Choice Of Antibiotics Research Articles

Applying Quality Improvement Methodology to Standardize Pediatric Urinary Tract Infection Diagnosis and Management throughout a Healthcare System.

Pediatric urinary tract infections (UTIs) require early diagnosis and appropriate treatment to avoid short- and long-term morbidity. Baseline data from 13,000 children across a regional health system demonstrated wide variation in UTI management, including antibiotic choice, duration, and dosing. In 2019, the local antibiotic stewardship team recommended cephalexin as the ideal first-line UTI treatment due to its effectiveness, narrow spectrum, low cost, and palatability. This project aimed to improve first-line prescription of cephalexin as an empiric antibiotic treatment for uncomplicated UTIs from 34% to 75% in children 60 days to 18 years of age presenting to any site within the healthcare system within 6 months. A multidisciplinary team of key stakeholders reviewed baseline data and developed three key drivers. These included a standardized UTI pathway, electronic health record enhancements, and provider education. Interventions were supported by a literature review and implemented via Plan-Do-Study-Act cycles with data monitored bimonthly. The primary outcome was the percentage of patients prescribed cephalexin for presumed UTI over the total number of presumed UTI diagnoses treated with empiric antibiotics throughout the healthcare system. The balancing measure included 14-day return visits for a UTI-related diagnosis across the system. After the release of the updated UTI pathway, first-line cephalexin prescribing for UTI improved from 34% to 66%. There was no change in 14-day revisits for UTI. Standardizing the diagnosis and management of UTIs across the spectrum of coordinated care led to improved system-wide adherence to local antibiotic stewardship guidelines for empiric UTI treatment.

Acute Respiratory Infection (ARI) in Children Seen in Emergency Consultation at the Pediatric Department of the Nianankoro Fomba Hospital in Ségou

Introduction: The aim of this study was to describe the epidemiological and clinical aspects of low-lying ARF in children aged 1 month to 14 years seen in the emergency department of the Nianankoro Fomba Ségou Hospital. Methodology: We included for this prospective descriptive study all children aged 1 month to 14 years of both sexes, seen in consultation at the pediatric emergency department, presenting with low-onset ARF, from January to December 2020. Results: The frequency of low ARF was 6.5%. More than half the patients were aged between 3 months and 2 years. Males predominated. The most frequent reason for consultation was fever. The most common diagnosis was bronchitis (63.23%). 78.6% of patients had moderate anemia and hyperleukocytosis. An opacity was found in 66.67 of the radiographs taken. Amoxicillin was the antibiotic of choice. Hospital mortality was 3.59%. Conclusion: ARIs are frequent in emergency consultations.

An Algorithm to Assess Guideline Concordance of Antibiotic Choice in Community-Acquired Pneumonia.

This study aimed to develop and evaluate an algorithm to reduce the chart review burden of improvement efforts by automatically labeling antibiotic selection as either guideline-concordant or -discordant based on electronic health record data for patients with community-acquired pneumonia (CAP). We developed a 3-part algorithm using structured and unstructured data to assess adherence to an institutional CAP clinical practice guideline. The algorithm was applied to retrospective data for patients seen with CAP from 2017 to 2019 at a tertiary children's hospital. Performance metrics included positive predictive value (precision), sensitivity (recall), and F1 score (harmonized mean), with macro-weighted averages. Two physician reviewers independently assigned "actual" labels based on manual chart review. Of 1345 patients with CAP, 893 were included in the training cohort and 452 in the validation cohort. Overall, the model correctly labeled 435 of 452 (96%) patients. Of the 286 patients who met guideline inclusion criteria, 193 (68%) were labeled as having received guideline-concordant antibiotics, 48 (17%) were labeled as likely in a scenario in which deviation from the clinical practice guideline was appropriate, and 45 (16%) were given the final label of "possibly discordant, needs review." The sensitivity was 0.96, the positive predictive value was 0.97, and the F1 was 0.96. An automated algorithm that uses structured and unstructured electronic health record data can accurately assess the guideline concordance of antibiotic selection for CAP. This tool has the potential to improve the efficiency of improvement efforts by reducing the manual chart review needed for quality measurement.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation.

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.

Nonoperative Treatment of Diverticulitis and Appendicitis: Which Antibiotic Regimen Fails?

IntroductionDiverticulitis and appendicitis are common emergency general surgical conditions. Both can be treated with antibiotics alone; however, no antibiotic regimen has been identified as superior to others. In this study, we review different antibiotic regimens and their rates of failure. MethodsRetrospective cohort study of patients treated empirically with antibiotics for diverticulitis or appendicitis from January 1, 2018, to December 31, 2020, at an independent academic hospital in the Midwest. ResultsA total of 587 (appendicitis, n = 43; diverticulitis, n = 544) patients were included in the cohort. They were equally male (49%) and female (51%) with a median age of 59 y. Three major antibiotic classes were compared: cephalosporin + metronidazole (C + M), penicillins, and quinolone + metronidazole. Appendicitis patients were more likely to receive C + M for empiric treatment (73%, P < 0.001), while diverticulitis patients were more likely to receive quinolone + metronidazole (45%, P < 0.001). Patients empirically treated with antibiotics for appendicitis were more likely than those treated for diverticulitis to require additional antibiotics or procedure within 90 d (33% versus 13%, respectively; P = 0.005). Empiric treatment with C + M for diverticulitis was more likely to be associated with the need for additional antibiotics or procedures within 90 d than treatment with other regimens (P = 0.003). Choice of antibiotic for empiric treatment did not correlate with death at 90 d for appendicitis or diverticulitis. Diverticulitis patients who were initially treated as inpatients and were prescribed C + M at hospital discharge had a higher rate of death than those who were prescribed the other antibiotics (P = 0.04). ConclusionsEmpiric antibiotic treatment of appendicitis is more likely to be associated with additional antibiotics or procedure when compared with diverticulitis; however, antibiotic choice did not correlate with any of the other outcomes. Empiric treatment with a C + M for diverticulitis was more likely to be correlated with the need for additional antibiotics or procedure within 90 d.

Acute cystitis in men- a nationwide study from primary care: antibiotic prescriptions, risk factors, and complications.

Research on acute cystitis in men is scarce and treatment guidelines differ between countries. Improved antibiotic stewardship is needed. To analyse antibiotic prescriptions and outcomes of Norwegian men diagnosed with cystitis in primary care. A nationwide retrospective study was undertaken in primary care in Norway. We identified all episodes of acute cystitis in men diagnosed in Norwegian primary care during 2012-2019. Choice of antibiotic (from the Norwegian Prescription Database), treatment failure, re-prescription, and complications were stratified by age, calendar year, and risk factors. We used logistic regression to explore predefined risk factors (diabetes, prostate cancer, benign prostate hyperplasia [BPH], urinary retention, and any cancer) with complications (pyelonephritis, prostatitis, and hospitalisation) and re-prescriptions. Linear regression was used to explore time trends. In total, 108 994 individuals contributed 148 635 episodes. Narrow-spectrum antibiotics were first-choice treatment in 71.0% of the episodes (52.5% of all prescriptions were pivmecillinam). More than 75% of the episodes with narrow-spectrum versus 82.2% of broad-spectrum treatment did not lead to any re-prescription or complication. Complications occurred in 1.8% of all episodes (0.5% prostatitis, 0.7% pyelonephritis, and 0.7% hospitalisation). BPH was associated with increased risk of complications and re-prescription. Diabetes was associated with a lower risk of re-prescriptions. Prostate cancer and urinary retention were associated with a lower risk of both complications and re-prescriptions. Our results support narrow-spectrum antibiotics as first-line treatment. Risk factor analyses warrants further investigation.

Metabolism-Triggered Plasmonic Nanosensor for Bacterial Detection and Antimicrobial Susceptibility Testing of Clinical Isolates.

Antimicrobial resistance (AMR) is predicted to become the leading cause of death worldwide in the coming decades. Rapid and on-site antibiotic susceptibility testing (AST) is crucial for guiding appropriate antibiotic choices to combat AMR. With this in mind, we have designed a simple and efficient plasmonic nanosensor consisting of Cu2+ and cysteine-modified AuNP (Au/Cys) that utilizes the metabolic activity of bacteria toward Cu2+ for bacterial detection and AST. When Cu2+ is present, it induces the aggregation of Au/Cys. However, in the presence of bacteria, Cu2+ is metabolized to varying extents, resulting in distinct levels of aggregation. Moreover, the metabolic activity of bacteria can be influenced by their antibiotic susceptibility, allowing us to differentiate between susceptible and resistant strains through direct color changes from the Cu2+-Au/Cys platform over approximately 3 h. These color changes can be easily detected using naked-eye observation, smartphone analysis, or absorption readout. We have validated the platform using four clinical isolates and six types of antibiotics, demonstrating a clinical sensitivity and specificity of 95.8%. Given its simplicity, low cost, high speed, and high accuracy, the plasmonic nanosensor holds great potential for point-of-care detection of antibiotic susceptibility across various settings.

P12 Unjustified use of antibiotics in wartime conditions in Ukraine

Abstract Background The Ministry of Health of Ukraine reported that every second patient who takes antibiotics does not need such treatment, and every third uses them for viral diseases. In Ukraine, during the war, there has formed a resonance between the availability of broad-spectrum antibiotics and their belonging to the non-recommended category according to the AWaRe classification 2023. Therefore, the fight against antibiotic resistance continues to be a leading task of modern medicine. Objectives To investigate the expediency of use of ceftriaxone/levofloxacin among Ukrainian and foreigners settled in Ukraine. Subjects and methods A total of 180 (55% Ukrainians, 45% foreigners) responders were examined by questionnaire for ceftriaxone/levofloxacin use over 1 year with specification of reasons, expediency of use, possible reason for cancellation/replacement of antibiotic therapy and preventable usage cases. Results The sample included 63.9% women, 36.1% men, average age 18–25 years. The incidence of ceftriaxone/levofloxacin use was 58.97% among foreigners versus 12.74% among Ukrainians (P&amp;lt;0.001). The antibiotic use by physician’s prescription occurred among 28.3% foreigners and 92.3% Ukrainians (P &amp;lt; 0.05). The frequency of antibiotic use due to microbiological confirmation was significantly lower among foreign responders: 13.05% versus 76.9% in Ukrainians (P &amp;lt; 0.01). The reasons for choice of ceftriaxone/levofloxacin in the Ukrainian sample were acute respiratory infections 46%, fever 7.8% and diseases of bacterial origin 84.6%. At the same time foreigners used antibiotics for acute respiratory infections 41.3%, fever 19.7% and diseases of bacterial origin 63.1%. The analysis found that antibiotic use for ‘prophylaxis’ (mainly for viral diseases) was 2.95% among Ukrainians and 32.05% among foreigners (P&amp;lt;0.05). The predominant reasons for cancellation/replacement of antibiotic therapy, such as allergic reactions and antibiotic-associated diarrhoea, were found in 67.4% of foreigners and 7.69% of Ukrainians (P&amp;lt;0.05). Conclusions The lack of antibiotic prescription on the basis of microbiological confirmation, self-limited choice of antibiotics and unreasonable use for diseases of non-bacterial origin can be factors that promote multiple resistance in future and complicate the natural clinical course of most common infectious diseases.

Alternatives to β-Lactams as Agents for the Management of Dentoalveolar Abscess.

Dentoalveolar abscess are localized infections within the tooth or the surrounding alveolar bone, often resulting from untreated dental caries or dental trauma causing alveolar bone resorption or even loss. Serious consequences arising from the spread of a dental abscess can often lead to significant morbidity and mortality. The acute dentoalveolar abscess is a polymicrobial infection comprising strict anaerobes, such as anaerobic cocci i.e., Prevotella fusobacterium species, and facultative anaerobes i.e., Streptococci viridians and Streptococcus anginosus. Moreover, inappropriately managed dental infections can progress to severe submandibular space infections with associated serious complications, such as sepsis and airway obstruction. An audit of the Hull Royal Infirmary between 1999 and 2004 showed an increase in the number of patients presenting to oral and maxillofacial surgery services with dental sepsis. Thus, the scientific community is forced to focus on treatment strategies for the management of dentoalveolar abscess (DAA) and other related dental problems. The current treatment includes antibiotic therapy, including β-lactams and non-β- lactams drugs, but it leads to the development of resistant microorganisms due to improper and wide usage. Furthermore, the currently used β-lactam therapeutics is non-specific and easily hydrolyzed by the β-lactamase enzymes. Thus, the research focused on the non-β-lactams that can be the potential pharmacophore and helpful in the management of DAA, as the appropriate use and choice of antibiotics in dentistry plays an important role in antibiotic stewardship. The newer target for the choice is NLRP inflammasome, which is the major chemical mediator involved in dental problems. This review focused on pathogenesis and current therapeutics for the treatment of dentoalveolar abscesses.

Деструктивные пневмонии у детей глазами телеконсультанта

Aim. To study problems that pediatricians face in the management of necrotizing pneumonia, and to show ways to its optimization. Materials and methods. Necrotizing pneumonia is a serious disease that causes difficulties in the choice of antibiotics, indications for pleural interventions and termination of the therapy. Although mostly pneumococcal, pneumonias with purulent cavities and methapneumonic pleurisy (immunopathologic in its origin) are clinically resistance to antimicrobials, and it is taken by pediatricians as indications for changing antibiotics and pleural taps. Hence the importance of studying the prevalent tactics. We conducted analysis of 52 tele-requests for children with pulmonary consolidation and air-filled cavities. Its share among all “general pediatric” requests increased from 5% in 2021–2022 to 18% in 2023–2024. Of 52 patients 43 had also pleural effusions, 11 — pneumothorax. Pneumonia followed measles in 6 children, pertussis in 3, scarlet fever — in 1. All diagnostic and curative actions were compared to Clinical guidelines. Results. In all instances conditions for hospital care (including intensive) were generally adequate, diagnostic activities were often redundant (nonrelevant analyses, multiple computer tomography instead of X-ray). Only 16 patients were started on cephtriiaxone and amoxicillin/ clavulanate recommended by Clinical guides, the rest received reserve antibiotics. All patients received the 2nd course (combinations of the reserve antibiotics), 20 of them also the 3rd course. Steroids were given only to 3 patients. Of 43 children with pleurisy taps or drainage had 33, only 9 of them according to indications. Conclusion. Pediatricians are not fully conversant with Clinical guides and it causes excessive administration of 2–3 courses of reserve antibiotics, unnecessary pleural interventions, infrequent use of steroid therapy that shortens the length of hospital stay. Keywords: necrotizing pneumonia, management optimization.

Evaluating the impact of culture-guided antibiotic therapy on clinical outcomes in neonatal septicemia: A cross-sectional study

Background: Neonatal sepsis is a critical health issue worldwide, with high morbidity and mortality rates, especially in developing countries. Effective management of neonatal sepsis includes timely administration of appropriate antibiotics based on antimicrobial susceptibility patterns. Aims and Objectives: This cross-sectional study aimed to investigate the choice of empiric and definitive antibiotics in neonatal septicemia, assess bacterial susceptibility patterns, and correlation with clinical outcomes, and highlight the importance of antimicrobial stewardship. Materials and Methods: The study was conducted at a tertiary care center and enrolled neonates diagnosed with septicemia over 2 months. Blood cultures were obtained, and antibiotics were initiated empirically based on local guidelines. Definitive antibiotics were started after culture sensitivity reports and compared with empiric treatment for clinical outcomes and bacteriological profiles were analyzed with appropriate statistical methods. Results: In this study, Piperacillin-Tazobactam and Amikacin were used as empiric treatment in all cases. Meropenem showed high sensitivity in definitive treatment post-culture. No significant difference between empiric and definitive treatment groups was observed in clinical outcomes. Conclusion: This study found no significant difference in clinical outcomes between empiric and definitive antibiotic regimens for neonatal sepsis. However, high meropenem susceptibility suggests the potential for more targeted therapy. Regularly updating local antibiogram, data remain crucial to optimize empiric treatment and combat resistance in this vulnerable population.

Molecular Characterization and Antibiotic Susceptibility Pattern of Commonly Encountered Bacteria from Wound Infection in Diabetic Patients Attending Specialist Hospital, Bauchi, Bauchi State

Diabetic wounds are significantly more susceptible to wound infection by bacteria as well as external contamination than non-diabetic wounds. This study characterized and determined the antibiotic susceptibility pattern of commonly encountered bacteria from wound infection in diabetic patients attending Specialist Hospital, Bauchi, involving 120 diabetic and 120 non-diabetic patients from February to May, 2023. Socio demographic data was collected using structured questionnaire, and sterile swab stick was used in sample collection the subjects and immediately processed for characterization of bacterial isolates according to the standard district microbiological laboratory techniques while Kirby Bauer disk diffusion technique was adopted for susceptibility testing of the isolates. Among diabetic and non-diabetic cases, majority of patients were in the age group 51-60 and the least were in the age group 11-20. The predominant organism isolated was Staphylococcus aureus (41.7%) in both diabetic and non-diabetic wounds. In diabetic wounds, the predominant Gramnegative bacteria were Pseudomonas aeruginosa (20.8%) followed by Klebsiella pneumoniae (17.5%) and Escherichia coli (3.3%) and in non-diabetic wounds, the predominant organism was K. pneumoniae (21.7%) followed by Pseudomonas aeruginosa (17.5%) and E. coli (13.3%). A total of five (5) antibiotics from Gram negative and five (5) from Gram positive disks, which represent the most commonly prescribed antibiotics for treatment of wound infections in the study area, were used in the study. In this study Levofloxacin (71.25%), Chloramphenicol (81.25%) and Gentamicin (69.6%) were effective for S. aureus from all patients, Erythromycin (52.65%) has intermediate effect. From the other hand, Gentamicin (73.7%), Streptomycin (72.4%) and Ampicillin (80.7%) were effective for P. aeruginosa, K. pneumoniae and E. coli. Treatment of wound infections has to be made based on the culture and susceptibility test results for the choice of appropriate antibiotics with maximum efficacy.

Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries.

The spread of drug-resistant bacteria into the community is an urgent threat. In most low-middle-income countries (LMICs) settings, community-acquired infection (CAI) is empirically treated with no data to support the choice of antibiotics, hence contributing to resistance development. Continuous antimicrobial resistance (AMR) data on community-acquired pathogens are needed to draft empirical treatment guidelines, especially for areas with limited culture and susceptibility testing. Despite the importance of addressing antibiotic-resistant pathogens in the community setting, protocols for the surveillance of AMR bacterial infections are lacking in most (LMICs). We present a protocol for surveillance of AMR in LMICs using urinary tract infection (UTI) as a proxy for CAI to enable users to quantify and establish the drivers of AMR bacteria causing UTI. The protocol intends to assist users in designing a sustainable surveillance program for AMR in the community involving children above two years of age and adults presenting to a primary health facility for healthcare. Implementation of the protocol requires initial preparation of the laboratories to be involved, surveillance areas, selection of priority bacteria and antimicrobials to be used, and the design of a coordinated sampling plan. Recruitment should occur continuously in selected health facilities for at least 12 months to observe seasonal trends of AMR. At least 10 mL of clean-catch mid-stream urine must be collected into 20 mL calibrated sterile screw-capped universal bottles lined with 0.2 mg boric acid and transported to the testing laboratory. Utilise the data system that generates standard reports for patient care to be shared internally and externally in the regions and the world through global platforms such as the Global Antimicrobial Resistance Surveillance System.

Rapid characterization of carbapenem-resistant Enterobacterales by multiplex lateral flow assay and detection of ceftazidime-avibactam-aztreonam synergy

PurposeThe choice of antibiotics for treatment of Carbapenem-Resistant Enterobacterales (CRE) is increasing becoming limited due to co-expression of Metallo-beta-lactamases (MBL) along with other carbapenemases in these isolates. The study aimed to investigate the occurrence of CRE and to determine the in-vitro synergy and clinical outcomes of Ceftazidime-Avibactam and Aztreonam combination in CRE infections in adult Intensive Care Units (ICUs). Methods79 CRE isolates recovered from adult ICUs during January to March 2023 were tested by O.K.N.V.I. RESIST-5, a lateral flow multiplex assay for rapid detection of OXA-48-like, NDM, IMP, VIM, and KPC carbapenemases. Ceftazidime-Avibactam MIC was determined by microbroth dilution method and in vitro synergy between Ceftazidime-Avibactam and Aztreonam was assessed by Modified E-test/disc diffusion method for these isolates. ResultsThe study revealed 7.5 % occurrence of CRE in our hospital, with high occurrence of NDM (n = 42, 53.1 %) and OXA-48-like (n = 63, 79.7 %) carbapenemase. Production of more than one type of carbapenemases was found in 44 isolates. A total of 57 isolates (72 %) had Ceftazidime-Avibactam resistance and 44 of them displayed Ceftazidime-Avibactam and Aztreonam in-vitro synergy. Successful clinical outcome was observed in two patients who received Ceftazidime-Avibactam and Aztreonam combination therapy for 7 days or more. ConclusionsDespite the preponderance of Ceftazidime-Avibactam resistant CRE expressing NDM and OXA-48-like carbapenemase in our hospital, 77.2 % of them displayed in-vitro synergy of Ceftazidime-Avibactam with Aztreonam. It emphasizes the potential therapeutic utility of this combination in CRE strains showing coproduction of MBL and serine carbapenemases. Greater therapeutic potential of Ceftazidime-Avibactam and Aztreonam combination was observed with extended duration of therapy. However, further clinical evidence is needed to establish the efficacy of this combination and consider other factors that influence treatment outcomes.

Management of Traumatic Bone Defects in Tibial Plateau Fractures with Antibiotic-Impregnated Biodegradable Calcium Sulfate Beads: A Prospective Clinical Trial

Objectives: The purpose of this study was to assess adverse events and resorption of antibiotic-impregnated calcium sulfate beads used as a nonstructural void filler in tibia plateau fractures. This device may be more adaptable to a specific bacterium than vancomycin powder as it allows the mixtures of specific bactericidal antibiotics to treat bacterium with specific sensitivities. Design: A multicenter, non-randomized, uncontrolled prospective cohort study. Setting: Five level 1 trauma centers. Participants: Thirty adults with an acute closed tibia plateau fracture, OTA 41B and 41C fractures, requiring operative fixation. Intervention: After fracture fixation, the subchondral bone void was filled with the study device. Main Outcome Measures: Local wound reaction to the device was assessed and resorption of the calcium sulfate was measured on serial x-rays. Follow-up assessments occurred at six weeks, three months, six months and one year, with a CT scan performed at six months to determine resorption of the device. Results: Thirteen male and 17 female participants were recruited with a mean age of 53.3 ± 12.8 years. The median age was 55 years with a range of 29 to 78 years of age. Two participants reported serous drainage: one resolved without treatment, the other was diagnosed as a deep infection and required plate removal and oral antibiotics. There were no local or systemic allergic reactions. Resorption of the material averaged 70% by three months, 87% at six months, and 100% at one year. Conclusions: This device performed as anticipated and completely resorbed without any unexpected adverse events. It allowed for personalizing antibiotic choice with better reported elutional characteristics than vancomycin powder over two weeks and six weeks. Surgical site drainage was low, and 97% union rate was achieved. This is a safe surgical augment for local release of a chosen antibiotic into a contained subchondral defect in a periarticular fracture.

Infections in Pregnancy

Abstract Infections in pregnant women tend to be more severe and pose unique treatment challenges. After all, the well-being of two individuals is at stake. Screening all pregnant women in early pregnancy for bacteriuria is recommended. Pyelonephritis and puerperal sepsis should be managed aggressively with appropriate empiric antibiotic choices. Increasing resistance in Enterobacterales is the complicating treatment of both these illnesses in the Indian setting. Influenza can lead to serious maternal and fetal outcomes; early empiric antiviral therapy and universal maternal vaccination are important. Dengue is an important cause of fever in pregnant women and can complicate vaginal and operative delivery due to thrombocytopenia. Falciparum malaria can now be treated with artemisinin-based combination therapy (ACT) in all trimesters. The drug of choice for scrub typhus is azithromycin; a combination of doxycycline and azithromycin can be considered in very severe disease. Treatment of both drug-sensitive and drug-resistant tuberculosis in pregnancy is similar to the nonpregnant. Safety data relating to bedaquiline and delamanid from animal models and cohort studies are reassuring.

Syndromic Antibiograms and Nursing Home Clinicians’ Antibiotic Choices for Urinary Tract Infections

Empirical antibiotic prescribing in nursing homes (NHs) is often suboptimal. The potential for antibiograms to improve empirical antibiotic decision-making in NHs remains poorly understood. To determine whether providing NH clinicians with a urinary antibiogram improves empirical antibiotic treatment of urinary tract infections (UTIs). This was a survey study using clinical vignettes. Participants were recruited via convenience sampling of professional organization listservs of NH clinicians practicing in the US from December 2021 through April 2022. Data were analyzed from July 2022 to June 2023. Respondents were randomized to complete vignettes using a traditional antibiogram (TA), a weighted-incidence syndromic combination antibiogram (WISCA), or no tool. Participants randomized to antibiogram groups were asked to use the antibiogram to empirically prescribe an antibiotic. Participants randomized to the no tool group functioned as controls. Empirical antibiotic selections were characterized as microbiologically (1) active and (2) optimal according to route of administration and spectrum of activity. Of 317 responses, 298 (95%) were included in the analysis. Duplicate responses (15 participants), location outside the US (2 participants), and uninterpretable responses (2 participants) were excluded. Most respondents were physicians (217 respondents [73%]) and had over 10 years of NH practice experience (155 respondents [52%]). A mixed-effects logistic model found that use of the TA (odds ratio [OR], 1.41; 95% CI, 1.19-1.68; P < .001) and WISCA (OR, 1.54; 95% CI, 1.30-1.84; P < .001) were statistically superior to no tool when choosing an active empirical antibiotic. A similarly constructed model found that use of the TA (OR, 1.94; 95% CI, 1.42-2.66; P < .001) and WISCA (OR, 1.7; 95% CI, 1.24-2.33; P = .003) were statistically superior to no tool when selecting an optimal empirical antibiotic. Although there were differences between tools within specific vignettes, when compared across all vignettes, the TA and WISCA performed similarly for active (OR, 1.09; 95% CI, 0.92-1.30; P = .59) and optimal (OR, 0.87; 95% CI, 0.64-1.20; P = .69) antibiotics. Providing NH clinicians with a urinary antibiogram was associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions. Although the antibiogram format was not associated with decision-making in aggregate, context-specific effects may have been present, supporting further study of syndromic antibiograms in clinical practice.

Nephroprotective Effect of Vinpocetine against Vancomycin-induced Nephrotoxicity in Rats

Background: The kidney is a vital organ for the body and is vulnerable to drug toxicity. For methicillin-resistant Staphylococcus aureus, vancomycin is the antibiotic of choice. It has been accompanied by nephrotoxicity, which restricts its use. Numerous studies have reported that nephrotoxicity was linked to oxidative stress and inflammatory response. Vinpocetine is a derivative of vincamine alkaloid used to treat some neurological disorders and has antioxidant and anti-inflammatory effects. The objective of the study: To evaluate the nephroprotective effect of vinpocetine against vancomycin-induced nephrotoxicity in rats. Methods: Twenty-four albino male rats were randomly selected and divided into three groups (n = 8): (1) Normal group: apparently healthy rats. (2) Induction group: treated with vancomycin (200mg/kg) twice daily intraperitoneally for 14 days. (3) Vinpocetine group: As the group (2) and treated with vinpocetine (2.5mg/kg) twice daily orally, an hour before vancomycin administration. Results: Vinpocetine group demonstrated a significant decrease in urea, creatinine, and cystatin C serum levels compared to the induction group. Also, it showed a significant reduction in the renal tissue level of malondialdehyde and a significant elevation in the renal tissue level of glutathione as compared to the induction group. Furthermore, the vinpocetine group showed a significant decrease in the renal tissue levels of tumour necrosis factor-alpha and neutrophil gelatinase-associated lipocalin. Histologically, all rats in vinpocetine group showed a significantly reduced level of renal tissue damage. Conclusion: The present study shows that vinpocetine exhibited nephroprotective due to its antioxidant and anti-inflammatory effects. Keywords: Nephrotoxicity, Oxidative stress, Vancomycin, Vinpocetine.

Non-cefazolin antibiotic prophylaxis is associated with higher rates of elbow periprosthetic joint infection

Periprosthetic joint infection (PJI) is a common source of failure following elbow arthroplasty. Perioperative prophylactic antibiotics are considered standard of care. However, there are no data regarding the comparative efficacy of various antibiotics in the prevention of PJI for elbow arthroplasty. Previous studies in shoulder, hip, and knee arthroplasty have demonstrated higher rates of PJI with administration of non-cefazolin antibiotics. The elbow has higher rates of PJI than other joints. Therefore, this study evaluated whether perioperative antibiotic choice affects rates of PJI in elbow arthroplasty. A single-institution, prospectively collected total joint registry database was queried to identify patients who underwent primary elbow arthroplasty between 2003 and 2021. Elbows with known infection prior to arthroplasty (25) and procedures with incomplete perioperative antibiotic data (7) were excluded, for a final sample size of 603 total elbow arthroplasties and 19 distal humerus hemiarthroplasties. Cefazolin was administered in 561 elbows (90%) and non-cefazolin antibiotics including vancomycin (32 elbows, 5%), clindamycin (27 elbows, 4%), and piperacillin/tazobactam (2 elbows, 0.3%) were administered in the remaining 61 elbows (10%). Univariate and multivariate analyses were conducted to determine the association between the antibiotic administered and the development of PJI. Infection-free survivorship was estimated using the Kaplan-Meier method. Deep infection occurred in 47 elbows (7.5%), and 16 elbows (2.5%) were diagnosed with superficial infections. Univariate analysis demonstrated that patients receiving non-cefazolin alternatives were at significantly higher risk for any infection (hazard ratio [HR] 2.6, 95% confidence interval [CI] 1.4-5.0; P<.01) and deep infection (HR 2.7, 95% CI 1.3-5.5; P<.01) compared with cefazolin administration. Multivariable analysis, controlling for several independent predictors of PJI (tobacco use, male sex, surgical indication other than osteoarthritis, and American Society of Anesthesiologists score), showed that non-cefazolin administration had a higher risk for any infection (HR 2.8, 95% CI 1.4-5.3; P<.01) and deep infection (HR 2.9, 95% CI 1.3-6.3; P<.01). Survivorship free of infection was significantly higher at all time points for the cefazolin cohort. In primary elbow arthroplasty, cefazolin administration was associated with significantly lower rates of PJI compared to non-cefazolin antibiotics, even in patients with a greater number of prior surgeries, which is known to increase the risk of PJI. For patients with penicillin or cephalosporin allergies, preoperative allergy testing or a cefazolin test dose should be considered before administering non-cefazolin alternatives.

Clinical success of clarithromycin, amoxicillin-clavulanic acid, enrofloxacin and doxycycline in dogs with infectious tracheobronchitis

Canine infectious tracheobronchitis (ITB) is a highly contagious disease of dogs expressed with remarkable respiratory signs. Therapy with antibiotics in canine ITB still remains questionable. The purpose of this study was to compare the clinical success of clarithromycin, amoxicillin-clavulanic acid, enrofloxacin and doxycycline in the treatment of canine ITB. Client-owned dogs with canine ITB signs (n=60) were enrolled in this prospective, controlled, and randomized blinded clinical trial. A computer-generated list randomization was employed to assign the dogs equally into the Group CLA: clarithromycin (25 mg/kg, PO), the Group AMX: amoxicillin and clavulanic acid (25 mg/kg, PO), the Group ENR: enrofloxacin (2.5 mg/kg, PO), and the Group DOX: doxycycline (5 mg/kg, PO). The administration of CLA alleviated the cough sign earlier than DOX. The recovery time of oculonasal discharge in group CLA were also earlier compared to the other groups. The tracheal sensitivity also disappeared earlier in the Groups CLA and AMX. In conclusion although there is no always statistically significance between groups, clarithromycin appears to be superior to other antibiotics suggesting that it can be the first antibiotic choice to alleviate the ITB signs in dogs.