Appropriateness Of Antibiotic Prescribing Research Articles

Appropriateness of antibiotic prescribing among patients treated for dental diseases in Mekelle city, Northern Ethiopia: a cross sectional study

BackgroundLocal operative treatments are generally preferred for most dental diseases, with antibiotics only recommended as an adjunct in specific cases. Misuse and overuse of antibiotics has been shown to significantly contribute to the development of resistant bacteria. However, the antibiotic prescribing practices of dentists in Ethiopia have not been thoroughly studied. This study aimed to assess the appropriateness of antibiotic prescribing for patients with dental diseases at dental clinics in Mekelle City, Northern Ethiopia.MethodsA cross sectional study was conducted in April and May 2020 among patients visiting dental clinics in Mekelle City. Data were collected through patient medical record reviews and dentist interviews. The appropriateness of antibiotic prescription was evaluated based on guidelines from the American Dental Association and the European Society of Endodontology. Data were analyzed using SPSS Statistics, version 29. Binary logistic regression analysis was performed, and the results were presented as odds ratios with 95% confidence intervals. A p value less than 0.05 was considered statistically significant.ResultsTwo hundred and thirty-one patients with dental diseases participated in the study. The mean age was 30.6 years with a standard deviation of 16.1. Most participants had dental pulp related disease. 89% of patients were prescribed antibiotics, with amoxicillin being the most common. Inappropriate antibiotic prescribing was identified in 175 (75.8%) of the study participants. The most common inappropriate prescribing was unnecessary antibiotic prescribing for dental conditions without systemic signs, assessed in 141 (80.1%) participants. Patients diagnosed with pulp related disease without systemic signs and those who had tooth extractions were significantly associated with inappropriate antibiotic prescription (p value < 0.001).ConclusionsThe study findings show that antibiotics are over-prescribed for dental conditions in this resource constrained setting, especially in patients who have had tooth extractions. Dentists need training on appropriate antibiotic use and antimicrobial stewardship interventions should be implemented in dental setting to reduce unnecessary antibiotic prescriptions and prevent antibiotic resistance development.

Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.

This work was undertaken to inform a National Institute for Health and Care Excellence guideline on the initial assessment of adults with suspected acute respiratory infection. To undertake a rapid evidence synthesis of systematic reviews and cost-effectiveness studies of signs, symptoms and early warning scores for the initial assessment of adults with suspected acute respiratory infection. MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for systematic reviews and MEDLINE, EMBASE, EconLit and National Health Service Economic Evaluation Database were searched for cost-effectiveness studies in May 2023. References of relevant studies were checked. Clinical outcomes of interest included escalation of care, antibiotic/antiviral use, time to resolution of symptoms, mortality and health-related quality of life. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool or the National Institute for Health and Care Excellence economic evaluations checklist. Results were summarised using narrative synthesis. Nine systematic reviews and one cost-effectiveness study met eligibility criteria. Seven reviews assessed several early warning scores for patients with community- acquired pneumonia, one assessed early warning scores for nursing home-acquired pneumonia and one assessed individual signs/symptoms and the Centor score for patients with sore throat symptoms; all in face-to-face settings. Two good-quality reviews concluded that further research is needed to validate the CRB-65 in primary care/community settings. One also concluded that further research is needed on the Pneumonia Severity Index in community settings; however, the Pneumonia Severity Index requires data from tests not routinely conducted in community settings. One good-quality review concluded that National Early Warning Score appears to be useful in an emergency department/acute medical setting. One review (unclear quality) concluded that the Pneumonia Severity Index and CURB-65 appear useful in an emergency department setting. Two poor-quality reviews concluded that early warning scores can support clinical judgement and one poor-quality review found numerous problems with using early warning scores in a nursing home setting. A good-quality review concluded that individual signs and symptoms have a modest ability to diagnose streptococcal pharyngitis, and that the Centor score can enhance appropriate prescribing of antibiotics. The cost-effectiveness study assessed clinical scores and rapid antigen detection tests for sore throat, compared to delayed antibiotic prescribing. The study concluded that the clinical score is a cost-effective approach when compared to delayed prescribing and rapid antigen testing. Several early warning scores have been evaluated in adults with suspected acute respiratory infection, mainly the CRB-65, CURB-65 and Pneumonia Severity Index in patients with community-acquired pneumonia. The evidence was insufficient to determine what triage strategies avoid serious illness. Some early warning scores (CURB-65, Pneumonia Severity Index and National Early Warning Score) appear to be useful in an emergency department/acute medical setting; however, further research is required to validate the CRB-65 and Pneumonia Severity Index in primary care/community settings. The economic evidence indicated that clinical scores may be a cost-effective approach to triage patients compared with delayed prescribing. Only systematic reviews were eligible for inclusion in the synthesis of clinical evidence. There was a great deal of overlap in the primary studies included in the reviews, many of which had significant limitations. No studies were undertaken in remote settings (e.g. NHS 111). Only one cost-effectiveness study was identified, with limited applicability to the review question. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159945.

Evaluation of appropriateness of antibiotic prescribing in primary healthcare institutions in China using proxy indicator

Our objectives were to develop a set of proxy indicators (PIs) suited for assessing antibiotic use appropriateness in China's primary healthcare institutions (PHIs), and assess performance scores of these PIs while exploring factors that influence the antibiotic appropriateness. We selected potential PIs for the PHIs through a RAND-modified Delphi procedure, and assessed clinimetric properties, focusing on measurability, applicability, and potential for improvement. PIs with favorable clinimetric properties were used to evaluate antibiotic prescription appropriateness by calculating performance scores of each PI. Institutions were categorized into three clusters representing different levels of appropriateness. We used the chi-square test and an ordinal logistic regression model at PHI level to explore factors influencing antibiotic appropriateness. Eighteen PIs were developed through two rounds of online surveys and one face-to-face meeting involving 20 stakeholders. All PIs met the clinimetric properties criteria and were used to analyze 209,662 antibiotic prescriptions across 269 PHIs. The percentage of PHIs meeting the target ranged from 3.1% to 69.3%, with 6 PIs below 10%. The appropriateness of antibiotic prescriptions was significantly associated with percentages of patients' gender of the PHIs. The varied and suboptimal performance of the PIs indicated the need for diverse efforts to enhance the rational antibiotic use at PHI level. It was necessary to devise distinct sets of PIs for diverse settings in future endeavors. This work was supported by the National Natural Science Foundation of China (grant numbers 72374009, 81973294).

Appropriateness of Antibiotic Prescriptions in Emergency Departments in the United States, 2016-2021

Background: Inappropriate antibiotic prescribing contributes to antimicrobial resistance, a global health threat. Prior studies have used ICD-9-CM codes to estimate inappropriate prescribing rates in ambulatory settings, including emergency departments (EDs), though the last national estimates date back to 2010-2015 (Hersh et al, CID 2021). Using the most recent publicly available data, we estimated inappropriate antibiotic prescribing rates in EDs across all conditions. For further characterization, we estimated rates of inappropriate antibiotic prescribing with and without codes that could be plausible indications for which antibiotics are prescribed. Methods: We analyzed 2016-2021 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of EDs, subsetting to visits with ≥1 oral antibiotic prescription. Using ICD-10-CM codes (Chua et al, BMJ 2019), we calculated proportions of visits with inappropriate antibiotic prescribing; inappropriate antibiotic prescribing and ≥1 plausible antibiotic-inappropriate indication (e.g., viral infection); and inappropriate prescribing without plausible antibiotic-inappropriate indications. Among visits with plausible antibiotic-inappropriate indications, we subcategorized these further (e.g. viral infection, ophthalmologic conditions). Among visits without plausible antibiotic-inappropriate indications, we determined the most common diagnosis codes. We conducted analyses overall and separately among children (0-17 years), adults (18-64 years), and older adults (≥65 years). Results: Demographic characteristics by age group are shown in Table 1. Antibiotic prescription rates overall and for children, adults, and older adults were 18.6%, 17.8%, 19.1%, and 18.0%, respectively. Inappropriate prescription rates were 27.6%, 23.7%, 29.8%, and 24.6%, respectively. Inappropriate antibiotic prescription rates with plausible indications were 14.9%, 16.7%, 15.0%, and 12.6%, while inappropriate antibiotic prescription rates without plausible indications were 12.7%, 7.0%, 14.9%, and 12.0%, respectively (Figure 1). Rates of subcategories of inappropriate prescribing with plausible antibiotic indications overall and by age group are shown in Figure 2, with the most common diagnoses for potential signs and symptoms of infection in Table 2. The most common diagnoses for inappropriate prescribing without plausible indications are in Table 3. Conclusions: Inappropriate antibiotic prescriptions in EDs are common with a substantial proportion without plausible conditions. Most inappropriate prescriptions with plausible antibiotic-inappropriate indications are associated with potential signs and symptoms of infection without a more definitive diagnosis code, suggesting either diagnostic uncertainty or poor coding quality. Future work should distinguish between these two possibilities to determine whether stewardship efforts should focus on educational strategies to avoid unnecessary empiric antibiotic prescribing in the setting of diagnostic uncertainty, improving coding quality, or both.

Appropriateness of intended antibiotic prescribing using clinical case vignettes in primary care, and related factors

Background Factors associated with the appropriateness of antibiotic prescribing in primary care have been poorly explored. In particular, the impact of computerised decision-support systems (CDSS) remains unknown. Objectives We aim at investigating the uptake of CDSS and its association with physician characteristics and professional activity. Methods Since May 2022, users of a CDSS for antibiotic prescribing in primary care in France have been invited, when registering, to complete three case vignettes assessing clinical situations frequently encountered in general practice and identified as at risk of antibiotic misuse. Appropriateness of antibiotic prescribing was defined as the rate of answers in line with the current guidelines, computed by individuals and by specific questions. Physician’s characteristics associated with individual appropriate antibiotic prescribing (< 50%, 50–75% and > 75% appropriateness) were identified by multivariate ordinal logistic regression. Results In June 2023, 60,067 physicians had registered on the CDSS. Among the 13,851 physicians who answered all case vignettes, the median individual appropriateness level of antibiotic prescribing was 77.8% [Interquartile range, 66.7%–88.9%], and was < 50% for 1,353 physicians (10%). In the multivariate analysis, physicians’ characteristics associated with appropriateness were prior use of the CDSS (OR = 1.71, 95% CI 1.56–1.87), being a general practitioner vs. other specialist (OR = 1.34, 95% CI 1.20–1.49), working in primary care (OR = 1.14, 95% CI 1.02–1.27), mentoring students (OR = 1.12, 95% CI 1.04–1.21) age (OR = 0.69 per 10 years increase, 95% CI 0.67–0.71). Conclusion Individual appropriateness for antibiotic prescribing was high among CDSS users, with a higher rate in young general practitioners, previously using the system. CDSS could improve antibiotic prescribing in primary care.

Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE. The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

Appropriateness of Antibiotic Prescribing in US Emergency Department Visits, 2016-2021.

In this national analysis of US emergency department visits with antibiotic prescribing during 2016-2021, 27.6% of visits resulted in inappropriate antibiotic prescribing: 14.9% had diagnosis codes plausibly antibiotic-related (eg, acute bronchitis), suggesting actual inappropriate prescribing, and 12.6% had diagnosis codes not plausibly antibiotic-related (eg, hypertension), suggesting poor coding quality.

2279. Appropriateness of Antibiotic Prescribing Before vs. After Minimum Inhibitory Concentration (MIC) Suppression in Culture Reports: A Quasi-experimental Study

Abstract Background Culture and susceptibility results are essential to identify the offending organism and optimize antibiotic treatment; hence, decrease the emergence of antibiotic resistance and achieve better clinical outcomes. Antibiotic prescribers should learn how to interpret MIC breakpoints to prescribe a suitable antibiotic as different antibiotics have different MIC breakpoints against different microorganisms. No study to date has evaluated the impact of MIC suppression in culture reports while keeping interpretation results on the appropriateness of antibiotics choice by non-infectious diseases prescribers. We assessed the impact of MIC suppression on the appropriateness of antibiotic prescriptions. Methods This was a quasi-experimental study (pre-post intervention) that was conducted over 14 months on hospitalized patients in the medical floor who had a symptomatic infection with a positive culture and were prescribed a full course of definitive antibiotics by prescribers not specialized in infectious diseases pre and post MIC suppression in culture reports. The primary outcome was appropriateness of antibiotic selection (the de-escalation to the narrowest spectrum antibiotic to which the organism is susceptible with appropriate dose). Secondary outcomes were clinical cure (resolution of signs and symptoms, including defervescence and normalization of white blood cells count), length of stay (LOS), and antibiotics expenditure as defined daily dose (DDD) per 1,000 patient days and days of therapy (DOT) per 1,000 patient days. Results 100 patients were included, 50 in each phase. No difference was observed in the baseline characteristics, including age, sex, infection site, isolated organism, and prescribers’ departments. Appropriate antibiotic selection was significantly higher in the post-intervention phase compared to the pre-intervention phase (62% vs. 40%; P=0.028). LOS was shorter in the post-intervention phase compared to the pre-intervention phase (5 vs. 9.5 days; P=0.011). No difference was reported in the other outcomes. Conclusion Our study showed that suppressing MIC values from cultures reports was helpful in choosing the appropriate antibiotic and minimizing the LOS. Future research is needed to confirm these findings. Disclosures All Authors: No reported disclosures

2250. Fluoroquinolone Stewardship at a Veterans Affairs Facility: A Six Year Review

Abstract Background Increased utilization of antibiotics leads to decreased antimicrobial susceptibility, a well-established phenomenon. Antimicrobial stewardship programs (ASP) promote appropriate prescribing of antibiotics by decreasing inappropriate use, aiming to improve patient outcomes and reducing antimicrobial resistance. Fluroquinolones (FQ) are among the most prescribed antibiotics. We describe out institutional FQ use since inception of our ASP and followed the trend for susceptibility of Enterobacteriaceae and Pseudomonas Methods Northport Veterans Affairs Medical Center (VAMC) provides care for over 30000 Veterans in Long Island, New York, with emergency room, acute care hospital, nursing homes and outpatient clinics A Retrospective review investigated FQ use by total refills per year and by days of therapy per 1000 patient days at Northport VAMC from 2012 to 2022, along with review of local annual antibiograms focusing on ciprofloxacin susceptibility to E. coli, K. pneumoniae, P. mirabilis and P. aeruginosa. An ASP in our facility was initiated in 2016. FQs are restricted antibiotics and require approval by the infectious diseases team (attendings, fellows, pharmacist) Results Figure 1 provides the outpatient total fills per year for Ciprofloxacin, Levofloxacin, Moxifloxacin. Inpatient FQ use during the ASP years was low: Figure 2 shows the FQ inpatient use (days of therapy/1000days) from 2019 to 2022. Comparing years 2012-2016 vs 2017-2022 there was a decrease in fills of ciprofloxacin (median 604 vs. 308 fills, P: 0.009), levofloxacin (276 vs. 116, P: 0.032), and moxifloxacin (116 vs. 14, P: 0.015). By same period comparison (see figure 3), Ciprofloxacin susceptibility for E. coli ranged median 66.5% to 61.5%, P: 0.126, K. pneumoniae 67% vs. 75.5% P: 0.086, P. mirabilis 45% vs. 47.5% P: 0.451, and P. aeruginosa 63% vs. 68.5% P: 0.308 Figure 2 inpatient FQ use 2019 to 2022 Figure 3 Ciprofloxacin susceptibility trend over time Conclusion There was a statistically significant decrease in the use of FQ in the outpatient setting after ASP was initiated in our facility. Although there was a trend in improvement in ciprofloxacin susceptibilities for Klebsiella, Proteus, and Pseudomonas, it was not statistically significant. Nevertheless, our results show that reducing FQ consumption can prevent worsening susceptibility trends for enteric gram negatives and Pseudomonas. Disclosures All Authors: No reported disclosures

Impact of antibiotic allergy labels on timely and appropriate antibiotics for sepsis in the emergency department

Abstract Objectives Time to initiation of effective antibiotic therapy is a strong predictor of survival for patients with sepsis presenting to the Emergency Department (ED). Antibiotic allergy labels (AALs) are a known barrier to timely sepsis management. The aim was to evaluate the influence of AALs on timely sepsis management for ED sepsis presentations in an Australian hospital. Methods A retrospective cohort study was conducted for ED presentations requiring direct ICU admission for suspected sepsis, comparing patients with and without an AAL using propensity scores. Results Between November 2018 and June 2021, 377 patients were included. The prevalence of an AAL was 29.6% (86/377). The median time to antibiotic administration was similar in the AAL versus non-AAL groups (51 versus 60 min, P = 0.11); there was no difference in mortality (14.1% versus 14.0%, P = 0.98) and length of stay (9.21 versus 10.10 days). The median time to antibiotic administration was shorter in those with Emergency Medicine (EM) pharmacist attendance versus those without (50 versus 92 min, P = 0.0001). Appropriateness of antibiotic prescription was 91.0% (343/377) for the overall cohort and was not associated with AALs, possibly due to our clear antimicrobial sepsis guidelines; however, EM pharmacist involvement was associated with increased antibiotic appropriateness (97.3% versus 88.4%, P = 0.00048). Conclusions In our Australian ED, AALs were not found to impact timeliness of antibiotic administration in patients with sepsis. EM pharmacist involvement was associated with improved timeliness and appropriateness of antibiotic selection in patients presenting with sepsis.

Appropriateness of Antibiotic Prescribing in the Emergency Department of Mofid Children's Hospital: A Retrospective Cross-Sectional Study

Background: Antibiotics should be used to treat bacterial infections, while prescribing antibiotics for viral infections is ineffective. Sometimes, physicians do not diagnose diseases correctly and misdiagnose viral infections as bacterial. Objectives: In this study, we aimed to evaluate the appropriateness of prescribed antibiotics in the Children’s Emergency Department of Mofid Hospital, Tehran, Iran. Methods: This cross-sectional study was conducted in the Emergency Department of Mofid Children's Hospital during January-December 2019. All children younger than 16 years who were hospitalized and received antibiotics were included in this study. The degree of fever, diagnosis of disease, and laboratory findings were assessed. Results: We found 12.6% (38/301) inappropriate antibiotic prescriptions in the studied cases. The causes of antibiotic inappropriateness were incorrect diagnosis in 4.31% of patients (13/301), incorrect medication dose in 1.99% (6/301) patients, and no indication for the prescribed medicine in 6.31% (19/301) patients. Erythrocyte sedimentation rate, C-reactive protein, and neutrophil count were not significantly different between the two groups (P &gt; 0.05). Conclusions: According to our results, incorrect antibiotic prescription is common in Mofid Hospital. Therefore, it is an urgent need to monitor and train the treatment system.

Highly specific detection of Neisseria gonorrhoeae based on recombinase polymerase amplification-initiated strand displacement amplification

Neisseria gonorrhoeae is the only pathogen that causes gonorrhea, and can have serious consequences if left untreated. A simple and accurate detection method for N. gonorrhoeae is essential for the diagnosis of gonorrhea and the appropriate prescription of antibiotics. The application of isothermal recombinase polymerase amplification (RPA) to detect this pathogen is advantageous because of its rapid performance, high sensitivity, and minimal dependency on equipment. However, this simplicity is offset by the risk of false-positive signals from primer-dimers and primer-probe dimers. In this study, RPA-initiated strand displacement amplification (SDA) was established for the detection of N. gonorrhoeae, and eliminated false-positive signals from primer–dimers and primer-probe dimers. The developed biosensor allows for the reduced generation of nonspecific RPA amplification through the design of enzyme cleavage sites on primers, introduction of SDA, and detection of the final product using a molecular beacon (MB). Using this system, the DNA double strand is transformed into single-stranded DNA following SDA, thereby providing a more suitable binding substrate and improving the efficiency of MB detection. Amplification can be conducted below 37 °C, and the process can be completed within 90 min. The limit of detection was determined to be 0.81 copies/μL. This system is highly specific for N. gonorrhoeae and exhibits no cross-reactivity with other common urogenital pathogens. The results of this study are consistent with those of real-time PCR performed on clinical specimens of urogenital secretions. In summary, the biosensor is a simple and specific detection method for N. gonorrhoeae.

Improving the management of medical emergency team calls due to suspected infections: A before–after study

ObjectiveTo introduce a management guideline for sepsis-related MET calls to increase lactate and blood culture acquisition, as well as prescription of appropriate antibiotics. DesignProspective before (Jun–Aug 2018) and after (Oct–Dec 2018) study was designed. SettingA public university linked hospital in Melbourne, Australia. ParticipantsAdult patients with MET calls related to sepsis/infection were included. Main outcome measuresThe primary outcome measure was the proportion of MET calls during which both a blood culture and lactate level were ordered. Secondary outcomes included the frequency with which new antimicrobials were commenced by the MET, and the presence and class of administered antimicrobials. ResultsThere were 985 and 955 MET calls in the baseline and after periods, respectively. Patient features, MET triggers, limitations of treatment and disposition after the MET call were similar in both groups. Compliance with the acquisition of lactates (p = 0.101), respectively. There was a slight reduction in compliance with lactate acquisition in the after period (97% vs 99%; p = 0.06). In contrast, there was a significant increase in acquisition of blood cultures in the after period (69% vs 78%; p = 0.035). ConclusionsIntroducing a sepsis management guideline and enhanced linkage with an AMS program increased blood culture acquisition and decreased broad spectrum antimicrobial use but didn't change in-hospital mortality.

Optimizing Antimicrobial Prescribing in Dentistry in India – From Policy to Practice

Introduction: It is estimated that in total, dentists prescribe 10% of all antimicrobials prescribed, and there is evidence of inappropriate use. Although National guidelines for antimicrobial prescribing and framing antibiotic policy are available for broad medical specialities, they don’t include various specialities in clinical dentistry. This guidance has been developed to promote judicious antimicrobial prescribing and antimicrobial stewardship in clinical dentistry in India. Methods: This policy was developed by the members of Antimicrobial Stewardship Practice Committee in consultation with the Dental practitioners in various specialities in dentistry. Results &amp; Discussion: The AMSP committee issued a policy for the year 2021-2022, outlining policies to improve antibiotic use and appropriateness of antibiotic prescriptions, and including targets for the various specialities in dentistry. Conclusion: Comprehensive National clinical practice and antimicrobial prescribing guidelines, in combination with sensitization campaigns are needed for dental practitioners to effectively combat growing antimicrobial resistance. Keywords: Antimicrobial stewardship, Antimicrobial prescribing, Dentistry, India

Three Klebsiella species as potential pathobionts generating endogenous ethanol in a clinical cohort of patients with auto-brewery syndrome: a case control study

Patients with auto-brewery syndrome (ABS) become inebriated after the ingestion of an alcohol-free, high-carbohydrate diet. Our previous work has shown that high-alcohol-producing (HiAlc) Klebsiella pneumoniae can generate excessive endogenous ethanol and cause non-alcoholic fatty liver disease (NAFLD). Therefore, it is reasonable to speculate that such bacteria might play an important role in the pathogenesis of ABS. The characteristics and metabolites of the intestinal flora from a clinical cohort of patients with ABS were analysed during different stages of disease and compared to a group of healthy controls. An invitro culture system of relevant samples was used for screening drug sensitivity and ABS-inducing factors. Rabbit intestinal and murine models were established to verify if the isolated strains could induce ABS invivo. We observed intestinal dysbiosis with decreased abundance of Firmicutes and increased of Proteobacteria in patients with ABS compared with healthy controls. The abundance of the genus Klebsiella in Enterobacteriaceae was strongly associated with fluctuations of patient's blood alcohol concentration. We isolated three species of HiAlc Klebsiella from ABS patients, which were able to induce ABS in mice. Monosaccharide content was identified as a potential food-related inducing factor for alcohol production. Treatments with antibiotics, a complex probiotic preparation and a low-carbohydrate diet not only alleviated ABS, but also erased ABS relapse during the follow-up observation of one of the patients. Excessive endogenous alcohol produced by HiAlc Klebsiella species was an underlying cause of bacterial ABS. Combined prescription of appropriate antibiotics, complex probiotic preparation and a controlled diet could be sufficient for treatment of bacteria-caused ABS. The funders are listed in the acknowledgement.

LBA01-10 USENSE: A LABEL-FREE, RAPID, NON-CULTURE BASED BIOSENSING PLATFORM FOR URINARY TRACT INFECTION DIAGNOSIS AND MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023LBA01-10 USENSE: A LABEL-FREE, RAPID, NON-CULTURE BASED BIOSENSING PLATFORM FOR URINARY TRACT INFECTION DIAGNOSIS AND MANAGEMENT Antra Ganguly, Ujjaini Basu, Philippe Zimmern, Nicole De Nisco, and Shalini Prasad Antra GangulyAntra Ganguly More articles by this author , Ujjaini BasuUjjaini Basu More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , Nicole De NiscoNicole De Nisco More articles by this author , and Shalini PrasadShalini Prasad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this work, we have developed a novel label-free and non-culture based, rapid point-of-care testing device for reliable UTI and recurrent UTI diagnosis and management, by combinatorially evaluating critical inflammatory biomarkers i.e., bacterial lipopolysaccharide (LPS), Prostaglandin E2 (PGE2) and Interleukin-8 (IL-8), within 5 minutes, using a drop (<0.2mL) of neat, unprocessed human urine requiring little to no sample preparation at the user end. Our POC diagnostic device can detect pathogen (e.g., bacterial lipopolysaccharide (LPS) and local inflammation (PGE2 and IL-8) and can thus diagnose UTI with high accuracy and precision. This technology is also able to assess risk of rUTI relapse. METHODS: The device platform is label-free and is made of gold-based electrodes immobilized with highly specific capture probes for highly selective detection. A wide dynamic range of 500-5,000pg/mL for PGE2, 1-1000 pg/mL for IL-8 and 1-1500 pg/mL for LPS was achieved using non-faradaic electrochemical impedance spectroscopy. Further, spike-in and recovery studies were performed to test for the accuracy of biomarker quantification. Cross-reactivity studies using potential intereferents were performed to gauge sensor specificity. The sensor performance and the ability to diagnose UTI was validated using human subject studies. RESULTS: USENSE platform is novel because it can detect UTI relevant biomarkers within a single sensor. This technology addressed the gap in the current urine dipsticks which are semi quantitative or give out a yes/no result. The measurement of two inflammatory markers (IL-8 and PGE2) and one bacterial marker (LPS) allows for a culture-free method with a rapid turnaround time for diagnosis, suitable for routine home-based screening. In addition, the USENSE framework will produce risk scores to help clinicians differentiate between UTI and asymptomatic bacteriuria. Further, USENSE uses PGE2 concentration to predict UTI recurrence and relapse. CONCLUSIONS: This work introduces a novel rapid POC testing device for reliable UTI diagnosis, by combinatorially evaluating critical inflammatory biomarkers using a drop of urine. The device is highly sensitive and specific and shows wide dynamic range, high accuracy, and reliability comparable to established lab standard technique. USENSE can be used as a vital clinical resource to make informed clinical decisions in <5 minutes. This will enable timely and appropriate prescription of antibiotics by allowing early UTI treatment. Source of Funding: Welch Foundation (Grant AT-2030-20200401) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antra Ganguly More articles by this author Ujjaini Basu More articles by this author Philippe Zimmern More articles by this author Nicole De Nisco More articles by this author Shalini Prasad More articles by this author Expand All Advertisement PDF downloadLoading ...

Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria — a retrospective cross-sectional study

BackgroundAntibacterial resistance is an ongoing global issue, threatening the lives of millions and affecting the quality of health systems, resulting in high costs to the worldwide economy. Syria is one of many countries with a high rate of antibiotic prescription or consumption, even before the war. MethodsA retrospective cross-sectional study was conducted to assess the pattern of antibiotic prescribing with regard to acute upper respiratory tract infection (AURTI) cases throughout the year 2019; data were collected from GlobeMed Syria (now Modern Healthcare Claims Management Company) following ethical approval. ResultsThe study comprised 14 913 cases, of which 13 382 (90%) had received an antibiotic prescription. All age groups showed high prescribing rates, with the 46–55 years age group having the highest (95.0%). Acute tonsillitis had the most significant percentage of antibiotics prescribed (98.7%). Cephalosporins were the most commonly prescribed antibiotic class. Family physicians were more inclined to prescribe antibiotics than those in other specialism groups. ConclusionSyria has a high rate of prescribing antibiotics for AURTIs, which may contribute to the evolution of resistant bacteria. The rate is higher than those reported in other Arab countries. Physicians need to commit to following the official guidelines, taking the appropriate prescribing of antibiotics more seriously, and should take more care in distinguishing viral origins of AURTIs.

Trends in Pseudomonas aeruginosa (P. aeruginosa) Bacteremia during the COVID-19 Pandemic: A Systematic Review.

Pseudomonas aeruginosa (P. aeruginosa) is among the most common pathogens associated with healthcare-acquired infections, and is often antibiotic resistant, causing significant morbidity and mortality in cases of P. aeruginosa bacteremia. It remains unclear how the incidence of P. aeruginosa bacteremia changed during the Coronavirus Disease 2019 (COVID-19) pandemic, with studies showing almost contradictory conclusions despite enhanced infection control practices during the pandemic. This systematic review sought to examine published reports with incidence rates for P. aeruginosa bacteremia during (defined as from March 2020 onwards) and prior to the COVID-19 pandemic. A systematic literature search was conducted in accordance with PRISMA guidelines and performed in Cochrane, Embase, and Medline with combinations of the key words (pseudomonas aeruginosa OR PAE) AND (incidence OR surveillance), from database inception until 1 December 2022. Based on the pre-defined inclusion criteria, a total of eight studies were eligible for review. Prior to the pandemic, the prevalence of P. aeruginosa was on an uptrend. Several international reports found a slight increase in the incidence of P. aeruginosa bacteremia during the COVID-19 pandemic. These findings collectively highlight the continued importance of good infection prevention and control and antimicrobial stewardship during both pandemic and non-pandemic periods. It is important to implement effective infection prevention and control measures, including ensuring hand hygiene, stepping up environmental cleaning and disinfection efforts, and developing timely guidelines on the appropriate prescription of antibiotics.

Flexor Tenosynovitis Caused by Neisseria gonorrhea Infection: Case Series, Literature Review, and Treatment Recommendations.

Neisseria gonorrhoeae is the most common sexually transmitted disease in the world and is known to cause disseminated disease, most commonly tenosynovitis. Classically, gonorrhea-associated tenosynovitis presents with concomitant dermatitis and arthralgias, though this is not always the case. N. gonorrhoeae -related tenosynovitis has become more commonly seen by hand surgeons. To aid in management, we present three cases of gonorrhea-induced tenosynovitis spanning a range of presentations with variable treatments to demonstrate the variety of patients with this disease. Only one of our patients had a positive gonococcal screening test and no patient had purulent urethritis, the most common gonorrhea-related symptom. A separate patient had the classic triad of tenosynovitis, dermatitis, and arthralgias. Two patients underwent operative irrigation and debridement, and one was managed with anti-gonococcal antibiotics alone. Though gonorrhea is a rare cause of flexor tenosynovitis, it must always be on the differential for hand surgeons when they encounter this diagnosis. Taking an appropriate sexual history and performing routine screening tests can assist in the diagnosis, the prescription of appropriate antibiotics, and potentially avoiding an unnecessary operation.

Intestinal colonization of vancomycin-resistant Enterococcus in children admitted to Mofid children's hospital intensive care unit at admission and at discharge.

This study aimed to investigate the frequency of intestinal colonization by vancomycin-resistant Enterococcus (VRE) carrying vanA and vanB genes in patients at ICU admission and at discharge from ICU in Mofid children's Hospital, Tehran, Iran. Sampling was performed using rectal swabs and vancomycin susceptibility testing for Enterococcus spp. was carried out using a minimum inhibitory concentration (MIC) assay on Muller Hinton Agar (MHA) medium using an E-test kit. The molecular detection of VRE isolates was performed by the PCR method using the vanA and vanB resistance genes. A total of 234 and 186 non-duplicate rectal swab samples were collected from patients at ICU admission and at discharge from ICU, respectively. Enterococcus spp. was detected in 34.6% (n = 81/234) of rectal swab samples collected from patients at ICU admission, of which 44.4% (n = 36/81) were VRE isolates. In contrast, the prevalence of Enterococcus spp. and VRE isolates among patients at discharge from ICU was 17.7% (n = 33/186) and 57.6% (n = 19/33), respectively. Out of 19 VRE isolated from patients at ICU admission, 4 (21%) and 1 (5.3%) contained vanA and vanB genes, respectively. In contrast, out of 36 VRE isolated from patients at discharge from ICU, 11 (30.5%) were positive for the vanA gene. Results revealed that the prevalence of Enterococcus spp. among patients at ICU admission was high. However, VRE was frequently isolated from patients who were hospitalized for several days in ICUs. The implementation of proper infection control strategies and the use of suitable protocols to guide the appropriate prescribing of antibiotics are necessary.