Antimicrobial Consumption Research Articles

Scoping Review of National Antimicrobial Stewardship Activities in Eight African Countries and Adaptable Recommendations.

Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists’ and other healthcare professionals’ curricula for pre-service and in-service training.

Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.

The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based metrics and days-supplied-based metrics. Outpatient antibiotic consumption metrics should incorporate the duration of therapy.

Air temperature and incidence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae

BackgroundHigher outdoor temperature may be related to an increase in antibiotic resistant bacteria. We investigated the association between local outdoor air temperature and the incidence of extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) correcting for known drivers of antibiotic resistance. MethodsWe performed a time-series regression study using prospectively collected weekly surveillance data on all ESBL-PE isolated from in- and outpatients of the University Hospital Basel, a tertiary care center in Switzerland, between 01/2008–12/2017. Temperature was measured hourly at the meteorological institute of the University Basel next to our institution over this time period. A time-series approach using a Poisson regression model and different lag terms for delayed exposure effects was performed to assess associations between minimal, mean and maximal weekly temperature and the number of ESBL-PE recovered. ResultsOver 10 years, recovery of ESBL-PE increased (annual incidence rate ratio [IRR] 1.14, 95%CI 1.13–1.16), while mean weekly temperature measures remained stable. In multivariable analyses, increasing temperature was associated with higher recovery rates of ESBL-PE after three to four weeks, correcting for potential confounders, such as the number of admissions, proportion of long-term nursing facility- and ICU-admissions, age, Charlson comorbidity index and consumption of antimicrobials (IRRs per 10 °C ranging from 1.14 to 1.22, 95%CIs 1.07–1.33). These trends remained when analyzing correlations between temperature with the proportion of extended spectrum cephalosporin resistance of all recovered Enterobacteriaceae. ConclusionsHigher outdoor temperature may be associated with an increase of ESBL-PE-incidence, independent of important confounders, such as antimicrobial consumption and thus should be considered for future resistance-trajectories.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19)-authors' response.

Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19)-authors' response.

Association between Antimicrobial Consumption and the Prevalence of Nosocomial Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae in a Tertiary Hospital in Northern Taiwan.

Carbapenem-resistant Enterobacteriales has become a threat in Taiwan. This is the first local study focusing on the association between carbapenem-resistant Enterobacteriales and antimicrobial consumption. From January 2012 to December 2020, data were collected in a tertiary care hospital in Taipei, Taiwan. Antimicrobial consumption was estimated by the defined daily dose/1,000 patient-days. During the same period, the prevalence of carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected through routine surveillance data. The following retrospective analyses were conducted: 1) analysis of antimicrobial consumption over time, (2) analysis and forecast of CREC and CRKP prevalence over time, and 3) analysis of correlation between antimicrobial consumption and the prevalence of CREC and CRKP. The consumption of piperacillin/tazobactam (β = 0.615), fluoroquinolones (β = 0.856), meropenem (β = 0.819), and doripenem (β = 0.891) increased during the observation period (P < 0.001), and the consumption of aminoglycosides (β = -0.852) and imipenem/cilastatin (β = -0.851) decreased (P < 0.001). The prevalence of CRKP rose over time (β = 0.522, P = 0.001) and correlated positively with the consumption of fluoroquinolones, levofloxacin, penicillin/β-lactamase inhibitor, piperacillin/tazobactam, meropenem, and doripenem (P < 0.05). The prevalence of CRKP and CREC both correlated negatively with consumption of aminoglycosides (P < 0.01). The prevalence of CRKP in our hospital increased as the forecast predicted based on an autoregressive integrated moving average model. This study provides alarming messages for members participating in antimicrobial stewardship programs, including the increasing prevalence of CRKP, the increasing consumption of broad-spectrum antibiotics, and the positive correlation between them.

Control of Healthcare-Associated Carbapenem-Resistant Acinetobacter baumannii by Enhancement of Infection Control Measures.

Antimicrobial stewardship and infection control measures are equally important in the control of antimicrobial-resistant organisms. We conducted a retrospective analysis of the incidence rate of hospital-onset carbapenem-resistant Acinetobacter baumannii (CRAB) infection (per 1000 patient days) in the Queen Mary Hospital, a 1700-bed, university-affiliated teaching hospital, from period 1 (1 January 2007 to 31 December 2013) to period 2 (1 January 2014 to 31 December 2019), where enhanced infection control measures, including directly observed hand hygiene before meal and medication rounds to conscious patients, and the priority use of single room isolation, were implemented during period 2. This study aimed to investigate the association between enhanced infection control measures and changes in the trend in the incidence rate of hospital-onset CRAB infection. Antimicrobial consumption (defined daily dose per 1000 patient days) was monitored. Interrupted time series, in particular segmented Poisson regression, was used. The hospital-onset CRAB infection increased by 21.3% per year [relative risk (RR): 1.213, 95% confidence interval (CI): 1.162–1.266, p < 0.001], whereas the consumption of the extended spectrum betalactam-betalactamase inhibitor (BLBI) combination and cephalosporins increased by 11.2% per year (RR: 1.112, 95% CI: 1.102–1.122, p < 0.001) and 4.2% per year (RR: 1.042, 95% CI: 1.028–1.056, p < 0.001), respectively, in period 1. With enhanced infection control measures, the hospital-onset CRAB infection decreased by 9.8% per year (RR: 0.902, 95% CI: 0.854–0.953, p < 0.001), whereas the consumption of the extended spectrum BLBI combination and cephalosporins increased by 3.8% per year (RR: 1.038, 95% CI: 1.033–1.044, p < 0.001) and 7.6% per year (RR: 1.076, 95% CI: 1.056–1.097, p < 0.001), respectively, in period 2. The consumption of carbapenems increased by 8.4% per year (RR: 1.84, 95% CI: 1.073–1.094, p < 0.001) in both period 1 and period 2. The control of healthcare-associated CRAB could be achieved by infection control measures with an emphasis on directly observed hand hygiene, despite an increasing trend of antimicrobial consumption.

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

ABSTRACT Objective Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. Methods A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. Results The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients’ files. Conclusions It’s encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.

Association between the Use of Antibiotics and the Development of Acute Renal Injury in Patients Hospitalized for COVID-19 in a Hospital in the Peruvian Amazon.

Introduction: A significant antibiotic prescribing pattern associated with the COVID-19 pandemic has been described. Multiple protocols included empirical antimicrobials, leading to a substantial increase in antimicrobial consumption in medical care. A higher mortality rate is described among patients diagnosed with COVID-19 who received antibiotics. Objectives: To determine the association between the use of antibiotics and the development of acute renal injury in patients infected with SARS-CoV-2 in patients treated at the Hospital II EsSalud de Ucayali, 2021. Methods: A cross-sectional-analytical study was conducted, evaluating the medical records of patients admitted to the intensive care unit between July 2020 and July 2021. For the statistical analysis, measures of central tendency and dispersion, statistical hypothesis contrast tests were used in relation to acute kidney injury (AKI), antibiotic use and associated factors, derived from linear regression models. Results: The factors that were positively associated with the development of AKI were sepsis (aPR: 2.86; 95% CI: 1.26–6.43), shock (aPR:2.49; 95% CI: 1.28–4.86), mechanical ventilation (aPR:9.11; 95% CI: 1.23–67.57), and use of vancomycin (aPR: 3.15; 95% CI: 1.19–8.27). Conclusions: In the Peruvian Amazon, there is a high consumption and inadequate prescription of antibiotics. The drugs most commonly used for the treatment of COVID-19 were: aminoglycosides, vancomycin, ivermectin, azithromycin, tocilizumab, and corticosteroids. The development of AKI among hospitalized patients was found to be related to vancomycin administration. In addition, an association was found with the use of mechanical ventilation, a high body mass index, and the presence of complications such as sepsis or shock. Therefore, inappropriate antibiotic use for COVID-19 has been associated with multiple negative outcomes and consequences.

How effective is a brief educational intervention on prescribing first-line antibiotics in acute cystitis? A quasi-experimental study among general practitioners in Croatia

AimTo assess the effectiveness of a brief educational intervention on prescribing first-line antibiotics in acute cystitis.MethodsThis quasi-experimental before-after study was conducted over a period of eight months. We collected prescribing data related to urinary tract infections four months before the educational intervention and four months after it. Aggregate data on office visits, diagnoses, and issued prescriptions were collected from each practice’s electronic medical records based on monthly reports.ResultsOverall, 3581 prescriptions were issued: 1717 before and 1864 after the intervention. The total number of prescriptions increased by 8.5%. The use of first-line antibiotics increased by 21.2%, the use of fluoroquinolones decreased by 6.6%, while the use of beta-lactams remained unchanged. After the intervention, nitrofurantoin was the most prescribed first-line antibiotic. The proportion of women who were prescribed first-line antibiotic did not reach the acceptable range (80%-100%) according to the European Surveillance of Antimicrobial Consumption quality indicators. The proportion of fluoroquinolones (17.9%) use was well above the acceptable range (0%-5%).ConclusionA brief educational intervention proved to be a useful method in adopting better prescribing habits. Of particular importance is the considerable increase in the use of nitrofurantoin due to its reliable efficacy against multidrug-resistant urinary pathogens.

Analysis of the Antimicrobial Stewardship Program Policy on Inpatients Antibiotics Use

The Exploration of Antimicrobial Consumption to Identify Targets for Quality Improvement in Indonesian Hospitals study showed that 97% of the use of empirical antibiotics was 81% empiric therapy, 12% medical prophylaxis, 4% surgical prophylaxis, and 16% without clear indications. The most common diagnoses are typhoid, pneumonia. and dengue fever. The Antimicrobial Stewardship Programme (ASP) Team supports the national program to reduce the use of irrational antibiotics. This study aims to analyse the ASP policy implementation on the use of antibiotics at the Royal Taruma Hospital. A secondary data on the use of Defined Daily Dose (DDD)/100 patient-days for the quarterly months of February, May, and August 2020. The 14 key informants' perceptions, opinions, thoughts are the primary data of qualitative research on the use of antibiotics during the ASP policy implementation. The three most antibiotics used were Ceftriaxone (64.7%), Levofloxacin (20.1%), and Meropenem (6.9%), which belong to the broad-spectrum antibiotic class. The total use of antibiotics was 1206.59 DDD/100 patient-days. The implementation of ASP policies has not been running optimally. It is necessary to formulate a pattern of germs and antimicrobial resistance, not only in the intensive room, but also in the care ward to achieve ASP quality indicators.

Impact of the COVID-19 pandemic on hospital antimicrobial consumption in Croatia

The aim of the study was to assess the impact of the COVID-19 pandemic on antimicrobial consumption (AMC) in the hospital sector in Croatia by analysing data reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) between 2016 and 2020. AMC was measured as the number of DDDs/1000 inhabitants/day and as the number of DDDs/100 bed days. To assess trends, linear regression was performed. To assess the impact of the pandemic on AMC, the compound annual growth rate was calculated for the years preceding the pandemic based on which AMC for 2020 was forecasted and compared with the actual consumption. While hospital AMC expressed as DDDs/1000 inhabitants/day between 2019 and 2020 decreased by 17%, when expressed as DDDs/100 bed days, an 8% increase was observed. Hospital consumption of antibacterials for systemic use in the 5 year period did not significantly change when expressed as DDDs/1000 inhabitants/day, while it statistically significantly increased when expressed as DDDs/100 bed days. An increasing trend in consumption of broad-spectrum antimicrobials was found. During the pandemic there was an increase in hospital AMC with a shift towards broad-spectrum antimicrobials requiring further in-depth qualitative analysis based on patient-level data. Contrasting results obtained using different denominators indicate that the metric DDDs/1000 inhabitants/day is not sensitive enough to evaluate hospital AMC. When assessing hospital AMC, the population under surveillance should be relevant for healthcare context. Antimicrobial stewardship remains one of the most important strategies to tackle antimicrobial resistance and antimicrobial surveillance methods must be as sensitive as possible.

Impact of an antimicrobial stewardship program in a COVID-19 reference hospital according to the AWaRe classification

This was a prospective observational study performed between January and October 2021. Antimicrobial consumption was classified according to AWaRe and expressed as daily defined doses (DDD/1000 patient-days). Watch group antibiotic consumption demonstrated a strong correlation with carbapenem resistance among both clinical and total isolates, but Acinetobacter baumannii resistance did not correlate with antimicrobial consumption. Efforts to reduce antimicrobial consumption are needed; however, prevention and control guidelines are also a cornerstone to better results.

Co-production of Classes A and B Carbapenemases BKC-1 and VIM-2 in a Clinical Pseudomonas Putida Group Isolate from Brazil.

Emergence of resistance to classical antimicrobial agents is a public health issue, especially in countries with high antimicrobial consumption rates. Carbapenems have been employed as first-choice option for empirical treatment complicated infections. However, in the last decades, frequency of carbapenemase-producing Gram-negative bacteria has rising, demanding the use of alternative antimicrobial agents. By sequencing the entire genomes with short and long reads technologies, we report the isolation and genomic characterization of a carbapenem-resistant Pseudomonas clinical isolate. The identification based on average nucleotide identity indicates a putative new species into the Pseudomonas putida Group, which carries both the blaBKC-1 and blaVIM-2 carbapenemase genes. The blaBKC-1 was found to be on a transferable IncQ plasmid backbone, whereas blaVIM-2 was found in a new integron, In2126 (intl1∆-blaVIM-2-aacA7-blaVIM-2∆-aacA27-3'CS), described in this study. Our findings indicate that co-occurrence of classes A and B carbapenemase enzymes underscores the evolving emergence of more complex antimicrobial resistance in opportunistic pathogens.

Method to Assess Farm-Level Vaccine and Antibiotic Usage Utilizing Financial Documentation: A Pilot Study in a Commercial Pig Farm in South Africa From 2016 to 2018.

The purpose of the study was to develop a blueprint using financial documentation to describe and quantify vaccine and antibiotic usage (ABU). This method was piloted in a commercial pig farm in South Africa, with the ultimate hope to serve as a tool in a future species-specific vaccine and ABU surveillance system. Data collection was based on templates from the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) network and the World Organisation for Animal Health (WOAH). Invoices from 2016 to 2018 were used as the main data source. In addition, monthly statement of accounts were used to check for missing invoices. An inventory check was done to ensure that the correct antibiotic concentrations were used in subsequent calculations. Livestock counts and slaughter statistics were also collected to be used as denominator data. Cost calculations for the procurement of antibiotics and vaccines were also done. The study showed that veterinary medicinal products were purchased only from a single veterinary practice. A total of 291 invoices were issued over 3 years, of which 2.75% (8/291) were missing and could therefore not be used in quantification. Tetracyclines (453.65 ± 25.49 kg and 135.16 ± 3.31 mg/kg), followed by quinoxalines (258.33 ± 8.04 kg and 77.07 ± 3.93 mg/kg) were used in the highest amounts, both in terms of weight (kg) and adjusted for animal biomass (mg/kg). Vaccines used on the farm targeted seven different diseases, namely enzootic pneumonia, erysipelas, ileitis, infectious infertility, leptospirosis, neonatal pig diarrhea and porcine circovirus disease. An average of 103 546 vaccine dosages was purchased for ZAR1 302,727 ($ 84,6201) per year, whereas the average cost for the procurement of antibiotics was ZAR 907,372 ($ 69,561) per year. The study showed that invoices and monthly statement of accounts, in combination with an inventory check and on-farm production statistics, are useful data sources to quantify vaccine and ABU in the absence of veterinary prescriptions. In addition, vaccinating pigs were more expensive than administering antibiotics.

Effect of educational session on antimicrobial consumption pattern in the medical intensive care unit of government tertiary care hospital, Jaipur, Rajasthan

Background: Polypharmacy and inappropriate usage of antibiotics are common in an intensive care unit which may increase morbidity, mortality, antimicrobial resistance, and treatment cost. Aims and Objectives: The objective of the present study is to evaluate the Effect of Educational Session on Antimicrobial consumption pattern in the Medical Intensive Care unit (MICU) of Government Tertiary Care hospital, Jaipur, Rajasthan. Materials and Methods: An interventional study was conducted over a period of 18 months, and the data were obtained from Medical Record Department (MRD) and from the MICU after organizing an educational session, of a tertiary care hospital. All the data were tabulated in summery sheets and were analyzed using computer software SPSS version 20 and Microsoft Excel 2019. Results: A total 257 cases were reviewed during the study period; among these 46.77% were males and 53.23% were females in MRD group, out of 124 cases and 53.38% were males and 46.62% were females in MICU group, out of 133 cases. In MRD group mean age of patients was 56.16 and in MICU group mean age of patients was 56.00 years. Discussion: A total of 616 antimicrobial drugs were prescribed, out of which Amoxiclav was most frequently given in MRD group and Meropenem was most frequently given in MICU group. Conclusion: This study gave an overview of antimicrobial use in the MICU and helped to find out the consumption pattern that would spread awareness among the prescribers.

Antimicrobial stewardship programmes focused on de-escalation: a narrative review of efficacy and risks

Background and Objective: Multi-drug resistance is an increasing problem and is associated with increased morbidity and mortality. High levels of antimicrobial consumption and broad-spectrum antimicrobial use are associated with antimicrobial resistance (AMR). Studies have shown substantial antimicrobial use across intensive care units (ICUs) worldwide. International guidelines advise antibiotic de-escalation (ADE) as part of an antimicrobial stewardship programme (ASP). ADE is a strategy to decrease the spectrum of the empirical antimicrobial therapy, with the aim to reduce the ecological impact on the patient’s microbiome and reduce the emergence of AMR. Our aim was to provide an insight into the latest developments on ADE in the intensive care setting.

Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015-2021).

The coronavirus disease 2019 (COVID-19)-pandemic-related overload of health systems has compromised the application of antimicrobial stewardship (AS) models and infection prevention and control (IPC) programs. We aimed to evaluate the impact of COVID-19 on antimicrobial consumption (AC) and antimicrobial resistance (AMR) in the University Hospital of Modena. A time series analysis with an autoregressive integrated moving average model was conducted from January 2015 to October 2021 to evaluate the AC in the whole hospital and the intensive care unit (ICU), the incidence density (ID) of bloodstream infections (BSIs) due to the main multidrug-resistant organisms, and of C. difficile infections (CDIs). After an initial peak during the COVID-19 period, a decrease in the trend of AC was observed, both at the hospital (CT: −1.104, p = 0.025) and ICU levels (CT: −4.47, p = 0.047), with no significant difference in the single classes. Among the Gram-negative isolates, we observed a significant increase only in the level of BSIs due to carbapenem-susceptible Pseudomonas aeruginosa (CL: 1.477, 95% CI 0.130 to 2.824, p = 0.032). Considering Gram-positive bacteria, an increase in the level of BSIs due to methicillin-resistant Staphylococcus aureus and in the trend of CDIs were observed, though they did not reach statistical significance (CL: 0.72, 95% CI −0.039 to 1.48, p = 0.062; CT: 1.43, 95% CI −0.002 to 2.863, p = 0.051; respectively). Our findings demonstrated that the increases in AMR and AC that appeared in the first COVID-19 wave may be later controlled by restoring IPC and AS programs to pre-epidemic levels. A coordinated healthcare effort is necessary to address the longer-term impact of COVID-19 on AC to avoid irreversible consequences on AMR.

Carbapenem use correlates with percentage of patients with COVID-19 in intensive care units.

BackgroundThe first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of carbapenem consumption and describe the implemented measures during the first year of the COVID-19 pandemic.MethodsWe calculated carbapenem consumption for all the hospital and for intensive care units (ICU) for three periods: baseline (before COVID-19 cases, January 2019–February 2020), and the period of COVID-19 cases as a pre-intervention (March–August 2020) and a post-intervention phase (September 2020–December 2021).ResultsDuring the study period, the percentage of admitted COVID-19 patients increased in the months of April–August of 2020 (pre-intervention period) from 5 to 26% of total admitted patients. The consumption of carbapenems (DDD/1000 patient days) increased from a mean of 67.1 at baseline to 142.9 pre-intervention. In ICUS, there was an increase in the mean from 125.7 to 240.8 DDD/1000 patient days. After interventions, the DDD/1000 patient days decreased by 49.5% overall the hospital and by 36% in ICUs. For the post-intervention period, there was a correlation between COVID-19 cases and carbapenem usage in the ICU but not the overall hospital.ConclusionAn increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Antimicrobial stewardship programs are essential to reduce consumption rate.

A Cross-Talk between Diet and the Oral Microbiome: Balance of Nutrition on Inflammation and Immune System's Response during Periodontitis.

Over the last few decades, studies on the oral microbiome have increased awareness that the balance between the host and the microbial species that coexist in it is essential for oral health at all stages of life. However, this balance is extremely difficult to maintain, and many factors can disrupt it: general eating habits, sugar consumption, tobacco smoking, oral hygiene, and use of antibiotics and other antimicrobials. It is now known that alterations in the oral microbiota are responsible for developing and promoting many oral diseases, including periodontal disease. In this context, diet is an area for further investigation as it has been observed that the intake of particular foods, such as farmed animal meat, dairy products, refined vegetable oils, and processed cereals, affects the composition of the microbiota, leading to an increased representation of acid-producing and acid-tolerant organisms and periodontal pathogens. However, little is known about the influence of diet on the oral microbiome and the creation of a suitable microenvironment for the development of periodontal disease. The aim of the present study is to evaluate current knowledge on the role of diet in the oral dysbiosis underlying periodontal disease.

Comment on: Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).

Comment on: Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19).