Appropriate Use Of Antibiotics Research Articles

Prevalence of Ventilator Associated Pneumonia Caused by Multidrug Resistant Isolates in an Intensive Care Unit Setting at a University Hospital

Abstract Background: Ventilator-associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns. Materials and Methods: We conducted a retrospective cross-sectional laboratory-based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250-day survival in the existence of specific comorbidities along with VAP. Results: Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates (n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253). Conclusion: There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician injudicious and appropriate use of antibiotics for treatment.

Synthesis, characterization, and antibacterial effectiveness of gemifloxacin C-3 modified amide analogs: A theoretical and experimental approach

In search of a newer, efficient, and adaptable antimicrobial solution to combat the resistance that has developed due to the widespread extensive and in appropriate use of antibiotics. Seven new amide analogs of Gemifloxacin (G-D01-G-D07), an important member of the fluoroquinolone (FQ's) was synthesized by modifying the C-3 position in a quick and facile way, using Schotten Baumann reaction approach exhibiting highly efficient yields and short reaction times. Their in-silico pharmacokinetic and toxicity studies were determined by SwissADME and Protox-II webserver, and found that all the compounds obeys the lipinski's rule and didn't exhibit any vital organ toxicity. The introduction of selected amines to form amide analogs (G-D01-G-D07) was assured by their spectroscopic characterization, structural stability studies by DFT parameters and Microbiological assay evaluates these synthesized analogs as potent antibacterial and antifungal agents against studied species. At the B3LYP/6–311 G level of theory, the molecular structures, reactivity, and electronic characteristics of candidate compounds exhibiting the most promising antibacterial actions were examined, and their quantum mechanical parameters were calculated. The energy gaps of all the synthesized compounds were found in ranges between 0.1088 and 0.1091 eV, indicating good softness, thermal and kinetic stability. This can be correlated by the activity of these analogs against Klebsiella pneumonia, and Citrobacter freundii, where synthesized derivatives G-D06 and G-D03, G-D04, and G-D07 exhibit activities more than the parent drug. The binding affinity of complexes revealed by docking was found in the range between -14.31 and -16.20 kcal/ mol, which indicates their high antibacterial potential against one of the major targets Klebsiella pneumoniae cytidine deaminase CDA protein by using AutoDock Vina and MD simulations by GROMACS, confirming them as potential antibacterial agents.

Improving antibiotic stewardship in an acute medical unit

Antibiotic resistance is related to the incorrect/inappropriate use of antibiotics.In 2019, there were nearly 5 million deaths associated with bacterialantimicrobial resistance across 204 countries. There has been anincrease in antibiotic prescription within secondary care by about 4.8%since the COVID-19 pandemic. Appropriate use of antibiotics reducesthe risk of antibiotic resistance and attendant morbidity and mortality.The aim was to improve compliance with trust guidelines when prescribingantibiotics as well as documentation of antibiotic indication andreview date.A retrospective study was conducted for patients admitted to AMUin October ‘22 who had been prescribed antibiotics as part of theirmanagement. Clinical information regarding the appropriateness of theantibiotic and documentation of the indication and review by date wasobtained. Interventions used were one-on-one teaching, group teaching,as well as posters put up throughout the department. We worked withtrust pharmacy and QI department and then completed the Plan-Do-Study-Act cycle.Post intervention, 12% of the patients admitted had received antibioticsfor non-infectious illness compared with 26% in the 1st cycle, 48%had antibiotics prescribed according to micro-guide, compared with41.6% pre-intervention, and 5% had indications documented on EPMA,compared with none previously. These were published at the trust SharedLearning Bulletin. Overall, there has been a positive change in attitudetowards the prescription of antibiotics, with more attention paid to indicationand review-by date.

Incidence and spontaneous clearance of gonorrhea and chlamydia infections among men who have sex with men: a prospective cohort study in Zhuhai, China.

Men who have sex with men (MSM) face significant risks of Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG) infection. Nevertheless, only limited studies have looked into the site-specific infection and clearance of CT/NG. In order to prevent transmission, it is essential to understand the underlying factors that drive infection and spontaneous clearance. A 12-week cohort study examined the association between CT/NG infection, self-clearance, and sexual behaviors among MSM. The Willingness Service recruited participants who completed weekly questionnaires and provided urine, throat, and rectal swab samples. The study involved 151 men, in which 51 (33.8%) were diagnosed with CT/NG infection during the study period. HIV (OR = 11.31), kissing (OR = 1.59), receptive oral sex (OR = 36.64), and insertive anal sex (OR = 19.73) constituted significant risk factors. 100% condom use (OR = 5.78) and antibiotic (OR = 7.53) were more likely to cause spontaneous clearance. MSM may engage in riskier sexual behaviors due to insufficient knowledge and awareness of STI prevention, leading to increased susceptibility to NG/CT. It is crucial to concentrate on enhancing health education for MSM. This study found that the rectum was the most prevalent site of CT/NG and sexual behavior can influence the infection. Additionally, the appropriate use of antibiotics and consistent condom use may contribute to clear spontaneously.

Opportunities and barriers to pediatric antimicrobial stewardship by community pharmacists.

Community Pharmacists (CPs) are easily accessible and can advocate for appropriate use of antibiotics in children. Semi-structured interviews were conducted with 47 CPs and 46 parents/caregivers. Both groups expressed challenges to intervening when antibiotics have already been prescribed and highlighted the need for more support for CPs to make informed decisions.

A Survey of the Awareness and Practices of Antibiotic use Among College Undergraduates and Graduates in Latakia

Antibiotic resistance has become a global health crisis, posing a significant threat to our ability to treat bacterial infections. Over the years, the overuse and misuse of antibiotics in both humans and animals have contributed to the development of antibiotic-resistant bacteria. This leads to longer and more complicated treatment courses, increased healthcare costs, and in some cases untreatable infections. In this study, a survey was conducted on antibiotic use among college undergraduates and graduates in Latakia. The age of 42.2% of participants was 20–25 years. More than half of the participants were male (55.9%). Most responses were from college undergraduates 51%, either of final-year students or graduates. Most of them had used antibiotics with prescriptions. The highest rate of antibiotic use was for sore throat treatment (47.1%). Most participants completed the antibiotic courses and their symptoms improved (70.6%). Black and red pills remained effective for most patients (67.6%). 68.6% of the participants would consult a doctor if symptoms did not improve after taking antibiotics. 62.7% of the participants didn’t give antibiotics to a family member when they were sick. 52.9% of the participants reserve antibiotics for use when necessary. Half of the participants would take the leftover antibiotics in case of respiratory diseases. The results didn’t show a good level of knowledge about antibiotic use among college undergraduates and graduates in Latakia. This study encourages the improvement of the public knowledge and their attitudes towards the appropriate use of antibiotics.

Utility of Antibiotic Use in Pediatric Facial Fractures: A Systematic Review.

Background: In regard to antibiotic stewardship, it is important to understand the appropriate time to prescribe antibiotics in pediatric facial fracture management. Objective: To evaluate the utility of antibiotics in pediatric facial fractures and determine situational variables influencing appropriate antibiotic prescription. Methods: A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2000 to 2022. Inclusion criteria consisted of all studies assessing pediatric facial fractures that mentioned antibiotic use. Results: A total of 13 studies were included in the full review. The reviewed studies comprised 31 pediatric patients ranging from 6 months to 18 years old. Most studies were case reports and case series (N = 9). Antibiotics were prescribed for the majority (96.7%) of patients. Antibiotic regimens varied by timing of administration, antibiotic used, and dosage. Fracture locations also varied widely, including orbital, zygomatic, nasal, mandibular, and maxillary fractures. Conclusions: Additional studies with more substantial evidence are needed to fully understand the situational appropriateness of antibiotic use in pediatric facial fractures.

Combining deep learning and droplet microfluidics for rapid and label-free antimicrobial susceptibility testing of colistin

Efficient tools for rapid antibiotic susceptibility testing (AST) are crucial for appropriate use of antibiotics, especially colistin, which is now often considered a last resort therapy with extremely drug resistant Gram-negative bacteria. Here, we developed a rapid, easy and miniaturized colistin susceptibility assay based on microfluidics, which allows for culture and high-throughput analysis of bacterial samples. Specifically, a simple microfluidic platform that can easily be operated was designed to encapsulate bacteria in nanoliter droplets and perform a fast and automated bacterial growth detection in 2 h, using standardized samples. Direct bright-field imaging of compartmentalized samples proved to be a faster and more accurate detection method as compared to fluorescence-based analysis. A deep learning powered approach was implemented for the sensitive detection of the growth of several strains in droplets. The DropDeepL AST method (Droplet and Deep learning-based method for AST) developed here allowed the determination of the colistin susceptibility profiles of 21 fast-growing Enterobacterales (E. coli and K. pneumoniae), including clinical isolates with different resistance mechanisms, showing 100 % categorical agreement with the reference broth microdilution (BMD) method performed simultaneously. Direct AST of bacteria in urine samples on chip also provided accurate results in 2 h, without the need of complex sample preparation procedures. This method can easily be implemented in clinical microbiology laboratories, and has the potential to be adapted to a variety of antibiotics, especially for last-line antibiotics to optimize treatment of patients infected with multi-drug resistant strains.

Understanding hospital antimicrobial prescribing decisions and determinants of uptake of new local antimicrobial prescribing guidelines in the Laos

Background Antimicrobial use in the Laos is among the highest in the Southeast Asia region. The first Lao comprehensive antimicrobial prescribing guidelines have been available since 2021. This study explored the determinants of antibiotic prescribing decisions and how the new prescribing guidelines were being used. Methods In August 2022, in-depth interviews were conducted with 16 Lao prescribers from two hospitals. Participants were questioned about their prescribing behaviours, attitudes to guidelines, how they learned about the guidelines and factors influencing their uptake. The interviews were audio-recorded, transcribed, and translated into English. Thematic analysis of the transcripts was conducted. Results Lao prescribers considered multiple factors before deciding to prescribe antibiotics to their patients. The most common factor was based on the clinical judgement of the prescribers. Lack of certain antibiotics and turnaround times of laboratory results were the main challenges to prescribing antibiotics appropriately. The majority of participants were satisfied with the guidelines, regarding them as comprehensive, simple and convenient. However, most participants admitted that they did not access the guidelines very often. The main reason was that they could remember the treatment recommendations because they treat similar diseases on a daily basis. Improving antibiotic knowledge was the most common recommendation in order to improve the appropriate use of antibiotics. Raising awareness of the guidelines and promoting their use should also be considered. In addition, heads of the wards, and policy and implementation leaders, should support, monitor and feedback their use to encourage all prescribers to follow the guidelines. Conclusions Several factors contribute to enhancing appropriate antibiotic prescription. Key factors for improving antibiotic prescription include enhancing prescribers' clinical knowledge, ensuring access to essential antibiotics, utilizing point-of-care diagnostics while waiting for culture and susceptibility testing results, and updating guidelines regularly. Health leaders must get involved to promote their use.

Delineating Gastrointestinal Dysfunction Variants in Severe Burn Injury Cases: A Retrospective Case Series with Literature Review

Background: Severe burns can significantly impact various organ systems, including the gastrointestinal (GI) system. GI complications are frequently observed in patients with over 20% total body surface area (TBSA) burn. Objectives: This case series delves into the intricate phenomenology of post-burn GI dysfunction, challenging conventional cause-and-effect paradigms. Our aim is to discern, comprehend, and explore variables influencing positive and negative outcomes, laying the foundation for further research given the current heterogeneity in the literature. Methods: Severe burn patients with GI dysfunction identified between April 1, 2022, and July 31, 2022, from the institutional database are included in this retrospective case-series, and comparisons were made across baseline and treatment conditions across participants. Data were collected on demographics, burn characteristics, complications, and treatment outcomes. Results: We analysed 12 patients with severe burns and GI dysfunction and categorized them into two patterns: Pattern A, characterised by early onset symptoms, gastric and small bowel dilatation, and a relatively benign course with high recovery rates was observed in 6 patients; and Pattern B, characterised by late-onset symptoms, colonic dilatation, shock, and a high mortality rate due to megacolon was seen in 6 patients. Conclusion: The post-burn GI dysfunction observed in our study is a complex interplay of multiple factors. Adequate fluid resuscitation, timely excision of necrotic tissue, staged food ingestion, specific nutrient administration, and appropriate use of antibiotics and judicious use of selective digestive decontamination (SDD) are essential strategies to prevent and treat this syndrome.

Antimicrobial resistance in Campylobacter species isolated from commercially sold steak (beef) and raw cow milk in Abakaliki, Nigeria

Abstract. Agumah NB, Effendi MH, Witaningrum AM, Tyasningsih W, Ugbo EN, Nwagwu CS, Ugbo IA. 2024. Antimicrobial resistance in Campylobacter species isolated from commercially sold steak (beef) and raw cow milk in Abakaliki, Nigeria. Biodiversitas 25: 950-956. This study aimed to ascertain antimicrobial resistance in Campylobacter species isolated from commercially sold steak (Beef) and raw cow milk in Abakaliki. Pools of milk samples and steak were bought at various outlets and analyzed using standard microbiological methods. Results showed that two species of Campylobacter, namely Campylobacter coli, were isolated from the samples. In raw cow milk, Campylobacter coli had a frequency of 65% higher than Campylobacter jejuni (20%). While in steak, C. coli was 34.53% higher than C. jejuni (19.10%). The antibiotic susceptibility profile for C. coli isolated from raw cow milk ranged from 61.54% to 100%, especially for trimethoprim and cephalexin. Resistance ranged from 0.00 to 38.46%. The highest resistance was recorded for tetracycline. The antibiotic susceptibility profile for C. coli isolated from steak recorded susceptibility values ranging from 60.53% to 86.84%. Cephalexin had the highest effect on C. coli isolates from steak. Resistance values ranging from 13.16% to 42.11% were recorded with Nalidixic acid as the least effective antibiotic. C. jejuni isolated from cow raw milk, susceptibility ranging from 0.00% to 100% was recorded, especially for Cefotaxime, Imipenem, Cephalexin, and Nalidixic acid. Resistance ranged from 0.00% to 100%, especially for Chloramphenicol and Kanamycin. For C. jejuni, susceptibility values ranged from 26.57% to 85.71%, with imipenem presenting the highest effect. Resistance values ranged from 23.81% to 71.43%. Gentamycin had the least effect. Adequate sanitation, personal hygiene, and appropriate use of antibiotics are highly recommended for food handlers and farmers to safeguard human health by reducing AMR challenges, even in milk and meat/meat products.

Prescription of antibiotics during endodontic treatments: Survey of senegalese dentists

: Irrational antibiotic prescribing is a phenomenon common to several countries, including Senegal.The aim of this study was to assess the level of antibiotic prescribing among Senegalese dental surgeons during the management of pulpal and periapical pathologies. This descriptive, analytical, cross-sectional study involved 132 dentists regularly registered with the Senegalese Dental Surgeons' Association.Data were collected and analyzed using SPSS version 17.0 software (SPSS, Inc., Chicago, IL, USA).The results of X2 tests showed a statistically significant difference between the private and public sectors for the management of root resorption (P≤0.005).: In patients with penicillin allergy, clindamycin was the first-line treatment (31.1%), followed by metronidazole combined with spiramycin (25%) and azithromycin 500mg (22.7%).: As with previous studies carried out in other countries, this study shows that very few practitioners make appropriate use of antibiotics for pulpal and periapical pathologies.

Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship.

Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.

Polymicrobial bloodstream infections per se do not increase mortality compared to monomicrobial bloodstream infections in sepsis patients: a Korean nationwide sepsis cohort study

BackgroundThere is limited information about the outcomes of polymicrobial bloodstream infections in patients with sepsis. We aimed to investigate outcomes of polymicrobial bloodstream infections compared to monomicrobial bloodstream infections.MethodsThis study used data from the Korean Sepsis Alliance Registry, a nationwide database of prospective observational sepsis cohort. Adult sepsis patients with bloodstream infections from September 2019 to December 2021 at 20 tertiary or university-affiliated hospitals in South Korea were analyzed.ResultsAmong the 3,823 patients with bloodstream infections, 429 of them (11.2%) had polymicrobial bloodstream infections. The crude hospital mortality of patients with sepsis with polymicrobial bloodstream infection and monomicrobial bloodstream infection was 35.7% and 30.1%, respectively (p = 0.021). However, polymicrobial bloodstream infections were not associated with hospital mortality in the proportional hazard analysis (HR 1.15 [0.97–1.36], p = 0.11). The inappropriate use of antibiotics was associated with increased mortality (HR 1.37 [1.19–1.57], p < 0.001), and source control was associated with decreased mortality (HR 0.51 [0.42–0.62], p < 0.001).ConclusionsPolymicrobial bloodstream infections per se were not associated with hospital mortality in patients with sepsis as compared to monomicrobial bloodstream infections. The appropriate use of antibiotics and source control were associated with decreased mortality in bloodstream infections regardless of the number of microbial pathogens.

Exploring general practitioners' decision-making in the management of women with uncomplicated urinary tract infections: a qualitative study.

To be effective, interventions aiming at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. To explore the decision-making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. Semi-structured interviews with 22 GPs in Bavaria and Baden-Wurttemberg (southern Germany). Verbatim transcripts analysed through inductive qualitative content analysis. We generated three main themes: factors facilitating the decision-making, factors complicating the decision-making, and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also conditions antibiotic prescribing, favouring it. Organisational constraints like time pressure, the day of the week (eg, before weekends) and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision-making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation, and shared decision-making were seen as helpful in this process. We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision-making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision-making may help GPs appropriately manage uUTIs in women.

‘When I tried to explain, they shouted back at me!’: exploring how community pharmacists navigate tensions implementing antimicrobial stewardship in Vietnam

ABSTRACT Antimicrobial resistance is a major global and national health challenge, accelerated by ‘irrational’ antibiotic use. In response, Vietnam has been implementing a public health plan of antimicrobial stewardship since 2013 to reduce antibiotic sales in community pharmacies, although it has had limited effect. Given that private pharmacies are increasingly the entry point to access healthcare, reflective of the inhibited accessibility of primary healthcare, understanding how the positioning of community pharmacists shapes the delivery of antimicrobial stewardship plans warrant further investigation. This qualitative analysis draws on data from 24 in-depth interviews with licensed community pharmacists in Vietnam. Interviewees described being constrained in rationing the sale of antibiotics by tensions within their professional role, in which the delivery of antimicrobial stewardship within their public health commitments rubs up against commercial and social obligations to their livelihoods and communities respectively. The concept of ‘resistance’ provides insight into what obstructs the integration of national antimicrobial stewardship guidance and policy, hindering the transformation of local practices concerning antibiotic sales at the community level. Findings reveal opportunities to recast community pharmacists as ‘productive anchors’ who can facilitate the appropriate use of antibiotics and strengthen links to primary care within the local context. Structural changes are needed, however, so that people do not use antibiotics as a proxy for health care. Improving the accessibility of primary healthcare would also curtail the reliance on community pharmacists’ to dispense antibiotics as a local mechanism of financial protection and social care within community.

Evaluation of Antibiotic Usage Using the Gyssens Qualitative Method in Pediatric Inpatients with Diarrhea at a Teaching Hospital in North Jakarta

Diarrhea is the second leading cause of death in children worldwide. Diarrhea is widespread in developing nations, Indonesia included. The primary treatment for diarrhea is the giving of rehydration fluids to prevent dehydration, and it generally does not require antibiotics. Giving antibiotics to pediatric patients with diarrhea indicates the presence of an infection, such as bloody diarrhea or cholera. Antibiotics are ineffective if not taken as prescribed and can lead to bacterial resistance. This study aims to understand the patient profile antibiotic usage, and evaluate the appropriateness of antibiotic use in pediatric inpatients with diarrhea using the Gyssens method at a Teaching Hospital in North Jakarta during the 2022 period. This research was a retrospective study that gathered data through qualitative analysis using the Gyssens algorithm to determine the appropriateness of antibiotic use in pediatric inpatients with childhood diarrhea at a Teaching Hospital in North Jakarta. The evaluation of antibiotic usage used the Gyssens flowchart, which included inclusion and exclusion criteria for assessing the appropriateness of antibiotic use. From this research, 81 patients are identified, with the majority of cases occurring in toddlers aged 0-5 years (86.4%), and the most common gender is male (58%). The most frequently prescribed antibiotic is ceftriaxone (40.6%), with the majority receiving only one antibiotic prescription (40.7%). The evaluation of antibiotics using the Gyssens method indicates that 45 patients (55.5%) are categorized as 0; 34 patients (42%) are categorized as IVa; and 2 patients (2.5%) are categorized as IIIa. No antibiotics categorized I, IIa, IIb, IIc, IIIb, IVb, IVc, or IVd. The evaluation of antibiotic usage using the Gyssens qualitative method for pediatric inpatients with diarrhea at a Teaching Hospital in North Jakarta during the 2022 period shows appropriate use.

Distribution and Antibiotic Resistance Analysis of Ocular Bacterial Pathogens at a Tertiary Hospital From 2012 to 2021

To analyze the distribution of ocular bacterial pathogens and their antibiotic resistance status at a tertiary-care hospital and to provide a reference for the appropriate use of antibiotics. Retrospective analysis was conducted with bacteria isolated from the ophthalmic samples sent for lab analysis at a tertiary-care hospital from 2012 to 2021. The suspected bacterial strains were identified with automated systems for microbial identification and susceptibility analysis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometer. VITEK 2 Compact, an automated microbial identification and antibiotic susceptibility analysis system, was used for antimicrobial susceptibility testing. A total of 1556 ophthalmology bacteria culture samples were collected, 574 of which showed bacterial growth, presenting an overall positive rate of 36.89%. Of the isolated bacteria, Gram-positive cocci, Gram-positive bacilli, Gram-negative bacilli, and Gram-negative cocci accounted for 63.15% (377/597), 18.76% (112/597), 17.09% (102/597), and 1.00% (6/597), respectively. Among the bacteria isolated in different years over the course of a decade, Gram-positive cocci always turned out to be the main cause of eye infections. Of the Gram-positive cocci, 73.47% (277/377) were isolated from patients with endophthalmitis, with the most important species being Staphylococcus epidermidis, which was followed by Streptococcus viridans. The rest, or 26.53% (100/377), of the Gram-positive cocci were isolated from patients with external eye infections, with the main isolated strains being Staphylococcus epidermidis, Streptococcus viridans, and Staphylococcus aureus. More than 70% of Staphylococcus epidermidis isolated from both endophthalmitis and external eye infections were resistant to methicillin. No strains resistant to vancomycin, linezolid, or tigecycline were detected. Staphylococcus epidermidis isolated from patients with external eye infections had a low rate of resistance to levofloxacin (2/27 or 7.41%), whereas those isolated from patients with endophthalmitis had a higher resistance rate (43/127 or 33.86%). The difference in drug resistance rate between the two groups was statistically significant (P<0.05). The chief ocular bacterial pathogens identified in a tertiary-care hospital were Gram-positive cocci, among which, Staphylococcus epidermidis was the most common species. The Staphylococcus epidermidis identified in the hospital had a high rate of resistance to oxacillin, but remained highly sensitive to vancomycin, linezolid, and tigecycline. The endophthalmitis caused by Staphylococcus epidermidis in the hospital can be treated empirically with vancomycin and then the treatment plan can be further adjusted according to the results of the drug susceptibility test. However, the establishment of the breakpoint of drug susceptibility test is mainly based on the model of bloodstream infection and has limited reference value for the treatment of eye infection. The required drug distribution concentration at the infection site can be achieved by dose increase or local administration.

Retracted: Drug Utilization Pattern of Antibiotics in Neonatal intensive care unit in a Tertiary Care Hospital, India

Article retractedMillions of babies are admitted to neonatal intensive care units worldwide, with a significant proportion facing various indications. Given that sepsis is a leading cause of mortality and morbidity among infants globally, including in India, the importance of efficient antibiotic use cannot be overstated. As the global problem of drug resistance intensifies, prudent antibiotic usage becomes crucial in mitigating treatment failures and ensuring the survival of newborns. Aim: to evaluate the pattern of antimicrobial drug utilization in neonatal intensive care unit (NICU) to assess the criteria for drug selection in tertiary care hospital.Materials and Methods. It was an observational prospective study conducted for six months in which 200 neonates admitted to neonatal intensive care unit at tertiary care Hospital, were included. Demographic details, duration of hospital stay, reason for admission (disease pattern), various drugs prescribed were noted. Results. Out of 200 neonates the number of male babies admitted to neonatal intensive care unit were 115 (57.5%) and female babies were 85 (42.5%). Many of the neonates were from age group of 1 to 5 (58.5%) days. Most of the neonates were from weight group of 2.5 to 3 (26.5%) kg. Majority of neonates hospital admission duration was 3 to 6 days is 98 (49%) neonates. Most common disorder requiring neonatal intensive care unit admission was Preterm with Respiratory Distress Syndrome (29%) followed by Neonatal Sepsis (19.5%) and Preterm (11%). Other distress reported include birth asphyxia (16 neonates or 8%), Neonatal convulsions (12 neonates or 6%), Late preterm (13 neonates or 6.5%), Hypernatremia (9 neonates or 4.5%), Meconium Aspiration Syndrome (3 neonates or 1.5%), Neonatal Hypoglycemia (5 neonates or 2.5%) and others (23 neonates or 11.5%). Among 423 antibiotics most prescribed antibiotic was Inj. Piperacillin + Tazobactam (35.4%) followed by Gentamycin (30.2%). Out of 423 drugs 152 are fixed dose combination and single drugs are 271 in this study in which piperacillin + tazobactam of fixed dose combination and gentamicin dose combination and single drugs are 271 in this study in which piperacillin + tazobactam of fixed dose combination and gentamicin of single drug had prescribed in more amount.Conclusion. The findings of this study will contribute to the existing body of knowledge regarding the appropriate use of antibiotics in the NICU, thereby providing insights for healthcare professionals to make informed decisions regarding antibiotic therapy. Empirical antibiotics were administered to every newborn based on their individual conditions. The antibiotic utilization pattern within this study group was determined to be rational.

Outpatient Antibiotic Prescribing Patterns in Children among Primary Healthcare Institutions in China: A Nationwide Retrospective Study, 2017-2019.

There is scarce evidence to demonstrate the pattern of antibiotic use in children in China. We aimed to describe antibiotic prescribing practices among children in primary healthcare institutions (PHIs) in China. We described outpatient antibiotic prescriptions for children in PHIs from January 2017 to December 2019 at both the national and diagnostic levels, utilizing the antibiotic prescribing rate (APR), multi-antibiotic prescribing rate (MAPR), and broad-spectrum prescribing rate (BAPR). Generalized estimating equations were adopted to analyze the factors associated with antibiotic use. Among the total 155,262.2 weighted prescriptions for children, the APR, MAPR, and BAPR were 43.5%, 9.9%, and 84.8%. At the national level, J01DC second-generation cephalosporins were the most prescribed antibiotic category (21.0%, N = 15,313.0), followed by J01DD third-generation cephalosporins (17.4%, N = 12,695.8). Watch group antibiotics accounted for 55.0% of the total antibiotic prescriptions (N = 52,056.3). At the diagnostic level, respiratory tract infections accounted for 67.4% of antibiotic prescriptions, among which prescriptions with diagnoses classified as potentially bacterial RTIs occupied the highest APR (55.0%). For each diagnostic category, the MAPR and BAPR varied. Age, region, and diagnostic categories were associated with antibiotic use. Concerns were raised regarding the appropriateness of antibiotic use, especially for broad-spectrum antibiotics.