Antimicrobial Usage Research Articles

Accessing the behavior and awareness of veterinary professionals towards antimicrobials use and antimicrobial resistance in Indian district.

Antimicrobial resistance (AMR) poses a significant public health threat, and understanding the awareness and practices of healthcare professionals is crucial for its mitigation. Since the animal sector plays a key role in India's economy, we decided to explore the understanding of Antimicrobial Use (AMU) and AMR among veterinary professionals. The study aimed to evaluate the awareness and behavior of veterinarians and para-veterinarians working in the Jhunjhunu district, Rajasthan, India, concerning AMU and AMR. Questionnaire surveys were administered to them with closed-ended questions. The data was collected and subjected to statistical analysis to derive meaningful insights. The key findings highlight notable differences in certain behavioral aspects of antibiotic prescription among the two groups. It appears that 53.8% of veterinarians as compared to 25.8% para-veterinarians do not surely inform farmers about the importance of adhering to antibiotic withdrawal periods, thereby failing to raise awareness about proper antibiotic use. Moreover, para-veterinarians (46.6%) tend to engage less in evidence-based antibiotic prescription than veterinarians (81%). Furthermore, both groups exhibit a lower frequency of advice on Antimicrobial Susceptibility Testing (ABST), essential for informed prescribing decisions. Most significantly, both groups show a tendency to prefer critically important antibiotics for prescription, raising concerns about the escalating threat of AMR. This study thus emphasizes the areas that need targeted interventions to enhance responsible antimicrobial usage and curb the growth of AMR in the region.

Comparative analysis of antimicrobial resistance phenotype and genotype of Riemerella anatipestifer

Riemerella anatipestifer is one of the important bacterial pathogens that threaten the waterfowl farming industry. In this study, 157 suspected R. anatipestifer strains were isolated from diseased ducks and geese from seven regions of China during 2019–2020, and identified using multiple polymerase chain reaction (PCR). Antimicrobial susceptibility tests and whole-genome sequence (WGS) analysis were then performed for comparative analysis of antimicrobial resistance phenotypes and genotypes. The results showed that these strains were susceptible to florfenicol, ceftriaxone, spectinomycin, sulfafurazole and cefepime, but resistant to kanamycin, amikacin, gentamicin, and streptomycin, exhibiting multiple antimicrobial resistance phenotypes. WGS analysis revealed a wide distribution of genotypes among the 157 strains with no apparent regional pattern. Through next-generation sequencing analysis of antimicrobial resistance genes, a total of 88 resistance genes were identified. Of them, 19 tetracycline resistance genes were most commonly found, followed by 15 efflux pump resistance genes, 11 glycopeptide resistance genes and seven macrolide resistance genes. The 157 R. anatipestifer strains contained 42–55 resistance genes each, with the strains carrying 47 different resistance genes being the most abundant. By comparing the antimicrobial resistance phenotype and genotype, it was observed that a high correlation between them for most antimicrobial resistance properties was detected, except for a difference in aminoglycoside resistance phenotype and genotype. In conclusion, 157 R. anatipestifer strains exhibited severe multiple antimicrobial resistance phenotypes and genotypes, emphasizing the need for improved antimicrobial usage guidelines. The wide distribution and diverse types of resistance genes among these strains provide a foundation for studying novel mechanisms of antimicrobial resistance.

Molecular Characterization of Extended Spectrum β-Lactamase-Producing Escherichia coli: Insights into the O25b-ST131 Clone in Mexican Urinary Tract Infections

Background: The urgent need for antimicrobial research to address the escalating global challenge of β-lactam antibiotic resistance, particularly in Escherichia coli-induced urinary tract infections (UTI), is underscored by the increasing resistance to ciprofloxacin in Latin America. This issue has led to a heightened dependence on alternative therapeutics, such as cephalosporins. The identification of extended-spectrum β-lactamase (ESBL)-producing E. coli, notably the O25b-ST131 clone, adds complexity to UTI management. The prevalence of ESBL-producing E. coli varies globally due to factors including regional antimicrobial usage practices. Objectives: The goal of this study was to identify and molecularly characterize ESBL-producing E. coli isolates to identify the pandemic O25b-ST131 clone related to UTIs in one healthcare institution in Mexico. Methods: Bacterial species identification and antibiotic susceptibility tests were performed using the VITEK 2. The ESBL genes were identified using polymerase chain reaction (PCR). The E. coli genotyping was carried out by the phylogenetic group analysis and the O25b-ST131 identification. Results: A total of 86 unique E. coli isolates were confirmed as ESBL, and 75% were obtained from UTIs. The most prevalent β-lactamase genes were blaCTX-M (66%), blaTEM (8.1%), blaCTX-M/SHV (5.8%), blaCTX-M/TEM (4.6%), and blaSHV (2.3%). The B2 phylogroup was most prominent (54.4%), with 46.5% identified as a globally pandemic O25b-ST131 clone. No evident relationship was observed using random amplified polymorphic DNA (RAPD) between nosocomial and community-acquired infections in ESBL-producing E. coli isolates. Conclusions: The obtained findings highlight the significance of monitoring molecular epidemiology in antibiotic resistance profiles of the O25b-ST131 E. coli clone.

Economic assessment of an intervention strategy to reduce antimicrobial usage in small-scale chicken farms in Vietnam

Antimicrobials are a core aspect of most livestock production systems, especially in low-and middle-income countries. They underpin the efficient use of scarce feed resources and stabilize returns on capital and labor inputs. Antimicrobial use (AMU) contributes to the production of healthy animals, yet AMU in livestock is linked to antimicrobial resistance (AMR) in animals, humans and the environment.The Vietnamese Platform for Antimicrobial Reduction in Chicken Production was implemented during 2016–2019 and was one of Southeast Asia's first interventions focused on AMU reductions in livestock production. The project targeted small-scale commercial poultry farms in the Mekong Delta region of Vietnam using a “randomized before-and-after controlled” study design. It provided farmers with a locally adapted support service (farmer training plan, advisory visits, biosecurity, and antimicrobial replacement products) to help them reduce their reliance on antimicrobials. A partial budget analysis was performed comparing the control group (status-quo) and intervention group (alternative). The median net farm-level benefit of the intervention strategies with the project's support was VND 6.78 million (interquartile range (IR) VND -71.9–89 million) per farm. Without project support the benefit was reduced to VND 5.1 million (IR VND -69.1–87.2 million) to VND 5.3 million (IR -VND 68.9–87.5 million) depending on the antimicrobial alternative product used. At the project level with a focus on AMU and its reduction, subsequently influence on the resistance reduction, our results showed that achieving resistance reduction benefits with the current knowledge and technologies required investment of at least VND 9.1 million (US$ 395.10) per farm during the project's lifetime. The results highlight the positive net profit for the majority of enrolled farms and a reasonable investments from the project. The recommendation focuses on the implementation of policies on financial support, legislation, and information as potential solutions to facilitate the application of intervention strategies to reduce AMU in poultry production.

Unravelling the complex interplay between antibiotic consumption and adaptive changes in methicillin-resistant Staphylococcus aureus.

This study aims to elucidate the genomic dynamics driving the emergence of antimicrobial resistance (AMR), with a specific focus on the interplay between AMR and antimicrobial usage. We conducted a comprehensive analysis using a ST239 methicillin-resistant Staphylococcus aureus (MRSA) dataset over a continuous 12-year period from a single hospital. Genomic analyses were performed tracking the changes in MRSA populations, particularly the emergence of reduced vancomycin susceptibility, and assessing the impact of glycopeptide use on these emergence events. Our findings reveal a significant correlation between hospital glycopeptide usage and the selection of MRSA strains with reduced vancomycin susceptibility. Genomic analyses provided insights into the molecular mechanisms driving resistance emergence, including the slowing of the molecular clock rate in response to heightened antimicrobial consumption. In conclusion, this study the highlights the complex dynamics between AMR and antimicrobial use at the hospital level. The observed correlation between antimicrobial consumption and the development of less susceptible MRSA strains underscores the importance of antimicrobial stewardship programmes and the establishment of optimal consumption thresholds for mitigating AMR effectively.

Analytical Cross-sectional Study on the Knowledge, Attitudes, and Practices on Antimicrobial Use and Resistance among Backyard Swine Raisers in Baybay City, Philippines

Antimicrobial resistance (AMR) is a global health concern, wherein microorganisms become resistant to antimicrobial drugs used in the treatment of human diseases and is linked to the misuse and overuse of antimicrobial drugs in food-producing animals. This study aimed to assess the knowledge, attitudes, and practices (KAP) of backyard swine raisers in Baybay City, Leyte, the Philippines, toward antimicrobial drugs and usage in the context of AMR. Data were gathered from 303 randomly selected backyard swine raisers in 28 villages of Baybay City through in-depth interviews. KAP levels were determined by performing descriptive statistics. Predictors and associated variables were analyzed through univariable and multivariable regression analyses. The majority of the respondents have poor to moderate knowledge (98.68%), moderate attitudes (68.65%), and poor practices (82.18%) on the use of antimicrobials. Attainment of a college degree (adjusted β = 1.32, p = 0.0021) was significantly associated with the respondents' knowledge. Meanwhile, the respondents’ attitude levels were positively associated with vocational (adjusted β = 4.84, p = 0.0004) and college education (adjusted β = 2.11, p = 0.0444). Overall, the educational attainment (college: adjusted β = 1.58, p = 0.0068), the knowledge mean (β = 5.25, p < 0.0001), and the attitude mean (β = 1.11, p < 0.0001) significantly influenced the respondents’ practices on antimicrobial use. Education is crucial in improving the farmers' KAP regarding the use of antimicrobials. To help prevent the furtherance of AMR, it is essential for government agencies to enhance the farmers’ KAP levels by conducting training on antimicrobial use and facilitating AMR awareness seminars.

A multidisciplinary approach to analyze the antimicrobial resistance in natural ecosystems

Antimicrobial Resistance (AMR) poses a global threat to both human health and environmental well-being. Our study delved into Costa Rican wildlife reserves, uncovering a substantial human impact on these ecosystems and underscoring the imperative to pinpoint AMR hotspots. Embracing a One Health perspective, we advocated for a comprehensive landscape analysis that intricately intertwined geographic, climatic, forest, and human factors. This study illuminated the link between laboratory results and observed patterns of antimicrobial use, thereby paving the way for sustainable solutions. Our innovative methodology involved deploying open-ended questions to explore antimicrobial usage across livestock activities, contributing to establishing a comprehensive methodology. Non-invasive sampling in wildlife emerged as a critical aspect, shedding light on areas contaminated by AMR. Feline species, positioned at the apex of the food chain, acted as sentinels for environmental health due to heightened exposure to improperly disposed waste. Regarding laboratory findings, each sample revealed the presence of at least one antimicrobial resistance gene (ARG). Notably, genes encoding resistance to tetracyclines dominated (94.9%), followed by beta-lactams (75.6%), sulfonamides (53.8%), aminoglycosides (51.3%), quinolones (44.9%), phenicols (25.6%), and macrolides (20.5%). Genes encoding polymyxins were not detected. Moreover, 66% of samples carried a multi-resistant microbiome, with 15% exhibiting resistance to three antimicrobial families and 51% to four. The absence of a correlation between forest coverage and ARG presence underscored the profound human impact on wildlife reserves, surpassing previous estimations. This environmental pressure could potentially modify microbiomes and resistomes in unknown ways. As not all antimicrobial families encoding ARGs were utilized by farmers, our next step involved evaluating other human activities to identify the primary sources of contamination. This comprehensive study contributed crucial insights into the intricate dynamics of AMR in natural ecosystems, paving the way for targeted interventions and sustainable coexistence.

Regional-Scale Analysis of Antimicrobial Usage in Smallholder Cattle Herds (Aosta Valley, Italy): Why Surveillance Matters.

Optimising antimicrobial usage (AMU) in livestock is pivotal to counteract the emergence of antimicrobial resistance. We analysed AMU in more than 1000 cattle herds over 11 years (2008-2018) in the Aosta Valley (Italy), a region where 80% of farms house less than 50 cattle. Dairy cows accounted for over 95% of AMU. AMU was estimated using the defined daily dose animal for Italy (DDDAit) per biomass for the whole herd and a treatment incidence 100 (TI100) for cows. Average annual herd-level AMU was low, with 3.6 DDDAit/biomass (range: 3.2-4.0) and 1.2 TI100 in cows (range: 1.1-1.3). Third and fourth generation cephalosporins, which are critical for human medicine, represented almost 10% of usage, and intramammary antimicrobials accounted for over 60%. We detected significant downward temporal trends in total AMU, as well as a positive relationship with herd size. The magnitude of such effects was small, leaving scant room for further reduction. However, the frequent use of critical antimicrobials and intramammary products should be addressed, following the principles of prudent AMU. Our findings highlight the importance of monitoring AMU even in low-production, smallholding contexts where a low usage is expected, to identify any deficiencies and implement interventions for further AMU optimisation.

Assessment of Knowledge, Attitude and Practice (KAP) Regarding Antimicrobial Usage and Resistance Among Animal Health Professionals of East Wallaga Zone, Oromiya, Ethiopia.

Antimicrobial resistance (AMR) is one of the top global public health and economic threats. The use of antimicrobials (AMs) in animal production is a major contributor to the development of AMR globally. Animal health professionals (AHPs) play a key role in ensuring judicious use of AMs. To assess the knowledge, attitude and practice (KAP) of antimicrobial usage (AMU) and AMR among healthcare professionals in Nekemte town, Leka Dulecha and Sibu Sire districts. A cross-sectional study was conducted with 120 purposively chosen AHPs residing in the districts and the town. A semi-structured questionnaire consisting of 49 questions was used to ascertain the KAP. The chi-square test (X2) was used to analyze the association between the knowledge score and demographic profile of the study participants. In the study the overall knowledge of the participants was moderately appreciable, and all participants had positive attitudes toward AMR and appropriate usage. In terms of knowledge of antibiotic use, the majority (93.33%) of the participants correctly answered the statement that antibiotics can kill viruses. About 84.17% of the participants correctly knew that antibiotics killed or stopped the growth of both bad and good bacteria. The majority of the participants (74.17%) always or (25.83%) sometimes rely on usage of antibiotics without a doctor's prescription. It was shown that comparing respondents from Sibu Sire, Leka Dulecha and Nekemte town, the scores of knowledge of AMU were significantly (X2=14.13, p=0.007) different. Most animal healthcare professionals from the Sibu sire have a good knowledge of AMU, and contribute to AMR development. The study revealed that there was moderate knowledge and positive attitude toward AMU and resistance. This warrants continuing capacity building programs for the professionals on AM usage and resistance, and development of field-friendly disease diagnosis and management tools is essential in the need to reduce AMR.

Limitations of Reporting Requirements under California's Livestock Antimicrobial Restriction Law.

Antimicrobial use in livestock production is considered a key contributor to growing antimicrobial resistance in bacteria. In 2015, California became the first state to enact restrictions on routine antimicrobial use in livestock production via Senate Bill 27 (SB27). SB27 further required the California Department of Food and Agriculture (CDFA) to collect and disseminate data on antimicrobial use in livestock production. The goal of this report is to assess whether CDFA's data release allows us to evaluate how antimicrobial use changed after the implementation of SB27. We combine the CDFA data with feed drug concentration ranges from the Code of Federal Regulation to evaluate the spread of plausible antimicrobial use trends. We also estimate antimicrobial consumption rates using data from the National Agricultural Statistical Service (NASS) and compare these to changes in medicated feed production reported by the CDFA. We show that CDFA's reported data are insufficient to reliably estimate whether antimicrobial usage has increased or decreased, most notably because no information is provided about the mass of antimicrobials approved for use or medicated feed drug concentrations. After incorporating additional external data on feed drug concentrations, one can at best provide uninformative bounds on the effect of SB27. We find some evidence that antimicrobial use has decreased by incorporating data on national sales of antimicrobials for food-producing animals, but the weakness of this inference underlines the need for improved data collection and dissemination, especially as other states seek to implement similar policies. We provide recommendations on how to improve reporting and data collection under SB27. https://doi.org/10.1289/EHP13702.

Using Natural Language Processing and Patient Journey Clustering for Temporal Phenotyping of Antimicrobial Therapies for Cat Bite Abscesses

BackgroundTemporal phenotyping of patient journeys, which capture the common sequence patterns of interventions in the treatment of a specific condition, is useful to support understanding of antimicrobial usage in veterinary patients. Identifying and describing these phenotypes can inform antimicrobial stewardship programs designed to fight antimicrobial resistance, a major health crisis affecting both humans and animals, in which veterinarians have an important role to play. ObjectiveThis research proposes a framework for extracting temporal phenotypes of patient journeys from clinical practice data through the application of natural language processing (NLP) and unsupervised machine learning (ML) techniques, using cat bite abscesses as a model condition. By constructing temporal phenotypes from key events, the relationship between antimicrobial administration and surgical interventions can be described, and similar treatment patterns can be grouped together to describe outcomes associated with specific antimicrobial selection. MethodsCases identified as having a cat bite abscess as a diagnosis were extracted from VetCompass Australia, a database of veterinary clinical records. A classifier was trained and used to label the most clinically relevant event features in each record as chosen by a group of veterinarians. The labeled records were processed into coded character strings, where each letter represents a summary of specific types of treatments performed at a given visit. The sequences of letters representing the cases were clustered based on weighted Levenshtein edit distances with KMeans++ to identify the main variations of the patient treatment journeys, including the antimicrobials used and their duration of administration. ResultsA total of 13,744 records that met the selection criteria was extracted and grouped into 8,436 cases. There were 9 clinically distinct event sequence patterns (temporal phenotypes) of patient journeys identified, representing the main sequences in which surgery and antimicrobial interventions are performed. Patients receiving amoxicillin and surgery had the shortest duration of antimicrobial administration (median of 3.4 days) and patients receiving cefovecin with no surgical intervention had the longest antimicrobial treatment duration (median of 27 days). ConclusionOur study demonstrates methods to extract and provide an overview of temporal phenotypes of patient journeys, which can be applied to text-based clinical records for multiple species or clinical conditions. We demonstrate the effectiveness of this approach to derive real-world evidence of treatment impacts using cat bite abscesses as a model condition to describe patterns of antimicrobial therapy prescriptions and their outcomes.

Economic impact of subclinical mastitis treatment in early lactation using intramammary nisin

Treatment of subclinical mastitis (SCM) during lactation is rarely recommended due to concerns related to both antimicrobial usage and costs associated with milk discard. Nisin is a naturally produced antimicrobial peptide with a Gram-positive spectrum that, when given to dairy cows, does not require milk discard. We evaluated the economic impact of treatment of SCM during early lactation using a nisin-based intramammary treatment under different scenarios which included various treatment costs, milk prices, and cure rates. We stochastically simulated the dynamics of SCM detected during the first week of lactation. The net economic impact was expressed in US dollars per case. The probabilities of an event and their related costs were estimated using a model that was based on pathogen-specific assumptions selected from peer-reviewed articles. Nisin cure rates were based on results of pivotal studies included in the FDA approval submission. Based on our model, the average cost of a case of intramammary infection (i.e., only true positive cases) in early lactation was $170 (90th percentage range = $148 to $187), while the cost of a clinical mastitis case was $521 (90th percentage range = $435 to $581). Both estimates varied with etiology, parity, and stage of lactation. When comparing the net cost of SCM cases (i.e., CMT-positive tests) detected during the first week of lactation, nisin treatment generated an average positive economic impact of $19 per CMT-positive case. Use of nisin to treat SCM was beneficial 93% of the time. Based on the sensitivity analysis, treatment would result in an economically beneficial outcome for 95% and 73% of multiparous and primiparous cows, respectively. At the herd level, use of intramammary nisin to treat SCM in cows in early lactation was economically beneficial in most tested scenarios. However, economic impact was highly influenced by factors such as rate of bacteriological cure, cost of treatment, and parity of affected animal. These factors should be considered when deciding to use nisin as a treatment for SCM.

Bovine Genital Leptospirosis: An Update of This Important Reproductive Disease.

Bovine leptospirosis is an important disease that affects the reproductive sphere. Due to its high relevance for the bovine production chain in a worldwide scenario, a better understanding of the disease is crucial to reduce its negative impacts. The main agents are strains from the Sejroe serogroup, such as Hardjo and Guaricura, which lead to renal and genital infection. The genital colonization causes a chronic, silent, and subclinical reproductive syndrome, called Bovine Genital Leptospirosis (BGL). Embryonic death, estrus repetition, subfertility, and abortions are the main signs of BGL condition in females. However, although leptospires have been identified in semen, the manifestation of BGL in bulls remains to be clarified. The recommended diagnosis of BGL includes a serologic screening of the herds using the microscopic agglutination test followed by PCR of genital samples (cervicovaginal mucus, uterine fragment, or semen), especially from animals with reproductive failures. After the identification of carriers, control is carried out considering three steps: antimicrobial treatment of the carriers, environmental and reproductive management, and herd vaccination. Systematic testing, quarantine of newly arrived animals, and usage of antimicrobials in semen diluents or embryo culture media are other sanitary approaches that are encouraged to improve the control of the syndrome. Herein we discuss protocols for an efficient diagnosis and preventive procedures of BGL, which are fundamental to reducing the negative impact of the disease on cattle reproduction and its consequent economic hazards.

Third nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2020 and 2021: Antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus

The Japanese surveillance committee conducted a third nationwide surveillance of antimicrobial susceptibility of acute uncomplicated cystitis at 55 facilities throughout Japan between April 2020 and September 2021. In this surveillance, we investigated the susceptibility of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Staphylococcus saprophyticus (S. saprophyticus) for various antimicrobial agents by isolating and culturing bacteria from urine samples. In total, 823 strains were isolated from 848 patients and 569 strains of target bacteria, including E. coli (n = 529, 92.9 %), K. pneumoniae (n = 28, 4.9 %), and S. saprophyticus (n = 12, 2.2 %) were isolated. The minimum inhibitory concentrations of 18 antibacterial agents were determined according to the Clinical and Laboratory Standards Institute manual. In premenopausal patients, there were 31 (10.5 %) and 20 (6.8 %) fluoroquinolone (FQ)-resistant E. coli and extended-spectrum β-lactamase (ESBL)-producing E. coli, respectively. On the other hand, in postmenopausal patients, there were 75 (32.1 %) and 36 (15.4 %) FQ-resistant E. coli and ESBL-producing E. coli, respectively. The rate of FQ-resistant E. coli and ESBL-producing E. coli in post-menopausal women was higher than that for our previous nationwide surveillance (20.7 % and 32.1 %: p = 0.0004, 10.0 % and 15.4 %; p = 0.0259). For pre-menopausal women, there was no significant difference in the rate of FQ-resistant E. coli and ESBL-producing E. coli between this and previous reports, but the frequency of FQ-resistant E. coli and ESBL-producing E. coli exhibited a gradual increase. For appropriate antimicrobial agent selection and usage, it is essential for clinicians to be aware of the high rate of these antimicrobial-resistant bacteria in acute uncomplicated cystitis in Japan.

Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study

BackgroundAntimicrobial resistance (AMR) is the process by which microbes evolve mechanisms to survive the medicines designed to destroy them i.e. antimicrobials (AMs). Despite being a natural process, AMR is being hastened by the abuse of AMs. In context of Nepal, there is limited information on drivers of AMR and barriers in addressing it from a community perspective. This study explores the local language and terminology used around AMs in the community, commonly used AMs and reasons for their usage, how these AMs are sourced, and the perceived barriers to addressing AMR via One Health approach.MethodsA phenomenological study design was utilized with applied qualitative research theoretically framed as pragmatism. Twelve in-depth interviews and informal discussions with a One Health focus, were purposively conducted with wide range of stakeholders and community resident of Kapilvastu municipality of Nepal during April 2022. The acquired data was analyzed manually via a thematic framework approach. The study obtained ethical approval from ethical review board of Nepal Health Research Council and University of Leeds.ResultsNepali and Awadhi languages does not have specific words for AMs or AMR, which is understandable by the community people. Rather, community use full explanatory sentences. People use AMs but have incomplete knowledge about them and they have their own local words for these medicines. The knowledge and usage of AMs across human and animal health is impacted by socio-structural factors, limited Government regulation, inadequate supply of AMs in local government health facilities and the presence of various unregulated health providers that co-exist within the health system. Novel ideas such as the use of visual and smart technology, for instance mobile phones and social media exposure, can enable access to information about AMs and AMR.ConclusionThis study shows that terminology that is understandable by the community referring to AMs and AMR in Nepali and Awadhi languages does not exist, but full explanatory sentences and colloquial names are used. Despite regular utilisation, communities have incomplete knowledge regarding AMs. Since, knowledge alone cannot improve behaviour, behavioural interventions are required to address AMR via community engagement to co-produce their own solutions.Trial registrationNot applicable.

Enhancing Commercial Antibiotics with Trans-Cinnamaldehyde in Gram-Positive and Gram-Negative Bacteria: An In Vitro Approach.

One strategy to mitigate the emergence of bacterial resistance involves reducing antibiotic doses by combining them with natural products, such as trans-cinnamaldehyde (CIN). The objective of this research was to identify in vitro combinations (CIN + commercial antibiotic (ABX)) that decrease the minimum inhibitory concentration (MIC) of seven antibiotics against 14 different Gram-positive and Gram-negative pathogenic bacteria, most of them classified as ESKAPE. MIC values were measured for all compounds using the broth microdilution method. The effect of the combinations on these microorganisms was analyzed through the checkboard assay to determine the type of activity (synergy, antagonism, or addition). This analysis was complemented with a kinetic study of the synergistic combinations. Fifteen synergistic combinations were characterized for nine of the tested bacteria. CIN demonstrated effectiveness in reducing the MIC of chloramphenicol, streptomycin, amoxicillin, and erythromycin (94-98%) when tested on Serratia marcescens, Staphylococcus aureus, Pasteurella aerogenes, and Salmonella enterica, respectively. The kinetic study revealed that when the substances were tested alone at the MIC concentration observed in the synergistic combination, bacterial growth was not inhibited. However, when CIN and the ABX, for which synergy was observed, were tested simultaneously in combination at these same concentrations, the bacterial growth inhibition was complete. This demonstrates the highly potent in vitro synergistic activity of CIN when combined with commercial ABXs. This finding could be particularly beneficial in livestock farming, as this sector witnesses the highest quantities of antimicrobial usage, contributing significantly to antimicrobial resistance issues. Further research focused on this natural compound is thus warranted for this reason.

Research on Bacterial Diversity and Antibiotic Resistance in the Dairy Farm Environment in a Part of Shandong Province.

Antimicrobials are extensively utilized in dairy farms to prevent and control diseases in cattle. However, their use contributes to the emergence of antimicrobial-resistant bacteria (ARB) and antimicrobial-resistant genes (ARG), and these can be transmitted to the environment. Regular monitoring of antimicrobial resistance (AMR) is crucial for implementing effective mitigation strategies. This research aimed to assess the environmental microbial species present on dairy farms in Shandong Province and characterize the antimicrobial resistance profiles of the isolates. Five dairy farms located in Shandong Province were selected, representing the prevalent large-scale farming patterns in the area. Sampling took place from April to June 2022, with a total of 223 isolates collected from various environmental locations within each farm (bedding, sports field, and milking parlor). Matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) was employed to identify the species of the clinical isolates. The main pathogens isolated were Aerococcus viridans (5.38%, n = 12), Corynebacterium xerosis (4.93%, n = 11), and Acinetobacter lwoffii (4.03%, n = 9). Among the bacterial isolates, resistance to lincomycin was highest at 91%, and 88% were resistant to sulfadiazine. Antimicrobial resistance genes were detected in only a small proportion of the isolates, the most common of which was sul1. These findings highlight the necessity for careful evaluation of antimicrobial usage in maintaining their effectiveness in human medicine. Understanding the microbial species present and their antimicrobial resistance profiles aids in focusing efforts toward sustainable antimicrobial use and safeguarding human health.

A coaching approach to strengthen farm management teams to reduce antimicrobial use in Dutch high usage pig farms: a 2 year intervention study.

The use of antimicrobials in the pig sector in the Netherlands has been reduced by more than 70% over the last decade. However, there is still a considerable number of pig farms that have not been able to lower their antimicrobial usage (AMU) to a sufficiently low level, comparable to the majority of the other pig farms. Therefore, an intervention study was initiated to lower on-farm antimicrobial use in which 45 pig farms with high AMU were recruited. These farms were coached over a period of 2 years whereby different management interventions were introduced. During the 2-year study period a significant reduction of 13 and 17% in total AMU was seen in weaned piglets and fattening pigs respectively. The introduction of coaching as well as multiple management interventions were (univariably) associated with the decrease in AMU. After mutual adjustment of coaching and individual interventions, the association between coaching and AMU became substantially weaker, indicating that coaching and interventions were interrelated and specific interventions explained the reduction in AMU. In conclusion, a coaching effect was observed in this study, with an effect on AMU through specific interventions. More insights are needed regarding the role and effects of coaching on the influence on the management team comprising the farmer, veterinarian and (feed) advisor, and interventions implemented.

Antimicrobial agent usage patterns and their role in preventing surgical site infections at a tertiary care teaching hospital: A comprehensive study

Background: Surgical site infections (SSIs) present a formidable challenge in contemporary healthcare, impacting patient well-being and contributing to escalating healthcare costs. The judicious utilization of antimicrobial agents is paramount in effectively combating SSIs. This study, conducted at a Tertiary Care Teaching Hospital in Kerala, seeks to unravel the intricate patterns of antimicrobial agent usage within the General Surgery Department over 10 months. Aims and Objectives: The primary aim is to thoroughly examine antimicrobial agent patterns within the General Surgery Department, focusing specifically on patients undergoing surgical procedures. The study aims to assess the appropriateness of antimicrobial agent usage, encompassing the choice for prophylactic purposes, timing of pre-operative dosing, the occurrence of intraoperative dosing, and the selection appropriateness for post-operative prophylaxis. Materials and Methods: Crafted for robust analysis, the study included 150 cases, implementing specific inclusion and exclusion criteria to ensure data quality. The emphasis was placed on patients undergoing surgical procedures, focusing on prophylactic antimicrobial use. Data collection involved meticulously evaluating appropriateness across critical parameters, including the choice of prophylactic antimicrobial agent, pre-operative dosing timing, intraoperative dosing, and selection appropriateness for post-operative prophylaxis. Results: Analysis of 150 cases provided valuable insights into the age and gender distribution, predominantly within the 41–60 age groups. Prevalent surgical procedures, such as hernia and appendicitis, underscored the necessity for tailored antimicrobial protocols. Cephalosporins emerged as the dominant class, raising concerns about potential overuse and resistance. Pre-exposure prophylactic antibiotics, predominantly cephalosporins, were administered in 88 cases. Post-exposure prophylaxis mirrored this trend, necessitating a critical evaluation of antibiotic selection and duration. Detailed analysis of cephalosporin pre- and post-exposure prophylaxis identified prevalent choices such as Cefotaxime and Cefoperazone + Sulbactam, emphasizing the importance of scrutinizing cephalosporin selection. Conclusion: This study furnishes valuable insights into the appropriateness of antimicrobial agent usage for preventing SSIs, serving as a model for analogous healthcare settings. It underscores the significance of local antibiotic stewardship, guideline adherence, and the ongoing commitment to optimizing prophylactic antimicrobial usage for ensuring patient safety and advancing healthcare quality amidst evolving challenges.

A quasi-experimental analysis comparing antimicrobial usage on COVID-19 and non-COVID-19 wards.

To describe antimicrobial usage (AMU) trends before and during the coronavirus disease 2019 (COVID-19) pandemic, between COVID-19 and non-COVID-19 wards, and if there was any association with a COVID-19 order set. Quasi-experimental retrospective interrupted time series analysis of AMU rates with a contemporaneous comparison of COVID-19 versus non-COVID-19 control wards. Analysis using incidence rate ratios (IRR) was conducted using a Poisson regression generalized linear model. Five COVID-19 and 4 comparable non-COVID-19 wards and 6 intensive care units (ICUs) at 4 hospitals during pandemic waves 1-4. All inpatients receiving systemic antimicrobials. The COVID-19 checkbox antimicrobial order set was implemented in March 2020, to be used only if considered clinically indicated with modification in August 2021. The primary outcome was a change in AMU rates (defined daily dose per 100 patient days per month) comparing pre- versus peri-pandemic periods and COVID-19 versus control non-COVID-19 wards. Secondary outcomes included antifungal usage rate in ICUs and assessing AMUs following implementation and modification of a COVID-19 order set. Significantly greater rates of AMU (IRR[95%CI]) were observed on COVID-19 wards versus non-COVID-19 wards during waves 1-4 for all systemic antimicrobials (1.76[1.71-1.81], 1.10[1.07-1.13], 1.48[1.43-1.53], and 1.06[1.03-1.09]); for azithromycin (11.76[9.80-14.23], 10.96[9.49-12.74], 12.41[10.73-14.45], and 4.88[4.31-5.55]); and for ceftriaxone (2.39[2.16-2.65], 3.64[3.29-4.03], 2.94[2.67-3.23], and 1.62[1.49-1.76]). We observed significantly increased AMU rates of all systemic agents during the first 4 waves of the pandemic and on COVID-19 wards compared with control wards for azithromycin and ceftriaxone. These agents saw a twofold reduction following order-set removal, suggesting that the clinical decision-support tool order set, as utilized, had influenced prescribing behavior.