Use Of Antimicrobial Drugs Research Articles

Стратегия эффективного административного контроля антимикробной терапии в отделении реанимации и интенсивной терапии хирургического профиля: ретроспективное пилотное исследование.

Objective: To evaluate a strategy for effective administrative control of targeted antimicrobial therapy in surgical intensive care unit (ICU) patients. Materials and methods. The study included 3522 patients who were treated in ICU No. 1 in the period 2022 to 2023. The first group (control), treatment period 2022, included 1764 patients. The second group (research), treatment period 2023, included 1758 patients. In both groups, the use of antimicrobial drugs (AMP) was carried out in accordance with the antibacterial therapy control strategy (ASCT); in group 2, systemic administrative control was additionally carried out in the form of the use of the “Effective Hospital” program and a developed analytical system with monitoring the financial stability of the unit, aimed at daily monitoring of operating activities. A comparative analysis of the frequency of use of various classes of antimicrobial agents, the incidence of infectious complications, mortality rates and financial costs between groups was performed. Results. There was a significant decrease in the consumption of AMPs of the carbapenem group from 8194 vials in 2022 to 6577 vials in 2023, which was a decrease of 19.7%; a decrease in the consumption of tetracycline group AMPs in 2023 compared to 2022, from 2338 bottles to 1581 bottles, which amounted to 32.4%; reduction in the consumption of vancomycin and linezolid in 2023 compared to 2022 from 562 vials to 313 vials, which amounted to 44.3%. There was a decrease in the incidence of VAP from 59.3 (57.6; 62.9) in 2022 to 48.1 (38.65; 61.9) units in 2023, which amounted to 10.8% (p = 0.053). The increase in the frequency of deaths from 10.9% (9.1; 12.4) in 2022 to 11.5% (10.5; 12.7) in 2023 did not have significant differences (p = 0.67). The total expenditure on AMP in 2023 significantly decreased by 22.3%, which allowed saving 1,477,205.53 rubles (p = 0.012). Conclusion. The use of a daily strategy of administrative control of operational activities and the use of antimicrobial therapy in the ICU can reduce the costs of expensive antimicrobial agents, reduce the incidence of nosocomial infectious and inflammatory complications without changing overall mortality.

The effect of local use of etiotropic drugs on the oropharyngeal microbiota in children with acute respiratory infection

Introduction. The microbiota of the oral cavity and oropharynx, actively interacts with the epithelium of the mucous membrane and the immune system, creates antagonistic conditions for the growth and reproduction of pathogens. Microbiocenosis-preserving therapy can provide conditions for maintaining colonization resistance and reduce the likelihood of adhesion of respiratory viruses.Aim. To evaluate the effect of local use of various antimicrobial drugs on the microbiota of the oropharyngeal mucosa in children with acute respiratory infection.Materials and methods. 120 children (5–10 years old) with acute respiratory infection were divided into three groups, in which they were used as part of complex therapy: in group 1st – hexetidine-containing aerosol, in group 2nd – a children’s spray containing gramicidin S and cetylpyridinium chloride, in the 3rd – 0.01% solution of benzyldimethyl-myristoylamino-propylammonium. On the 1st and 12th days of observation, participants had a throat swab taken to study the state of the oropharyngeal microbiota using 16S rRNA sequencing. The results obtained were compared with those of healthy peers.Results. According to sequencing data, the microbiota of participants in all groups before treatment differed from the microbiota of healthy peers in terms of alpha and beta diversity, as well as in the results obtained by the nearest balance method. Local use of antiseptic drugs influenced the microbiota at the level of species and genera of microorganisms. After treatment in the 2nd group, in contrast to the 1st and 3rd, statistically significant changes in the balances at the level of microorganism species were revealed towards the indicators of healthy peers.Conclusions. A combined drug containing cetylpyritinium chloride and the bacteriocin-like antimicrobial peptide gramicidin S demonstrated no negative effect on commensal microbiota and contributed to the stabilization of the regional microbiota.

In vitro evaluation of the susceptibility of bacterial biofilms to hecogenin acetate

Biofilms are a bacterial resistance strategy through which microorganisms organize themselves in the form of a colony fixed to a surface that is protected by a polymer matrix. Infectious diseases that result in biofilm formation have been considered a relevant public health problem due to the potential to increase patient morbidity and mortality, in addition to increasing the burden on health services. Such pathologies are treated with the use of antimicrobial drugs, the indiscriminate use of which has contributed to the process of bacterial resistance, demanding the need to invest in new alternatives to combat them. Based on this, the present work aimed to evaluate the anti-biofilm formation and eradication capacity of Hecogenin Acetate, a steroidal sapogenin of natural origin with important antibacterial properties. For this, we used strains of Streptococcus mutans INCQS 00,446 (ATCC 25,175), Enterococcus faecalis INCQS 00,018 (ATCC 14,506), Staphylococcus epidermidis INCQS 00,016 (ATCC 12,228), Staphylococcus aureus ATCC 25,923, Pseudomonas aeruginosa ATCC 9027 and Escherichia coli ATCC 259,223. The formation, formation inhibition and treatment assays were carried out in microdilution plates and revealed using the crystal violet method. Readings were carried out using absorbance at wavelengths of 492 nm. All tests were performed in triplicate and statistical analyzes were performed using Graphpad Prism v.5.0 software. It was observed that the bacterial strains used have a relevant capacity for biofilm formation, with the Gram positive ones identified in the present study as the best former. In the results of the analyzes with bacterial biofilm, it was identified that Hecogenin Acetate had a relevant antibiofilm capacity, and could therefore serve as a basis for further research into the development of new antimicrobial drugs.

Novel coronavirus infection (COVID-19) — clinical recommendations

The treatment of patients with a new coronavirus infection (COVID-19) is the cornerstone of practical healthcare. This is due to the widespread and unjustified use of antimicrobial drugs, the use of irrational antiviral therapy schemes. Also, the discussion regarding the use of systemic glucocorticosteroids and monoclonal antibodies continues to this day. In this publication, based on research data and own clinical observations, clinical recommendations for COVID-19 pharmacotherapy are presented.

Antimicrobial residues in meat from chickens in Northeast Vietnam: analytical validation and pilot study for sampling optimisation

Antimicrobials used in chicken farming for therapeutic and/or prophylactic purposes may result in unacceptable levels of edible residues, if withdrawal periods are not respected. To evaluate the risk in Vietnam, we validated an analytical method to detect antimicrobial residues from chicken meat samples and carried out a pilot cross-sectional study to identify optimal sampling strategies. A total of 45 raw meat samples were collected from 4 markets, 1 slaughterhouse and 4 farms (5 per site) in Northern Vietnam, between March and April 2021. Farmers were asked about antimicrobials used during sampled production cycles (5 chickens sampled per batch). Samples were analysed using liquid chromatography-tandem mass spectrometry for the presence of 68 antimicrobials at a pre-defined validation concentration. 7 compounds were identified from 4 classes (tetracyclines, sulphonamides, macrolides, and fluoroquinolones). In markets, where the source of sampled chickens was unknown, a diverse pool of residual antimicrobials was detected in 20% (4/20) of the meat samples. No residues were detected in samples from the slaughterhouse. No residues were detected in chickens from the one farm that reported using antimicrobials, whereas sulfadimethoxine, doxycycline and tilmicosin residues were identified from the other 3 farms reporting no antimicrobial use. The probability of detecting antimicrobial residues present in a flock based on sampling a single chicken was estimated at 0.93 (highest density interval 0.735–0.997). The preliminary results suggest a disparity between farmers’ reports on antimicrobial drug use and actual usage, and that the analysis of a single sample per farm has a high probability of detecting antimicrobial residues, if present.

Development of an Evaluation System for the Prophylactic Use of Antimicrobial Drugs in the Perioperative Period of Class I Surgical Incisions in Neurosurgery

BackgroundThis study aimed to establish a precise preoperative high-risk factor scoring system and algorithm for antibiotic prophylaxis decision-making, provide guidance for the judicious use of AMP, refine interventions, and ensure the appropriate application of AMP for class I incisions in neurosurgery. Study DesignAccording to PRISMA guidelines, Literature searches, study selection, methodology development, and quality appraisal were performed. The quality of evidence across the study population was assessed using the Newcastle-Ottawa Scale. A two-round Delphi expert consultation method involved 15 experts from leading tertiary hospitals in China. Establishing an algorithm of SOPs for perioperative antimicrobial prophylaxis in Class I neurosurgical incisions. ResultsThirteen studies, encompassing 11,936 patients undergoing clean neurosurgical procedures, were included. 791 patients experienced SSI, resulting in an average incidence of 6.62%. Identified risk factors significantly associated with an increased incidence of postoperative SSI (P < 0.05) included emergency surgery, preoperative hospitalization ≥7 days, intraoperative blood loss ≥300 mL, operation time ≥4 hours, diabetes mellitus, cerebrospinal fluid leakage, and repeat surgery. Sensitivity analysis demonstrated robust results for emergency surgery, intraoperative blood loss ≥300 mL, operation time ≥4 hours, cerebrospinal fluid leakage, and repeat surgery. Established a risk assessment system for Class I neurosurgical incisions by the Delphi method. Additionally, we have formulated an algorithm of SOPs for perioperative antimicrobial prophylaxis in Class I neurosurgical incisions. ConclusionsThe established index for AMP utilization and SOPs in the preoperative period of class I neurosurgical incisions proves valuable, contributing to improved patient outcomes in neurosurgical procedures.

Antimicrobial Susceptibility in Respiratory Pathogens and Farm and Animal Variables in Weaned California Dairy Heifers: Logistic Regression and Bayesian Network Analyses.

Weaned dairy heifers are a relatively understudied production group. Bovine respiratory disease (BRD) is the most common cause of antimicrobial drug (AMD) use, morbidity, and mortality in this production group. The study of antimicrobial resistance (AMR) is complicated because many variables that may affect AMR are related. This study generates hypotheses regarding the farm- and animal-level variables (e.g., vaccination, lane cleaning, and AMD use practices) that may be associated with AMR in respiratory isolates from weaned dairy heifers. A cross-sectional study was performed using survey data and respiratory isolates (Pasteurella multocida, Mannheimia haemolytica, and Histophilus somni) collected from 341 weaned dairy heifers on six farms in California. Logistic regression and Bayesian network analyses were used to evaluate the associations between farm- and animal-level variables with minimum inhibitory concentration (MIC) classification of respiratory isolates against 11 AMDs. Farm-level variables associated with MIC classification of respiratory isolates included the number of source farms of a calf-rearing facility, whether the farm practiced onsite milking, the use of lagoon water for flush lane cleaning, and respiratory and pinkeye vaccination practices. Animal-level variables associated with a MIC classification included whether the calf was BRD-score-positive and time since the last phenicol treatment.

Etiological structure, clinical and epidemiological characteristics of bloodstream infections caused by resistant microorganisms among COVID-19 patients

Infectious diseases caused by resistant pathogens are a serious public health problem. Generalized forms of resistant infections involving the vascular system in the pathological process are often associated with the irrational use of antimicrobial drugs. The pandemic of a new coronavirus infection (COVID-19) was a significant factor that determined further negative trends in the development of antibiotic resistance. The aim of the study was to investigate the spectrum of microorganisms and analyze clinical and epidemiological data in patients with COVID-19 and bloodstream infections caused by resistant bacterial pathogens in the first 10 months of the pandemic. It has been shown that resistant gram-negative microorganisms are the leading etiological cause of bloodstream infections among hospitalized patients. A. baumannii, as a mono-etiological agent or as part of microbial associations, is the predominant causative pathogen of generalized infections in COVID-19 patients. A high level of comorbidity according to the Charlson index and previous courses of antibiotic therapy can be regarded as potential out-hospital predictors of contamination by resistant pathogens. The severe course of the COVID-19 including of the phenomenon of immunosuppression and the occurrence of sepsis determine the high level of hospital mortality. The addition of generalized infections is an extremely unfavorable factor that worsens the prognosis for recovery.

Этиологическая структура и антибиотикорезистентность возбудителей сепсиса у больных COVID-19

The purpose — to study the etiological structure and antibiotic resistance of sepsis pathogens in patients with COVID-19. Material and methods. A retrospective observational, uncontrolled study was conducted. We analyzed the results of an examination survey of 584 patients with severe and extremely severe forms of COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital in Kazan from April 1, 2020 to October 1, 2022. Identification of the pathogen in blood and other biological materials was carried out using a Microflex LT Bruker mass spectrometer. The antibiotic sensitivity of the isolated bacterial strains was determined by the disk diffusion method using an ADAGIO analyzer (France). Results. Various types of bacteria were isolated from the blood of 76 (13%) patients with severe and critical forms of COVID-19, including: A. baumannii (23.7%), K. pneumoniae (19.7%), S. haemolyticus (19.7%), S. aureus (7.9%), E. faecium (11.8%), E. faecalis (7.9%), E. coli (3.9%), R. planticola (2.6%), P. aeruginosa (2.6%), S. pneumoniae (2.6%), S. maltophilia (1.3%), and B. cereus (1.3%). In 15 patients (19.7%) associations of 2–3 types of bacteria were isolated from the blood. A. baumannii isolates were resistant to carbapenems (94.5%), fluoroquinolones and aminoglycosides (100%), and trimethoprim-sulfamethoxazole (83.3%) strains. K. рneumoniae strains were resistant to carbapenems (60%), cephalosporins (cefixime, ceftazidime) (73.3%), fluoroquinolones (ciprofloxacin) (80%), aminoglycosides (60%), and semisynthetic penicillins (100%). 33.3% of S. aureus strains were resistant to trimethoprim-sulfamethoxazole, 16.7% — to oxacillin, erythromycin and gentamicin. Resistance of S. haemolyticus to trimethoprim-sulfamethoxazole was detected in 86.7%, to erythromycin — in 80%, to norfloxacin — in 50% of strains. 93.3% of S. haemolyticus strains were methicillin-resistant. 88.9% of E. faecium strains were resistant to ampicillin, 22.2% to tigecycline, 11.1% to linezolid. 50% of E. faecalis strains were resistant to norfloxacin, 16.7% of strains were resistant to amoxicillin, ampicillin and piperacillin. P. aeruginosa 50% of strains were resistant to levofloxacin. R. planticola was resistant to all antibiotics tested. S. maltophilia demonstrated sensitivity to co-trimoxazole only with increased exposure. Conclusion. Bacterial sepsis was diagnosed in 13% of severe and extremely severe patients with COVID-19. The etiological structure of sepsis includes a wide range of pathogens with a predominance of multi-resistant bacteria from the group of ESKAPE pathogens. Data on the etiological structure and antibiotic resistance of isolated pathogens should be taken into account for the rational use of antimicrobial drugs in the treatment of sepsis in patients with COVID-19.

Determining knowledge of antimicrobial therapy in practitioners (results of the KANT-IV project)

Objective. To determine the level of knowledge of doctors on the rational use of antimicrobial drugs in clinical practice and to compare with data of the previous stage of the study and results obtained from students in a parallel project. Materials and Methods. A multicenter questionnaire survey of practitioners with analysis of results – stage of KANT project (full name of the project – «Physicians’ (Students’) knowledge in antimicrobials usage») conducted in 2020–2023. Results. A total of 336 participants were surveyed in 5 centers (10 Russian regions: Belgorod, Novosibirsk, Rostov, Voronezh, Lipetsk, Sakhalin, Primorsky, Krasnodar, and Krasnoyarsk regions, Republic of Tatarstan). The average level of correct answers (LCA) for the whole questionnaire was 47.5% (taking into account the extended analysis of sub-items questions No. 8 and 9 – 46.8%). Doctors showed the best results in answering questions about the time interval during which the effectiveness of antimicrobial therapy is evaluated (LCA – 84.2%); about choosing the most rational action if antimicrobial therapy (AMT) has a positive clinical effect, but requires a long course of therapy (LCA – 72.6%); selection of rational diagnostic/treatment action in the diagnosis of acute tonsillitis or pharyngitis, in a case where etiologic diagnosis is required (LCA – 63.1%). The worst results were recorded in answering to the following questions: indication of the antimicrobial drug of choice in the treatment of various infections (LCA – 29.1%); the choice of auxiliary drugs in addition to the justified appointment of antimicrobial drugs in the treatment of bacterial infections of the respiratory tract for the entire period of the disease or in certain phases (LCA – 26.6% – 35.1%); indication of a combination of antimicrobial drugs that is irrational to prescribe in clinical practice due to a similar mechanism and/or spectrum of activity against pathogens (LCA – 24.4%). Significant differences were found between centers in a number of questions, between physicians in KANT-III and KANT-IV projects (p &lt; 0.001), and between physicians and students in a parallel project (KANT-IV students, LCA – 42.6%, p &lt; 0.001). Conclusions. An unsatisfactory level of physicians’ knowledge of AMT and choice of adjuvant agents, as well as appropriateness of antimicrobial combination was found. The authors believe there is a need for making more efforts in areas of increasing physicians’ compliance to clinical recommendations, expertise and quality control of pharmacotherapy, recruitment of clinical pharmacologists; to optimize the educational process in universities, to expand the scope and availability of additional educational programs within the system of continuous education, as well as to train physicians in using modern sources of scientific medical information.

Antibacterial efficacy of copper-based metal-organic frameworks against Escherichia coli and Lactobacillus.

The widespread and excessive use of antimicrobial drugs has resulted in a concerning rise in bacterial resistance, leading to a risk of untreatable infections. The aim of this study was to formulate a robust and efficient antibacterial treatment to address this challenge. Previous work focused on the effectiveness of the Cu-BTC metal-organic framework (MOF; BTC stands for 1,3,5-benzenetricarboxylate) in combatting various bacterial strains. Herein, we compare the antibacterial properties of Cu-BTC with our newly designed Cu-GA MOF, consisting of copper ions bridged by deprotonated gallate ligands (H2gal2-), against Escherichia coli (E. coli) and Lactobacillus bacteria. Cu-GA was synthesized hydrothermally from copper salt and naturally derived gallic acid (H4gal) and characterized for antibacterial evaluation. The gradual breakdown of Cu(H2gal) resulted in a significant antibacterial effect that is due to the release of copper ions and gallate ligands from the framework. Both copper MOFs were nontoxic to bacteria at low concentrations and growth was completely inhibited at high concentrations when treated with Cu-BTC (1500 μg for E. coli and 1700 μg for Lactobacillus) and Cu-GA (2000 μg for both bacterial strains). Furthermore, our agarose gel electrophoresis results indicate that both MOFs could disrupt bacterial cell membranes, hindering the synthesis of DNA. These findings confirm the antibacterial properties of Cu-BTC and the successful internalization of Cu2+ ions and gallic acid by bacteria from the Cu-GA MOF framework, suggesting the potential for a sustained and effective therapeutic approach against pathogenic microorganisms.

Investigation of hospital-acquired infections prevalence and analysis of influencing factors: a case study of a specialized infectious disease hospital in Chongqing, 2017-2023.

This study aimed to investigate the prevalence of hospital-acquired infections (HAIs) and their main influencing factors in a specialized infectious disease hospital in Chongqing from 2017 to 2023, providing reference for the formulation of precise infection control measures. A retrospective cross-sectional survey method was employed, combining bedside investigations with medical record reviews. Surveys were conducted on all hospitalized patients on a certain day of the last week of October each year from 2017 to 2023. Data collected included patients' basic information, diagnosis, and hospital infection status. Statistical analysis, including retrospective case-control and multivariable logistic regression analysis, was performed to identify the risk factors for hospital infections. The investigation compliance rate for the prevalence of HAIs in the specialized infectious disease hospital in Chongqing from 2017 to 2023 was greater than 96% each year. The prevalence rate of HAIs ranged from 0.89 to 2.52%. Hospital infection departments were mainly concentrated in general internal medicine, tuberculosis, and HIV/AIDS departments, accounting for 31.25, 26.25, and 23.75%, respectively. The most common infection site was the lower respiratory tract (54.22%), followed by bloodstream and urinary tract infections, each accounting for 9.64%. The predominant pathogens of hospital infections were Klebsiella pneumoniae and fungi. The utilization rate of antimicrobial drugs ranged from 20.75 to 33.25%, primarily for monotherapy. The rate of pathogen testing for therapeutic antimicrobial drug use was 82.84%, meeting national requirements. Multivariable logistic regression analysis revealed that the use of antibiotic (OR = 7.46, 95%CI 2.54-21.89, p < 0.001) and the presence of cardiovascular diseases (OR = 26.69, 95%CI 6.69-106.54, p < 0.001) increased the risk of HAIs. The prevalence of HAIs in specialized infectious disease hospitals remains stable, primarily concentrated in departments such as general internal medicine, tuberculosis, and HIV/AIDS. The lower respiratory tract is the main infection site, and comorbid cardiovascular diseases and antibiotic use are risk factors for HAIs. Therefore, to reduce the risk of hospital infections, it is necessary to strengthen the daily monitoring of key departments and the care of key patients. Further implementation of precise and effective infection control measures, including rational antibiotic use, regular infection monitoring and pathogen culture is warranted.

Проблема антибиотикорезистентных штаммов и её решение

Antibiotic resistance is a global health problem around the world and is a type of antimicrobial resistance. Solving it requires concerted efforts on a global scale. The main antibiotic-resistant microorganisms are Enterococcus spp., Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Helicobacter pylori. Many countries have programs aimed at preventing the development of antibiotic resistance, as well as stimulating the development of new drugs with antimicrobial activity. Many scientific works are devoted to this topic. The rational use of available antimicrobial drugs, considering the spectrum of their activity and the antibiotic resistance profile of the main pathogens, is becoming increasingly necessary. The purpose of this study was to examine interventions aimed at combating the growing antibiotic resistance in the world. The basic principles of the development of these problems and mechanisms of antibiotic resistance are shown. The mechanism is mainly associated with the evolution of microorganisms of a phenotypic and genetic nature. An analysis of antibiotic-resistant strains was carried out, their characteristics were given, and methods for studying antibiotic resistance to antibacterial drugs were reflected. The diffusion method and the dilution method for assessing sensitivity are described. The problem of antibiotic resistance has been confirmed by many studies in various departments, especially surgical ones and in intensive care units. In Kazakhstan, the main antibiotic-resistant pathogens are considered Acinetobacter spp., Enterococcus spp., Haemophilus influenza, Pseudomonas spp., streptococci, staphylococci and enterobacteriae. The main measures to prevent this problem are control over the use of antibiotics, the development of new drugs, namely new antibiotics and bacterial lysates based on thtse microorganisms.

ANALYSIS OF THE DYNAMICS OF UROPATHOGENS ANTIMICROBIAL RESISTANCE IN PATIENTS OF MULTI-SPECIALTY HOSPITAL

Urinary tract infections are among the most common bacterial infections. Currently, one of the main problems of therapy, as for the infections of other localizations, is the high level of antibiotic resistance. Timely prescribed and adequately selected antimicrobial therapy is the main factor determining the treatment outcome. The aim of the study. To carry out dynamic analysis of the etiological structure of urinary tract microflora and to assess antibiotic resistance of the most significant uropathogens in patients of the Clinics of the Irkutsk State Medical University (Clinics of ISMU) in order to optimize the use of antimicrobial drugs in a multidisciplinary hospital. Materials and methods. We analyzed bacterial strains (n = 2414) collected from urine of patients treated at the Clin-ics of ISMU from 2018 to 2022. Microbiological examination of urine was conducted in bacteriological laboratory of the Clinics of ISMU. Results. During the study period, E. coli remained the main uropathogen. There has been an increase in antibiotic resistance of E. coli to the main antimicrobial agents which are traditionally used to treat urinary tract infections, including fluoroquinolones and third-generation cephalosporins. There is an increase in the frequency of detection of E. coli strains producing extended-spectrum b-lactamases from 5.4 % to 12.4 %. Meropenem and nitrofurantoin retain the greatest activity against E. coli. Conclusion. The results of this study indicate the need to strengthen control over the use of antimicrobial agents in medical organizations, the importance of constant microbiological monitoring in order to identify the characteristics of local antibiotic resistance and update protocols for empirical treatment of urinary tract infections.

Viability of Bacillus coagulans spores with ofloxacin &amp; ornidazole: Implications for gut health

The balance of gut microbiota significantly impacts host health. Disruption of the natural gut flora, often caused by infections or the use of broad-spectrum antimicrobial drugs, can lead to dysbiosis, causing gastrointestinal disorders, such as diarrhea. Probiotics show promising outcomes in restoring gut health, but concerns remain about their interaction with antimicrobials and the viability of spores in the intended gut location. To address these uncertainties, the current study was devised to evaluate how well spores-forming bacteria endure and develop in an environment where antimicrobial agents are present.: The study investigated the survival and growth of spores under the influence of broad-spectrum antimicrobial agents, Ofloxacin and Ornidazole. To cultivate the spores in the presence of these antimicrobials, a mixture of MRS broth and PNY agar media was used. The number of colonies that developed were measured to assess the extent of spore survival and germination.In a simulated environment resembling human intestinal pH, spores exhibited viability. Starting with an initial count of 1.38 billion CFU, the spores multiplied to 8.75 billion CFU at 24 hours and further reached to 86.25 billion CFU at 72 hours in the presence of Ofloxacin and Ornidazole. On the other hand, the viable count reached to the level of 88 billion CFU in the absence of antimicrobial agents.This study offers evidence that spores are able to remain viable and germinate when co-administered with Ofloxacin and Ornidazole.

Factors and challenges contributing to antimicrobial resistance in East African pastoral settings and importance of One Health approach

Abstract Antimicrobial resistance (AMR) is acknowledged as a One Health dilemma because resistant microbial and genes are swiftly appearing and spreading worldwide across humans, animals and the environment. Livestock owners in East African pastoral regions face significant financial and socio-economic challenges owing to animal diseases that can be particularly severe in remote areas, where communities rely solely on their livestock for subsistence. Unfortunately, providing veterinary services in these regions is challenging because of the inadequate infrastructure and limited resources. Consequently, pastoralists may resort to self-medicating their animals, often using antimicrobials in ways that can contribute to the emergence of AMR. Prolonged use, overuse, or misuse of antimicrobial drugs in both human and animal populations in low-income East African pastoral settings is a significant factor that contributes to the emergence of AMR in these regions. Similarly, a significant factor contributing to the spread of AMR in pastoral regions is the disregard for withdrawal periods by pastoralists, owing to a lack of awareness about AMR. Inadequate sanitation protocols and limited access to uncontaminated water sources are additional factors contributing to the dissemination of AMR pathogens in both animals and humans. This leads to critical public health concerns that hinder effective antimicrobial treatment, reduce animal productivity, and have economic consequences for pastoralists. Addressing the challenges associated with AMR requires a comprehensive, multi-sectoral approach that can facilitate the coordinated surveillance and monitoring of AMR, promote the rational use of antimicrobials, advocate for alternative disease prevention and management strategies, and raise awareness among communities and healthcare professionals in pastoral areas about the emergence of AMR. The challenges and factors contributing to AMR in pastoral settings are complex; however, the One Health approach offers a promising strategy for reducing the risk of AMR. This review aims to present a comprehensive overview of the factors and challenges associated with AMR in pastoral settings, and proposes the adoption of a One Health approach as a solution to this pressing issue. One Health impact statement The review highlights that antimicrobial resistance (AMR) in East African pastoral settings is a significant issue that contributes to the emergence and spread of AMR worldwide. Prolonged use, overuse, or misuse of antimicrobials in human and animal populations is a significant factor in the emergence of AMR in these settings. The challenges and factors contributing to AMR in pastoral settings are intricate and call for a multi-faceted approach that encourages rational use of antimicrobials, promotes alternative prevention and management methods, and enhances awareness among Eastern African pastoral communities. The article highlights the significance of adopting the One Health approach in mitigating the hazards of AMR in these settings.

BACTERIAL ENDOMETRITIS OF COWS AND THE CURRENT STATUS ITS ETIOTROPIC THERAPY

In the article a literature review related to the etiology, epizootology, pathogenesis, clinical symptoms of endometritis in cows and modern means of its etiotropic therapy is provided. Postpartum endometritis is considered one of the most common diseases in cows, causing great economic losses to dairy operators, due to the increase in the number of unfertilized cows after repeated artificial insemination, the increase of the service period and the percentage of culled cows, treatment costs, decrease in milk yield, etc.&#x0D; The main role in the etiology of endometritis in cows in the postpartum period is assigned to bacterial opportunistic microflora. In the etiology of endometritis, the basic role is played by Staphylococcus spp., Streptococcus spp. and Escherichia coli. Other bacteria can cause endometritis in cows, such as: Actinomyces pyogenes, Fusobacterium necrophorum, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Prevotella spp., Bacteroides spp. In many cases, acute postpartum endometritis in cows is caused by the association of microorganisms, especially Escherichia coli with streptococci and staphylococci.&#x0D; Microorganisms penetrate the mucous membrane of the uterus, their toxins and enzymes destroy nerve endings and capillaries, what leads to a reaction in the form of an inflammatory process, what is localized mainly in the surface layers of the endometrium and in the inter-glandular connective tissue. The development of endometritis depends on the immune response of the cow, as well as on the type and number of bacteria that colonize the endometrium.&#x0D; According to the kind of the inflammatory process, endometritis in cows are classified into: purulent; serous; catarrhal; serous-catarrhal; fibrinous; catarrhal-purulent. According to the passing of the disease, endometritis are acute, subacute, less often - chronic.&#x0D; Diagnosis of endometritis includes collection of anamnestic data, general clinical exploring of the animal and special gynecological (vaginal and rectal) testing.&#x0D; The basis of the treatment of endometritis in cows is etiotropic therapy, what involves by the use of antimicrobial drugs that affect the cause of the disease, and is used to stop the reproduction of opportunistic microflora in the uterine cavity and normalize the microbiocenosis. For the etiotropic therapy of endometritis in cows, drugs for intrauterine administration and drugs for systemic treatment in the form of a solution or suspension for injections are used.

2233. Burden of Bacterial Antimicrobial Resistance in United States in 2019: A Systematic Analysis

Abstract Background The burden of AMR in the United States (US) is significant. According to the Centers for Disease Control and Prevention (CDC), at least 2.8 million people in the United States acquire antibiotic-resistant infections each year, and more than 35,000 people die as a result. Methods Using the Global Burden of Disease, Antimicrobial resistance (AMR) methodology, data were obtained on deaths and DALYs attributable to and associated with bacterial AMR for 23 pathogens in the US in 2019. Results In the US, there were 60,813 deaths (95% uncertainty interval [UI]:32,520-102,231) associated with and 14,987 deaths (95% UI:7,712-25,156) attributable to bacterial AMR in blood stream infection highest in 2019. Staphylococcus aureus (61,011) and E Coli (41,656) accounted for the majority of deaths attributable to and associated with AMR in 2019, and resistance was high among multiple types of antibiotic class. There is a significant burden of AMR in Staphylococcus aureus, with up to 50% of the resistance attributed to macrolides, 38% attributable to fluoroquinolones. Deaths associated and attributable to bacterial antimicrobial resistance by pathogen in USA, in 2019 A) All age-counts B) Age-standardized Rate Deaths Associated with and attributable to bacterial Antimicrobial resistance by syndrome in USA, in 2019 A) All age counts B) Age-Standardized Rate DALYs attributable to and associated with bacterial antimicrobial resistance in USA, in 2019 A) Age-standardized DALY by Infectious Syndrome B) Age-Standardized DALY by Pathogen Conclusion AMR is a serious burden in the United States, with millions of people acquiring antibiotic-resistant infections each year and tens of thousands dying as a result. Preventing the spread of AMR requires a multifaceted approach that includes improved infection control practices, more judicious use of antimicrobial drugs, increased surveillance and monitoring of resistance patterns, and the development of new antibiotics and other treatment options. Disclosures All Authors: No reported disclosures

The substantiation of the role of a clinical pharmacist in preventing antibiotic resistance

Aim. To study the role of a clinical pharmacist in overcoming antibiotic resistance in healthcare institutions that provide both primary (outpatient) and specialized (inpatient) medical care.&#x0D; Materials and methods. The research materials were the Order of the Ministry of Health of Ukraine No. 1513 of 23.08.2023 “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”. Such methods as analysis, synthesis, grouping, formal-dogmatic, logical-semantic, ascent from abstract to concrete, historical, comparative, systematic, graphic ones were used.&#x0D; Results. According to the results of the analysis of the new standard of medical care “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”, it can be noted that clinical pharmacists are responsible for promoting, managing and optimizing the use of antimicrobial drugs. It is the level of professional training, qualification and experience in working with infectious diseases that allow clinical pharmacists to be leaders of programs to combat antibiotic resistance.&#x0D; Conclusions. According to the provisions of the Standard, the clinical pharmacist should be in close cooperation with the doctor through counseling. An important aspect of preventing complications of antibacterial pharmacotherapy and developing antibiotic resistance is a retrospective audit of antibacterial drug prescriptions performed by a clinical pharmacist. Taking into account the above, in our opinion, it will be rational to include the elements of practical training on prospective counseling and retrospective audit of the use of antibacterial agents in the working program of “Clinical Pharmacy and Pharmaceutical Care” for applicants of higher education of the educational and professional program “Clinical Pharmacy”.

CDC Guidelines for the Prevention and Treatment of Anthrax, 2023.

Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis. B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.