Combination Of Penicillin Research Articles

Occurrence and Resistance Pattern of Gram-Negative Bacteremia and Sepsis in A Tertiary Care Hospital - A Four-Year Study

The rise in antibiotic resistance has been a major source of public health concern. As a result, mortality and morbidity rates have risen significantly. This study was done to identify gram-negative organisms causing bacteremia/sepsis, study their prevalence rates, and antimicrobial resistance patterns, as evidence-based knowledge of gram-negative organisms causing sepsis and their resistance profiles is essential for effective hospital control and better management of infections caused by resistant bacteria. A retrospective study, conducted from January 2016 to December 2019, blood samples were collected using aseptic guidelines and cultured using automated blood culture methods. Biochemical tests were done according to microbiology standard procedures, while antimicrobial testing was done according to CLSI guidelines. A total of 13,808 blood samples were received within the study period of four years. Of the total, 2079 showed significant growth, with 765 being GNB isolates. The most common isolates were Escherichia coli (35.42%), Klebsiella pneumonia (19.74%), Acinetobacter species (9.67%), and other non-fermenting gram-negative bacilli (11.76%). Escherichia coli showed yearly resistance to aminoglycosides, cephalosporins, penicillin, fluoroquinolones, and B-lactam combination agents. Routine surveillance and awareness of the prevalence, etiological agents, and antibiotic resistance of gram-negative bacteria causing bacteremia/sepsis is critical for individual therapy, hospital control, and the effectiveness of preventive interventions.

Potentiation of β-Lactams against Methicillin-Resistant Staphylococcus aureus (MRSA) Using Octyl Gallate, a Food-Grade Antioxidant.

Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to a number of antibiotics of clinical importance and is a serious threat to public health. Since bacteria rapidly develop resistance even to newly discovered antibiotics, this study aimed to develop drug potentiators to enhance the antibacterial activity of existing antibiotics for the control of MRSA. Based on our previous studies, screening of antimicrobial synergy was conducted with gallic acid and its derivatives using checkerboard assays. Antimicrobial synergy was confirmed with MRSA isolates from clinical cases. Combinations of penicillin, ampicillin, and cephalothin with octyl gallate (OG), an antioxidant approved by the US Food and Drug Administration (FDA), consistently exhibited synergistic bacteriostatic and bactericidal activities against MRSA, rendering MRSA sensitive to β-lactams. The fractional inhibitory concentration (FIC) and fractional bactericidal concentration (FBC) indices exhibited that the antimicrobial effects of OG were synergistic. The results of a permeability assay showed that OG significantly increased the permeability of the bacterial cell wall. Despite the intrinsic resistance of MRSA to β-lactams, the findings in this study demonstrated that OG enhanced the activity of β-lactams in MRSA and sensitized MRSA to β-lactams, suggesting that OG can be used as a drug potentiator to control MRSA using existing antibiotics.

Clinical Outcome of Discordant Empirical Therapy and Risk Factors Associated to Treatment Failure in Children Hospitalized for Urinary Tract Infections.

With the spread of antibiotic resistance in pediatric urinary tract infections (UTIs), more patients are likely to be started empirically on antibiotics to which pathogens are later found to be resistant (discordant therapy). However, in-vivo effectiveness may be different from in-vitro susceptibility. Aims of this study were to describe clinical outcomes of discordant empirical treatments in pediatric UTIs and to investigate risk factors associated to treatment failure. This observational, retrospective study was conducted on children hospitalized for febrile UTIs with positive urine culture and started on discordant empirical therapy. Failure rates of discordant treatments and associated risk factors were investigated. A total of 142/1600 (8.9%) patients were treated with inadequate empirical antibiotics. Clinical failure was observed in 67/142 (47.2%) patients, with no fatal events. Higher failure rates were observed for combinations of penicillin and beta-lactamase inhibitors (57.1%). Significant risk factors for failure of discordant treatment were history of recurrent UTIs (95% CI: 1.13–9.98, OR: 3.23, p < 0.05), recent use of antibiotics (95% CI: 1.46–21.82, OR: 5.02, p < 0.01), infections caused by Pseudomonas aeruginosa (95% CI: 1.85–62.10, OR: 7.30, p < 0.05), and empirical treatment with combinations of penicillin and beta-lactamase inhibitors (95% CI: 0.94–4.03, OR: 1.94, p = 0.05). This study showed that discordant empirical treatments may still be effective in more than half of pediatric UTIs. Clinical effectiveness varies between different discordant antibiotics in pediatric UTIs, and patients presenting risk factors for treatment failure may need a differentiated empirical approach.

Identification of colistin resistance and its bactericidal activity against uropathogenic gram negative bacteria from Hayatabad Medical Complex Peshawar.

Objectives:Identification of colistin resistance and its bactericidal activity against gram-negative bacteria isolated from urinary tract infection (UTI) patients.Methods:This 6-month cross sectional study was conducted in Hayatabad Medical Complex Peshawar from January 2019-June2019.. A total of 2000 urine samples were collected and transported to the Health Research Institute, NIH, Research Centre, Khyber Medical College Peshawar. Samples were streaked on different media and incubated at 37C° for 24hrs. Gram negative bacteria were identified through gram staining and Analytical Profile Index (API) 10s. Gram negative bacteria were subjected under antibiotic sensitivity profile through Kirby-Bauer disc diffusion method. Colistin resistance was found through broth microdilution method. Minimum bactericidal activity was performed to find out the lowest concentration of colistin required to kill gram-negative bacteria.Results:A total of 241(12.05%) uropathogenic gram negative bacteria were isolated and identified from 2000 urine samples while excluding intrinsically resistant bacteria. After broth microdilution, colistin resistance was found in 48(19.9%) Escherichia coli, 4(1.6%) Klebsiella pneumoniae and 3(1.3%) Pseudomonas aeruginosa respectively. Colistin resistant Escherichia coli were resistant to 77% Cephalosporins, 81% to Fluoroquinolones and 70% to Penicillin combinations. Colistin resistant Klebsiella pneumoniae were 100% resistant to Cephalosporins, Penicillin combinations and Fluoroquinolones while 75% were resistant to Carbapenems and Monobactams. Pseudomonas aeruginosa isolates were sensitive to all used antibiotics.Conclusion:E.coli was the mainly responsible uropathogen causing UTIs. Colistin resistance was found in 22.8% gram negative uropathogens. Klebsiella pneumoniae isolates exhibited highest resistance to antibiotics.

Comparative Efficacy of Two Antibiotics for the Management of Secondary Bacterial Infection in Goats Clinically Affected by Peste des Petits Ruminants

Aims: Peste des petits Ruminants (PPR) is a major viral disease that poses a challenge to small ruminant farming. Its natural occurrence has been complicated by secondary bacterial infection which has led to an increase in morbidity and mortality rates. This study reports the management outcome of natural PPR-infected goats using two types of antibiotics in Nsukka metropolis of Enugu State Nigeria.&#x0D; Methodology: Goats (N=24) were confirmed to be suffering from PPR based on clinical signs and using polymerase chain reaction (PCR). The animals were divided into two groups. Group A was treated with 20% oxytetracycline (N= 10) and group B with procaine penicillin and streptomycin combination (penstrept) (N= 14) injection. Clinical signs, recovery and survivability, temperature, haematology [Packed cell volume (PCV); haemoglobin concentration (Hbconc); red blood cell (RBC) and white blood cell (WBC) counts] and some serum biochemical profiles [alanine aminotransferase (ALT); aspartate transaminase (AST); total protein (TP); Albumin; urea; creatinine; potassium and sodium] were used to assess the efficacy of the antibiotics using standard techniques.&#x0D; Results: The mean temperature, RBC, WBC and urea values of the PPR-infected goats were above their reference ranges, mean albumin values were below the reference range while mean Hbconc, PCV, AST, ALT, TP and creatinine values were within their reference range before the commencement of treatment. Following treatment, clinical signs cleared in 20% and 35.7% of the goats treated with oxytetracycline and penstrep respectively. Death was recorded in 20% and 15% of goats treated with oxytetracycline and penstrep respectively before the end of treatment. Penstrep-treated group showed improvement in their haematological profile.&#x0D; Conclusion: Based on our findings, the use of penstrep in the management of PPR-infected goats gave a better result.

Medicine shortages in France: a 6-year retrospective study in a university medical centre

ObjectivesMedicine procurement disorders, commonly referred to as ‘shortages’, are a health-threatening phenomenon that have been reported by several stakeholders around the world. This study aimed to describe data from a...

EFFECT OF PENICILLIN -CIPROFLOXACIN COMBINATION ON SEMEN CHARACTERISTIC AND BACTERIAL CONTAMINANTS OF DILUTED BULL SEMEN

Effect of penicillin- ciprofloxacin combinations on some semen characteristics and bacterial contaminants of diluted bull semen was determined and compared with those of penicillin- streptomycin combinations. Sperm motility, percentage of dead and abnormal spermatozoa and survival index did not differ significantly for penicillin (1000 IU) and ciprofloxacin (125, 250, 500, 1000 ug) combinations per milliliter of diluted bull semen from those of penicillin (1000 I.U) and streptomycin (500 ug) combination / ml. Each penicillin ciprofloxacin combination effectively controlled bacterial growth. However penicillin streptomycin combination did not effectively control the growth. Accordingly, the combination of penicillin- ciprofloxacin seems to be a satisfactory substituent for penicillin- streptomycin combination for controlling bacterial contaminants in diluted bull semen without impairing semen characteristics.

Microbiological and Clinical Aspects of Diphtheria-Confirmed Cases from Capital City of Indonesia, Jakarta, and Surrounding Areas in 2017

Background: The World Health Organization reported Indonesia as one of the countries with the most prevalent cases of diphtheria worldwide. The microbiological aspects of diphtheria-inducing bacteria are of great significance in tracing disease transmission and case management. However, clinical aspects are critical for updating clinical features and case management in the field, which may sometimes differ from theoretical foundations. Objectives: This study aimed to identify the microbiological and clinical aspects, including molecular typing and case fatality rates, in diphtheria-confirmed cases from the capital city of Indonesia, Jakarta, and surrounding areas in 2017. Methods: The microbiological aspect of 40 diphtheria-confirmed cases were obtained by re-identify diphtheria-inducing bacteria isolated from the samples, while the clinical aspects of the cases were obtained from the medical records and epidemiological data. The chi-square test was used to examine the correlation between fatal cases and myocarditis and diphtheria antitoxin administration delay. In this study, P ≤ 0.05 was set as the significance level. Results: All 40 diphtheria confirmed cases were induced by toxigenic Corynebacterium diphtheriae with two biotypes, namely intermedius (60.0%) and mitis (40.0%). There are six sequence types of bacteria with two main sequence types, ie, ST534 (46.4%) and ST377 (35.7%). The proportions of cases that had a fever and sore throat were 72.5% and 77.5%, respectively; however, the prevalence rates of the cases with pseudomembrane and bull neck were 100% and 47%, respectively. Most cases were administered a combination of penicillin or erythromycin with other antibiotics (40%), and 22.5% of the cases only received penicillin. Myocarditis was noticed in three fatal cases, and their relationship was statistically significant (P = 0.000). All five fatal cases (12.5% of cases) received diphtheria antitoxin (DAT) lately or had not received it yet. Conclusions: Toxigenic C. diphtheriae with two biotypes (namely mitis and intermedius) and two main sequence types (ie, ST534 and ST377) was the causative agent of diphtheria-confirmed cases from Jakarta and surrounding areas in 2017. It was also concluded that those fatal cases were correlated with myocarditis complications.

Antibiotic use and associated factors in adult outpatients from 2000 to 2019.

The aims of the study were to assess the changes in 19‐years use of antibiotics (overall, by age, sex and geographical area) and of those classes deemed to be quality indicators for their consumption and to evaluate factors associated to antibiotic use. We analyzed drug prescription data collected in the administrative database of the Lombardy Region (Northern Italy) for outpatients aged 40+ years from 2000 to 2019. Logistic regression analyses were performed to evaluate the association between receiving at least one antibiotic prescription and year of observation, gender, age groups, area of residence, polypharmacy and hospitalizations in the index year. The prevalence of patients prescribed with antibiotics remained high from 2000 (33.8%) to 2019 (32.6%). Prevalence of use of second‐line choice antibiotics (penicillin combinations with beta‐lactamase inhibitors, third and fourth generation cephalosporins, macrolides) continued to increase, only fluoroquinolones decreased in 2019 (19%) comparing to 2018 (26%), at the time when the Italian Medicines Agency promulgated safety warnings. Females (OR 1.28, 95%CI 1.27–1.28), people living in Brescia (OR 1.24, 95%CI 1.24–1.25), those exposed to polypharmacy (OR 2.57, 95%CI 2.56–2.57) and those hospitalized 1 to 3 (OR 1.86, 95%CI 1.85–1.86) or more than 3 (OR 2.02, 95%CI 2.01–2.03) times a year had a statistically significant higher risk of receiving antibiotics. The high use of antibiotics over the study period further reinforces the need of impactful interventions, in order to improve the rational use of antibiotics and to reduce the risks of antimicrobial resistance. The differences outlined should be considered when monitoring and planning these interventions.

1616 Antibiotic Use in The Management of Mandibular Fractures: A Survey of Current Practice in the UK

Abstract Aim Traumatic mandibular fractures account for a significant proportion of UK oral and maxillofacial trauma. Prophylactic antibiotics is standard practice for management of these patients, however evidence for this is weak and relevant RCTs are insufficiently powered or poorly designed. The Maxillofacial Trainee Research Collaborative (MTReC) aims to survey current antibiotic regimens in UK OMFS units treating mandibular trauma, Method A multicentre online survey was shared via email and social media. Questions focused on current practices regarding management of mandibular fractures during pre-, peri-, and post-operative phases. Results 89 responses from 50 UK OMFS units including 76 trainees and 4 consultants were collated over 2.5-months. 45 units routinely admitted patients; 88% clinicians starting pre-operative IV antibiotics;11 different pre-operative antibiotic regimens were identified across all surveyed clinicians, with 65% prescribing Augmentin, and remaining 35% using variable combinations of penicillins with 4 other antibiotic classifications. 5 different protocols were identified in use across the 88.8 % of respondents who chose to prescribe post-operative antibiotics. Conclusions There is inter-unit and inter-clinician variability in prophylactic antibiotic prescription in UK patients undergoing ORIF mandibles. Given antimicrobial resistance has been declared a WHO public health threat, efforts must be made to reduce antibiotic overuse and understand regional situation specific sensitivities. The survey highlights need for nationalised protocols for antibiotics use in mandibular fractures, if at all. This survey of clinician reported practice will be used to inform a prospective observational study on 30-day outcomes of ORIF mandibles taking into account patient factors, fracture pattern, fixation type and antibiotic use.

Listeria monocytogenes infections: presentation, diagnosis and treatment.

Listeriosis is an infective complication that primarily affects pregnant women, patients at extremes of age or those with weakened immune systems. Ingestion of food contaminated with Listeria monocytogenes is the most common source of infection, causing self-limiting illness in immunocompetent hosts but associated with invasive infection and high mortality in high-risk patient groups. Milder illness presents as gastroenteritis with fever, diarrhoea, nausea and vomiting common in the 7 days post exposure. Invasive infection, characterised by bacteraemia and encephalitis, can develop in high-risk patients. Fetal loss is a major complication of listeriosis during pregnancy. Penicillin-based therapy (high dose penicillin or amoxicillin) in combination with gentamicin is advised for invasive infection; co-trimoxazole may be considered for patients intolerant to penicillin. Vulnerable individuals, notably pregnant women, should be counseled on appropriate preventative strategies including avoiding foods commonly contaminated with L. monocytogenes, such as soft ripened cheeses, pate, cooked chilled meats, unpasteurised milk, and ready to eat poultry unless thoroughly cooked.

LACTOBACILLUS ENDOCARDITIS, A SINISTER CONSEQUENCE OF AN INNOCUOUS BACTERIUM

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lactobacillus species are gram positive rods that are part of the normal flora in gastrointestinal, oropharyngeal and genital tracts. Rarely they are implicated as causative agents of endocarditis in patients who are immunocompromised, undergo dental procedures, use probiotics or have a valvulopathy or prosthetic device. We describe the case of lactobacillus jensenii causing aortic valve endocarditis in an immunocompetent patient with a bicuspid aortic valve. It is important to recognize lactobacillus species as an emerging cause of endocarditis. Treatment involves a synergistic combination of penicillin and gentamicin. CASE PRESENTATION: 55 years old female with past medical history of bicuspid aortic valve presented to the emergency department with chief complaint of fever of 3 weeks' duration. COVID-19 testing was negative. Her medical history was significant for bicuspid aortic valve with aortic regurgitation and hyperlipidemia. Vitals signs were significant for a fever of 103 F. Physical exam was remarkable for a diastolic murmur heard best in the left third intercoastal space. Labs showed a normal blood count, and electrolytes. Patient's blood and urine cultures were obtained, and they were sent home with an oral antibiotic only to be called two days later for a positive blood culture. Blood cultures initially grew gram positive bacilli and patient was started on vancomycin and piperacillin-tazobactam pending final cultures. Due to her history of bicuspid aortic valve, endocarditis was suspected, and patient underwent transesophageal echocardiogram (TEE) which showed a 10-millimeter vegetation attached to the non-coronary cusp of aortic valve. Blood cultures came back positive for lactobacillus jensenii. Patient satisfied the Duke's criteria for endocarditis and was switched to penicillin and gentamicin. Further history did not elicit further risk factors of lactobacillus endocarditis including probiotic use, recent dental work, and immunodeficiency. Patient completed six weeks of antibiotics and had negative final blood cultures. DISCUSSION: This case highlights the importance of lactobacillus species to be a causative factor of endocarditis in patients with a predisposing risk factor. These risk factors include, in order of decreasing frequency, valvulopathy, dental procedures, probiotic use and immunosuppression. It is important to consider lactobacilli as a causative agent of infection if they are isolated on routine blood cultures in predisposed patients with a compatible clinical picture. TEE should be done if endocarditis is suspected. Lactobacilli are highly sensitive to penicillin G and synthetic penicillins. However, they are usually resistant to vancomycin. This is important as vancomycin is an integral regimen of most initial sepsis regimens. CONCLUSIONS: . REFERENCE #1: Campagne, J., J. F. Guichard, M. C. Moulhade, H. Kawski, and F. Maurier. "Lactobacillus endocarditis: a case report in France and literature review." IDCases 21 (2020): e00811. REFERENCE #2: Prendergast, B. D. "Diagnostic criteria and problems in infective endocarditis." Heart 90, no. 6 (2004): 611-613. DISCLOSURES: No relevant relationships by Muhammad Hasib Khalil, source=Web Response

Consumption of Antibacterials for Systemic Use in Slovakia: A National Study and the Quality Indicators for Outpatient Antibiotic Use.

This paper aims to analyse the consumption of antibiotics in the Slovak health care system from 2011 to 2020. The data source on the consumption of antibiotics is sales data from SUKL and NCZI. The study employed the ATC/DDD Index and focused on the consumption of antibiotics in the primary care sector. Total antibiotic consumption decreased from 19.21 DID in 2011 to 13.16 DID in 2020. Consumption of beta-lactamase-sensitive penicillins, expressed as a percentage of the total consumption of antibiotics, decreased from 8.4% in 2011 to 4.2% in 2020. Consumption of the combination of penicillins, including beta-lactamase inhibitor, expressed as a percentage of the total consumption of antibiotics, increased from 16.2% in 2011 to 17.9% in 2020. Consumption of third- and fourth-generation cephalosporins, expressed as the percentage of the total consumption of antibiotics, increased from 2.0% in 2011 to 4.6% in 2020. Consumption of fluoroquinolones, expressed as the percentage of the total consumption of antibiotics, decreased from 10.7% in 2011 to 8.6% in 2020. Overall, antibiotic consumption significantly changed in Slovakia from 2011 to 2020. The ratio of the consumption of broad-spectrum to the consumption of narrow-spectrum penicillins, cephalosporins and macrolides decreased from 14.98 in 2011 to 13.38 in 2020.

Consumption of penicillins in the community, European Union/European Economic Area, 1997-2017.

ObjectivesData on consumption of penicillins in the community were collected from 30 EU/European Economic Area (EEA) countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in the composition of the main subgroups of penicillins.MethodsFor the period 1997–2017, data on consumption of penicillins, i.e. β-lactam antibacterials, penicillins (ATC group J01C), in the community aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Consumption of penicillins was analysed based on ATC-4 subgroups, and presented as trends, seasonal variation, presence of change-points and compositional changes.ResultsIn 2017, consumption of penicillins in the community expressed in DDD per 1000 inhabitants per day varied by a factor of 4.9 between countries with the highest (Spain) and the lowest (the Netherlands) consumption. An increase in consumption of penicillins, which was not statistically significant, was observed between 1997 and 2003 and up to 2010. A decrease, which was not statistically significant, was observed from 2010 onwards. Proportional consumption of combinations of penicillins, including β-lactamase inhibitors (J01CR) increased during 1997–2017, which coincided with a decrease in the proportional consumption of extended-spectrum penicillins (J01CA) and narrow-spectrum penicillins (J01CE).ConclusionsConsiderable variation in the patterns of consumption of penicillins was observed between EU/EEA countries. The consumption of penicillins in the EU/EEA community did not change significantly over time, while the proportional consumption of combinations of penicillins increased.

Antibiotic use amongst pregnant women in a public hospital in KwaZulu-Natal.

BackgroundAntibiotics are amongst the more frequently prescribed medicines in pregnant women and the use of antibiotics is increasing. However, with limited studies available in this population, the safe use of antibiotics in pregnancy remains a concern.AimTo evaluate the use of antibiotics amongst pregnant women attending a public health care facility. The main objective of this study was to quantify the types of antibiotics used in pregnant women.SettingA public hospital classified as a referral hospital located in Durban, KwaZulu-Natal.MethodsDemographic and treatment information of women were collected retrospectively from January 2019 to July 2019. A total of 184 pregnant patients, who received antibiotic therapy, were included in this study. Descriptive and analytical measures were used to analyse both patient demographics and treatment variables.ResultsA total of 416 antibiotic prescriptions, issued to 184 patients, were reviewed. Penicillins (39.7%), macrolides (13.0%) and combination penicillin- and beta-lactam inhibitors (12.3%) were reported as the most commonly prescribed antibiotics. Rifamycin (2.9%), hydrazides (2.2%) and aminoglycosides (1.9%) were less frequently prescribed. Most antibiotics were prescribed for diseases of the circulatory system (36.1%).ConclusionSeveral classes of antibiotics were used in pregnancy despite the lack of available safety data and clinical evidence. Informing women of the potential side effects and keeping abreast with new information played an important role in the safe, rational and effective use of medicines that contributed to improving maternal health.

Epidemiology, evolution and cryptic susceptibility of methicillin-resistant Staphylococcus aureus in China: a whole-genome-based survey

ObjectivesThe aim of this study was to investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in China to identify predominant lineages and their associations with clinical data and antimicrobial resistance profiles. MethodsWe performed a national prevalence study of patients with S. aureus infections in 22 tertiary hospitals in China from 2015 to 2017. Clinical data from patients and the antimicrobial phenotypes were collected for each isolate. Genome sequencing was performed on a proportion of isolates and a phylogenetic analysis was undertaken. Genotypic and phenotypic β-lactam susceptibilities were compared. ResultsA total of 1900 patients with S. aureus infections were included, of which 40% involved MRSA. Community-associated MRSA (CA-MRSA) infections were 24% of the total isolates. Genomic data showed that more than three-quarters of the MRSA were from three dominant lineages CC239 (25%, 116/471), CC5 (21%, 96/471) and CC59 (33%, 154/471) with CC59 accounting for more than half of the CA-MRSA isolates. Penicillin susceptibility genomic features were observed in 53% (251/470) of MRSA, including almost all of the CC59 (152/154) lineage, and 96% (242/251) of these isolates demonstrated in vitro susceptibility to penicillin or amoxicillin combined with clavulanic acid. Phylogenetic analysis indicated that the CC59 lineage can be divided into six lineages with all Asian CC59 isolates likely arising from an ancestral Mainland China lineage. ConclusionsThis study showed a high prevalence of CA-MRSA in China, largely due to the widespread presence of CC59. As almost all isolates in this lineage possess genetic variants leading to increased β-lactam susceptibility, we suggest that to improve antibiotic stewardship combinations of penicillins and β-lactamase inhibitors should be included in the antibiotic susceptibility testing panels used to inform treatment decisions and research undertaken on this combination therapy.

Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010–2018

Background The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010–2018. Methods Antibiotic resistance among invasive isolates from 2010–2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. Results Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0–2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (<10%) except in Finland and Iceland (<15%), but benzylpenicillin was recommended for community-acquired pneumonia in all countries. Conclusion Despite similar resistance rates among Enterobacteriaceae there were differences in practice guidelines for pyelonephritis and sepsis. National surveillance of antibiotic resistance can be used for comparison and optimization of guidelines and stewardship interventions to preserve the low levels of antibiotic resistance in Nordic countries.

A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications

ABSTRACT Objectives: Antimicrobial use is growing, driven mainly by rising demands in developing countries. Knowing how antimicrobials are prescribed is important. Consequently, we undertook a point prevalence survey (PPS) quantifying antimicrobial consumption among 18 public sector hospitals across South Africa. Method: A purpose-built web-based application was used to collect PPS data. Results: Out of 4407 adult patients surveyed, 33.6% were treated with an antimicrobial. The most frequently prescribed groups were a combination of penicillins including β-lactamase inhibitors. Amoxicillin combined with an enzyme inhibitor accounted for 21.4% total DDDs. In the medical and surgical wards, Access antimicrobials (54.1%) were mostly used, while in the ICU, Watch antimicrobials (51.5%) were mostly used. Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%; however, concerns with extended use of antimicrobials for surgical prophylaxis (73.2% of patients). Conclusion: The web-based PPS tool was easy to use and successful in capturing PPS data since the results were comparable to other PPS studies across Africa. High use of amoxicillin combined with an enzyme inhibitor, possibly because it was among the broad-spectrum antimicrobials in the Access group. The findings will assist with future targets to improve antimicrobial prescribing among public sector hospitals in South Africa.

Microbial Contaminants in Fresh and Extended Turkey Semen and their Sensitivity to Antibiotics

Microorganisms that inhabit the avian cloaca usually contaminate poultry semen which could easily spread throughout an entire flock. This study was conducted to determine the presence of microbial contaminants in turkey semen and evaluate their antibiotic sensitivity. Semen was collected from each tom, pooled and then divided into two aliquots A and B. Aliquot A was immediately evaluated for microbial contaminants and antibiotic sensitivity while aliquot B, was extended and preserved for 24 hours at 40 C and thereafter microbial culture, identification and antibiotic sensitivity were conducted. Escherichia coli, Enterococcus faecalis, Bacillus subtilis, Corynebacteria species and a fungal organism Candida albican were isolated and identified in both aliquots. All the identified organisms were sensitive to pefloxacin, gentamicin and ciprofloxacin, while Enterococcus faecalis, Bacillus subtilis and Corynebacteria species were resistant to Ampicillin-cloxacillin, cefuroxime, amoxicillin and ceftriaxone. Escherichia coli was only resistant to co-trimoxazole, ofloxacin and nalidixic acid. The study concludes that, Escherichia coli, Enterococcus foecalis, Bacillus subtilis, Corynebacteria species and Candida albican were found to be turkey semen contaminants and were resistant to penicillin and streptomycin combination in turkey semen extender but sensitive to pefloxacin, gentamicin and ciprofloxacin.&#x0D; Key words: Microbial contaminants, turkey semen, extender, antibiotic sensitivity

Antibiotics and healthcare facility-associatedClostridioides difficileinfection: systematic review and meta-analysis 2020 update

Antibiotic use is the most important modifiable risk factor for healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). Previous systematic reviews cover studies published until 31 December 2012. To update the evidence for associations between antibiotic classes and HCFA-CDI to 31 December 2020. PubMed, Scopus, Web of Science Core Collection, WorldCat and Proquest Dissertations & Theses were searched for studies published since 1 January 2013. Eligible studies were those conducted among adult hospital inpatients, measured exposure to individual antibiotics or antibiotic classes, included a comparison group and measured the occurrence of HCFA-CDI as an outcome. The Newcastle-Ottawa Scale was used to appraise study quality. To assess the association between each antibiotic class and HCFA-CDI, a pooled random-effects meta-analysis was undertaken. Meta-regression and subgroup analysis was used to investigate study characteristics identified a priori as potential sources of heterogeneity. Carbapenems and third- and fourth-generation cephalosporin antibiotics remain the most strongly associated with HCFA-CDI, with cases more than twice as likely to have recent exposure to these antibiotics prior to developing HCFA-CDI. Modest associations were observed for fluoroquinolones, clindamycin and β-lactamase inhibitor combination penicillin antibiotics. Individual study effect sizes were variable and heterogeneity was observed for most antibiotic classes. This review provides the most up-to-date synthesis of evidence in relation to the risk of HCFA-CDI associated with exposure to specific antibiotic classes. Studies were predominantly conducted in North America or Europe and more studies outside of these settings are needed.