EMPIRICAL ANTIBIOTIC THERAPY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY - THE ROLE OF LOCAL ANTIBIOGRAMS.

Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.

Rationalising empirical antibiotics for bloodstream infections: A retrospective study at a South African district-level hospital

Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor clinical outcomes and the development of antimicrobial resistance. Knowledge of the local infectious disease burden and antibiotic resistance patterns can assist with development of strategies, updating of guidelines and subsequent improvement in initial empirical therapy. Objectives. To determine whether the empirical antibiotic choice for treatment of septic episodes at a district-level hospital was appropriate according to national guidelines, and to describe the epidemiological features of the septic episode population being studied and depict their antibiotic susceptibility profile. Methods. This was a retrospective, descriptive study of adult inpatients with bloodstream infections at Karl Bremer Hospital, Cape Town, South Africa. Laboratory and clinical data were obtained and analysed for the period 1 July 2017 - 30 June 2018. Septic episodes were subdivided into community-acquired bloodstream infection (CABSI) and hospital-acquired bloodstream infection (HABSI) study populations, and empirical antibiotics for both groups were assessed and compared with the adult Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level Care, 2015 edition (STG and EML). Results. Our study sample consisted of 184 septic episodes, isolated from 176 patients. Nearly half of the septic episodes (49.5%) were hospital acquired. Overall guideline adherence in the CABSI population was 88%, compared with 58% in the HABSI population. The reasons for guideline non-adherence in the CABSI population were lack of source-appropriate empirical antibiotics (n=7) and septic episodes where empirical antibiotics were indicated but not prescribed (n=4), while in the HABSI group the main reason was that the patients were treated by community-acquired standards (n=30; 33.0%). The in-hospital mortality rate for a septic episode in this study was 38%. Considering the typical first-line antibiotics used, 77.3% of CABSIs were found to be susceptible to co-amoxiclav (n=75) and 59.8% to ceftriaxone (n=58). With the exclusion of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii isolates as confounders, HABSIs had a susceptibility of 86% to the piperacillin/tazobactam plus amikacin combination, 81% to ertapenem, 90% to imipenem and 93% to meropenem. Conclusions. This study demonstrates poor guideline adherence in HABSIs, emphasising the importance of distinguishing between CABSIs and HABSIs. The empirical antibiotics advised by the STG and EML were found to be appropriate in the majority of septic episodes. Future revision and improvement of prescribing practices can assist in rationalising empirical antibiotic decisions.

How to investigate and manage a patient with a Staphylococcus aureus bacteraemia

Staphylococcus aureus bacteraemia is common, and associated with significant morbidity and mortality as a result of its high relapse rate and the risk of complicated infection. A positive blood culture for S. aureus should prompt a thorough patient assessment to identify a potential focus of infection, and the risk factors for the development or presence of complicated infection. Clinical management depends on the patient's characteristics and presenting features. This article gives a systematic approach to the patient with S. aureus bacteraemia, including points to look for on history and examination, the markers of complicated infection, and when to request transoesophageal echocardiography and further imaging. Treatment principles outlined include the rationale for choice of antibiotic treatment and need to involve infection specialists.

First Report: Colistin Resistance Gene mcr-3.1 in Salmonella enterica Serotype Choleraesuis Isolated from Human Blood Sample from Thailand.

This study describes the first finding of Salmonella enterica serotype Choleraesuis (Salmonella Choleraesuis) isolate harboring mobile colistin resistance (mcr)-3.1 obtained from human blood sample. The clinical relevant blood sample was collected during October 2018. The phenotypic identification and antimicrobial susceptibility testing (AST) were studied by using automate microbiology platform (Phoenix M50, BD), and in-depth characterization by whole genome sequencing. The phenotypic identification was reported Salmonella Choleraesuis. AST result demonstrated that this isolate had high minimum inhibitory concentrations (MICs) against colistin, fluoroquinolone, and cephalosporin III and IV, which are first-line antibiotic treatment choices for Gram-negative bacterial pathogen infections. This Salmonella Choleraesuis is harboring mcr-3.1 and presented a diversity carbapenemase including blaTEM and blactx-m-55. Regarding the multilocus sequence typing result, this Salmonella presented ST139 that related to the Choleraesuis variant sensu stricto. Swine is not the host specific for the Salmonella Choleraesuis since it also causes enteric and other diseases in human. Hence, the presence of the mobile plasmid colistin mcr-3.1 resistant gene in human sample is resulting to the public health concerns due to the fact that it is enable to transmit to other hosts and distribute into an environment.

Prevalence of Extended-Spectrum Beta-Lactamases in producing Escherichia coli in beef sold in traditional markets in Surabaya, Indonesia

Abstract. Wardhana DK, Safitri DA, Anisa S, Harijani N, Estoepangestie S, Maghfiroh L. 2021. Prevalence of Extended-Spectrum Beta-Lactamases in producing Escherichia coli in beef sold in traditional markets in Surabaya, Indonesia. Biodiversitas 22: 2789-2793. Meat is a source of protein, but it can be contaminated by microorganisms such as Escherichia coli (E. coli). Some species of E. coli become resistant to antibiotics and produce Extended-Spectrum Beta-Lactamase (ESBL) that limit the choice of antibiotics for treatment of E. coli infection. The purpose of the study was to investigate the prevalence of ESBLs leading to the growth of Escherichia coli (E. coli) in beef sold in local markets in Surabaya City, Indonesia. A total of 60 samples from 10 traditional markets were tested. Isolated and identified E. coli strains were examined to detect the ESBL production through four-disc diffusion tests using cefotaxime (30 ?g), ceftazidime (30 ?g), ceftriaxone (30 ?g), and aztreonam (30 ?g). Then, the minimum inhibitory concentration was measured. The study showed the presence of ESBL-producing E. coli in beef sold in the traditional markets in Surabaya. The average E. coli concentration in the beef was at 43.3%, and the highest resistance of the isolates was observed for cefotaxime (46.1%), ceftazidime (23.1%) ceftriaxone (19.2%), and aztreonam (38.4%). Data of ESBL-producing E. coli in broiler chicken meat in the traditional markets showed all of the E. coli isolates were resistant to ampicillin, while 48.4% of them were resistant to, cephazolin. Only few (13%) were resistant to ceftazidime, and few others (9.6%) showed resistance to cefotaxime. The least number of them (6.4%) were resistant to ceftriaxone, and most of them were resistant to tetracycline (87.2%). Therefore, ESBLs were not reported producing E. coli in the beef. The presence of ESBL-producing E. coli in the beef gives an alert that good hygiene practices should be applied to handle meat safety and control the use of antibiotics

Bloodstream infection with Acinetobacter baumanii in a Plasmodium falciparum positive infant: a case report

BackgroundThe increasing incidence of multi-antibiotic-resistant bacterial infections, coupled with the risk of co-infections in malaria-endemic regions, complicates accurate diagnosis and prolongs hospitalization, thereby increasing the total cost of illness. Further, there are challenges in making the correct choice of antibiotic treatment and duration, precipitated by a lack of access to microbial culture facilities in many hospitals in Ghana. The aim of this case report is to highlight the need for blood cultures or alternative rapid tests to be performed routinely in malaria patients, to diagnose co-infections with bacteria, especially when symptoms persist after antimalarial treatment.Case presentationA 6-month old black female child presented to the Agogo Presbyterian Hospital with fever, diarrhea, and a 3-day history of cough. A rapid diagnostic test for malaria and Malaria microscopy was positive for P. falciparum with a parasitemia of 224 parasites/μl. The patient was treated with Intravenous Artesunate, parental antibiotics (cefuroxime and gentamicin) and oral dispersible zinc tablets in addition to intravenous fluids. Blood culture yielded Acinetobacter baumanii, which was resistant to all of the third-generation antibiotics included in the susceptibility test conducted, but sensitive to ciprofloxacin and gentamicin. After augmenting treatment with intravenous ciprofloxacin, all symptoms resolved.ConclusionEven though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream. Bacterial blood cultures and antimicrobial susceptibility testing should be routinely performed to guide treatment options for febril illnesses in Ghana in order to reduce inappropriate use of broad-spectrum antibiotics and limit the development of antimicrobial resistance.

Prevalence of antibiotic allergy labels and their consequences in people presenting to a teaching hospital Emergency Department; a retrospective chart review.

Antibiotic allergy labels have a direct impact on individual patient care and on the consumption of broad-spectrum antibiotics. Our aim was to establish the prevalence of antibiotic allergies and to determine whether patients with documented antibiotic allergy labels received guideline concordant antimicrobial therapy. Additionally we wanted to evaluate the quality of allergy documentation in the medical record. Prospective audit of all patients presenting to the Emergency Department of an adult teaching hospital in Sydney over a 4 month period. Documented allergy labels, diagnoses, antibiotic administration and outcomes were recorded. Appropriateness of antibiotic choice was based on the Australian National Antimicrobial Prescribing Survey. 9.9% of presentations had at least one antibiotic allergy recorded. Significantly more women than men had antibiotic allergies documented. One third of patients with documented antibiotic allergies were prescibed inappropriate antibiotic therapy and some had significant adverse events. The documentation of antibiotic allergy labels and choice of antibiotic treatment can be significantly improved. Strategies to safely de-label people with documented allergies who are not truly allergic need to be implemented.

Türkiye'nin Batı Kesiminde Tularemi Salgını; İda Dağı'nın İntikamı

Objective: Tularemia is a zoonotic disease. Sporadic cases and outbreaks occur in humans. Here, we report a waterborne outbreak, its clinical presentation, and the results of treatment. Material and Methods: An increase in the frequency of patients presenting with lymphadenopathy from the same region was detected. Patients with serological diagnosis of tularemia were included in the study between December 2018 and April 2019. This case series were evaluated as an outbreak, clinical and laboratory parameters, demographic characteristics, clinical forms of tularemia and laboratory findings such as immunoglobulin M antibody titer for F. tularemia, inflammatory markers (C-reactive protein, leukocytosis, erythrocyte sedimentation rate), choice of first antibiotic treatment, total duration of treatment, initial clinical/laboratory response day, relapse and reinfection ratios have been investigated. The bacteria was investigated from drinking water fountains by polymerase chain reaction (PCR) (16sRNA Nanobiz® F. tularemia). Results: Tularemia was diagnosed serologically in 35 patients. Distribution of clinical forms was glandular (21 cases-60%); ulceroglandular (11 cases-31.4%); oropharyngeal (2 cases-5.7%) and oculoglandular (1 case-2.8%), respectively. First serologic test positivity was 80%. Inflammatory markers such as C-reactive protein, leukocytes, erythrocyte sedimentation rate were high. Antibiotic choice for treatment was streptomycin in 19 cases (54.3%), ciprofloxacin in nine cases (25.7%), gentamicin in four cases (11.4%); doxycycline in three cases (8.6%) respectively. The common suspicious contact was the use of drinking water from street fountains. F.tularemia PCR (16sRNA) was positive in 35 of these fountains (35/80, 43.75%). Conclusion: Tularemia should always be considered in head and neck lymphandenopathies that do not heal or show late recovery. We should keep in mind tularemia in a water-borne outbreak, were high it is rare.