Development Of Microbial Resistance Research Articles

What is the science underpinning the prescription of antibiotics in dentistry?

A critical review on the use of antimicrobials in dentistry. To provide a general overview of the use of antimicrobials in dentistry. The paper was divided into different topics, starting with an approach to understanding both commensal and pathogenic oral microbiota. Subsequently, emphasis was placed on the main categories of antibiotics used in dentistry (β-lactams, tetracyclines, macrolides, lincosamides, nitroimidazoles and quinolones), and the basis for their prescription. Finally, the implications between systemic diseases and the use of orally-administered antibiotics are presented. The study suggests that an adequate medical history can minimize the risk of systemic adverse effects, unwanted drug interactions, and allergies related to the use of antibiotics. In this regard, when facing a potential history of allergy to a particular group of antibiotics, the prescription of a different group is mandatory. In most indications, β-lactam antibiotics represent the first-choice in dentistry. Moreover, a short-term prescription of antibiotics when treating acute oral infections is recommended. The use should be extended for 2 to 3 days following the resolution of the infection, with an average duration of 6 days in order to prevent the development of antibiotic resistance. Oral infections should be managed with interventions aiming at the elimination/reduction of the associated pathogens. Furthermore, inadequate prescription of antibiotics can lead to potential risks to the patient such as allergy, adverse effects, and development of microbial resistance.

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review.

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Novel Photodynamic/Photothermal Treatment of Fungal Keratitis Using Rose Bengal-Loaded Polypyrrole-Gold Nanoparticles in Wistar Albino Rats.

Purpose: Fungal keratitis is a potential corneal contagious disease mainly caused by yeast such as Candida albicans and filamentous fungi such as Aspergillus niger. The response of fungal keratitis to standard antifungals is limited by the poor bioavailability, the limited ocular penetration of antifungal drugs, and the development of microbial resistance. Photodynamic therapy using rose bengal (RB) as a photosensitizer was found to be effective in fungal keratitis management; however, the hydrophilicity of RB limits its corneal penetration. Polypyrrole-coated gold nanoparticles (AuPpy NP) were introduced as a nano-delivery system of RB with high loading capacity. It was proved that (RB-AuPpy NP) exhibited a combined photodynamic/photothermal effect. This study aims to use the combined photodynamic/photothermal effect of RB-AuPpy NP as a novel protocol for treating Fungal Keratitis in albino Wistar rats. Methods: The rats were infected by C. albicans and A. niger. Each infected group of rats was subdivided into groups treated by RB followed by radiation (photodynamic only), AuPpy NP followed by radiation (photothermal only), and RB-AuPpy NP followed by radiation (combined photodynamic/photothermal). Histopathological examination and slit lamp imaging were done to investigate the results. Results: The results revealed that 3 weeks post-treatment, the corneas treated by RB-AuPpy NP (combined photodynamic/photothermal effect) exhibited the best improvement compared to other groups. Conclusion: This protocol can be considered a promising one for Fungal Keratitis management that overcomes microbial resistance problems.

COMPARATIVE EFFICACY OF MEDICATED SOAPS ON STAPHYLOCOCCUS AUREUS ASSOCIATED WITH WOUNDS AND POST-OPERATIVE WOUNDS FROM HOSPITALS IN ONDO STATE, NIGERIA

Introduction: Staphylococcus aureus remains one of the leading causes of wound infection and medicated soaps have antimicrobial substances which when applied on living tissues, reduces the possibility of S. aureus wound infection, sepsis or putrefaction. Aim: Therefore, this study is aimed at determining the antibacterial activities of 6 medicated soaps on S. aureus isolated from wounds. Methodology: One hundred and eight (108) wound samples were collected from patients with wound infection found in the orthopedic and surgical wards of selected hospitals in Ondo State. The antibacterial activity of medicated soaps on S. aureus isolated from wound infection was determined using agar well diffusion technique and the antibiogram profile was determined using disc diffusion technique. Results: Of the 108 wound samples tested, 64 (59.3%) were infected with S. aureus. Tetmosol soap recorded the highest zone of inhibition against all S. aureus strains with (24.3 mm) at 200 mg/ml and (20.3 mm) at 100 mg concentrations. Carat soap had the least antibacterial activity against all staphylococcus strains with (6.0 mm) for both concentrations. Over 70% of the isolates were resistant to amoxicillin, rocephine, gentamycin, zinnacef, ampiclox and septrin; whereas, ≤ 50% were susceptible to ciprofloxacin, streptomycin, erythromycin and perfloxacin. Medicated soaps had a better activity on S. aureus compared to conventional antibiotics. Conclusion: Therefore, antiseptic soaps could be used in the cleaning of wounds and cuts during time of hurts to prevent infection and the transmission of wound pathogens. However, this should be used moderately by patients in order to avoid irritation and development of microbial resistance in the future.

Clinical effectiveness of generic vancomycin products compared to Vancocin CP® in patients with methicillin-resistant Staphylococcus aureus infections: A retrospective cohort

Introduction: Approval of generic drugs requires only bioequivalence studies. Some research suggests that generic vancomycin is not clinically equivalent to the branded drug, and this exposes patients to therapeutic failure and the development of microbial resistance.
 Aims: Compare the rates of microbiological and clinical failure between generic vancomycin and Vancocin-CP®.
 Methods: Retrospective cohort analysis of hospitalized adults with culture-proven methicillin-resistant Staphylococcus aureus infection, treated with vancomycin in a tertiary care hospital in Medellín, Colombia. General clinical variables, laboratory findings, severity and mortality scores, and type of vancomycin used were recorded. Logistical regression models, adjusted for potential confounders, were fitted to estimate the effect of vancomycin on clinical and microbiologic outcomes.
 Results: Of 209 patients, 153 (73.2%) received generic vancomycin and 56 (26.8%) Vancocin-CP®. Systems more commonly affected were skin and soft tissues (28.5%), blood with involvement of catheters (27.6%) and blood without the involvement of catheters (23.3%). There were 62 clinical failures (29.5%) and 41(38%) microbiological failures. The hospital mortality rate was 15% (n = 31); only 7 (3.4%) episodes of adverse drug reactions were documented. No difference was found in the risk of clinical or microbiological failure between Vancocin-CP® and generic products with OR = 2.3 (95% CI = 0.8; 6.3) and 0.89 (95% CI = 0.4; 1.9), respectively. 
 Conclusion: There were no association between the use of generic vancomycin and the outcomes of clinical or microbiological failure. Sample size is an important limitation for these findings.
 
 Keywords: Vancomycin, bioequivalence, MRSA, clinical equivalence

Evaluation of Short-Chain Antimicrobial Peptides With Combined Antimicrobial and Anti-inflammatory Bioactivities for the Treatment of Zoonotic Skin Pathogens From Canines.

The incidence of zoonotic Staphylococcus pseudintermedius and Microsporum canis infections is rapidly growing worldwide in the context of an increasing frequency of close contact between animals and humans, presenting challenges in both human and veterinary medicine. Moreover, the development of microbial resistance and emergence of recalcitrant biofilms, accompanied by the insufficiency of new antimicrobial agents, have become major obstacles in treating superficial skin infections caused by various microbes including S. pseudintermedius and M. canis. Over recent years, the prospects of antimicrobial peptides as emerging antimicrobials to combat microbial infections have been demonstrated. In our study, two novel short-chain peptides, namely, allomyrinasin and andricin B, produced by Allomyrina dichotoma and Andrias davidianus, were revealed to exhibit potent antimicrobial efficacy against clinical isolates of S. pseudintermedius and M. canis with remarkable and rapid fungicidal and bactericidal effects, while allomyrinasin exhibited inhibition of biofilm formation and eradication of mature biofilm. These peptides displayed synergistic activity when combined with amoxicillin and terbinafine against S. pseudintermedius and M. canis. Cytoplasmic leakage via cytomembrane permeabilization serves as a mechanism of action. Extremely low hemolytic activity and serum stability in vitro, as well as superior anti-infective efficacy in reducing bacterial counts and relieving the inflammatory response in vivo, were detected. The potent antibacterial, antifungal, and anti-inflammatory activities of allomyrinasin and andricin B might indicate promising anti-infective alternatives for the treatment of S. pseudintermedius and M. canis infections in the context of human and veterinary medicine.

Identification of potential quorum quenching compounds in Brassica oleracea var. capitata against MDR Pseudomonas aeruginosa and Escherichia coli clinical isolates

Over the last decades, the development of microbial resistance has become an alarming situation. This has urged the search for new antimicrobial strategies. In this context, two Brassicaceae edible plants; Brassica oleracea var. capitata (cabbage) and Brassica rapa subsp. rapa (Turnip) were assessed for their antimicrobial activity against P. aeruginosa and E. coli clinical isolates. Antibiogram analysis was done according to the CLSI 2019 guidelines and proved that both P. aeruginosa and E. coli clinical isolates were multidrug resistant. A green extraction methodology – assisted by microwave and ultrasound- was used to prepare the aqueous extracts. Determination of minimum inhibitory concentration (MIC) of the extracts was also carried out according to the CLSI guidelines. At sub-MIC concentration, cabbage extract showed promising results in the inhibition of quorum sensing mediated virulence determinants of P. aeruginosa. Highest reduction was observed in pyocyanin and rhamnolipid production. Chemical profiling via UPLC-ESI-MS analysis of cabbage extract revealed the presence of different glucosinolates together with iberin and sulforaphane. The in silico docking study was conducted and revealed the ability of sulforaphane and iberin to bind to LasR regulator responsible for quorum sensing in P. aeruginosa. These compounds thus represent potential candidates that can be developed into novel antimicrobial infection control tools.

A review on the role of genomics, various environmental factors, biochemical and physiological determinants and biofilms responsible for the development of antibiotics resistance in microbes

Antibiotic (antimicrobial drug), an organic compound causes a sterling impact on microbes by inducing cellular responses. For years, genetic changes were thought to be the only active influencer in development of microbial resistance against antibiotics. With advancement many other factors came up to mutually participate in onset of microbial resistance. This review article is focused on identifying various other possible microbial antibiotic resistance factors. Since there has been identified multitude of factors, the crucial being the horizontal gene transfer (HGT), genetic changes (point mutations), development of biofilms acting as barrier, physiological factors i.e. efflux pump; most effective impact factor, environmental factors; natural selection pressure, metal contamination, anthropogenic activities cooperating specifically with farms serve as vectors to transfer pathogens or their resistance genes to human directly and indirectly through livestock, dairy products consumption, and biochemical responses in terms of mortality and morbidity, working in correlation as a stimulator to each other. To develop a strong antibiotic, it necessitates the knowledge of the evolutionary backgrounds of the microbe. This would help in developing next generation drugs way before the outbreak of next epidemic or pandemic. This requires the development of a gene bank of total resistant genes of pathogens of concern known as resistome. Beneficial bioinformatics databases are in progress to provide useful data in this regard e.g. Antibiotic Resistance Genes Database (ARDB) gathers extensive publicly available info on microbial resistance. Comprehensive Antibiotic Research Database (CARD) generates molecular sequencing data, Antibiotic Resistance Ontology (ARO) and rapidly identifies antibiotic resistance genes in genome. Keywords: Antibiotic resistance; Antimicrobial Drugs; Biofilms; Cryptic genes; Efflux pumps; Horizontal gene transfer (HGT); Integrating conjugative elements (ICE); Natural selection; Plasmid acquisition MDR efflux pump; resistome http://dx.doi.org/10.19045/bspab.2020.90245

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome.

Background and objectives: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, being related to frequent and long-term hospitalisation, reduced quality of life of the patient, amputations, a high rate of morbidity and mortality. The bacterial aetiology is complex, sometimes involving more than one pathogen, playing a major role in the infection prognosis and development of microbial resistance. This study evaluated the current state of the aetiology, clinical and pathological characteristics of DFU in a single diabetes centre in order to provide some specific measures to prevent it. Materials and Methods: This retrospective study was conducted on patients with diabetes mellitus (252 individuals diagnosed with DFU) between January 2018–December 2019. All participants were assessed based on their clinical characteristics, including complications of diabetes and pathological and microbiological evaluations. Results: The present research revealed that diabetic foot ulcer prevalence was higher in males than in females and higher in type 2 diabetic patients than in type 1 diabetic patients. The patients with diabetic foot ulcer were older, had a higher body mass index (BMI), longer diabetic duration and had more diabetic complications, such as retinopathy, diabetic polyneuropathy and diabetic kidney disease, than patients without diabetic foot ulceration. Conclusions: Taking into account all factors involved, including the aetiology and the antibiotic susceptibility pattern of these isolates, planning the suitable treatment options of patients is possible.

Multimodal Role of Amino Acids in Microbial Control and Drug Development.

Amino acids are ubiquitous vital biomolecules found in all kinds of living organisms including those in the microbial world. They are utilised as nutrients and control many biological functions in microorganisms such as cell division, cell wall formation, cell growth and metabolism, intermicrobial communication (quorum sensing), and microbial-host interactions. Amino acids in the form of enzymes also play a key role in enabling microbes to resist antimicrobial drugs. Antimicrobial resistance (AMR) and microbial biofilms are posing a great threat to the world’s human and animal population and are of prime concern to scientists and medical professionals. Although amino acids play an important role in the development of microbial resistance, they also offer a solution to the very same problem i.e., amino acids have been used to develop antimicrobial peptides as they are highly effective and less prone to microbial resistance. Other important applications of amino acids include their role as anti-biofilm agents, drug excipients, drug solubility enhancers, and drug adjuvants. This review aims to explore the emerging paradigm of amino acids as potential therapeutic moieties.

Bioequivalence of Two Oral Formulations of Ciprofloxacin 250 mg Tablets in Healthy Mexican Volunteers

Background. There are numerous reports of low-quality formulations of ciprofloxacin in the market, which has been associated with therapeutic failure and the development of microbial resistance. Objective. The aim of this study is evaluating the bioequivalence between two oral immediate-release ciprofloxacin 250 mg tablets. Material and Methods. The study was performed in 24 Mexican healthy volunteers following a randomized cross over 2 × 2 design. Single doses of a test formulation Lemyflox® (Lemery Laboratories, Mexico) and the reference formulation Ciproxina® (Bayer, Mexico) were administered; blood samples were obtained during a 12 h period. Ciprofloxacin plasma concentrations were quantified using a validated High-Pressure Liquid Chromatography (HPLC) method, plasma concentration against time curves were constructed and pharmacokinetic parameters were determined by non-compartmental analysis. In order to determine bioequivalence, test/reference ratios of Cmax, AUC0-t and AUC0-inf were compared using analysis of variance (ANOVA), followed by the 90 % confidence intervals and the Schuirmann bilateral test. Results. The 90 % confidence intervals limits ranged from 82.92 to 100.88 % for Cmax, from 93.05 to 109.15 % for AUC0-t and from 97.76 to 114.99 % for AUC0-inf, all cases were within bioequivalence acceptance range of 80 - 125 %. Schuirmann test confirmed such observation as the probability that Cmax, AUC0-t and AUC0-inf ratios were beyond 80 - 125 % was lower than 0.05. Conclusions. The results obtained demonstrate bioequivalence between the test and reference formulations.

Comparison of the effectiveness of preventive systemic administration of antibiotics with topical use of decamethoxin during clean surgical interventions

Introduction. The lack of generally accepted standards of perioperative antimicrobial prophylaxis leads to the inadequate preventive use of antibiotics associated with development of microbial resistance, changes in the natural biota and sensitization of the patient’s body. Prevention of infectious complications after surgery with topical antiseptic is an appropriate alternative to antibiotic prophylaxis. The purpose of this study was to evaluate the efficacy and safety of topical antiseptic prophylaxis of infectious complications with a 0.02 % decamethoxin solution compared to systemic antibiotic prophylaxis with cefuroxime (beta-lactam antibiotics) during clean surgeries.
 Materials and methods. In the first group of patients (n = 25), the operative field was treated with decametoxin, the abdominal cavity was irrigated through an irrigator during laparoscopic interventions after trocart placement or with a syringe in case of open surgeries (50–150 ml). In the second group (n = 22), cefuroxime was administered at a single dose of 1.5 g 30 to 60 minutes before surgery. Patients underwent inguinal hernia repair (Lichtenstein and laparoscopic transabdominal preperitoneal repair), thyroidectomy, parathyroidectomy, laparoscopic adrenalectomy, cholecystectomy, cystectomy of the spleen and ovaries for uncomplicated cysts.
 Results. Microbiological analysis of the inoculation material taken from the bottom and walls of the surgical wound before suturing (before the wound was treated with an antiseptic agent in the decamethoxin group) revealed no growth of pathological microbiota at clinically significant levels.
 Conclusions. The antimicrobial effect of a 0.02 % decamethoxin solution when applied topically during clean surgical interventions is comparable to that of cephalosporin antibiotics. Perioperative antiseptic prophylaxis can reduce the incidence of antibiotic-resistant strains of microorganisms in surgical departments.

Pharmaceuticals and endocrine disruptors in raw and cooked seafood from European market: Concentrations and human exposure levels

Pharmaceuticals (PhACs) and endocrine disrupting compounds (EDCs) are chemicals of emerging concern that can accumulate in seafood sold in markets. These compounds may represent a risk to consumers through effects on the human reproductive system, metabolic disorders, pathogenesis of breast cancer or development of microbial resistance. Measuring their levels in highly consumed seafood is important to assess the potential risks to human health. Besides, the effect of cooking on contaminant levels is relevant to investigate. Therefore, the objectives of this research were to study the presence and levels of PhACs and EDCs in commercially available seafood in the European Union market, to investigate the effect of cooking on contaminant levels, and to evaluate the dietary exposure of humans to these compounds through seafood consumption. A sampling survey of seafood from 11 European countries was undertaken. Twelve highly consumed seafood types were analysed raw and cooked with 3 analytical methods (65 samples, 195 analysis). PhACs were mostly not detectable or below quantification limits in seafood whereas EDCs were a recurrent group of contaminants quantified in the majority of the samples. Besides, cooking by steaming significantly increased their levels in seafood from 2 to 46-fold increase. Based on occurrence and levels, bisphenol A, methylparaben and triclosan were selected for performing a human exposure assessment and health risk characterisation through seafood consumption. The results indicate that the Spanish population has the highest exposure to the selected EDCs through seafood consumption, although the exposure via seafood remained below the current toxicological reference values.

Antiseptic properties of aminoadamantane derivative

Development of microbial resistance to current antimicrobial drugs created a critical need of the new antiseptics. The object of our study was phenyladamantane derivative (4-(adamantyl-1)-1-(1-aminobutyl)benzol, AM-166). The aim of the presented study was to investigate the specific activity of 4% AM-166 solution in isopropanol and 5% AM-166 solution in 76% ethanol (manufactured by PJSC SIC «Borshchahivskiy CPP») against the wide spectrum of bacteria and fungi, and effective concentrations and exposition time determination. Desinfectant/antiseptic activity was evaluated by quantitative suspension method with subsequent neutralization.
 Our results showed that both solutions exhibited similar activity against gram-positive and gram-negative bacteria as well as against yeasts. Antibacterial and antifungal action was demonstrated for all investigated concentrations (initial solution, 5-fold and 10-fold dilutions), observed effect was maintained throughout the whole observation period (from 5 to 30 min).
 Tested solutions in initial concentrations demonstrated fungicidal activity against A. niger. 5-fold dilution of 5% AM-166 solution in 76% ethanol was more effective than 5-fold dilution of 4% AM-166 solution in isopropanol. 10-fold dilutions of both solutions were ineffective against A. niger. The data obtained suggest the prospects of adamantane derivatives for the development of novel antiseptics.

Evaluation of antimicrobial activity using Artemisia afra, Psidium guajava and Erythrina lysistemon on Staphylococcus species

Background: Medicinal plants contain components of therapeutic value and provide an alternative form of available antibiotics to multiple infections. Development of microbial resistance to the available antibiotics has further enhanced the investigation of the role of antimicrobial activity of medicinal plants. Method: Here we report the antimicrobial properties of Artemisia afra, Psidium guajava and Erythrina lysistemon extracts obtained by using two different extraction solvents. Extracts were subjected to tests using zones of inhibition, Thin Layer Chromatography and High Pressure Liquid Chromatography (HPLC). Results: Pronounced antimicrobial activity was observed against Staphylococcus aureus using the ethanol extraction technique. However, no statistical significance was observed between the results produced using extracts from both methods A (according to dilution factor) and B (method 3a of the German Homeopathic Pharmacopoeia). Conclusion: The potential for developing antimicrobials from plants in vivo provides a platform for phytomedicine and pharmacological studies.

Self-medication with Antibiotics in WHO Southeast Asian Region: A Systematic Review.

Antibiotics are essential treatments, especially in the developing world like World Health Organization (WHO) Southeast Asian region where infectious diseases are still the most common cause of death. In this part of the world, antibiotics are purchased and used without the prescription of a physician. Self-medication of antibiotics is associated with the risk of inappropriate drug use, which predisposes patients to drug interactions, masking symptoms of an underlying disease, and development of microbial resistance. Antibiotic resistance is shrinking the range of effective antibiotics and is a global health problem. The appearance of multidrug-resistant bacterial strains, which are highly resistant to many antibiotic classes, has raised a major concern regarding antibiotic resistance worldwide. Even after decades of economic growth and development in countries that belong to the WHO Southeast Asian region, most of the countries in this region still have a high burden of infectious diseases. The magnitude and consequence of self-medication with antibiotics is unknown in this region. There is a need for evidence from well-designed studies on community use of antibiotics in these settings to help in planning and implementing specific strategies and interventions to prevent their irrational use and consequently to reduce the spread of antibiotic resistance. To quantify the frequency and effect of self-medication with antibiotics, we did a systematic review of published work from the Southeast Asian region.

Urinary tract infection management – do the guidelines agree?

Urinary tract infection (UTI) is defined as the inflammatory response of the urothelium to bacterial invasion. UTI in adults is one of the most prevalent infectious diseases worldwide with a substantial financial burden on society. There is mounting concern surrounding the ongoing development of microbial resistance. In addition, the increasing resistance of organisms to broad-spectrum antibiotics is worrying. There is a continuing drive for antibiotic stewardship and more prudent prescribing of antimicrobial agents. There is currently no national UK guideline on the management of UTI in adults but the EAU, AUA and SIGN all have their separate recommendations. In this review, we discuss the existing guideline recommendations particularly relating to lower UTIs (cystitis and epididymo-orchitis), upper UTIs (pyelonephritis) and catheter-associated infections (due to their large healthcare burden). The aims are to identify common recommendations and assess how they may apply for the UK setting. This review has highlighted considerable differences in practice recommendations between the major UK, European and American guidelines. Discrepancy exists in the choice of antibiotics and for some types of infection, whether or not any guidance for treatment is offered. Antibiotic avoidance and prudent antibiotic prescribing will be key components of future strategies in reducing antimicrobial resistance.

The Rational Use of Antibiotics Medicine

Introduction: The abuse of antibiotics as well as the development of microbial resistance in them is a global phenomenon. Aim: The purpose of this study is to highlight the rational use of antibiotics and limitation of microbial resistance. Material and methods: Extensive review of the recent literature was conducted in electronic database Medline and via the link of the Greek Association of Academic Libraries (HEAL-Link), using the following key words: antibiotics, medicine, and rational use. Results: The rational use of antibiotics is therefore it should not be random. It requires reflection and thought and should be based on rules. The correct diagnosis, the patient's condition, the location of the infection, the severity of the microbial cause sensitivities to antibiotics, the pharmacokinetics and pharmacodynamics of antimicrobials, the side effects and cost are the main elements which must be supported in every decision for their use. Conclusion: Doctors and other professionals should prescribe antibiotics only when necessary, based on existing guidelines.

The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis.

The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop. Among a large array of laboratory tests, procalcitonin (PCT) emerged as the leading biomarker to accurately and time-effectively indicate the presence of systemic infection. In the presence of systemic infection, PCT blood levels undergo a sudden and dramatic increase, following the course of the infection, and quickly subside after the control of the septic process. This work is a meta-analysis on PCT performance as a biomarker for sepsis. This meta–analysis showed that overall pooled area under the curve (AUC) is 0.83 (95% CI = 0.76 to 0.90); the estimated cut-off is 1.47 ng/mL. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% CI = 1.1 to 3.2). This meta–analysis showed PCT may be considered as a biomarker with a strong diagnostic ability to discriminate between the septic from the non-septic burn patients. Thus, this work encourages the determination of PCT levels in clinical practice for the management of these patients, in order to timely identify the susceptibility to sepsis and to initiate the antimicrobial therapy, improving the patients’ outcomes.

АНТИСЕПТИКИ ПРИ ИНТРАВИТРЕАЛЬНЫХ ИНЪЕКЦИЯХ

Authors analyze efficiency of application antiseptics of a miramistin in prevention of infectious complications in case of repeated intravitreal injections of VEGF inhibitor Ranibizumab in 156 patients with the age related macular de-generation. 0,01% solution of antiseptic Miramistin (Okomistin®) was instillated 4 times per day two days before operation to all patients for the purpose of infection prevention. Just before the operation (60 and 30 minutes before) and right after it instillations of antiseptic continued within a week after intravitreal injection. During the operation in the conditions of the operating room with keeping of all rules of aseptic, three minutes prior to operation the surgery field and the conjunctival cavity of the patient were twice processed by 5% povidone-iodine solution (Betadine). The results analysis showed no expressed signs of irritation of the eyes connected to miramistin treatment preceding the operation. In the postoperative period all patients endured antiseptics well. Within a week of applications there were no complaints about pain, burning, foreign body sensation or hazy vision after the medicine instillation, and biomicroscopic research revealed no signs of inflammatory injection of conjunctiva or sclera, no cornea epitheliopathy, there was no cellular response in moisture of the anterior chamber and vitreous body. Thus, the authors state that antiseptics Okomistin® as an additional measure of prevention of infectious complications in case of intravitreal injection provide high level antimicrobic protection with no risk of development of microbial resistance.