Consumption Of Antimicrobial Agents Research Articles

Metagenomic next-generation sequencing-guided antimicrobial treatment versus conventional antimicrobial treatment in early severe community-acquired pneumonia among immunocompromised patients (MATESHIP): A study protocol.

BackgroundSevere community-acquired pneumonia (SCAP) is the main cause of mortality in immunocompromised patients. Compared with conventional microbiological tests (CMT), metagenomic next-generation sequencing (mNGS) can quickly and simultaneously detect a wide array of bacteria, viruses, and fungi in an unbiased manner. It is increasingly used for severe respiratory infectious diseases, especially for immunocompromised patients. However, the effects of mNGS-based antimicrobial treatment procedures on clinical outcomes in immunocompromised patients with SCAP have not been evaluated.Methods/DesignThe MATESHIP study is a prospective, multicenter, parallel-group, open-label, randomized controlled trial from 20 ICUs in university hospitals and academic teaching hospitals across Shandong Province, China. We will enroll 342 immunocompromised patients with early onset SCAP who are admitted to an intensive care unit (ICU). Participants will be randomly allocated to an mNGS-guided treatment group or a conventional treatment group (guided by CMT), according to centrally computer-based block randomization stratified by participating centers. Participants will undergo CMT tests using appropriate lower respiratory tract (LRT) and other necessary specimens, with or without mNGS tests using LRT specimens. The primary outcomes will be: (1) The relative change in Sequential Organ Failure Assessment (SOFA) score from randomization to day 5, day 7, day 10, or the day of ICU discharge/death; and (2) the consumption of antimicrobial agents during ICU stay (expressed as defined daily doses). The secondary outcome measures will be: days from randomization to initiation of definitive antimicrobial treatment; overall antimicrobial agent use and cost; total cost of hospitalization; length of ICU stay; 28- and 90-day mortality; and clinical cure rate. This study hypothesizes that mNGS-guided treatment will decrease the degree of organ dysfunction/failure, the consumption of antimicrobial agents, and mortality, while the cure rate will be increased, and the time to initiation of appropriate therapy will be advanced.DiscussionThe MATESHIP study will evaluate for the first time whether mNGS-guided antimicrobial therapy improves the outcomes of SCAP in an immunocompromised population, and provide high-level evidence on the application of mNGS in the management of this population.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT05290454].

Prevalence of pathogenic bacteria in meat products and their antimicrobial resistance pattern

Background: There is increase in consumption of antimicrobial agents with misuse and/or overuse of antimicrobial agents in animals and resulting to rise in antimicrobial resistance. The controlled use of antimicrobials is important for national and international policymakers to draw guidelines on its use. Assessing AMR in meat-producing industry is essential to track emerging resistant pathogens that are common between animals and humans. In this study, we have aimed to investigate the prevalence of bacteria in meat products and the antimicrobial resistance pattern in those isolates. Methods: This study is a quantitative, observational study, where we collected meat samples (n=118) from shops, in Banepa and Dhulikhel Municipality. The samples were cultured in appropriate media for isolation of bacteria. Subsequently, AMR pattern was studied through antibiotic susceptibility test using Kirby Bauer Disc Diffusion method. Results: In our study, only two sites, out of 48, did not have any pathogenic bacteria. There were total of 113 iso-lates from 118 samples. E. coli (62.8%), Enterococcus (14.1%), Klebsiella pneumoniae (11.5%), were the most prevalent bacteria in processed samples including MRSA (4%). Additionally, 81.6% of the isolated E. coli were resistant to Ampicillin and 60.5% to Ciprofloxacin and 35% to Gentamycin. 43.6% of all isolated E. coli, 100% of all Klebsiella, 100% of all Enterobacter and 25% of all Citrobacter were multi-drug resistant. The resistance was mostly observed against Ampicillin (83.3%), followed by resistance against Ciprofloxacin (64.4%), Gentamycin (58.8%), Ceftazidime (38.8%), with the lowest resistance against Sulbactam/Cefoperazone (3.3%). Conclusion: E. coli was the most prevalent organism in meat samples. Multi-drug resistance was also most common in E. coli with resistance against Ampicillin, Ciprofloxacin and Gentamycin. Therefore, we recommend for more controlled use of antibiotics in animal rearing industry and more hygienic environment at meat vendors.

What antibiotics for what pathogens? The sensitivity spectrum of isolated strains in an intensive care unit

Antibiotic sensitivity spectrum of isolated strains differs according to hospital departments, the hospitals themselves, and countries. Discrepancies also exist in terms of antibiotic use and dosage. The aim of the present study is to compare the antibacterial agents, the types of infections, the number and type of pathogens, and the sensitivity to antibiotics used in the Intensive Care Unit (ICU) of the Emergency Clinical County Hospital of Oradea, Romania. Over a one-year period, data were gathered from the pharmacy computer system and medical records of inpatients. WHO Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology was used to assess drug administration data, and antibiotic use was expressed as DDD/1000 PD (patient days). The antibiotic susceptibility of isolated strains was expressed through the cumulative antibiogram. The overall consumption of antimicrobial agents was 1247.47 DDD/1000 PD. The most common drugs used were cephalosporins and fluoroquinolones (52.97% of the total). Ceftriaxone was the most commonly used, followed by levofloxacin. Infections of the respiratory and urinary tract were the most frequently diagnosed infections. The most commonly isolated bacteria type was Acinetobacter baumannii (22.12% overall), isolated especially from the respiratory tract and resistant to all the β–lactam antibiotics including carbapenems. Antimicrobials intake at the ICU is much higher compared to medical and surgical wards. After we tested the existence of a possible connection between antibiotic consumption and antibiotic resistance of bacteria, it was revealed that on our sample exists a poor positive association.

ANALYSIS OF CONSUMPTION OF ANTIBACTERIAL DRUGS FOR SYSTEMIC USE IN HOSPITALS OF SAINT PETERSBURG IN 2014–2015

Introduction. The overuse of antimicrobial agents, and poor adherence to infection control measures are leading factors in the development of bacterial resistance. Despite the existence of numerous guidelines for the management of patients with different sites of infections up to 50% of assignments of antimicrobial agents does not follow them.Aim. The aim of the study is to evaluate the structure and dynamics of the consumption of antimicrobial agents for systemic use in the multidisciplinary hospitals of St. Petersburg in 2014–2015.Materials and methods. From the database of IMS Health were selected information regarding the supply of antimicrobial agents for systemic use (ATC code J01) in hospitals of St.Petersburg in 2014–2015. The Number of purchased antimicrobial drugs (g) is translated into a number of Defined Daily Dose (DDDh) for each international non-proprietary name.Results. The level of consumption of AMP in 2014 was 83,3 DDDh/100 bed-days. In 2015, this figure amounted to 50,5 DDDh/100 bed-days. 70% of consumption of antimicrobial drug for systemic use in multidisciplinary hospitals amounted to 3 groups: fluoroquinolones, cephalosporins and semisynthetic penicillins. In 2015, in comparison with the previous year absolute value of fluoroquinolones decreased by 58% in favor of cephalosporins (+15%) while reducing the total number of DDDs used system antimicrobial agents (-40,5%), which is probably connected with the introduction into clinical practice of Russian clinical guidelines for the treatment of infections of various localizations and the perioperative antibiotic prophylaxis. There was growth in the number of purchased carbapenems and macrolides (+21 and +7% respectively) and significant decrease in the absolute number of purchased aminoglycosides (61%), with significant reduction in the consumption of expensive drugs: tigecycline, polymyxin, daptomycin, cefoperazone/sulbactam.Conclusion. The level and structure of consumption of antimicrobial agents corresponds to global data. The implementation of monitoring of antimicrobial therapy is an important factor influencing the volume and structure of consumption of antibacterial drugs.

Successful control of resistance in<em> Pseudomonas aeruginosa</em> using antibiotic stewardship and infection control programs at a Chinese university hospital: a 6-year prospective study

ObjectivePseudomonas aeruginosa is emerging as a highly multidrug-resistant (MDR) nosocomial pathogen. Data on the efficacy of infection control measures in endemic situations are lacking. We investigated the effect of antimicrobial stewardship (AMS) and infection control programs (ICPs) in controlling the resistance of P. aeruginosa at a tertiary hospital center.MethodsSusceptibility and resistance were investigated using broth microdilution, as per the guidelines of the Clinical and Laboratory Standards Institute. Antibiotic use was restricted through AMS, which included a classification management system for antibiotic use. The ICPs included environmental cleaning and disinfection, hand hygiene, active surveillance of P. aeruginosa, and education about infection control.ResultsA total of 2,241 P. aeruginosa isolates were evaluated between 2012 and 2017. Sensitivity and resistance of the isolates to the antipseudomonal antimicrobials colistin and tigecycline were stable. The sensitivity and resistance to other antipseudomonal antimicrobials improved after 2014, after the AMS and ICPs were implemented in 2013. The use of alcohol-based hand gel significantly increased from 0.6 to 10.9 L per 1,000 patient-days (PD) during the study period (P=0.005). The incidence rates of extensively drug-resistant (XDR) and MDR P. aeruginosa showed a sustained decrease from 2013 (4.9 and 22%) to 2017 (1 and 15%), respectively. The yearly consumption of antimicrobial agents also showed a sustained and significant decrease from 45 defined daily doses (DDDs) per 1,000 PD to 38.15 DDDs per 1,000 PD (P=0.04). A significant correlation was found between the incidence rate of MDR P. aeruginosa and the consumption of antimicrobial agents (P=0.01).ConclusionMonitoring of P. aeruginosa, AMS, and comprehensive ICPs could be one of the best and effective methods to prevent the development of resistance in P. aeruginosa.

Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit

BackgroundDue to the vulnerable nature of its patients, the wide use of invasive devices and broad-spectrum antimicrobials used, the intensive care unit (ICU) is often called the epicentre of infections. In the present study, we quantified the burden of hospital acquired pathology in a Romanian university hospital ICU, represented by antimicrobial agents consumption, costs and local resistance patterns, in order to identify multimodal interventional strategies.MethodsBetween 1st January 2012 and 31st December 2013, a prospective study was conducted in the largest ICU of Western Romania. The study group was divided into four sub-samples: patients who only received prophylactic antibiotherapy, those with community-acquired infections, patients who developed hospital acquired infections and patients with community acquired infections complicated by hospital-acquired infections. The statistical analysis was performed using the EpiInfo version 3.5.4 and SPSS version 20.ResultsA total of 1596 subjects were enrolled in the study and the recorded consumption of antimicrobial agents was 1172.40 DDD/ 1000 patient-days.The presence of hospital acquired infections doubled the length of stay (6.70 days for patients with community-acquired infections versus 16.06/14.08 days for those with hospital-acquired infections), the number of antimicrobial treatment days (5.47 in sub-sample II versus 11.18/12.13 in sub-samples III/IV) and they increased by 4 times compared to uninfected patients. The perioperative prophylactic antibiotic treatment had an average length duration of 2.78 while the empirical antimicrobial therapy was 3.96 days in sample II and 4.75/4.85 days for the patients with hospital-acquired infections. The incidence density of resistant strains was 8.27/1000 patient-days for methicilin resistant Staphylococcus aureus, 7.88 for extended spectrum β-lactamase producing Klebsiella pneumoniae and 4.68/1000 patient-days for multidrug resistant Acinetobacter baumannii.ConclusionsSome of the most important circumstances collectively contributing to increasing the consumption of antimicrobials and high incidence densities of multidrug-resistant bacteria in the studied ICU, are represented by prolonged chemoprophylaxis and empirical treatment and also by not applying the definitive antimicrobial therapy, especially in patients with favourable evolution under empirical antibiotic treatment. The present data should represent convincing evidence for policy changes in the antibiotic therapy.

Pharmacoepidemiological analysis of the use of antibacterial drugs in the pulmonary department of the multi-specialty hospital of the Republic of Tajikistan

The uncontrolled and excessive use of antibiotics in infectious diseases significantly reduces the effectiveness of the drug therapy, increases the risk of adverse reactions, increases the cost of treatment and, most importantly, promotes the growth and spread of antibiotic resistance. Monitoring of the consumption of this group of drugs for systemic use is one of the most important methods used in the system of measures to improve prescribing practices of this group. Aim . To analyze the consumption of antimicrobial agents in the pulmonary department of the multi-specialty hospital using the DDD-methodology. Materials and methods . The retrospective descriptive analysis of prescribing pharmacotherapy for patients being treated in the pulmonary department of the Sughd regional clinical hospital (Khujand, Tajikistan) was performed. Using the ATC/DDD-methodology the consumption of antimicrobial agents was studied. As a unit of measurement the grams of the active substance was used with the subsequent calculation of the indicator of DDD/100 bed-days and the percentage of the total DDD. Results and discussion . The DDD-analysis of the consumption of antimicrobial drugs on the example of the pulmonary department of the multi-specialty hospital showed a significant change in the structure of the drug consumption in this group for the starting antibiotic therapy of respiratory tract infections over the past five years. A clear downward tendency was identified in the consumption of drugs of penicillin and macrolides with the transition to monotherapy with cephalosporins of the 3-rd generation (ceftriaxone) and partially fluoroquinolones. Conclusions . Monitoring of the consumption of antimicrobials in in-patient departments using the ATC/DDD-methodology allows to make strategic decisions concerning the tactics of antibiotic treatment of diseases according to the department specialization, as well as to determine the direction of administrative measures for further improvement of the range of antibacterial drugs introducing modern effective products into practice and optimizing the consumption of antibiotics in each specific department.

High consumption of tetracyclines for acne treatment among young Danish adults

Background: Tetracyclines are used as acne treatment in adolescents worldwide. A large increase in the consumption of antimicrobial agents in Danish primary health care was recently linked to high levels of tetracycline use in adolescents.Methods: Here we closely examine how demographic factors influenced tetracycline use from 2005 to 2014 using consumption data from primary health care expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID) and number of persons treated per 1000 inhabitants.Results: From 2005 to 2013, tetracycline consumption increased by 54% followed by a decrease of 14% in 2014. Increases were especially pronounced in persons aged 15–39 years where nearly 9000 additional persons were treated with tetracyclines.Conclusions: This study shows a long-lasting high consumption of tetracyclines in young Danes with a notable recent decrease breaking the otherwise worrying trend. To obtain a further decrease, focus on public awareness and suitable acne treatment guidelines are highly important.

PHARMACOEPIDEMIOLOGY OF ANTIMICROBIAL AGENTS IN NEONATOLOGY: RESULTS OF THE RETROSPECTIVE CROSS-SECTIONAL STUDY

Background. Infectious diseases remain the leading causes of morbidity and mortality worldwide. Against the background of ever-increasing resistance of bacteria, it is necessary to develop effective measures aimed at the structure optimization of consumption of antimicrobial agents. Therefore, the pharmacoepidemiological data describing either the consumption of antimicrobial agents or the resistance level to them is required. Objective: Our aim was to assess the antimicrobial load in term and preterm newborns during their stay in the maternity wards and/or in the intensive care units (ICU). Methods. A retrospective cross-sectional study has been carried out. The analysis included data of 419 newborns from 5 medical centers. The study has been carried out as part of a multi-purpose program on antibiotic resistance containment being held in St. Petersburg from 2014. Results. The antimicrobial load on the child's body expressed in days of the antimicrobial therapy was 1,838 per 1,000 patient-days in children staying in the ICU for not more than 16 days, and 1,434 per 1,000 patient-days when staying in the ICU for more than 16 days. The average duration of the antimicrobial therapy is 28 days in the ICU and 5 days out the ICU (department for newborns, physiological departments). The most commonly, the children were treated with ampicillin — 384 (92%), gentamicin — 254 (61%), and fluconazole — 150 (36%). The prevalence of off-label prescriptions was 41% (of 1,557 analyzed prescriptions), unlicensed prescriptions — 10%. Congenital infections were the main reasons for prescription of antimicrobial drugs — 225 (62%). Conclusion. The high anti-bacterial load in newborns has been established. The indicator 'days of antimicrobial therapy' in the ICU is 4 times higher than that in the United States. The prevalence of off-label and unlicensed prescriptions is comparable with foreign data.

Register of Microorganisms as a Tool for Automated Antibiotics Consumption Planning and Monitoring of Antibiotic Resistance in Intensive Care Units and Specilized Hospital Departments

The purpose of the study is to assess the possibility of managing the antibiotic resistance level and consumption of antimicrobial agents in a hospital based on the analysis of the drug resistance index. Material and methods. The antibiotic consumption planning system was employed at the multidisciplinary surgical hospital based on the unified Registry of microorganisms (ROM). ROM included data on 25.581 strains obtained from patients with infections admitted to the intensive care units (ICU) and specialized departments. Protocols of empiric antimicrobial therapy and perioperative antibiotic prevention were developed. The ROMbased system allowed automated calculation of drug resistance indices for nosocomial microor ganisms. Data obtained during the preintervention period (2012) and intervention period, (2014—2015) were compared. Results. Decreases in the drug resistance indices for Pseudomonas aeruginosa from 0.721 in 2012 to 0.596 in 2015, Acinetobacter baumannii from 0.96 in 2012 to 0.889 in 2015, Klebsiella pneumoniae from 0.728 in 2012 to 0.595 in 2015 were achieved due to reduction of antimicrobial resistance, reduced consumption of III—IV generation cephalosporins and antipseudomonal carbapenems, and more frequent use of ertapenem for treatment of infections caused by Klebsiella pneumoniae. There was an increase in the drug resistance index of Escherichia coli from 0.325 in 2012 to 0.382 in 2015 due to increased consumption of protected penicillins and first generation cephalosporins for prevention in abdominal surgery and urology and increased pathogen resistance to these antibiotics. Conclusion. A development of a unified hospital ROM and application of the drug resistance index for math ematical modeling of the pathogens resistance level allows to perform timely monitoring of changes in antibiotic resistance of nosocomial microorganisms in ICU setting and other hospital departments and proper managinge the antibiotics prescription.

Risk Factors for Methicillin Resistant Staphylococcus aureus: A Multi-Laboratory Study

BackgroundThe present study aimed to investigate the dose response relationship between the prescriptions of antimicrobial agents and infection/colonization with methicillin resistant Staphylococcus aureus (MRSA) taking additional factors like stay in a health care facility into account.MethodsMulti-centre retrospective study on a cohort of patients that underwent microbiological diagnostics in Belgium during 2005. The bacteriological results retrieved from 17 voluntary participating clinical laboratories were coupled with the individual antimicrobial consumption patterns (July 2004-December 2005) and other variables as provided by pooled data of health insurance funds. Multivariate analysis was used to identify risk factors for MRSA colonization/infection.ResultsA total of 6844 patients of which 17.5% died in the year 2005, were included in a logistic regression model. More than 97% of MRSA was associated with infection (clinical samples), and only a minority with screening/colonization (1.59%). Factors (95% CI) significantly (p≤<0.01) associated with MRSA in the final multivariate model were: admission to a long term care settings (2.79–4.46); prescription of antibiotics via a hospital pharmacy (1.30–2.01); age 55+ years (3.32–5.63); age 15–54 years (1.23–2.16); and consumption of antimicrobial agent per DDD (defined daily dose) (1.25–1.40).ConclusionsThe data demonstrated a direct dose-response relationship between MRSA and consumption of antimicrobial agents at the individual patient level of 25–40% increased risk per every single day. In addition the study indicated an involvement of specific healthcare settings and age in MRSA status.

CP-040 Correlation between consumption of antimicrobials in the intensive care unit and resistance of Pseudomonas and Klebsiella in pulmonary infections

BackgroundEvidence exists that treatment with antimicrobial agents leads to the development of resistance to the same compound or cross-resistance to other compounds.PurposeTo detect correlations between the consumption of antimicrobial agents...

Associations between host characteristics and antimicrobial resistance ofSalmonellaTyphimurium

A collection of Salmonella Typhimurium isolates obtained from sporadic salmonellosis cases in humans from Lower Saxony, Germany between June 2008 and May 2010 was used to perform an exploratory risk-factor analysis on antimicrobial resistance (AMR) using comprehensive host information on sociodemographic attributes, medical history, food habits and animal contact. Multivariate resistance profiles of minimum inhibitory concentrations for 13 antimicrobial agents were analysed using a non-parametric approach with multifactorial models adjusted for phage types. Statistically significant associations were observed for consumption of antimicrobial agents, region type and three factors on egg-purchasing behaviour, indicating that besides antimicrobial use the proximity to other community members, health consciousness and other lifestyle-related attributes may play a role in the dissemination of resistances. Furthermore, a statistically significant increase in AMR from the first study year to the second year was observed.

Estudio de la actividad antibacteriana en un hospital terciario. Evolución durante el período 2000-2005

Knowledge of the antibiotic resistance in a specific healthcare area is essential for suitable application of the antibiotic policy, which can be understood as the use of recommendations for the application and consumption of antimicrobial agents, as well as for education and continual surveillance to achieve the most effective, rational and least expensive antibiotic therapy possible. We performed a study of antimicrobial susceptibility between 2000 and 2005 in the Health Area of the West of Valladolid (Spain) corresponding to the Rio Hortega University Hospital, with a catchment area of approximately 235,0000 inhabitants. The microorganisms tested were obtained from isolates of distinct samples from patients with infectious processes. The agents were considered causal. The most frequently isolated agents were described. The antibiotics tested were those that showed acceptable in vitro and in vivo activity against each isolated species. The criteria considered were clinical effectiveness, the prevalence of resistance, a low possibility of developing resistance, indications for clinical use and being the first treatment choice or alternative. The results were expressed in percentages of susceptibility or sensitivity to the antibiotics analyzed. The sensitivity criteria of the National Committee on Clinical Laboratory Standards (USA) were followed. The category of SENSITIVE to a given antibiotic implies that the infection caused by the isolated bacterium can suitably be treated with the routine dosage of this antibiotic. The RESISTANT category implies that isolated bacteria are not inhibited with the routine dosage of this antibiotic. The antibiotic types studied followed general lines and the following agents were taken as representative of their class: Ampicillin (ampicillin and amoxicillin derivatives), Amoxicillin/clavulanic acid(ampicillin/sulbactam), Cefalotin (cefazolin, cefaclor, cephradine, cefalexin, etc), Cefoxitin (cefmetazole), Cefotaxime (ceftriaxone, imipenem, meropenem), Gentamicin (netilmicin, tobramycin), Ciprofloxacin (ofloxacin), Ofloxacin (levofloxacin). In Enterococci: Gentamicin synergy (gentamicin, tobramycin, netilmicin and amikacin). Streptomycin synergy (streptomycin). The results obtained in the study were grouped in different antibiotic activities: 1. Antibiotic activity against Gram-positive bacteria: a. Antibiotic activity against to Staphylococcus aureus. b. Antibiotic activity against S epidermidis. c. Antibiotic activity against Enterococcus faecalis d. Antibiotic activity against E. faecium. e. Antibiotic activity against Streptococcus agalactiae. 2. Antibiotic activity against Gram-negative bacteria. a. Antibiotic activity against Enterobacteriaceae. Antibiotic activity against Escherichia coli. Antibiotic activity against Klebsiella pneumoniae and K. oxytoca. Antibiotic activity against Enterobacter cloacae. Antibiotic activity against Serratia marcescens. Antibiotic activity against Proteus mirabilis. Antibiotic activity against Morganella morganii. 3. Antibiotic activity against Non- fermenting Gram- negative bacilli (NFGNB). Antibiotic activity against Pseudomonas aeruginosa. Antibiotic activity against Acinetobacter baumannii. Antibiotic activity against Stenotrophomonas maltophilia. 4. Antibiotic activity against miscellaneous microorganisms. a. Antibiotic activity against Branhamella catarrhalis. b. Antibiotic activity against Haemophilus influenzae. Therefore, although many antibiotic-resistant bacteria exist, there are some strains that frequently cause infections and cannot be treated with common antibiotics. Consequently routinely-used therapeutic regimens should be changed. These bacteria are usually particularly virulent and cause serious infections.

Experiences with the Dutch Working Party on Antibiotic Policy (SWAB)

The Dutch Working Party on Antibiotic Policy (Stichting Werkgroep AntibioticaBeleid, SWAB) was founded in 1996 as an initiative of the Society for Infectious Diseases, the Dutch Society for Medical Microbiology, and the Dutch Association of Hospital Pharmacists. Its primary goal is to contribute to the containment of antimicrobial resistance and the expanding costs incurred for the use of antibiotics. SWAB is the Intersectoral Coordinating Mechanism (ICM) for the Netherlands, and it is at present the National Antimicrobial Resistance (AMR) Focal Point. It coordinates the national surveillance of antibiotic resistance, in collaboration with the National Institute for Public Health and the Environment(RIVM), coordinates the surveillance of the use of antibiotics,and runs a guideline development programme. Information about consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria is presented annually in NethMap. Over the past decade, outpatient consumption of antibiotics has risen only slightly, but in the hospital setting there was an overall significant increase in antibiotic use, due mainly to the steady reduction in the average length of patient hospital stays. In 2006 we introduced our electronic national antibiotic guide 'SWAB-ID' for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals.

Veterinary Drug Usage and Antimicrobial Resistance in Bacteria of Animal Origin

In the production of food animals, large amounts of antimicrobial agents are used for therapy and prophylaxis of bacterial infections and in feed to promote growth. There are large variations in the amounts of antimicrobial agents used to produce the same amount of meat among the different European countries, which leaves room for considerable reductions in some countries. The emergence of resistant bacteria and resistance genes due to the use of antimicrobial agents are well documented. In Denmark it has been possible to reduce the usage of antimicrobial agents for food animals significantly and in general decreases in resistance have followed. Guidelines for prudent use of antimicrobial agents may help to slow down the selection for resistance and should be based on knowledge regarding the normal susceptibility patterns of the causative agents and take into account the potential problems for human health. Current knowledge regarding the occurrence of antimicrobial resistance in food animals, the quantitative impact of the use of different antimicrobial agents on selection of resistance and the most appropriate treatment regimes to limit the development of resistance is incomplete. Programmes monitoring the occurrence and development of resistance and consumption of antimicrobial agents are strongly desirable, as is research into the most appropriate ways to use antimicrobial agents in veterinary medicine.

Regulation of the erm(C) Gene in Staphylococci from Reservoir with Different Usage of Macrolides

Regulation of the erm(C) Gene in Staphylococci from Reservoir with Different Usage of Macrolides

Spanish primary healthcare physicians' knowledge of resistance of respiratory germs and antimicrobial treatment in acute bronchitis

Objectives: To determine what Spanish primary healthcare physicians consider the rates of pneumococcal resistance to be, the type of antimicrobial treatment they would prescribe on suspicion of high resistance and ascertain in which cases of acute bronchitis these physicians would initiate antibiotic treatment.Methods: A cross-sectional, observational study was performed with a questionnaire distributed to 1368 physicians on their opinion on the degree of resistance of pneumococci to penicillins and macrolides in Spain. They were also asked which treatment they would recommend in penicillin-resistant pneumococcal infection and to indicate their degree of agreement regarding the use of antibiotics in different clinical situations of acute bronchitis.Results: 843 physicians completed and returned the questionnaire, a response rate of 59.1%. Of the 750 physicians who answered the question concerning pneumococcal resistance, 312 stated resistance to be>30% (41.6%) while only 90 felt it to be<15% (12%). 153 physicians reported resistance to macrolides to be>30% (23%). In cases with suspicion of penicillin-resistant pneumococci, the clinicians stated they would prescribe quinolones (321, 40.3%) and macrolides (251, 31.5%). Of the 784 physicians who answered the questions on bronchitis, 662 preferred antibiotic therapy in acute bronchitis with purulent sputum (84.6%), 610 on uncertain diagnosis (77.8%), 569 in patients with fever over 38 °C (72.6%) and 210 on patient request (26.8%).Conclusion: Primary healthcare physicians in Spain are more concerned about pneumococcal resistance to penicillins than to macrolides although 35% of the strains isolated are resistant to the latter while only 10% are resistant to aminopenicillins. Furthermore, many physicians believe macrolides to be effective against pneumococcal infections. Despite their lack of efficacy in the treatment of acute bronchitis, many physicians prescribe antibiotics, mainly in cases with purulent expectoration, thus justifying the high consumption of antimicrobial agents in this disease.

The prevalence of faecal carriage of ampicillin-resistant and high-level gentamicin-resistant enterococci among inpatients at 10 major Norwegian hospitals

From March to October 1999, 854 patients hospitalized at 10 major Norwegian hospitals were screened for rectal carriage of ampicillin-resistant enterococci (ARE) and high-level gentamicin-resistant enterococci (HLGRE). A total of 59 ARE carriers (prevalence 6.9%, range 0–22% among hospitals) and 28 HLGRE carriers (prevalence 3.3%, range 1–11%) were detected. All ARE or HLGRE strains were susceptible to vancomycin, whereas 77% of the ARE isolates were resistant to ciprofloxacin. All the ARE strains were identified as Enterococcus faecium, and 48% of these were genomically closely related as shown by PFGE. Specific point mutations in the pbp5 gene were associated with reduced susceptibility to ampicillin. The adjusted risk of becoming a carrier of ARE was related to the use of glycopeptides [odds ratio (OR) = 4.8], the use of any antimicrobial agent (OR = 3.1) and more than one hospital admission during the last six months (OR = 2.0). Twenty-five of 28 HLGRE isolates were Enterococcus faecalis. The aacA/aphD genes were detected in 26 (93%) and the aphA3 in 19 (68%) of the HLGRE isolates. Sixty-four percent of the HLGRE isolates belonged to two PFGE clusters. Consumption of antimicrobial agents was also a significant risk factor for HLGRE colonization (OR = 5.4), while prescription of penicillins was associated with reduced risk (OR = 0.28).

Antibiotic Use and Development of Resistance in Blood Culture Isolates: 8 Years of Experience from a Cancer Referral Center

The consumption of antimicrobial agents in a Slovakian national cancer institute from 1989-1996 was compared with resistance rates in clinically significant blood culture isolates. We observed an increase in resistance of viri-dans streptococci to penicillin and of enterococci to ampicillin. Resistance to vancomycin and teicoplanin was stable over the entire period despite a 20-fold increase in vancomycin consumption. Nor did we observe increased resistance to ofloxacin despite a 10-fold increase in consumption. Consumption of aminoglycosides and resistance levels were both stable. A different situation was observed with third-generation cephalosporins, where resistance of Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter spp. to ceftazidime and cefotaxime increased with increasing consumption. Resistance of Enterobacteriaceae to cefotaxime and ceftazidime was stable. Resistance to imipenem did not change significantly. However, the number of Stenotrophomonas maltophilia bacteremias increased significantly after imipenem was introduced in 1991. Because ofimproved outcome in bac-teremia, an increased incidence of both Gram-negative and Gram-positive bac-teremia led to only a slight increase in associated mortality.