Antimicrobial Medication Research Articles

Analysis of Antimicrobial Medication Consumption in Intensive Care Unit, North West (Tabuk) Region Hospitals, Saudi Arabia

Analysis of Antimicrobial Medication Consumption in Intensive Care Unit, North West (Tabuk) Region Hospitals, Saudi Arabia

An Investigation of the Presence, Types and Sensitivity to Different Antimicrobial Medications of the Communal Bacteria in the Children Dental Clinic Service

The mouth contains tremendous diversity of microorganisms which constitutes the normal oral flora. The dental clinical practice room is predominantly the source of largely multiple dental procedures that exhibit occupational exposure to blood and saliva borne contamination and other potentially infectious dental materials, (such as the periodontal crevice and pockets, tongue dorsum and other mucosal surfaces).

Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia.

To characterize the risk of bloodstream (BSI) and urinary tract infection (UTI) and describe antibiotic use in infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). The Children's Hospitals Neonatal Database was queried for infants with CDH and ECMO treatment from 2010 to 2016. The outcomes included BSI, UTI, and antimicrobial medication. Member institutions completed a survey on infection practices. Eighteen of the 338 patients identified (5.3%) had ≥1 BSI during their ECMO course. The likelihood of BSI increased with time: 1.2/1000 ECMO days; 0.6% (2/315) in the first week and rising to 14.6/1000; 8.6% (5/58) after 21 days (p = 0.002). More than 95% of patients received antibiotics each week on ECMO. Confirmed BSI is rare in infants with CDH treated with ECMO in the first week, but increases with the duration of ECMO. Use of antibiotics was extensive and did not correspond to infection frequency.

Specific Aspects of Endodontic Medication in Chronic Apical Periodontitis

Abstract This article presents specific aspects regarding the role of endodontic medication in the conservative treatment in chronic apical periodontitis. Starting from the bacterial microflora, the etiological factor of the periapical lesions, we discuss about the modalities of identification by the means of in vivo and in vitro tests of the microorganisms present inside the root canal. The characteristics of these methods of microbiological evaluations, as well as their clinical relevance, are reviewed. The general characteristics of endodontic antimicrobial medication are presented, as well as the causes of endodontic failures in treatment in chronic apical periodontitis. It is underlined the essential importance of the rigorous biomechanical treatment, in association with endodontic lavage, which makes the antibacterial medication only have a subordinate role in the treatment of chronic apical lesions.

Antimicrobial Stewardship: Laboratory to Clinical Microbiology: A Road Map

Antimicrobial stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. While clinical microbiologists with clinical pharmacists are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture, and guidance in the pre analytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems.
 Bangladesh J Med Microbiol 2019; 13 (2): 25-29

Success of non-surgical periodontal therapy in adult periodontitis patients: A retrospective analysis.

ObjectiveTo evaluate the results of active non‐surgical treatment in patients diagnosed with adult periodontitis treated in a specialized clinic for periodontology.Material & MethodsIn total, 1182 patients with adult periodontitis received active non‐surgical therapy, which involved professional oral hygiene instruction, scaling and root planing, supragingival polishing and elective systemic antimicrobial medication. The results of this therapy were based on a full‐mouth periodontal chart as assessed at the time of evaluation. Successful treatment as periodontal pocket depth (PPD) ≤5 mm was the main outcome parameter with bleeding on pocket probing as secondary outcome. Patient‐related factors such as smoking and severity of periodontitis at baseline and site‐related factors such as tooth type, furcation involvement and endodontic treatment were analysed. Possible relations with assessed parameters and the success of active periodontal therapy were evaluated.ResultsOverall 39% of the patients reached the successful treatment objective and a mean bleeding on pocket probing tendency of 14%. Treatment success appeared to be dependent on tooth type where the results at single‐rooted front teeth (85%) and premolar teeth (78%) were more successful than at molar teeth (47%). Analysis revealed that in 55% of the cases furcation involvement at molars was associated with the absence of success. Endodontic treatment was associated with absence of success in 8%‐11% of the cases. Smoking negatively influences successful treatment outcome (P < 0.001).ConclusionActive non‐surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in the success endpoint of PPD ≤ 5mm. Sub‐analysis showed that the outcome appeared to be dependent on tooth type, furcation involvement, severity of periodontal disease at intake and smoking status.

Post-treatment Guillain-Barre Syndrome in a Patient with Brucellosis; A Case Report

Introduction: Guillain-Barre Syndrome is an uncommon complication during acute brucellosis. Case presentation: In this study, we present a case of Guillain-Barre Syndrome in a 22-year old male patient with complaints of weakness in his lower limbs. He had a history of acute Brucella infection for four months and received antimicrobial medication. Conclusion: the patients can be affected by GBS after antimicrobial treatment.

A Multidisciplinary Approach to Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention

Antimicrobial stewardship programs exist to promote appropriate antimicrobial use. The Joint Commission has reported that although many US hospitals have implemented basic components of antimicrobial stewardship programs, there now exists a need for innovative, multidisciplinary approaches, including involving frontline clinicians such as bedside nurses. A retrospective evaluation of bedside nurse-driven antimicrobial stewardship and infection prevention rounds was conducted on a 31-bed telemetry unit of a community regional medical center. Rounds were managed by a nurse coordinator and attended by an infectious diseases pharmacist, an infection preventionist, and a nurse practitioner. Primary outcome measures were antimicrobial and acid suppressant medication and invasive catheter use. In the 12-month intervention period the nurse-driven rounds team reviewed of a total of 472 antimicrobial medication, 480 acid suppressant medication, 321 urinary catheter, and 61 central venous catheter therapies over 867 total patient encounters. Compared with the 12-month preintervention period, significant reductions in unit antimicrobial use (791.2 vs. 697.1 days of therapy per 1,000 patient-days; p = 0.03), acid suppressant medication use (708.1 vs. 372.4 days of therapy per 1,000 patient-days; p = 0.0001), and urinary catheter use (0.3 vs. 0.2 catheter-days per patient-day; p = 0.002) were observed. This study demonstrates successful engagement of bedside nurses in antimicrobial stewardship and infection prevention activities and a measurable impact on meaningful outcomes. More studies of strategies to integrate bedside nurses in antimicrobial stewardship are needed.

Enhancing the Yield of Bioactive Compounds from Sclerocarya birrea Bark by Green Extraction Approaches.

Sclerocarya birrea is a tree indigenous to Southern Africa with significant importance in rural livelihoods for food, medicine, and carving. The bark, which contains 10–20% tannin, provides several pharmacological benefits as an antidiabetic, anti-inflammatory, antimicrobial, anti-atherogenic, and antioxidant medication, among others. This study compared different extraction techniques used to recover bioactive compounds from marula bark. For this purpose, solid–liquid extraction, supercritical fluid extraction (SFE), and pressurized liquid extraction (PLE) were performed under selected conditions, using only “food-grade” solvents. The potential use of the proposed extraction methodologies was evaluated in term of yield, and the individual phenolic composition determined by HPLC–ESI–TOF–MS. PLE provided a high extraction yield in all experimental conditions. With regard to bioactive compounds composition, a total of 71 compounds, a significant percentage of which in a galloyl form, were distributed in five major categories. The largest number of compounds, mostly flavonoid aglycones, were extracted by PLE, generally when the extraction was developed at low temperatures. SFE did prove effective as a way of extracting antidiabetic proanthocyanidins. Advanced extraction techniques represent a powerful tool to obtain bioactive compounds from S. birrea bark, which can be used as supplements or food ingredients, promoting the valorization of this crop.

In vitro comparison of efficacy of catheter locks in the treatment of catheter related blood stream infection

Venous access used for parenteral nutrition (PN) application is extremely important for patients with intestinal failure. Potential loss of venous access might be a catastrophy for the patient. Catheter infections are a serious complication of PN application. Systemic administration of antibiotics as well as local antibiotic locks into the catheter to sterilize the catheter are used to treat catheter infections. However, there is no clear recommendation applying use of antibiotic locks, that would specify the type and concentration of antimicrobial medication. Our objective were to compare the efficacy of different types of antimicrobial lock therapy (especially taurolidine) and their concentrations to eradicate infectious agents. Bacterial strains of microorganisms (Staphylococcus epidermidis, Staphylococcus aureus, methicillin resistant S.aureus (MRSA), Pseudomonas aeruginosa, multidrug-resistant P.aeruginosa, Candida albicans) were used. Subsequently, the catheter was exposed to the microbes and then was incubated with a specific lock for 2 or 24h at 37°C. We used these locks: ethanol 70%, taurolidine, gentamicine in concentrations 0,5, 1 and 10mg/ml and vancomycine in concentrations 1, 5, and 10mg/ml. The number of remaining CFU (colony forming units) was compared after incubation. 70% ethanol and taurolidine were most effective for all studied microorganisms. Gentamicine was more effective than vancomycine. The most effective antimicrobial lock solutions to eradicate selected pathogenic agents were ethanol and taurolidine. Use of antibiotics is often effective after many hours of treatment and there is a risk of inadequate therapy.

Utility of surface plasmon resonance response of silver nanoparticles for assay of Teicoplanin in human plasma using spectrofluorimetric technique

Teicoplanin (TEIC) is a glycopeptide antimicrobial medication for management of several bacterial infectious diseases caused by gram-positive bacteria including methicillin-resistant Staphylococcus aureus and Enterococcus faecalis. Novel, very simple, fast and cost-effective two spectrofluorimetric methods were developed for the ultra-trace determination of TEIC in pharmaceutical vials and human plasma. The investigated methods based on measuring the fluorescence of TEIC in methanol (method A) and enhancing its fluorescence by 10 folds using silver nanoparticles (AgNPs) without any solvent extraction (method B). The fluorescence of TEIC was investigated at 385nm (excitation at 335 nm) with calibration ranged from 1 to 25 ng mL−1 and from 0.6 to 30 ng mL−1 with Limit of detection (LOD) of 280 and 160 pg mL−1 for method A and B respectively. The established methods were optimized, validated and bio-analytically validated via ICH and US-FDA guidelines. The performed methods were used to determine TEIC in human plasma with high percentage recovery of 98.8 ± 1.75. Further, the proposed methods were applied to study the stability of TEIC after exposure to various degradation stress conditions and kinetic degradations.

Analysis of creatinine clearance in patients on antimicrobial and analgesic therapy

Background: Nephrotoxicity has become increasingly common due to indiscriminate use of drugs. Analgesic nephropathy is a unique drug-induced kidney disease which is characterized by renal papillary necrosis and interstitial nephritis resulting from prolonged excessive consumption of combination antipyretic analgesics. This study was done to assess the renal work load in hospitalized patients taking analgesics and antimicrobial medication by creatinine clearance and to find their consequences. Aim and Objectives: (1) To determine the proportion of participants having altered creatinine clearance. (2) To compare the creatinine clearance among the hospitalised patients on treatment with antimicrobials and analgesics. Materials and Methods: It was a cross sectional observational study in which 1200 patients were enrolled, divided into 2 groups, with Group A: Comprising of those under antibiotic treatment; with Group B: Comprising of those under analgesic treatment. Creatinine clearance was calculated by Modification of Diet in Renal Disease (MDRD) equation and CKD-EPI equation. Observation and Results: On analyzing the drugs causing renal impairment out of 1200 participants, it was found that among analgesics diclofenac (52%) and among antibiotics, aminoglycosides (61%), were more commonly resulting in renal dysfunction. Conclusion: According to the present study, it is clear that precaution has to be taken before initiating antimicrobials and analgesic therapy, as they are often nephrotoxic.

Cerrahi Alan Enfeksiyonlarını Azaltmada Antimikrobiyal Medikal Tekstil Ürünlerinin Etkisi

Cerrahi Alan Enfeksiyonlarını Azaltmada Antimikrobiyal Medikal Tekstil Ürünlerinin Etkisi

Antimicrobial Medical Textiles Used in Clinical Settings May Play an Important Role in Reducing Healthcare-Acquired Infections

Antimicrobial Medical Textiles Used in Clinical Settings May Play an Important Role in Reducing Healthcare-Acquired Infections

Antimicrobial exposure and the risk of delirium in critically ill patients

BackgroundPrior retrospective cross-sectional work has associated antimicrobials with a non-specific phrase: encephalopathy without seizures. The purpose of this study is to determine whether different classes of antimicrobials have differential associations with the daily risk of delirium after critical illness is adjusted for.MethodsOur study was a nested cohort that enrolled non-neurological critically ill adults from a medical or surgical intensive care unit (ICU) with daily follow-up to 30 days. Our independent variable was exposure to previous-day antimicrobial class: beta-lactams (subclasses: penicillins, first- to third-generation cephalosporins, fourth-generation cephalosporins, and carbapenems), macrolides, fluoroquinolones, and other. We adjusted for baseline covariates (age, comorbidities, cognition scores, sepsis, and mechanical ventilation), previous-day covariates (delirium, doses of analgesics/sedatives, and antipsychotic use), and same-day covariates (illness severity). Our primary outcome of delirium was measured by using the Confusion Assessment Method for the ICU. A daily delirium logistic regression model was used with an ICU time-restricted sensitivity analysis including daily adjustment for sepsis and mechanical ventilation.ResultsOf 418 ICU patients, delirium occurred in 308 (74%) with a median of 3 days (interquartile range 2–6) among those affected and 318 (76%) were exposed to antimicrobials. When covariates and ICU type were adjusted for, only first- to third-generation cephalosporins were associated with delirium (logistic regression model odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.28–3.79, P = 0.004; sensitivity analysis OR = 2.13, 95% CI 1.10–4.10, P = 0.024).ConclusionsFirst-, second-, and third-generation cephalosporins doubled the odds of delirium after baseline co-morbidities, ICU type, the course of critical care, and other competing antimicrobial and psychotropic medication risks were adjusted for. We did not find an association between delirium and cefepime, penicillins, carbapenems, fluoroquinolones, or macrolides.

1130. Low Risk of Pneumocystis jiroveci Pneumonia in Patients With Waldenstrom’s Macroglobulinemia on Ibrutinib

BackgroundIbrutinib is a Bruton’s tyrosine kinase inhibitor that is FDA approved for the treatment of chronic lymphocytic leukemia (CLL), mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom’s macroglobulinemia (WM). Fungal infections including Pneumocystis jiroveci pneumonia (PCP) are increasingly reported in patients with CLL and lymphoma on ibrutinib possibly due to the off-target effect of ibrutinib on the adaptive immune system. Whether this increased risk is due to the effect of ibrutinib alone or in combination with immune dysregulation due to underlying malignancy is unknown. The purpose of this study was to assess the incidence of PCP in patients with WM on ibrutinib therapy.MethodsA retrospective cohort study was performed of all patients with WM who initiated ibrutinib monotherapy at Dana-Farber Cancer Institute between July 1, 2015 and January 30, 2018. Baseline characteristics, laboratory parameters, previous and concomitant malignancy treatment regimens, and antimicrobial medications were collected by chart review. Patients were followed until April 1, 2018 for the development of PCP.ResultsThere were a total of 106 patients with WM on ibrutinib during the study period. Sixty-one (58%) were male, and the median age at initiation of ibrutinib was 69 years (range 43 – 89). Forty-six patients (43%) received prior therapy for WM, with a median of two previous treatment courses (range 1–6). Fourteen patients (13%) were on PCP prophylaxis for a combined duration of 8 person-years. No cohort patient developed PCP during the study period, which included 146 person-years of ibrutinib exposure. Three patients (3%) died due to disease progression (n = 2) and E. coli sepsis (n = 1).ConclusionPatients with WM on ibrutinib monotherapy appear to have a different infectious risk profile than patients with CLL or lymphoma and do not have a high risk of developing PCP. These data suggest that PCP prophylaxis is likely not beneficial for patients with WM on ibrutinib.Disclosures M. P. Cheng, Royal College of Physicians and Surgeons of Canada: Member, Salary. S. P. Hammond, Merck: Investigator, Research support. J. J. Castillo, Pharmacyclics: Consultant and Grant Investigator, Consulting fee and Research grant. N. C. Issa, GSK: Investigator, Research grant. Merck: Investigator, Research grant. Akros Pharma: Consultant, Consulting fee.

Hazards from physical attributes of the home environment among patients on outpatient parenteral antimicrobial therapy

Outpatient parenteral antimicrobial therapy (OPAT) requires that patients and their caregivers administer antimicrobial medications in the home via venous catheters. Hazards from physical attributes of the home environment may impede safe performance of OPAT tasks. We performed a qualitative study, including semistructured telephone interviews and contextual inquiries, of patients performing OPAT tasks inside the home. Eligible participants were discharged from 2 academic medical centers in Baltimore, Maryland, on OPAT. We coded interview transcripts and contextual inquiry forms based on a model of healthcare work systems. Twenty-nine patients underwent semistructured telephone interviews, and 14 patients underwent contextual inquiry. We identified hazards including bathing, animal or pets, extremes in temperature, household clutter, indoor soil and food exposures, outdoor soil, and travel. Patients often developed strategies to mitigate these hazards. Multiple hazards related to the home environment could have led to harm, and in the absence of specific guidance, patients developed strategies to mitigate these hazards. Educational interventions to improve OPAT should incorporate an understanding of hazards that may occur in the home environment.

Neonatal Antibiotic Use: How Much Is Too Much?

* Abbreviations: AUR — : antibiotic use rate NEC — : necrotizing enterocolitis Antimicrobial stewardship efforts benefit the individual and the community by improving patient-specific outcomes as well as decreasing the overall burden of antimicrobial resistance. Antibiotic stewardship can also save the health care system substantial amounts of money through decreased pharmacy costs, decreased inpatient use for antibiotic-resistant infections, and decreased frequency of antibiotic-associated adverse events.1 In NICUs, infants are frequently exposed to antimicrobial medications as prophylaxis against infection, as empirical treatment of suspected infection, and as targeted treatment of confirmed infection. Most neonatal antibiotic treatment is for suspected rather than proven infection, and researchers in several studies suggest that antibiotics are overused in both term and preterm infants.2–8 Evolving concern for unintended harm from neonatal antibiotic exposures has energized interest in the general principles of antimicrobial stewardship.3,5,9–13 Stewardship recommendations and quality collaborative programs support the appropriate use of antimicrobial agents in the NICU.14–17 Single centers report variably successful impacts of neonatal antibiotic stewardship interventions on the use of antibiotics for term infants who are at risk for early-onset infection, on the overall use of antibiotics across gestational ages, and on appropriate choice and duration of antibiotic therapy.18–21 In recent analyses using large multicenter data sets, researchers find small but significant declines in overall neonatal antibiotic use and in extended use in … Address correspondence to Dustin D. Flannery, DO, Division of Neonatology, Children’s Hospital of Philadelphia, Newborn Care at Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA 19107. E-mail: flanneryd{at}email.chop.edu

Prior antibiotic exposure and risk of type 2 diabetes among Veterans

BackgroundExposure to antibiotics may increase the risk of type 2 diabetes. Veterans are at increased risk for diabetes and for exposure to antibiotics. ObjectiveTo determine the impact of antibiotic exposure for risk of diabetes. DesignRetrospective cohort study. ParticipantsVeterans at the New York Harbor Healthcare System enrolled in primary care, 2004–2014, with ≥2 glycosylated hemoglobin test results <6.5%. Main measuresThe primary exposure was any antimicrobial prescribed >6 months prior to the date of diabetes diagnosis, loss to follow-up, death, or the end of the study, measured as the number of courses of antimicrobial prescriptions filled and the mean daily dose (MDD). The primary outcome was incident diagnosis of diabetes through 2014, defined ≥2 ICD-9 codes for diabetes or ≥2 prescriptions of diabetes medications, other than metformin. Cox proportional hazards regression was used to model antimicrobial medications, demographic and anthropometric measures, and comorbid cardiovascular conditions to incident diabetes. Models incorporated time varying covariates of antimicrobial medication and MDD to analyze associations by antimicrobial class. Key resultsAmong 14,361 Veterans, 9922 (69.1%) were prescribed any antimicrobial medication during the study period. 1413 (9.8%) individuals developed type 2 diabetes. Increased risk of diabetes was associated with >1 prescription (HR 1.13 [1.01–1.26]) compared to none. Time varying analysis of the total number of cumulative courses prescribed showed increased diabetes risk for cephalosporin (HR 1.17 [1.04–1.31]), macrolide (HR 1.08 [1.03–1.13]) and penicillin (HR 1.05 [1.02–1.07]). MDD showed increased risk per 100-unit (mg) increase in antibiotic exposure from (HR 1.05 [1.02–1.08]) for sulfonamide to (HR 1.70 [1.51–1.92]) for cephalosporin. ConclusionAny and repeated exposure to certain antibiotics may increase diabetes risk among Veterans. Results from this study add to the growing evidence suggesting that antibiotic exposure increases risk for diabetes. Antibiotic stewardship may be enhanced by better understanding this risk, and may lower the incidence of diabetes in populations at risk.

Graft of Small Patch of Partial Thickness in Equine Wound

Background: Cutaneous wounds in locomotor limbs represent one of the most frequent disorders in equine medicine. Wounds in equines are distinguished from those in other species by unique characteristics, including different healing rates among breeds, wound location and high propensity to formation of exuberant granulation tissue during the healing process. The wound healing process that cannot be sutured can be accelerated by the use of skin grafts, lowering the treatment cost.The objective of this report was to divulgate the success upon treatment of an extensive lacerated wound in the metatarsal region of a horse using autologous skin grafts.Case: A 3-year-old, female, American quarter horse weighting 450 kg was brought to veterinary hospital with lower limb injury. According to the owner’s report, the animal had one of its limbs stuck in a plain wire fence. A wound was observed in the metatarsal region during physical examination, the lesion caused an extensive skin laceration that showed the dorsal surface of the metatarsal bone and the digital extensor tendon. After injury assessment, wound debridement was carried out by surgery intervention followed by antisepsis and application of autologous plasma every two days as post-surgical care and wound preparation to receive the graft. Forty-five days after the first intervention, grafts were collected from the neck and implanted in the wound. The procedure achieved 70% of success. After approximately 75 days, transplantation was performed in other regions of the wound using the same technique. The duration of treatment at the Veterinary Hospital of the Universidade Paranaense (UNIPAR) was eight months, and then the animal returned home, where dressings were applied for two months to avoid the risk of contamination and until complete recovery.Discussion: The debridement of the wound and edges approximation were of great value in order to begin the process of wound granulation. The established therapy with scarring with gauze and use of antiseptics only in the initial stages of treatment, the frequent exchange of bandages every two days, preventing the accumulation of exudate and the use of autologous plasma favored the formation of the granulation bed and was sufficient to avoid infection and the formation of exuberant granulation tissue. Factors such as excessive movement and local infection were also attributed as responsible for the longer healing period, so the use of the spring coupled to the horseshoe decreased the joint movement, proving tobe effective in patients with severe extensor tendon lacerations. The use of the spring coupled to the horseshoe promoted a correct biomechanical alignment and no walking complication or deficiency was observed. The correct anatomical structural positioning prevents the formation of flexural deformities and fibrosis of the joint capsule. The use of micrografts wasbeneficial and simple to perform and the use of grafts contributed to a better cosmetic result. The main factor contributed to the grafting success was the use of dressing, which was regularly changed, and topical antimicrobial therapy correctly applied to avoid contamination. Based on the clinical result of this patient, it was concluded that the use of small autologous grafts can provide good recovery and healing of extensive wounds in horses when proper care with dressings and antimicrobial medication is provided after surgical interventions.Keywords: equine, surgery, graft, healing.