Appropriate Use Of Antibiotics Research Articles

Clinical, Sociodemographic and Environmental Risk Factors for Acute Bacterial Diarrhea among Adults and Children over Five Years in Bangladesh.

In 2016, diarrheal disease was the eighth leading cause of mortality globally accounting for over 1.6 million deaths with the majority of deaths in adults and children over 5 years. This study aims to investigate the clinical, sociodemographic, and environmental risk factors associated with common bacterial acute diarrhea among adults and children over 5. Data were collected from March 2019 to March 2020 in patients over 5 years presenting with acute gastroenteritis at icddr,b. Stool samples were collected from each patient for culture and polymerase chain reaction (PCR) testing. Bivariate associations between independent variables and stool-testing indicating bacterial etiology were calculated. This analysis included 2,133 diarrheal patients of whom a bacterial enteropathogen was identified in 1,537 (72%). Detection of bacteria was associated with: younger age (OR 0.92; 95% CI: 0.88-0.96), lower mean arterial pressure (OR 0.84; 95% CI: 0.79-0.89), heart rate (OR 1.06; 95% CI: 1.01-1.10), percentage dehydration (OR 1.33; 95% CI: 1.13-1.55), respiration rate (OR 1.23; 95% CI: 1.04-1.46), lower mid-upper arm circumference (OR 0.97; 95% CI: 0.94-0.99), confused/lethargic mental status (OR 1.85; 95% CI: 1.11-3.25), rice watery stool (OR 1.92; 95% CI: 1.54-2.41), and vomiting more than three times in the past 24 hours (OR 1.30; 95% CI: 1.06-1.58). Higher monthly income (OR 0.92; 95% CI: 0.86-0.98), > 8 years of education (OR 0.79; 95% CI: 0.63-1.00), and having more than five people living at home (OR 0.80; 95% CI: 0.66-0.98) were associated with lower odds of bacterial diarrhea. These findings may help guide the development of predictive tools to aid in identifying patients with bacterial diarrhea for timely and appropriate use of antibiotics.

A Qualitative Analysis of the Culture of Antibiotic Use for Upper Respiratory Tract Infections Among Patients in Northwest Russia.

Introduction: Due to the globally persistent threat of Antimicrobial Resistance (AMR), the purpose of this study was to gain an in-depth understanding of the antibiotic (AB) practices, knowledge and attitudes among patients residing in five regions in the northwest part of Russia. Given the high prevalence, this study focused on ABs for Upper Respiratory Tract Infections (URTI). Methods: The qualitative, semi-structured interviews followed a guide organized by major themes such as common symptoms, consultations with doctors and external influences in decision-making. Patient participants were recruited via convenience sampling. Fifty-five interviews were conducted among patients using ABs for URTIs purchased with or without prescription. Data was analyzed using a direct content analysis and validation rounds were conducted between interviewers and data analyzers. Results: Self-medication with ABs seemed a common practice across all five Russian regions; in some cases, patients tried to persuade pharmacists into selling them ABs without prescription. Factors, such as time spent going to the doctor, need of a sick leave or self-persuasion, influenced the decisions of whether or not to seek the doctor for symptoms of URTIs. Knowledge of ABs and AMR was generally low; however, some patients with seemingly good knowledge practiced self-medication from time to time. Family members and friends were often involved in decisions about how to handle symptoms of URTIs, especially among those patients using ABs without prescription. Few patients had noticed ABs awareness campaigns, and very few reported having learned something important from them. Conclusion: Despite enforced regulation of AB use in Russia, self-medication still exists. Knowledge is not always linked to appropriate use of AB, and the few campaigns conducted were not always noticed.

Antibiotic resistance pattern and clonal relationship of Enterobacter spp isolates from different clinical samples in Odisha, India

Bacteria with increase antibiotics resistant caused serious health treat worldwide. Regular surveillance of resistance spectra and clonal relationship of infectious bacteria are important for appropriate use of antibiotics. In this study, we investigated the antibiotic resistant pattern and clonal relationship of Enterobacter spp isolated from different clinical samples of a tertiary care hospital of Odisha, India. The results of this study indicated the presence of multidrug resistant Enterobacter spp with multiple β-lactamases production. The phylogenetic tree showed three unique clusters of ERIC within the nineteen Enterobacter spp. isolates.

RATIONALITY OF ANTIBIOTICS USE WITH QUANTITATIVE AND QUALITATIVE METHODS AT HOSPITAL IN INDONESIA


 Infection is one of the biggest causes of death in Indonesia which can be influenced by the appropriate use of antibiotics. Irrational use of antibiotics can cause bacteria to become resistant to antibiotics so that the effectiveness of the drug decreases or even disappears. This study aims to evaluate the use of antibiotics given to inpatients at a private hospital in Indonesia both quantitatively and qualitatively in the period July to December 2021. This study is an observational study with retrospective data collection where qualitative analysis using the Gyssens Method and quantitative analysis uses the DDD method. The results of the qualitative analysis showed that from 30 cases observed, there were 9 cases (30%) irrational prescriptions, namely 1 case in category V, 4 cases in category IVA, 2 cases in category IIIB and 2 cases in category IIA. The results of the quantitative analysis showed that the antibiotics with the highest DDD/100 patient days in the period July to December 2021 were Ceftriaxone with a successive value of 39.15; 39.81; 36.22; 55.65; 41,48 and 49, 42 while antibiotics with the lowest DDD/100 patient-days values in the period July to December obtained different results. Based on research results, there are irrational antibiotic prescriptions and Ceftriaxone became the most commonly prescribed antibiotic.
 
 
 
 
 
 
 
 
 

Antibiotic application may raise the potential of methylmercury accumulation in fish

Mercury (Hg) biotransformation can significantly affect the Hg speciation and bioaccumulation in fish, where gut microbiota play an important role in this process. Antibiotics have been extensively used in aquaculture and can affect gut microbial structure. However, the influence of antibiotics on Hg biotransformation in fish has not been thoroughly understood. The present study investigated the effects of antibiotic (florfenicol) application on gut microbiota and subsequent impacts on Hg biotransformation and bioaccumulation in tilapia (Oreochromis mossambicus). The results showed that the florfenicol treatment did not affect IHg accumulation in the IHg-exposed fish or the MeHg accumulation in the MeHg-exposed fish. However, methylation was significantly weakened (from 0.015% d−1 to 0.005% d−1) and demethylation was completely terminated (from 0.046% d−1 to non-observable level) in the florfenicol-treated fish as compared to the control fish. This can be ascribed to the major shift in the richness of microbial methylators/demethylators in fish gut. Furthermore, florfenicol disturbed the homeostasis of gut microbiome and enhanced the growth of opportunistic pathogens. Our results strongly suggested that antibiotic application significantly altered the gut microbial community, thereby increasing the potential of MeHg accumulation by fish. This study highlights the importance of appropriate use of antibiotics in aquaculture as well as decreasing the environmental risks of Hg contamination in fish.

Ocular surface flora and prophylactic antibiotics for cataract surgery in the age of antimicrobial resistance.

According to the World Health Organization alert about the antimicrobial resistance crisis released in 2015, clinicians should strongly reconsider the prolonged use of antimicrobials. In this review, we focus on the ocular surface flora with respect to the trend of fluoroquinolone resistance, and its upset and restoration after topical administration of antimicrobials and preservatives. Even 3weeks of topical administration of levofloxacin (LVFX) yields a selection of fluoroquinolone-resistant isolates bearing genetic changes in the ocular surface flora. One month of topical prophylactic administration of LVFX after cataract surgery induces the loss of diversity with LVFX-resistance of the ocular surface flora. Restoration of LVFX-sensitive flora occurs 6 to 9months after the final topical administration of LVFX. The ocular surface flora recovers earlier in patients given LVFX for 1week after the surgical procedure. These findings suggest that shorter periods of postoperative topical antibiotics are less frequently associated with persistent antimicrobial-resistant bacteria in the ocular flora. In addition, microbiologic analysis of ocular surfaces treated with a long period of eye drops containing benzalkonium chloride (BAC) showed a higher incidence of isolates resistant to methicillin and fluoroquinolones than did ocular surfaces treated with eye drops not containing BAC. To avoid the emergence of antimicrobial-resistant bacteria on the ocular surface, an urgent discussion must be held about the appropriate use of antibiotics and preservatives in the ophthalmology field.

The Significance of Antibiotic Treatment for Patients After Surgery

Antibiotics are essential in the prevention and treatment of bacterial infections, however, their misuse and overuse may lead to the development of antibiotic-resistant bacteria. In post-operative patients, selecting the appropriate antibiotics is crucial and should be based on factors such as the site of infection, causative organism, and pharmacokinetics of the antibiotics. Rational use of empirical antibiotics is critical in these cases and should be based on clinical indicators like a rise in total count and temperature spikes.   To ensure the rational use of antibiotics, it is important to consider the time and duration of treatment, as well as the selection of antibiotics based on the specific patient and their medical history.   Overall, the appropriate use of antibiotics is crucial in the prevention and treatment of bacterial infections, and healthcare professionals should prioritize rational prescribing practices to ensure the best outcomes for their patients while minimizing the risk of antibiotic resistance &nbsp

Appropriateness of antibiotic use in patients with and without altered mental status diagnosed with a urinary tract infection.

The objective of this study was to determine antibiotic appropriateness based on Loeb minimum criteria (LMC) in patients with and without altered mental status (AMS). Retrospective, quasi-experimental study assessing pooled data from 3 periods pertaining to the implementation of a UTI management guideline. Academic medical center in Lexington, Kentucky. Adult patients aged ≥18 years with a collected urinalysis receiving antimicrobial therapy for a UTI indication. Appropriateness of UTI management was assessed in patients prior to an institutional UTI guideline, after guideline introduction and education, and after implementation of a prospective audit-and-feedback stewardship intervention from September to November 2017-2019. Patient data were pooled and compared between patients noted to have AMS versus those with classic UTI symptoms. Loeb minimum criteria were used to determine whether UTI diagnosis and treatment was warranted. In total, 600 patients were included in the study. AMS was one of the most common indications for testing across the 3 periods (19%-30.5%). Among those with AMS, 25 patients (16.7%) met LMC, significantly less than the 151 points (33.6%) without AMS (P < .001). Patients with AMS are prescribed antibiotic therapy without symptoms indicative of UTI at a higher rate than those without AMS, according to LMC. Further antimicrobial stewardship efforts should focus on prescriber education and development of clearly defined criteria for patients with and without AMS.

Clinical Characteristics of Chlamydia psittaci Pneumonia Confirmed by Metagenomic Next-Generation Sequencing

Chlamydia psittaci pneumonia has atypical clinical manifestations and the diagnosis may be missed by traditional methods of microbiological diagnosis. Twelve cases of Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing (mNGS) in Huizhou Central People's Hospital in China between January 2020 and August 2021 were reviewed and analyzed, retrospectively, using hospital records, the clinical characteristics, treatment, and prognosis. Ten of the 12 cases (83%) were associated with a definite history of bird/poultry contact. Common symptoms included high fever, cough, fatigue, anorexia (12/12, 100%), dyspnea (11/12, 92%), and changes in the level of consciousness and headache (5/12, 42%). There was a marked increase in C-reactive protein and D-dimer levels, but white blood cells and neutrophils were normal or slightly increased. Nine patients (75%) had liver enzyme abnormalities, and six (50%) had cardiac insufficiency and myocardial injury. There was no correlation between the mNGS sequence number of Chlamydia psittaci and the pneumonia severity. The chest imaging manifestations were mainly large areas of consolidation, predominantly in the lower lung lobes. Monotherapies or combinations of doxycycline, moxifloxacin/levofloxacin, and azithromycin were effective for treating Chlamydia psittaci pneumonia. The use of mNGS increases the probability of diagnosing Chlamydia psittaci pneumonia, and good prognosis can be achieved with timely use of appropriate antibiotics.

Nepal Paediatric Society Guideline for use of Antibiotics in Critically ill Children in the Pediatric Intensive Care Unit

Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit

Mycobacterial profile and antibiotic susceptibility pattern in chronic suppurative otitis media: a cross- sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media (CSOM) is a disease of mucoperiosteal lining of the middle ear cleft. The poor compliance of patients to antibiotic treatment, Incomplete treatment, misuse/improper choice of antibiotics have resulted in changes in susceptibility to antibiotics and also development of resistant strains by microbes to commonly used antibiotics. This study aimed to identify the mycobacteriological profile and determine antibiotic susceptibility pattern in CSOM patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross sectional study was conducted on 120 clinically diagnosed cases of CSOM attending otolaryngology department. Ear discharges obtained were processed for microbial culture (aerobic, anaerobic and fungi). Antimicrobial susceptibility testing was done by Kirby–Bauer disc diffusion method. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of total 120 cases, pathogens were isolated from 114 cases. The commonest aerobic organism isolated was &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; (34.5%) followed by &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (29.4%). &lt;em&gt;Staphylococcus aureus&lt;/em&gt; showed maximum sensitivity to erythromycin (70%), followed by cotrimoxazole (62.5%) and ampicillin (55%). Maximum resistance was observed for ciprofloxacin (77.5%), followed by amoxiclave (55%). &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; showed maximum sensitivity to piperacillin (89.36%) followed by gentamicin (70.2%), amikacin (70.2%), moderate sensitivity to ceftazidime (51.06%); however resistance to carbpenicillin (60%). Ciprofloxacin which is the most prescribed topical antibiotic showing an increase in resistance to causative organisms of CSOM.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hence, it becomes essential to study each case of CSOM bacteriologically to formulate local antibiotic policy for appropriate use of antibiotics. This will certainly help in achieving a safe ear and to control the organisms developing resistance to prevalent antibiotics.&lt;/p&gt;

A Peer Educational Tool to Promote Antimicrobial Stewardship on a University Campus.

Antibiotic resistance is a major public health threat. Patient education on the appropriate use of antibiotics is a key component in combating antimicrobial resistance. The purpose of this study was to analyze the utility of an origami fortune teller as a novel peer educational tool in promoting antimicrobial stewardship on a university campus. An origami fortune teller, with various case scenarios to demonstrate key antibiotic principles, was developed and used by peer educators to educate students attending a university wellness fair. The case studies included: antibiotic indications; differentiation between viral vs. bacterial infection; proper use of antibiotics; non-pharmacologic measures to combat infection; and antibiotic resistance. Students were asked to take an assessment pre and post working with the tool. One hundred and forty-three students received education using the novel tool. A significant improvement in the assessment score was observed after education was completed using the novel tool (69.5 vs. 96.6 p ≤ 0.05).

Inappropriate antibiotic use for respiratory infections in outpatient settings

Background: Overuse of antibiotics is a significant problem in low- and middle-income countries where recommended treatment guidelines are not routinely practiced, resulting in antimicrobial resistance. Acute respiratory tract infections, mostly viral in origin, remain the clinical category for most commonly prescribed antibiotics. Due to the lack of local evidence about antibiotic prescribing trends in such infections, this study was conducted to evaluate the prescribing patterns in general and antibiotic prescribing trends specifically in prescriptions with the diagnosis of acute respiratory infections in district Mirpur of Azad Kashmir.&#x0D; Patients and methods: A prospective cross-sectional study carried out in the Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi, and outpatient departments of public health facilities in district Mirpur, Kashmir, from Aug to Oct 2020. Data were collected from 10 different public health facilities in District Mirpur, Kashmir including, three rural health centers (RHC) and five basic health units (BHU). Prescribing pattern analysis by objective observations of the prescriptions after patient-physician encounter against the World Health Organization defined core prescribing indicators. The appropriateness of antibiotic use was analyzed against clinical practice guidelines. IBM SPSS Statistics for Windows, Version 26 was used for data analysis. Descriptive analysis was done to find frequencies and percentages for categorical data and means and standard deviation for continuous data.&#x0D; Results: Total number of prescriptions evaluated was 144. Number of prescriptions containing antibiotics was 118 (82%) (standard, 20 - 26.8%). Inappropriate use of antibiotics was seen in 78% of cases where no antibiotics were indicated. The average number of medicines per prescription was 3.11 (standard, 2.1), whereas 79% of medicines prescribed were from the national essential medicine list (standard, 100%). Only 2.5% (standard, 100%) of the medications were prescribed with generic names.&#x0D; Conclusion: This study shows an inappropriate and overuse of antibiotics for acute respiratory tract infections, indicating a lack of adherence to core prescribing indicators and clinical guidelines by the physicians in outpatient clinics of Mirpur.

31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea

BackgroundThe U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementation on antibiotic use and resistance rates in an institution with limited infrastructural support.MethodsA series of ASP activities were reviewed according to the core elements of ASP. The retrospective data of all hospitalized patients at a tertiary care teaching hospital was collected from January 2010 to December 2019, including antibiotic prescription data and culture results of all clinical specimens. The trends of the antibiotic-resistant rates were compared with nationwide data in Korea. The trend analyses were performed with 2-sided correlated seasonal Mann-Kendall nonparametric tests.ResultsThe ASP activities over the past decade were summarized in Table. After activities such as preauthorization were achieved, other ASP activities were added one by one. Also, the infectious disease pharmacists, as ASP co-leaders, mainly carried out the following activities: reducing redundant anti-anaerobic antimicrobials and intravenous fluoroquinolones, and advised the physicians to discontinue the antibiotic prescription in cases when the intervention was plausible. After the ASP implementation, total antibacterial use significantly decreased (P < 0.01; Figure). The use of glycopeptides (P < 0.01) and fluoroquinolones (P < 0.01) gradually decreased, while the use of third-generation cephalosporines did not significantly change (P=0.48). There was no significant change in total carbapenems use, but ertapenem use increased (P=0.02). Compared with the nationwide data, methicillin-resistant Staphylococcus aureus was on a decreasing trend consistently. Although third-generation cephalosporin-resistant Escherichia coli increased, third-generation cephalosporin resistant-Klebsiella pneumoniae and carbapenem resistant-Pseudomonas aeruginosa did not increase.Table. Antimicrobial stewardship activities for hospitalized patients over the past decade in Seoul National University Bundang Hospital. ASP: antimicrobial stewardship; ID: infectious disease; CDSS: Clinical decision support system Figure. DOT per 1,000 patient-days in Seoul National University Bundang Hospital and implemented actions of antimicrobial stewardship program. DOT: days of therapy; ID: infectious disease; PCR: polymerase chain reaction; GPC: gram positive cocci; Group 1 carbapenem: ertapenem ConclusionA stepwise implementation of the core ASP elements was effective in improving the appropriate use of antibiotics and reducing the antibiotic resistant organisms, even with limited human resources.Disclosures All Authors: No reported disclosures

How To Successfully Design and Implement a Clinical Trial To Evaluate the Clinical Impact of New Diagnostic Assays for Testing Positive Blood Culture Bottles

New infectious disease diagnostics are being introduced into clinical practice at high rates. For tests that are better, faster, and less expensive than what came before, adoption is easy. However, many new tests, though faster than conventional diagnostics, are more expensive. Whether they will add value to patient care must be evaluated and can best be assessed by randomized controlled clinical trials (RCTs). Here, an overview of RCTs of new blood culture diagnostics is presented. Operational logistics of executing RCTs of new diagnostics are presented based on the authors' experience. For tests that facilitate appropriate use of antibiotics, involvement of an antimicrobial stewardship team in the associated clinical trial is important.

Non-prescription antibiotic use for cough among Chinese children under 5 years of age: a community-based cross-sectional study

ObjectiveThis study aimed to investigate the non-prescription use of antibiotics for cough among children under 5 years in China.DesignA community-based cross-sectional survey.SettingA face-to-face interview based on a standard questionnaire in...

Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017

BackgroundLack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017.MethodsAn AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017.ResultsOne month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5.ConclusionsAlthough progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals’ ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

P-ANCA Systemic Vasculitis Induced by Brucellosis in an Elderly Male Patient

One of the most prevalent causes of vasculitis is bacterial infection. An infection that causes anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is uncommon and not reported frequently. We report a case of a 74-year-old male who presented with fever for ten days and was found to have brucellosis. Then, he was diagnosed with Guillain-Barré syndrome (GBS) and started on immunoglobulin (IVIG) for one week without a response. His fever was still persistent despite appropriate antibiotic therapy. Rheumatology evaluation revealed a history of multiple joint pain and swelling, elevated inflammatory marker, and a high titer of P-ANCA. Steroid therapy was started initially on the background of antibiotics therapy. His fever and other symptoms showed marked improvement after one week. However, P-ANCA titer was still elevated. The decision was made to treat the patient as a case of brucellosis-induced P-ANCA vasculitis. Azathioprine was added, and steroid was maintained for one month and then it was tapered gradually. All symptoms improved from the third month of follow-up except weakness from peripheral neuropathy with normalization of P-ANCA titer. His condition remained stable after six months of follow-up. Clinicians should be aware of the possibility of infection-induced vasculitis, particularly when patients' symptoms persist despite the appropriate use of antibiotics.

Impact of an antibiotic stewardship programme in a surgical setting.

BackgroundAntibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting.MethodsBaseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients’ days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm.ResultsThere was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage.ConclusionThe implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.

Sixteen cases of severe pneumonia caused by Chlamydia psittaci in South China investigated via metagenomic next-generation sequencing.

Introduction. Chlamydia psittaci is an important cause of community-acquired pneumonia (CAP). The spectrum of CAP due to Chlamydia psittaci ranges from mild, self-limited to acute respiratory failure and the early identification of this disease can be challenging. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to improve the pathogen identification in severe CAP.Hypothesis/Gap Statement. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to rapidly identify pathogens in severe CAP. The early identification and appropriate use of antibiotics can improve the prognosis of severe CAP caused by Chlamydia psittaci.Aim. The aim of the study is to describe the clinical spectrum of severe psittacosis pneumonia to provide a better understanding of this disease and to demonstrate that mNGS is an effective method for pathogen detection.Methodology. Retrospective case analysis from November 2019 to November 2020 was performed. Sixteen cases of severe psittacosis pneumonia were diagnosed through mNGS. Clinical features, laboratory findings, imaging features, treatment and outcome were summarized.Results. Frequent symptoms included fever (16/16, 100%), dyspnoea (16/16, 100%), cough (12/16, 75%), sputum (11/16, 69%) and headache (9/16, 56%). The median leukocytosis was within the normal range, while C-reactive proteins, CK, LDH, AST, D-Dimer were significantly elevated. The feature of computed tomography included ground-glass opacity with consolidation and multiple lobar distributions. The total number of sequences of Chlamydia psittaci identified from bronchoalveolar lavage by mNGS varied from 58 to 57115. Five patients underwent noninvasive mechanical ventilation, four patients underwent high flow humidified oxygen therapy and one patient underwent invasive mechanical ventilation. Two patients had septic shock needing vasoactive medications. All of the sixteen patients experienced full recoveries.Conclusion. The symptoms of severe CAP caused by Chlamydia psittaci were not typical while laboratory results may have some clues. The mNGS technology can early detect of psittacosis, reduce unnecessary use of antibiotics and short the course of the disease.