Correct Use Of Antibiotics Research Articles

Antimicrobial stewardship: from theory to reality in a resource-limited setting (and beyond)

Correct use of antibiotics is paramount to present global health. Among other actions, antimicrobial stewardship emphasizes de-escalation and suspension whenever possible. Nonetheless, roadblocks can be encountered (e.g., lack of culture results or availability of specific antibiotic classes). Furthermore, in an ever-increasing interconnected world, global success relies on local success. In this perspective, a particular case study in a resource-limited setting is an example of the many difficulties encountered in the fight against antimicrobial resistance that could hamper global advancements.

The origins of the antimicrobial resistance crisis and emerging solutions

Antimicrobial-resistant infections, already responsible for millions of deaths every year, are increasing worldwide. To tackle this crisis, a growing number of institutions, both public and private, have come together to implement policies that aim to curb the spread of antimicrobial-resistant disease. The resulting policy network has culminated in several tangible effects, including increased education on correct antibiotic use, improved support structures for the development of AMR therapeutics, global public health efforts to specifically help low- and middle-income countries gain access to better diagnostic and care facilities, and the growth of promising new treatments for antimicrobial-resistant disease. The following review provides background on AMR and outlines the progress in developing policies and technologies to combat rising cases of antimicrobial-resistant infections.

Analysis of health knowledge awareness and influencing factors of permanent residents in Songshan Lake Science and Technology Industrial Park, Dongguan City

Objective: To understand the health knowledge awareness and influencing factors of permanent residents in Songshan Lake Science and Technology Industrial Park, Dongguan City, and to provide a data basis for the development of health education and public health services in the region. Methods: A multi-stage stratified sampling method was used to select 1,000 permanent residents from 13 residential areas in the region as survey subjects. Basic demographic information and health knowledge awareness were obtained through questionnaires, and statistical analysis was conducted on the data. Results: The health knowledge awareness rate of permanent residents in the region is relatively low, with the highest rate being the dangers of smoking in pregnant women, with the correct answer rate reaching 87.1%. Correct use of antibiotics, transmission routes of AIDS, salt intake standards and hypertension diagnostic standards have correct answer rates between 40% and 55%. The three knowledge points of risk factors for hypertension, diabetes and cerebrovascular disease had the lowest correct answers. Respondents with higher education levels know more health knowledge. Conclusion:The awareness rate of health knowledge is very low, which is not suitable for the current economic development and population quality. Health education and publicity should be strengthened for groups with low awareness and knowledge content.

Patients' Opinions on Antibiotics in the Treatment of Dental Infections: A Cross-Sectional Survey.

Background: The aim of this study was to evaluate patients' knowledge and perceptions of the use of systemic antibiotics in the treatment of endodontic infections and to determine the possible contribution of patients to the development of bacterial resistance. Methods: A total of 550 patients were asked to respond to a survey on the perception of systemic antibiotic use in the treatment of endodontic infections and antibiotic resistance during January 2022 and March 2023. A bivariate and multivariate analysis was performed to determine possible correlates in the population regarding antibiotic use in the endodontic world. Results: A total of 514 patients were included in the study, 65.9% of whom were women. While 34.6% of the population studied thought that it was always necessary to take antibiotics prior to endodontics, 49.4% considered that they were necessary after endodontics, regardless of the clinical symptoms. The prevalence of self-medication was 17.3%, and women self-medicate more than men, with significant differences (p < 0.05), although they have a greater knowledge of antibiotic resistance than men (p < 0.05). Forty-four percent of the population expected to take antibiotics when faced with dental pain, mainly women (p < 0.05). Conclusions: The general population is contributing to the serious problem of bacterial resistance. It is necessary to promote educational strategies focused on the correct use of antibiotics in the community. The worst results were found mainly in the population with a low level of education. The level of education was the variable that most influenced the knowledge and attitudes of the population, followed by the sex of the participants.

Changes in Antibiotic Redemption Related to Hungarian Dental Care During COVID-19

Introduction and aimsAntibiotic resistance is a global health problem that can affect individuals, health systems, and the economy. Our aim was to investigate how the redemption of antibiotics and the associated dental care changed during COVID-19 in Hungary. MethodsThe ICD codes for the infections for which antibiotics should be prescribed in dental care were identified based on the professional recommendation. The database was provided by the National Health Insurance Fund Manager of Hungary. Pearson's chi-squared test with Bonferroni correction was used to compare both the redemption of antibiotics and the associated dental care based on the recommendations in the year 2020 of the COVID-19 and the 2 preceding years. ResultsThere were fewer antibiotic redemptions and associated dental care in 2020 than in 2018 and 2019. The ratio of professionally relevant and nonrelevant antibiotics redeemed did not change significantly between 2018 and 2019, but the proportion of antibiotics redeemed following recommendations increased significantly during the COVID-19 year of 2020 compared to the previous 2 years. The proportion of all dental care involving antibiotic redemptions increased significantly from 2018 to 2019, and then showed a further increase in 2020. The sex and age of the patient did not affect these findings, while the type of dental care did alter the trends in some cases. ConclusionsAntibiotics in dentistry are required only for very low proportion of cases, due to the nature of dental care where most infections such as caries and periodontal disease could be managed without resorting to antibiotics. Antibiotic redemptions during COVID-19 pandemic period increased compared to the pre-pandemic period in Hungary. Therefore, Hungarian policy makers need to develop control systems to promote the correct use of antibiotics in dental care. Clinical relevanceIt is important to reduce unjustified use of antibiotics so as to curb the emergence of antibiotic resistance organisms.

Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study.

The effectiveness of procalcitonin-based algorithms in guiding antibiotic usage for febrile acute necrotizing pancreatitis (ANP) remains controversial. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infectious diseases. The authors aimed to evaluate the effectiveness of blood mNGS in guiding antibiotic stewardship for febrile ANP. The prospective multicenter clinical trial was conducted at seven hospitals in China. Blood samples were collected during fever (T ≥38.5°C) from ANP patients. The effectiveness of blood mNGS, procalcitonin, and blood culture in diagnosing pancreatic infection was evaluated and compared. Additionally, the real-world utilization of antibiotics and the potential mNGS-guided antimicrobial strategy in febrile ANP were also analyzed. From May 2023 to October 2023, a total of 78 patients with febrile ANP were enrolled and 30 patients (38.5%) were confirmed infected pancreatic necrosis (IPN). Compared with procalcitonin and blood culture, mNGS showed a significantly higher sensitivity rate (86.7% vs. 56.7% vs. 26.7%, P <0.001). Moreover, mNGS outperformed procalcitonin (89.5 vs. 61.4%, P <0.01) and blood culture (89.5 vs. 69.0%, P <0.01) in terms of negative predictive value. Blood mNGS exhibited the highest accuracy (85.7%) in diagnosing IPN and sterile pancreatic necrosis, significantly superior to both procalcitonin (65.7%) and blood culture (61.4%). In the multivariate analysis, positive blood mNGS (OR=60.2, P <0.001) and lower fibrinogen level (OR=2.0, P <0.05) were identified as independent predictors associated with IPN, whereas procalcitonin was not associated with IPN, but with increased mortality (Odds ratio=11.7, P =0.006). Overall, the rate of correct use of antibiotics in the cohort was only 18.6% (13/70) and would be improved to 81.4% (57/70) if adjusted according to the mNGS results. Blood mNGS represents important progress in the early diagnosis of IPN, with particular importance in guiding antibiotic usage for patients with febrile ANP.

Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia.

Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.

Edukasi Penggunaan Antibiotik Dan Peduli Resistensi Antibiotik Pada Masyarakat Kota Padang

Antibiotics are drugs used to prevent and treat infections caused by bacteria. People mistakenly assume that antibiotics cure all diseases and are not careful in consuming or providing complete antibiotic therapy. Inappropriate use of antibiotics can increase medical costs because resistance makes the drugs more toxic. This Community Service activity aims to provide knowledge about the proper and correct use of antibiotics, providing knowledge about antibiotic resistance. This service activity is carried out by providing education and also providing leaflets about the use of antibiotics and antibiotic resistance. This activity was carried out by GOR H. Agus Salim, Padang City. The results of the activity where the number of participants was 80 people, there were still some who did not understand how to use drugs and antibiotic resistance. The activity was carried out by 6 lecturers assisted by 6 students from the Pharmacy Study Program at Dharma Andalas University. From this service activity, it is hoped that the people of Padang City will receive education about the use of antibiotics and be aware of the dangers of antibiotic resistance.

YOUTUBE™ QUALITY AS A RESOURCE ON RATIONAL USE OF ANTIBIOTICS IN THE COMMUNITY: A REMEDIAL APPROACH TO ANTIMICROBIAL MANAGEMENT

Objective: Infections for which antibiotics were influential in the past, cannot be adequately treated today and the evolution of microorganisms with multiple antibiotic resistance is due to the irrational use of antibiotics. The study aims to help develop effective drug information systems for rational antibiotic use and enable patients to make informed treatment decisions. Material and Methods: A search of YouTube™ was performed using the three keywords ‘correct antibiotic use’, ‘wrong antibiotic use’, and ‘antibiotic resistance’. Video lengths, dates of upload, numbers of total views, likes, dislikes, and comments were collected. The study viewed and analyzed the top 90 directly relevant videos for each of our search terms. Two pharmacologists independently evaluated the videos. For each video viewed, the following information was analyzed: the video's title, the date it was uploaded, the source and location of the video, the number of views the video has received overall, its duration, the number of likes and dislikes, and the number of comments. Results: 90 of the top 422 videos from the YouTube™ search results after evaluation were added to the study for additional examination. The mean DISCERN and JAMA scores were 46.42±10.91 and 2.29±0.58, respectively. There was a high correlation between the videos evaluated according to DISCERN and JAMA scales. Conclusion: YouTube™ videos can be used as a valuable source for rational antibiotic use. This inclusion of antimicrobial resistance topics in social media could be a cornerstone in the worldwide fight against antimicrobial resistance if tested extensively in field conditions and used in the public interest on a larger scale.

Rising Antimicrobial Resistance In Pakistan: A Call For An Urgent Action.

Madam, Antibiotic resistance is a growing global concern. Pakistan is a developing nation in South Asia with a high rate of antibiotic resistance, posing a serious concern on a global and regional scale1 In Pakistan in recent years, both extensively drug-resistant (XDR) and multi-drug-resistant. (MDR) microorganisms have been found2.From January 2017 to June 2021, a total of 14,360. XDR-TF cases were reported in Karachi, according to the National Institute of Health (NIH) Islamabad's Weekly Field Epidemiological Report2.Only three antimicrobials: azithromycin, carbapenems, and tigecycline(parenteral) are effective against the XDR strains3. However, after Covid-19, the misuse of Azithromycin has increased manifold, which is worrisome. Pakistani public’s lack of awareness about the harms of antibiotic self-prescription and the widespread presence of quacks in the society has posed a great threat to rational use of antimicrobials4. According to a cross-sectional survey of pharmacy staff’s opinion ,approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs5. The chicken industry of Pakistan is excessively using important antimicrobials in their bird feed6. According to a surveillance survey done in 2019 in Pakistan; among the antimicrobials used for therapeutic or prophylactic purposes in animals; colistin, tylosin, enrofloxacin, and doxycycline were the most frequently used6.This calls for an urgent action in Pakistan to prevent a public health crisis. It is a dire need of the hour to implement the National Drug Policy (NDP) of Pakistan. There should be a national action plan on how to curb this menace of the misuse of therapeutically important antimicrobials in Pakistan. Special units should be devised by Drug regulatory Authority of Pakistan (DRAP) and The Ministry of Health (MoH) to rein back those chemist stores involved in selling of prescription only antimicrobials without the advice of a medical doctor. These teams should catch quacks working in all provinces of Pakistan. Quackery should be made illegal. The sale of large flocks of antimicrobials to animal keepers and broiler industry people should be immediately stopped and the involved people should be fined and their licenses cancelled. Talks and sessions should be held in schools, colleges and public places about the correct use of antibiotics. A medical doctor’s stamp with a registration number should be mentioned on each prescription of an antimicrobial. ---Continue

Evaluation of antibiotic resistance in bacterial strains isolated from sewage of slaughterhouses

Abstract Background The frequent and incorrect use of antibiotics in animal husbandry has led to the spread of antimicrobial resistance. The issue should be addressed in a One Health vision, since human and animal health, as well as the environment are interconnected. Wastewater from slaughterhouses can be contaminated with multidrug-resistant bacteria, representing a possible cross-contamination route. This study evaluated the presence of antibiotic-resistant bacteria in wastewater from slaughterhouses to highlight their role in the spread of antibiotic resistance. Methods In total, 18 out 35 slaughterhouses in Sicily (Italy) were considered. For each wastewater system the samples were collected before any treatment, and cultured within 24 h of sampling. The isolates were identified by API20NE, API20E profiles (bioMerieux, France). Using the Kirby Bauer test, the isolated strains were classified as resistant (R), intermediately resistant (I), or sensitive (S) to the tested antibiotics. Results Proteus mirabilis (85.7%) and Peudomonas aeruginosa (27.3%) were the most frequently isolated microorganisms, followed by Enterobacter cloacae, Aeromonas hydrophila, and Citrobacter freundii. The most resistant strains belonged to Enterobacter spp., which showed the highest resistance rate for macrolides, penicillins and cephalosporins. Aeromonas spp. was resistant to carbapenems while E. coli showed the highest resistance to colistine. Finally, Citrobacter spp. was completely resistant to macrolides, rifampicin, and tetracycline. Conclusions High resistance levels were detected for some antibiotics widely used in human medicine such as macrolides, penicillins, and cephalosporins. Resistance to carbapenems and colistine, which are now considered key drugs in human medicine for the treatment of severe multidrug-resistant infections, was also reported. Thus, continuous monitoring on the correct use of antibiotics in animal husbandry is necessary. Key messages • Wastewater from slaughterhouses may be a vehicle of antibiotic-resistant bacteria. • The One Health approach should be used for the management of health security, food safety and antimicrobial resistance.

Understanding Public Knowledge and Behavior Regarding Antibiotic Use in Indonesia.

Inappropriate use of antibiotics is a prominent factor contributing to the development of antibiotic resistance, which subsequently increases healthcare costs and heightens mortality rates. This study sought to evaluate the level of knowledge and behavior pertaining to antibiotic usage within the Indonesian population. This observational study was conducted in Indonesia between December 2019 and June 2020 and employed a validated questionnaire to survey 582 respondents. A comparative analysis was performed to investigate the differences in mean scores across various respondent characteristics, specifically related to their knowledge and practice regarding antibiotic usage. Regression analysis was used to identify the factors influencing the adoption of appropriate behavior in antibiotic utilization. Study participants comprised 68.2% males and 31.8% females. Participants achieved an average score of 4.86 ± 2.40 out of eight points for knowledge and behavior with an average score of 5.29 ± 1.85 out of seven points. Approximately 57.7% and 56.0% of the respondents have knowledge and behavior scores above the average score of the total population, respectively. The findings indicated notable variations in average knowledge scores associated with educational attainment and employment status regarding antibiotic use. Similarly, differences were observed in gender and employment status concerning behavior. Regression analysis highlighted that employment status, trust in physicians, and possessing sound knowledge of antibiotic usage were significant predictors of good behavior in utilizing antibiotics. Some misconceptions were identified, such as using antibiotics to kill viruses and believing antibiotics are effective for any kind of disease. Less than 60% of the respondents have knowledge and behavior scores above the average score of the total population; however, there are some misconceptions regarding antibiotic utilization. This underscores the importance of implementing targeted strategies, such as health education and public health campaigns, to improve the population's understanding of the correct antibiotic use.

Assessment of Prescription Patterns and Appropriateness of Antibiotics for Prophylaxis in Dental Procedures: A Retrospective Study

There is a lack of data on dentists’ prescribing behaviors when it comes to the correct use of antibiotics in dental treatments. Antibiotic prescriptions made by dentists were analyzed from a diagnostic perspective in a countrywide study. This study retrospectively examined national health data from January 2018 through August 2019, collected through the Prescription Information System. The analysis only included prescriptions for a single illness and at least one systemic antibiotic. Antibiotic prescribing practices and the role of dental specialization and diagnosis were studied. A total of 9,214,956 prescriptions out of 9,293,410 matched the criteria for inclusion. An average course of antibiotic treatment consists of 1.01 pills. Antibiotics were prescribed most frequently for dental caries (16.2% of cases), dental examinations (20.7% of cases), and periapical abscess without sinuses (28.1% of cases). Antibiotics were prescribed for 96.6% of patients for illogical or confusing reasons, whereas just 3.4% were given based on a single, unambiguous diagnosis, such as cellulitis or a mouth abscess. The most commonly prescribed treatment for any medical issue was amoxicillin combined with an enzyme inhibitor (58.6%). Compared to unidentified dental practitioners (58.2%; p = 0.0001), dental specialists in Groups A and B significantly overprescribed amoxicillin plus an enzyme inhibitor (67.0 and 67.8%, respectively; p = 0.0001) (data not shown). The results of the study suggest that dentists routinely and arbitrarily prescribe antibiotics with questionable rationale in the contexts studied. These results emphasize the need for dentists to begin prescribing antibiotics more deliberately and evidence-based. Educational programs, awareness campaigns, and antibiotic stewardship programmes are just some of the interventions that may be implemented to improve prescribing practices and ensure the correct use of antibiotics in dental operations. The results of this countrywide study highlight problems with dentists’ procedures for prescribing dental antibiotics. The paper states that dentists should base their prescription practices on sound reasoning and empirical data. Dentists can help with global efforts to lower antibiotic resistance and improve patient care if they prescribe them in a more reasonable and responsible manner.

ANALYSIS OF HOSPITAL ANTIBIOTIC PRESCRIPTIONS AFTER THE IMPLEMENTATION OF STEWARDSHIP: A RETROSPECTIVE OBSERVATIONAL STUDY IN TWO HOSPITALS IN NORTH-EASTERN SICILY

Introduction: Antimicrobial resistance is a global problem caused by the inappropriate use of antibiotics. To combat this phenomenon, multidisciplinary antimicrobial stewardship programmes have been initiated, the primary objectives of which include improving both the level of appropriateness of prescription and clinicians’ awareness of the correct use of antibiotics. Objective/Purpose: The objective of the work was to conduct an analysis of antibiotic consumption at hospital level to assess the appropriateness of antibiotic prescription in a number of Operational Units. Method: From 01/01/2021 to 31/12/2022, data were extracted from the Pharmacy Operational Unit’s management software on the dispensing of antibiotics (injectable and oral use), the Defined Daily Doses, and the number of dosage units dispensed to the General Medicine, Intensive Care, General Surgery and Neurorehabilitation Operational Units of two hospitals. Results: Total antibiotic consumption was 7,845 dosage units in 2021 and 10,182 in 2022. The comparison of the defined daily dose values (4,565,485 in 2021 and 5,079,671 in 2022) is indicative of the use of antibiotics with different dosages, with a percentage increase of 11.3%. A comparison was also made between the Defined Daily Doses/100 bed-days delivered in 2021 and the regional and national figures, yielding a significantly lower figure than these latter figures. Conclusions: The loss of antibiotic efficacy threatens to throw healthcare systems into crisis, leading to in an increase in morbidity and mortality from infections. The implementation of antimicrobial stewardship programmes remains, at present, the best tool to harness in order to curb the phenomenon of antimicrobial resistance. There is therefore a need for increasingly specialised professionals in the field of infectious diseases. Nurses and pharmacists play a crucial role in antimicrobial stewardship programmes, as they collaborate not only in the implementation of antimicrobial guidelines, but also in the review of individual patient regimens in order to optimise treatment and in the training of healthcare personnel on the appropriate use of antimicrobials.

Clinical and microbiology profile of typhoidal and nontyphoidal Salmonella blood stream infection: An observational study from a university hospital

Objectives: Species distribution and antibiotic resistance pattern of Salmonella varies with time and place. Rapid and correct use of antibiotics requires understanding of the distribution and drug resistance patterns. Therefore, we aimed to study the clinical profile of patients along with speciation and antibiogram of Salmonella isolates from blood. Materials and Methods: It is an observational study, conducted from December 2019 to December 2021 at our university hospital. Blood cultures were processed by automated blood culture system. Salmonella isolates were identified by their morphological properties, biochemical reaction, and serological tests. Antibiotic susceptibility pattern was assessed by Kirby–Bauer’s disc diffusion method and Phoenix automated system. Results: The male-to-female ratio of the patients in the study was 2.5:1 and the mean age of the patients was 11.7 years (1–27 years). Salmonella spp. was isolated from 21 patients out of 1,350 positive blood cultures. Nine isolates were identified as S. Typhi seven as S. Choleraesuis three as S. Paratyphi A and two as S. Paratyphi B. Immuno-compromised conditions were significantly associated in nontyphoidal Salmonella bacteremia (p = 0.0253). Isolates showed maximum resistance toward nalidixic acid (100%) followed by fluoroquinolones (52.4%). Multidrug resistance, extreme drug resistance, and azithromycin resistance was seen in 14.3, 4.8, and 4.8% isolates, respectively. Posttreatment recovery was observed in 20 patients. Conclusions: Emergence of S. Choleraesuis among Salmonella spp. in blood stream infection, next only to S. Typhi was noted. Rising drug resistance is a matter of concern.

Knowledge, Attitudes, and Practices (KAP) About Antibiotic Use in Hemodialysis Patients with Chronic Kidney Disease and Their Household Contacts, Medellín-Colombia.

The lack of knowledge and the excessive and inappropriate use of antibiotics are some of the causes of bacterial resistance. Hemodialysis patients have a high consumption of antibiotics and are constantly cared by their household contacts. This population circulates between hospital and community and are a model to study knowledge regarding bacterial resistance and antibiotic use in these settings. This study describes the knowledge, attitudes and practices (KAP) about antibiotic use and bacterial resistance in hemodialysis patients and their household contacts in Medellín-Colombia. A cross-sectional descriptive study was conducted on hemodialysis patients from a renal unit associated with a hospital in Medellín-Colombia, and their household contacts between May 2019 and March 2020. A KAP instrument was applied to participants during home visits. The KAP regarding antibiotic use were characterized, and a content analysis of open questions was made. A total of 35 hemodialysis patients and 95 of their household contacts were included. Of participants, 83.1% (108/130) did not correctly identify the situations in which antibiotics should be used. Likewise, a gap in knowledge about antibacterial resistance was evidenced thanks to the emerging categories in content analysis. Regarding attitudes, 36.9% (48/130) of the participants discontinued antibiotic treatment when they felt better. Additionally, 43.8% (57/130) agree to keep antibiotics in their home. Finally, it was found that it is usual for pharmacists and family members to recommend or sell antibiotics without prescription; likewise, pharmacies were the most popular place to acquire these medications. This study identified gaps in KAP regarding the use of antibiotics and bacterial resistance in hemodialysis patients and their household contacts. This allows focusing education strategies in this regard, in order to increase awareness about the correct use of antibiotics and the consequences of bacterial resistance and to improve prevention actions in this vulnerable population.

In Vitro Antibacterial Activity of Ginger Extract (Zingiberofficinale) on Bacteria Isolated from Diabetic Patient with Urinary Tract Infections in Shendi Locality, Sudan

Background: Urinary tract infections frequently occur in diabetic patients due to an impaired immune status and increased glucose content in the urine among other reasons. This makes UTIs very important to investigate. Complicated cases of UTI may be frequent but are more common in diabetics with more severe consequences. And so warrant further investigations. The proper management of UTI in diabetics is crucial as prompt diagnosis and correct use of antibiotics are vital for treatment. Finding alternative antimicrobial agents from plant extracts has received growing interest. Ginger (Zingiberofficinale) is a safe, non-toxic, cheap spice that has been reported to have antimicrobial effects against various pathogenic bacteria. Objectives: This study aimed to evaluate the effectiveness of ginger extract on different types of bacteria isolated from diabetic patients suffering from urinary tract infections. Methodology: A cross- sectional and hospital-based study has been conducted at the University of Shendi –faculty of medical laboratory sciences- department of microbiology from May to November 2018. Following informed consent, 100 diabetic patients suffering from UTI of different ages were enrolled in this study. Sixty-two bacteria were isolated, different Gram- positive and Gram-negative bacteria, in vitro sensitivity testing using a well diffusion technique against ginger extract. Results: The main causative agent of UTI in the study population was E. coli 32.3% then S. aureus 29%, S. saprophyticus 29%, and E. faecalis9.7%. The largest diameter of the inhibition zone appeared in Gram-positive S.saprophyticus (13.4mm). The concentrations of ginger extract used were 100, 50, 25, and 12.5 mg/ml. mean of inhibition zone of chloramphenicol for isolated bacteria S.aureus 31mm, S.saprophyticus 20.2 mm, E.coli 17.7mm, and faecalis24.6mm. Conclusion: The antimicrobial activity of the crude extract was compared with that of standard antimicrobial chloramphenicol based on the mean diameter of the inhibition zone. The extract exhibited maximum relative percentage inhibition against S.saprophyticus(42.3%) and minimum relative percentage inhibition against S. aureus (6.3%).

Antibiotic Susceptibility of the Bacteria Causing Odontogenic Infections

Introduction: Odontogenic infection is polymicrobial, consisting of various facultative and strict anaerobes. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci. Aims and Objectives: To identify the most common microorganisms responsible for causing infection and different species in oral infections. To evaluate the common types of dental infections and its site. To identify the sensitivity and resistance of antibiotics. Materials and Method: This study was conducted on 62 subjects, of which 11 showed no pathogens. After collection of the sample, it was sent to the microbiology laboratory for aerobic and anaerobic culture, gram staining, and antibiotic susceptibility test. Results: Staphylococcus (40.3%, n = 25) was the most commonly found microorganism. Maxillary anterior (32.25%, n = 20), maxillary posteriors (32.25%, n = 20), and mandibular posteriors teeth (27.4%, n = 17) showed almost similar occurrences. Maximum resistance was shown to co-trimoxazole (70.5%), amoxicillin (62.7%), erythromycin (54.9%), and azithromycin (37.25%). Linezolid (78.4%), amoxiclav and gentamicin (39.2%), vancomycin, imipenem, doxycycline showed (56.9%), and cefuroxime showed 37.25% sensitivity. Conclusions: Appropriate and correct use of antibiotics is essential to ensure that effective and safe treatment is available. The result of the present study should not be considered an absolute one; however, they can serve to increase awareness about the pathogens responsible for different infections and the sensitivity and resistance toward different antibiotics.

Promoters and inhibitors for quality improvement work in general practice: a qualitative analysis of 2715 free-text replies

BackgroundContinuous quality improvement (QI) is necessary to develop and maintain high quality general practice services. General Practitioners (GPs’) motivation is an important factor in the success of QI initiatives. We...

Innovative gamification and outreach tools to raise awareness about antimicrobial resistance.

Since 2017, the SWICEU team has developed various informative actions and innovative gamification supports to educate and raise awareness about antimicrobial resistance (AMR) and the correct use of antibiotics among the general population especially among young people. This case study presents the results obtained in the last 5 years with the strategies carried out by this team, composed of students and professors of Health Sciences, Industrial Design Engineering, and Communication Sciences at CEU Cardenal Herrera University (CEU UCH) in Valencia (Spain). Over the past 5 years, playful educational supports have been developed to make the health problem of bacterial resistance and the action of antibiotics more understandable among young people. The dissemination media used, with the same objective of teaching and raising awareness about AMR in a creative and innovative way, have been selected according to the trends in digital communication and use of scientific and health content provided by the most recent studies carried out among the Spanish population. These strategies have included decalogues or “tips” with useful advice, infographics, YouTube videos, Twitter threads, online challenges on Kahoot, stories on Instagram, use of QR codes, etc. These actions have also obtained diffusion in the media and have been awarded by different national and international entities. The good results obtained in the case under study allow us to establish recommendations for the design of innovative educational gamification and dissemination supports on AMR, especially aimed at younger audiences.