Prescription Of Antimicrobial Drugs Research Articles

Prescribing Practices in Pediatrics and Drug Utilization Studies Promoting Pediatric Health

Knowledge of drug administration in children and infants lags behind that of adults for many reasons. These include developmental differences that affect the pharmacodynamic and pharmacokinetic profiles of drugs, ethical and financial reasons, research capabilities, and regulatory guidelines and constraints. Most of the drugs prescribed for children have not been tested in the pediatric population due to the difficulties in carrying out clinical studies in children and ethical issues due to children not being able to make their own decisions to participate in a clinical trial. Epidemiological evaluation of medicine use in elderly is now a highly visible topic, but drug prescribing studies in pediatric patients have been limited. The higher incidence of infections in pediatric population as compared to adults leads to higher prescription of Antimicrobial Drugs (AMDs), at times more than two in single prescription. The use of antibiotics in children has been a major area of concern. . Periodic prescriptions analysis and effective feedback to clinician should be done based on results to ensure rational prescribing and effective health care management, which will ultimately lead to a better child health. In this review article, we will to analyze prescribing practices in pediatrics and drug utilization studies promoting pediatric health.

Review of clinical guidelines for the diagnosis, treatment and prevention of urinary tract infection in children

Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. The difficulty of diagnosis and timely administration of adequate therapy is associated with differences in the clinical course of the disease in different age groups, localization of the infectious process (upper and lower urinary tract), methods of urine collection and interpretation of the obtained results. The possibility and amount of instrumental diagnostics also varies depending on the region and the specifics of the organization of the healthcare system. The problem of increasing resistance of microorganisms is aggravated by the often-excessive prescription of antimicrobial chemotherapy drugs, which leads to a narrowing of the range of available drugs and the possibility of their use in appropriate age groups. All of the above explains the lack of uniform approaches and the existence of many international and local clinical recommendations on the problem of UTI. This review highlights the features of urine collection in non- and toilet-trained children and also discusses the assumptions and limitations of using screening methods for urinalysis. Indications for urine culture and differences in the interpretation of results depending on the method of obtaining a urine sample are presented, as well as data on modern instrumental diagnostic methods and strategies for their use in practice. A comparative description of current international clinical recommendations for the diagnosis, treatment and prevention of UTIs in children is provided.

Three-Year Point Prevalence Survey of Antimicrobial Use in a Chinese University Hospital.

To evaluate the prevalence and quality of antimicrobial prescriptions using a Global Point Prevalence Survey (PPS) tool and help identify targets for improvement of antimicrobial prescribing and inform the development of antimicrobial stewardship activities. Antimicrobial prescriptions for inpatients staying at a hospital overnight were surveyed on one weekday in October 2018, November 2019, and November 2020. Data including basic patient information, antimicrobial drugs, quality evaluation of antimicrobial drug prescription, and the risk factors of nosocomial infection were collected from doctor network workstation. Patient information was anonymized and entered in the PPS Web application by physicians. A total of 720 patients (median age, 62 years) were surveyed. Of them, 246 (34.2%) were prescribed antimicrobials on the survey days. Hospital-wide antimicrobial use had a significantly decreasing trend (P < 0.001). The most commonly prescribed antimicrobial drugs were third-generation cephalosporins (40.5%), followed by quinolones (21.8%) and second-generation cephalosporin (12.5%). In our study, cefoperazone/sulbactam, ceftazidime, and levofloxacin were the most commonly used antimicrobials. The most common indication for antimicrobial use was pneumonia or lower respiratory tract infection (159/321, 49.5%). Antimicrobial for surgical prophylaxis represented 16.2% of the total antibiotic doses. Of those, 67.3% were administered for more than 24 h. The rate of adherence to antibiotic guidelines was 61.4%. The indications for antimicrobials were not documented in 54.5% of the prescriptions. Stop/review date was documented for 36.8% of prescriptions. The PPS tool is useful in identifying targets to enhance the quality of antimicrobial prescriptions to improve the adherence rate in hospitals. This survey can be used as a control to assess the rational application quality of antimicrobial after regular application of antimicrobial intervention.

Geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants: A nationwide database study in Japan.

To examine spatial effects in neonatal care, we conducted a retrospective cohort study to investigate the geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants in Japan. We utilized a nationwide claims database in Japan to extract prescriptions of injectable antimicrobials for 41,423 very preterm and very low birth weight infants admitted within the first two days of life from April 2010 to March 2021. We identified frequently prescribed antimicrobials, revealed early neonatal exposure and neonatal exposure to each antimicrobial agent by 47 prefectures in Japan, and evaluated their spatial autocorrelation using global and local Moran's I statistics. We then scrutinized regional disparities in antimicrobial drug prescriptions. The top 10 antimicrobials prescribed to very preterm and very low birth weight infants in Japan were ampicillin, amikacin, gentamicin, cefotaxime, fluconazole, ampicillin combination, micafungin, cefmetazole, cefazolin, and vancomycin. We identified northern cold spots for fluconazole exposure and southern hot spots for ampicillin, amikacin, gentamicin, and cefmetazole exposure. Geographical heterogeneity in the selection of antibacterial and antimycotic agents was observed. Our study revealed the geographical distribution of antimicrobial exposure among very preterm and very low birth weight infants in Japan, thus disclosing its spatial effects. Further research addressing the spatial effects of neonatal care is needed to understand how drug exposure affects the outcomes of preterm infants.

Acute bronchitis - modern possibilities of mucactive therapy

Analysis of the clinical effectiveness and safety of erdosteine use in comparison with standard (real practice) mucoactive therapy in patients with acute bronchitis (АВ) in adults. The observational program included 100 adult patients with АВ, 50 of them (group 1) received erdosteine, the group 2 also included 50 patients who received acetylcysteine, bromhexine and other mucolytics (real clinical practice). The following were assessed: cough severity, average time for resolution of night and daytime cough, satisfaction with treatment, NO concentration in exhaled air, levels of C-reactive protein (CRP) and interleukin-6 (IL-6). The average duration of relief of severe daytime cough requiring continued therapy was: in group 1 - 3.7±0.46 days, night cough - 1.14±0.94 days. In the second group, daytime cough was relieved in 3.8±0.4 days, night cough - 1.08±0.7 days. The duration of mucoactive therapy in group 1 was 5.32±0.82 days, in group 2 this figure was 8.5±1.4 days (p<0.05). The number of АВ patients with a significant reduction in the severity of productive cough (1 point on cough severity scale) on the 6th day from the beginning of treatment in group 1 (erdosteine) amounted to 32 (64%), in group 2 - 27 (54%). Satisfaction with the treatment was higher in the group receiving erdosteine: according to the indicators "very satisfied" and "extremely satisfied" the patients of the group 1 - 42 - were the leaders in comparison with the group 2, where these positions were marked by 28 patients. The level of CRP in patients with АВ in group 1 was 24.7±21.24 mg/l, in group 2 - 16.37±16.5 mg/l, which indicates the viral etiology of the process and no need in the prescription of antimicrobial drugs. For the first time in Russian practice, the following were determined: the level of IL-6, which in the group 1 was 10.3±6.7 pc/ml; in the group 2 - 10.03±3.94 pc/ml; the level of exhaled NO in group 1 was 16.5±5.1 ppb, in group 2 - 14.9±4.6 ppb (the norm is up to 25 ppb). These indicators, against the background of mucoactive therapy, decreased to normal values by 6th day. The findings expand our understanding of АВ in adults. New results have been obtained on the role of CRP, IL-6 and NO in exhaled air during АВ. The use of erdosteine was accompanied by a significant mucoactive effect in the form of a pronounced regression of cough in patients with АВ compared to the comparison group in shorter term.

Clinical, epidemiological, and laboratory profiles of bacterial infection or colonization among patients hospitalized in COVID-19 and non-COVID-19 intensive care units (ICUs) in Southeast Pará

Objectives: To compare the clinical, epidemiological, and laboratory profiles of bacterial infection or colonization among patients hospitalized in COVID-19 and non-COVID-19 intensive care units (ICUs) in Southeast Pará, Brazil. Methods: This was a retrospective analytical study based on the analyses of electronic medical records and microbiological reports of patients admitted to the ICU of a regional hospital located in Pará in the Brazilian Amazon due to complications associated with COVID-19 and other causes from March 2020 to December 2021. The sample consisted of data from the medical records of 343 patients collected after approval by the ethics and research committee (opinion number 5281433)was granted. The data extracted from the bacteriological and antibiogram culture reports were analyzed to characterize the clinical-epidemiological profile of the patients. The data were transferred and tabulated in Microsoft Excel 2019 to conduct a descriptive analysis, and the associated statistical analyses were performed using Stata 17.0 statistical software. Results: Of the total patients, 59.5% were hospitalized in the COVID-19 ICU and 40.5% were hospitalized in the non-COVID-19 ICU. Most individuals admitted to the COVID-19 ICU and non-COVID-19 ICU were aged between 66 and 78 years and between 54 and 66 years, respectively. The hospitalization duration in the COVID-19 ICU was fewer than 15 days, whereas that in the non COVID-19 ICU was 15 to 30 days. Deaths were more frequent in the Covid-19 ICU compared to the non-Covid-19 ICU (64% versus 41%). In contrast, hospital discharge was more frequent in the non-Covid-19 ICU (58.3% versus 34.8%).The most prevalent comorbidity in both ICUs was circulatory system disease. Gram-negative bacteria were the most frequent etiological agent in both groups and were present in 63.1% of the cultures analyzed. Regarding the phenotypic profile of resistance, carbapenemase production was detected in 43.0% of the cultures analyzed. Multidrug resistance against antimicrobial drugs was more frequent in the non-COVID-19 ICU(55.7%). Most of the antimicrobial drug prescriptions for were empirical. Conclusions: The recurrence of secondary infections and bacterial colonization in both COVID-19 and non-COVID-19 ICU patients should not be underestimated. The clinical, microbiological, and bacterial resistance profiles elucidated in this study highlight the need to develop and implement holistic and assertive strategies to control and mitigate these problems. Which will contribute to an improved prognosis for patients and quality of life patients.

Examining the Veterinary Electronic Antimicrobial Prescriptions for Dogs and Cats in the Campania Region, Italy: Corrective Strategies Are Imperative.

Companion animals are increasingly being recognised as important contributors to the spread of antimicrobial-resistant bacteria. The present work aimed to measure the antimicrobial drug prescribing in dogs and cats in the Campania Region, Italy by analysing the Veterinary Electronic Prescriptions (VEPs) between 2019 and 2020. The medical records associated with antimicrobial drug prescriptions were collected according to the drug administration (systemic or topical) and the rationale for the treatment chosen. In the period under investigation, 166,879 drugs were prescribed of which 129,116 (73.4%) were antimicrobial. A total of 83,965 (65%) antibiotics were prescribed to dogs, 40,477 (31.4%) to cats, and 4674 (3.6%) to other companion animals. In dogs, 90.5% of VEPs prescribed for systemic treatment included an antimicrobial Critically Important or Highly Important or Important for human medicine (WHO, 2018). The most widely prescribed class was fluoroquinolones. The antimicrobials prescribed were mainly metronidazole-spiramycin (29.7%), amoxicillin-clavulanic (19.6%), enrofloxacin and cephalexin in dogs (16.5%) and enrofloxacin (22.6%) and amoxicillin-clavulanic acid (21.4%) in cats. Based on the results, the widespread use of broad-spectrum antimicrobials and the use of molecules for which limitations should be observed according to the EMA guidelines has emerged.

Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA.

Compared with notifiable disease surveillance, claims-based algorithms estimate higher Lyme disease incidence, but their accuracy is unknown. We applied a previously developed Lyme disease algorithm (diagnosis code plus antimicrobial drug prescription dispensing within 30 days) to an administrative claims database in Massachusetts, USA, to identify a Lyme disease cohort during July 2000-June 2019. Clinicians reviewed and adjudicated medical charts from a cohort subset by using national surveillance case definitions. We calculated positive predictive values (PPVs). We identified 12,229 Lyme disease episodes in the claims database and reviewed and adjudicated 128 medical charts. The algorithm's PPV for confirmed, probable, or suspected cases was 93.8% (95% CI 88.1%-97.3%); the PPV was 66.4% (95% CI 57.5%-74.5%) for confirmed and probable cases only. In a high incidence setting, a claims-based algorithm identified cases with a high PPV, suggesting it can be used to assess Lyme disease burden and supplement traditional surveillance data.

Advancing antimicrobial stewardship in companion animal veterinary medicine: a qualitative study on perceptions and solutions to a One Health problem.

The term antimicrobial stewardship (AMS) is used to describe the coordinated efforts and programs required to sustain the clinical efficacy of antimicrobials and slow the development of antimicrobial resistance. However, companion animal veterinarians are provided with few "cage-side" resources to achieve these goals. The aims of our study were to understand the current perceptions, attitudes, and knowledge of AMS among companion animal veterinarians and to source technology-based solutions that reduce barriers to judicious antimicrobial drug prescribing. 6 focus groups were conducted via a teleconference platform. The focus group recordings were transcribed and coded thematically using a grounded theory approach and inductive coding. A total of 25 companion animal veterinarians participated in 6, 1-hour focus groups. Two themes emerged from the data: (1) Veterinarians feel that AMS is important and understand the principles of AMS, but experience barriers to practicing judicious AMD use principles. (2) Veterinarians agree that technology can promote AMS, but express that a tool needs to support their prescribing decisions, provide accurate and concise stewardship information, and be integrated into the existing workflow. For an AMS technology tool to be successful in improving AMS in companion animal medicine, veterinarians need centralized information on antimicrobial use, improved access to geographical AMR patterns, and communication support with clients and their hospital teams.

The Microbiome and Antimicrobial Stewardship in Surgical Patients

Abstract The human microbiome plays a critical role in health and disease. The microbiota of the human body undergoes disruptions in critical illness, in part due to alterations in physiology but also as the result of medical interventions, most notably antimicrobial drug administration. These alterations may lead to a significant dysbiosis, with increased risks of multi-drug-resistant organism-based secondary infections, Clostridioides difficile promotion, and other infection-related complications. Antimicrobial stewardship is a process that seeks to optimize antimicrobial drug prescription, with recent evidence emphasizing shorter courses of therapy, earlier transitions from empiric to pathogen-specific regimens, and enhanced diagnostic testing. Through a combination of prudent stewardship and wise use of diagnostic testing, clinicians can improve outcomes, reduce the risk of antimicrobial resistance, and help improve the integrity of the microbiome.

Colorado pet owners' perceptions of and attitudes towards antimicrobial drug use and resistance.

Antimicrobial drug (AMD) use in companion animal medicine may contribute to antimicrobial resistance (AMR) in both pets and humans. However, pet owners' attitudes and perceptions regarding AMD use and AMR have not been extensively studied in the United States. A cross-sectional survey at five Colorado veterinary hospitals collected information about pet owners' knowledge and perceptions of AMD use and AMR, adherence with AMD treatment instructions and the role of the veterinarian in the AMD prescribing process. The petowners surveyed did not have an adequate understanding of AMR and were unaware of the potential human health impact of AMD use in pets. However, most pet owners reported adherence with veterinary prescription instructions and indicated that they trusted their veterinarian to make appropriate decisions for their pets. The cross-sectional design focusing on Colorado pet owners limits the generalisability of the results. Selection and social desirability biases may have occurred, which could have affected who participated and how participants responded to statements. Pet owners play an important role in the AMD prescription process, and their lack of AMR understanding should be addressed in antimicrobial stewardship plans. Further research on how to effectively incorporate pet owners into stewardship interventions is needed.

Evaluation of the Bactericidal Activity of Gramicidin S Against &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt; and &lt;i&gt;Staphylococcus aureus&lt;/i&gt; Clinical Isolates with Single and Multiple Exposure

Background . Sore throat of infectious and inflammatory origin is one of the most common reasons for the prescription of antimicrobial drugs. The use of antimicrobial peptides (AMPs) for topical therapy may be a promising solution, due to the peculiarities of AMPs’ mechanism of action, taking into account the high importance of microbial resistance spread problem in relation to systemic etiotropic drugs. The aim of the study was to assess the formation of resistance to AMP Gramicidin S (GS) of clinical isolates of Streptococcus pneumoniae and Staphylococcus aureus , including strains resistant to antimicrobial drugs during repeated exposure, in the setting close to their actual use in clinical practice. Materials and methods . The object under study is AMP GS. The test microorganisms are reference strains of S.pneumoniae (ATCC 6303), S.aureus (ATCC 6538–P), and 10 strains of clinical isolates of each type of microorganisms, types with antimicrobial resistance (including MRSA). At the first stage, the antimicrobial activity of GS was evaluated by the method of microdilutions in plates by estimating the value of the minimum inhibitory and the minimum bactericidal concentrations (MIC and MBC, respectively). At the second stage, using reference strains and 4 clinical isolates of each microorganism, including types with antimicrobial resistance, resistance was formed in two ways simultaneously (with liquid and solid media) for 7 consecutive passages over 7 days with GS at concentrations equal to 0.5 and 1.0 MIC. The number of surviving microorganisms was estimated and the MIC and MBC were determined at each passage. Results . At the first stage, the MIC of GS in relation to S.pneumoniae was 8 µg/ml for 5 strains, 16 µg/ml for 5 strains, and 4 µg/ml for one. For 10 out of 11 strains of S.aureus , including MRSA, the MIC of GS was 4 µg/ml (for 1 strain — 8 µg/ml). For 4 strains of S.pneumoniae , MBC of GS was equal to MIC (16 µg/ml), for 7 strains MBC was 4–8 times higher than MIC, and mostly amounted to 32 µg/ml (for 1 strain — 64 µg/ml). MBC for 6 strains of S.aureus was equal to MIC (4 µg/ml), for the 5 remaining strains MBC was 2–8 times higher than MIC, but did not exceed 64 µg/ml. At the second stage, it was found that the estimated values of GS MIC and MBC with repeated exposure to GS remained at the same level for 7 passages in all strains, including those resistant to antibiotics in liquid and solid media. Conclusions . Gramicidin S demonstrated high bactericidal activity against reference strains and clinical isolates of leading pathogenic microorganisms S.pneumoniae and S.aureus , including strains resistant to systemic antimicrobial drugs, while MIC and MBC did not exceed concentrations contained in single doses of drugs used in clinical practice. During repeated exposure (7 passages in 7 days), there were no signs of the formation of resistance of test strains of pathogens, including those resistant to systemic antimicrobial medicines from the groups of beta-lactams, macrolides, fluoroquinolones, tetracyclines, aminoglycosides, etc.

Antimicrobial Drug Prescription Patterns for Respiratory Tract Infections in Military Hospitals Lagos Nigeria.

Background: Antibiotics are powerful and effective medicines used for treating infections caused by bacteria. Of all the challenges faced due to antibiotics abuse, the greatest is antibiotic resistance. A major cause of antibiotic resistance is the wrong use of antibiotics in the management of diseases not caused by bacteria.Antibiotics are irrationally used in the treatment of viral infections as seen in many cases of respiratory tract infections. This study aims to evaluate the frequency of various RTIs, themanagement and factors that influence antimicrobial prescription patterns for various RTIs in Military Hospital Lagos, Lagos State, Nigeria. Methods: A cross-sectional study was conducted in Military Hospital Lagos where Data was obtained, using two designs of questionnaires, from prescribers and patient records. The target population was all patients treated for RTIs within a period of seven years and all prescribers who had treated patients for RTIs in Military Hospital Lagos. Post-Hoc Power Analysis with&nbsp; Dichotomous Endpoint was utilized in obtaining the sample size. Reliability tests of the instruments was obtained using Cronbach's Alpha. This involved descriptive statistical analysis, Chi-Square test, Binary Logistic regression analysis. The data used in the study were obtained from 209 patient records and 30 physicians. Results: In this study, it was observed that 196(93.8%) patients admitted at Military Hospital Lagos for RTI presented with Upper Respiratory Tract Infections (URTIs; cough, common cold, pharyngitis, tonsillitis), 11(5.3%) with Lower respiratory tract infections&nbsp; (LRTIs; pneumonia and bronchitis) and2(0.9) with COVID. Young patients&lt;45years&nbsp; (125) made up about 60% of the admissions. RTIs were more prevalent in females (111, 53.1%) than in males (98, 46.9%). It was observed that 21 (70%) physicians followed the Standard Treatment Guidelines (STG) in prescribing antibiotics for RTIs, 11(36.7%) physicians modelled their choice of&nbsp; antimicrobials after the senior consultants, 4(13.3%) on sensitivity results, 1(3.3%) on period preferences and 3(10%) on other factors. Out of 209 patients' records sampled, only 6(3%) patients underwent tests as ordered by their physicians before antibioticswere prescribed even though 21(70%) physicians claimed to follow the STG. Results of the laboratory investigation ordered implicated 6 individual organisms: Gram negative cocci, Enterobacter cloacae, E. coli, SARS CoV-2, Streptomyces pyogenes and Staphylococcus species. Conclusion: The gender of patient, physician educational qualification, observation of RTIs and frequency of RTIs significantly influence the antimicrobial prescription pattern for various RTIs in Military Hospital Lagos. In order to increase prescription quality, improve the rationality of drug use and reduce the prevalence of antibiotic resistance, we recommend the development of targeted intervention programs including but not limited to continuous enlightenment of physicians on strict compliance to the guidelines in the management of RTIs.

Factors associated with antimicrobial drug prescription among inpatient dogs and cats at an academic veterinary hospital

Background: Widespread antimicrobial use in dogs and cats drives antimicrobial resistance in both animals and humans. Knowledge of the factors associated with antimicrobial use is limited in veterinary medicine. We examined factors associated with antimicrobial drug prescription among inpatient dogs and cats at an academic veterinary hospital. Methods: A veterinary-adapted observational medical outcomes partnership common data model was utilized to extract demographic, clinical, and prescription data from the electronic medical record system in this descriptive observational study. Using generalized estimating equations, we assessed the association between demographic and clinical factors and systemic antimicrobial drug prescription among inpatient dogs and cats at a small-animal teaching hospital between 2018 and 2020. Results: Across 11,685 dogs with 14,328 admissions (mean age, 7.4 years; 47% females), the following factors were associated with increased odds of any antimicrobial drug prescription: female, longer admission, a history of chemotherapy within 30 days of hospital admission, surgery upon admission or within the last 30 days, urinary catheterization, ICU admission, and oxygen support. In 3,371 cats with 4,088 admissions (mean age, 8.6 years; 39% females), the following factors were associated with increased odds of any antimicrobial drug prescription: female, longer admission, increased age (&gt;8 years), admission into the ICU, surgery upon admission, and feline that did not require oxygen support or urinary catheterization. Conclusions: This study identifies multiple patient and clinical factors associated with increased risk of antimicrobial drug use in inpatient dogs and cats that can inform veterinary antimicrobial stewardship efforts and may be useful for antimicrobial use benchmarking on an institutional or multi-institutional scale.Funding: NoneDisclosures: None

Serial analysis of blood biomarker concentrations in dogs with pneumonia, septic peritonitis, and pyometra.

BackgroundProlonged antimicrobial drug (AMD) treatment is associated with antimicrobial resistance development. Biomarker measurement may aid treatment decision‐making.ObjectivesInvestigate temporal changes in blood biomarker concentrations in dogs undergoing treatment for pulmonary and intra‐abdominal infections; compare time to biomarker concentration normalization with duration of clinician‐directed AMD treatment.AnimalsForty‐two client‐owned dogs with pneumonia (n = 22), septic peritonitis (n = 10), or pyometra (n = 10).MethodsPlasma concentrations of C‐reactive protein (CRP), serum amyloid A (SAA), haptoglobin, procalcitonin, nucleosomes, cell‐free DNA (cfDNA), high‐mobility group box‐1 (HMGB1), CC‐motif chemokine ligand‐2 (CCL2), CXC‐motif chemokine ligand‐8 (CXCL8), and keratinocyte chemoattractant‐like (KC‐Like) were quantitated in samples collected on days 1, 3, 7, 14, 28, and 60. Treatment was directed by clinicians blinded to biomarker concentrations.ResultsConcentrations of CCL2, CRP, and KC‐Like were maximal on D1, concentrations of SAA, cfDNA, HMGB1, and nucleosomes were maximal on D3 and haptoglobin concentrations were maximal on D7. These maximal concentrations were significantly different from those on D60. Concentrations of CRP and SAA decreased by 80% from peak and into respective reference intervals before AMDs were discontinued. For CRP, the median (interquartile range [IQR]) times to 20% peak and normal were 7 (6‐9) and 7 (6‐12) days, respectively, and for SAA they were 4 (4, 5) and 6 (5‐8) days, respectively, compared to a median (IQR) duration of AMD prescribing of 16 (12‐23) days (all P < .0001).Conclusions and Clinical ImportanceBiomarker concentrations normalized within 7 to 14 days. Serial measurements of CRP and SAA might aid identification of disease resolution and could help guide AMD prescription decision‐making.

Survey of companion animal veterinarians' antimicrobial drug prescription practices and awareness of antimicrobial drug use guidelines in the United States.

Antimicrobial drug use in companion animal medicine, the subsequent development of antimicrobial resistance and the potential hazard of animals transmitting resistant bacteria to humans are of increasing concern. Antimicrobial prescription patterns among companion animal veterinarians in the United States are understudied, and the association between antimicrobial drug use guideline awareness and antimicrobial drug prescription practices is unknown. Information on antimicrobial recommendations for five hypothetical clinical scenarios, including canine pyoderma, acute canine diarrhoea, feline lower urinary tract illness, canine dental procedures and feline upper respiratory illness, was gathered using an anonymous, online cross-sectional survey. A logistic regression approach was used to assess the association between self-reported awareness of antimicrobial drug use guidelines and prescribing recommendations for the five hypothetical scenarios. Responses (n=2,410) indicated antimicrobial drugs were commonly recommended for the five hypothetical clinical scenarios. After controlling for key demographic characteristics, prescribers who reported an awareness of existing antimicrobial drug use guidelines were significantly less likely to recommend antimicrobial drugs for the scenarios describing feline lower urinary symptoms, feline upper respiratory illness and canine acute diarrhoea. Results from hypothetical clinical scenarios point to the possibility for widespread unsupported prescribing of antimicrobial drugs in companion animal medicine. Additionally, results provide evidence of an association between awareness of antimicrobial drug use guidelines and lower prescribing levels for certain hypothetical disease presentations.

Presumed Urinary Tract Infection in Patients Admitted with COVID-19: Are We Treating Too Much?

Despite the low rates of bacterial co-/superinfections in COVID-19 patients, antimicrobial drug use has been liberal since the start of the COVID-19 pandemic. Due to the low specificity of markers of bacterial co-/superinfection in the COVID-19 setting, overdiagnosis and antimicrobial overprescription have become widespread. A quantitative and qualitative evaluation of urinary tract infection (UTI) diagnoses and antimicrobial drug prescriptions for UTI diagnoses was performed in patients admitted to the COVID-19 ward of a university hospital between 17 March and 2 November 2020. A team of infectious disease specialists performed an appropriateness evaluation for every diagnosis of UTI and every antimicrobial drug prescription covering a UTI. A driver analysis was performed to identify factors increasing the odds of UTI (over)diagnosis. A total of 622 patients were included. UTI was present in 13% of included admissions, and in 12%, antimicrobials were initiated for a UTI diagnosis (0.71 daily defined doses (DDDs)/admission; 22% were scored as ‘appropriate’). An evaluation of UTI diagnoses by ID specialists revealed that of the 79 UTI diagnoses, 61% were classified as probable overdiagnosis related to the COVID-19 hospitalization. The following factors were associated with UTI overdiagnosis: physicians who are unfamiliar working in an internal medicine ward, urinary incontinence, mechanical ventilation and female sex. Antimicrobial stewardship teams should focus on diagnostic stewardship of UTIs, as UTI overdiagnosis seems to be highly prevalent in admitted COVID-19 patients.

Cross-sectional Study to Clarify the Status of Antimicrobial Drug Prescription in dental outpatient care Study to Clarify the Status of Antimicrobial Drug Prescription in dental outpatient care

Cross-sectional Study to Clarify the Status of Antimicrobial Drug Prescription in dental outpatient care Study to Clarify the Status of Antimicrobial Drug Prescription in dental outpatient care

Commentary: Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter.

“Superbugs” are the antimicrobial-resistant microorganisms. Bacteria, viruses, fungi, and parasites acquire the ability to evade the antimicrobial drug effects, not only to survive but also, in some cases, become more virulent. As such, the existing antimicrobial drugs are no longer effective and useful in treating the infections (used to be treatable). Superbug-induced infections are the major worldwide health concern with higher human mortality and an increased financial burden on society. The underlying mechanism of the evolvement of drug-sensitive to drug-resistant microorganisms is an extremely complex phenomenon. It is partly related to microorganism's unique ability to modify their genetic structures and biochemical functionality to survive and keep growing even in the presence of antimicrobial drugs. Since there are multiple factors involved in developing antimicrobial drug resistance, it cannot be reversed by adopting a single prevention strategy. Of importance, certain bacterium may not require antimicrobial drug exposure to develop resistance, as surrounding environmental exposure can facilitate the resistance. Consistent misuse and overuse of antimicrobial drugs by healthcare professionals and consumers with its extensive use in food and meat production have put human health at risk. Lack of resources for research and low interest in developing the newer generation of antimicrobial drugs are also contributing to the evolution of superbugs. Without global involvement, partnership and collaboration, superbug-induced morbidity and mortality will be unmanageable in the future. To address this impending global health crisis, in May 2015, the World Health Organization (WHO) assembly adopted a global action plan to combat the antimicrobial resistance, that include (1) to increase the awareness of antimicrobial resistance, (2) to advance research and surveillance, (3) to cut down the rate of infections through preventive measures, (4) to ensure the optimal use of antimicrobial drugs, and (5) to develop sustainable investment, taking into account the needs of the countries, to develop novel interventions. Unfortunately, implementing such WHO measures have both financial and logistic hurdles, and the rates of superbug-induced infections are alarmingly increasing. A recently published article in “Frontiers in Public Health” has highlighted the importance of microbial resistance movements to reduce the burden of superbug-induced infections (1). The authors have elaborated on the genesis of antimicrobial drugs and listed the challenges of producing the newer generation of drugs to combat existing drug-resistant pathogens (1). Although the authors briefly touched on the irrational prescription of antimicrobial drugs in the both developed and developing countries, the review article did not discuss in depth the regulatory enforcement procedures to minimize the antimicrobial resistance (1). The opportunities and challenges of global standardization of the antimicrobial prescription processes were not explained in detail in the publication (1). Another critical area that was not emphasized enough in the article was the use of the antimicrobial drugs on animals and its potential consequences in developing antimicrobial resistance. This commentary will briefly elaborate on the cross-species transmission of resistant pathogens from animal to human. Appreciating that one single review article cannot cover all the aspects of antimicrobial resistance, the authors have fittingly highlighted the scientific and economic challenges that are hindering the novel antimicrobial drug development (1). The publication has justifiably concluded that antimicrobial resistance is a multifaced issue driven by numerous interrelated factors, and therefore, the use of any single intervention would have limited success (1). Recent publications have also emphasized why implementing an antimicrobial stewardship program is necessary to prepare the future medical professionals to enhance their awareness and knowledge of antimicrobial resistance to reduce the disease burden related to superbug-mediated infections (Figure 1) (2, 3). Open in a separate window Figure 1 Schematic diagram showing the main steps needed to be implemented to minimize the antimicrobial drug resistance (2).

Prevalence of and rationale for antimicrobial prescription during ambulatory care visits in Japan: a prospective, multicentre, cross-sectional study

ObjectiveTo determine the rate of outpatient antimicrobial use and the rationale for antimicrobial prescription.DesignA prospective, multicentre, cross-sectional study.SettingAmbulatory care settings at community general hospitals.ParticipantsA total of 1972 consecutive ambulatory visits...