Antibiotic Resistance Effects Research Articles

The impact of antibiotic resistance on the rampant spread of infectious diseases in Pakistan: Insights from a narrative review.

Antibiotic resistance (ABR) is a global public health emergency which has seen an uptick in low- to middle-income countries in recent times due to a plethora of aggravating factors and has led to a whole host of setting-specific pathogens registering high rates of resistance, causing outbreaks with graver mortality and morbidity. This review analyzes available literature to determine the causes and effects of ABR and recommend solutions to the problem in a Pakistani setting. Sources for this narrative review were identified via electronic databases using keyword search methods. The information was retrieved using databases such as PubMed and Science Direct. Additionally, websites such as CDC and World Health Organizationwere used to attain pertinent information. All the sources were selected as per their relevance and appropriateness towardthe purpose of this review. This review details the causes by dividing them into three primary strata, namely (1) under-regulation, (2) over-prescription and self-medication, and (3) lack of medical stewardship. This is made much graver when the COVID-19 pandemic and the subsequent erratic treatment response is considered, with the pandemic augmenting already high levels of consumption. These factors have led a cascade of effects including, but not limited to, a considerable increase in ABR in pathogens to first-line drugs. ABR is a serious and growing issue which will result in undesirable personal, local, and national consequences if unchecked. Mitigation and reversal of this trend is necessary by developing existing programs and investing in novel therapies and pharmaceutical research and strengthening regulatory policies and mechanisms.

Gut microbiome and antibiotic resistance effects during travelers' diarrhea treatment and prevention.

The travelers' gut microbiome is potentially assaulted by acute and chronic perturbations (e.g., diarrhea, antibiotic use, and different environments). Prior studies of the impact of travel and travelers' diarrhea (TD) on the microbiome have not directly compared antibiotic regimens, and studies of different antibiotic regimens have not considered travelers' microbiomes. This gap is important to be addressed as the use of antibiotics to treat or prevent TD-even in moderate to severe cases or in regions with high infectious disease burden-is controversial based on the concerns for unintended consequences to the gut microbiome and antimicrobial resistance (AMR) emergence. Our study addresses this by evaluating the impact of defined antibiotic regimens (single-dose treatment or daily prophylaxis) on the gut microbiome and resistomes of deployed servicemembers, using samples collected during clinical trials. Our findings indicate that the antibiotic treatment regimens that were studied generally do not lead to adverse effects on the gut microbiome and resistome and identify the relative risks associated with prophylaxis. These results can be used to inform therapeutic guidelines for the prevention and treatment of TD and make progress toward using microbiome information in personalized medical care.

Patterns and determinants of antibiotic prescription among children admitted to public hospitals in Kenya: A cross-sectional observational study

Background: Sick children frequently have antibiotics prescribed as part of their treatment. Inappropriate use of antibiotics, especially broad-spectrum antibiotics, can result in the development of antibiotic resistance and the consequences of antibiotic resistance. In this study, we use routinely collected data to describe the patterns and identify factors influencing antibiotic prescription among admitted children. Methods: Routine data collected from medical records of children aged 2 months or older admitted between 2014 and 2020 to paediatric wards of 12 hospitals which are part of a Clinical Information Network (CIN) are used. Multivariable mixed effects logistic regression is used to assess determinants of antibiotic prescription with a random slope and intercept for hospital level. Results: A total of 127,984 antibiotic prescriptions were made in 107,500 participants included in the study where 81.1% (87,183/107,500) had one or more antibiotic prescriptions. The commonly prescribed antibiotics were a combination of benzylpenicillin and gentamicin (37,939/127,984 - 29.6%), ceftriaxone (31,172/127,984 - 24.6%) and oral amoxicillin (12,593 /127,984 - 9.8%). Factors associated with antibiotic prescription were history of cough (adjusted odds ratio (aOR), = 2.06, 95% confidence interval (CI):1.966 - 2.152), bloody diarrhoea (aOR=5.6, CI:4.453 - 7.036), diagnoses of pneumonia (aOR=27.66, CI:21.768 - 35.154), malnutrition (aOR=6.3, CI:4.558 - 8.701) and meningitis (aOR=11.85, CI:9.502 - 14.779). Antibiotic prescription was less likely in children diagnosed only with severe anaemia (aOR=0.8, CI:0.742 - 0.870), malaria (aOR:0.22, CI:0.201 - 0.231), diarrhoea (aOR:0.36, CI:0.331 - 0.398), and dehydration (aOR=0.4, CI:0.347 - 0.464). Conclusion: Antibiotics are prescribed in approximately four of every five children admitted to paediatric wards of Kenyan hospitals. Prescriptions are mainly in patients who fulfil syndromic clinical criteria where antibiotics are indicated. Without the introduction of reliable pathogen diagnostics, it will be difficult to reduce antibiotic prescriptions among admitted children.

Enhanced bacterial adhesion force by rifampicin resistance promotes microbial colonization on PE plastic compared to non-resistant biofilm formation

The microbial biofilm formed on plastics, is ubiquitous in the environment. However, the effects of antibiotic resistance on the development of the biofilm on plastics, especially with regard to initial cell attachment, remain unclear. In this study, we investigated the initial bacterial adhesion and subsequent biofilm growth of a rifampin (Rif) resistant E. coli (RRE) and a normal gram-positive B. subtilis on a typical plastic (polyethylene, PE). The experiments were conducted in different antibiotic solutions, including Rif, sulfamethoxazole (SMX), and kanamycin (KM), with concentrations ranging from 1 to 1000 μg/L to simulate different aquatic environments. The AFM-based single-cell adhesion force determination revealed that Rif resistance strengthened the adhesion force of RRE to PE in the environment rich in Rif rather than SMX and KM. The enhanced adhesion force may be due to the higher secretion of extracellular polymeric substances (EPS), particularly proteins, by RRE in the presence of Rif compared to the other two antibiotics. In addition, the higher ATP level of RRE would facilitate the initial adhesion and subsequent biofilm growth. Transcriptome analysis of RRE separately cultured in Rif and SMX environments demonstrated a clear correlation between the expression of Rif resistance and the augmented bacterial adhesion and cellular activity. Biofilm biomass analysis confirmed the promotion effect of Rif resistance on biofilm growth when compared to non-resistant biofilms, establishing a novel association with the augmentation of microbial adhesion force. Our study highlights concerns related to the dissemination of antibiotic resistance during microbial colonization on plastic that may arise from antibiotic resistance.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

ANTIBIOTIC RESISTANCE AS A GLOBAL PROBLEM IN THE CONTEXT OF BIOSECURITY

Unreasonable (Unjustified), excessive and uncontrolled use of antibiotics in the field of healthcare and agriculture sectors has become the main reason for the formation of antibiotic resistance (AR) and the spread of antibiotic-resistant microorganisms in the environment. Every year the growth of AR is recorded in the world, which has become a challenge for humanity. The WHO (World Health Organization) has recognized the problem of AR as one of the 10 global threats to public health facing humanity, which causes about 700,000 deaths per year in the world, and endangers the possibility of achieving the UN Sustainable Development Goals, in particular goal No. 3 " Ensuring healthy lifestyles and promoting well-being for everyone at all ages." And it also causes(carries) significant socio-economic losses and unpredictable environmental consequences. The purpose of the research is to analyze modern data on the formation and spread of AR and modern approaches to solving the AR problem at the global level. By using a systematic approach, content analysis, bibliosemantics and scientometrics methods, analysis and generalization of data from modern scientific sources, statistics (statistical data) of leading international organizations involved(engaged) in monitoring AR and solving the problem of spreading AR were carried out. This review demonstrates the relevance of the problem of resistance of microorganisms (problem of antimicrobial resistance) to antibiotics, the main mechanisms of the development and spread of AR, the global scope(scale) and consequences of AR, and aims to provide an insight into international initiatives to reduce AR, in particular the Concept of "One Health" (the "One Health" Concept) and the strategies that are currently being implemented. Solving the AR problem requires a comprehensive (an integrated) approach, which includes mandatory systematic monitoring of the state of resistance of microorganisms to antibiotics, control of the use of antimicrobial drugs and educational programs to prevent the misuse of antibiotics, environmentally safe methods of waste disposal of medical, food and other industries that produce or use antibiotics, and their safe disposal, etc. In perspective (In the future), it is relevant to study the environmental consequences associated with the waste of(from) medical, food, and agricultural enterprises that produce or use antibiotics, and their safe disposal.

An Overview on Antibiotic Resistance Effects and Preventions

An Overview on Antibiotic Resistance Effects and Preventions

Challenges and Perspectives on Plasmid Curing, Medicinal and Pharmacological Traits of Plumbago Zeylanica (Chitraka): A Review

From ancient times of vedas, charaksamhita and sushrutsamhita, to modern day developments and research in medicine, the medicinal importance of Chitraka (Plumbago zeylanica) as a wonderful Indian remedy has been upheld through the test of time. Chitraka is used in ayurveda for relief from many ailments, especially digestive disorders, bronchitis, diseases of liver, leucoderma, inflammation, piles, itching, laryngitis, rheumatism, diseases of spleen, many skin disorders etc. The root extracts of P. zeylanica have been incorporated in various Indian indigenous ayurvedic drug formulations. This paper reviews various aspects of Chitraka like different pharmacological activities, medicinal properties including wound healing, antioxidant, antiulcer, anticancer, leishmanicidal, antifertility, antimalarial, antidiabetic, hypolipidemic, trypanocidal, antibacterial, antifungal, antiviral, anti-inflammatory, antimutagenic, anti-allergic, larvicidal, insecticidal and anxiolytic activities. P. zeylanica plant contains naphthoquinones, flavonoids, terpenes, alkaloids, glycosides, steroids, triterpenoids, tannins, phenolic compounds, glucopyranoside, sitosterol saponins, coumarins, carbohydrates, fixed oils, fats and proteins having a wide variety of bioactivities. The important compound responsible for bioactivity is plumbagin which is chemically 5-hydroxy-2-methyl-1,4-naphthoquinone. Studies of P. zeylanica roots resulted in identification of plumbagin and lawsone as an active principle exhibiting the plasmid elimination activity. Due to the toxicity of chemical curing agents like acridine orange or ethidium bromide, there is a constant need of developing novel curing agents which are more effective and at the same time their non- toxic nature. Bacterial strains resistant to multiple antibiotics have emerged to which the invention of new antibiotics has failed to match up. The effects of antibiotic resistance are serious with mortality and morbidity constantly on the rise. Therefore P. zeylanica root extracts containing lawsone and plumbagin would have great potential as drugs of choice in the treatment of antibiotic resistant bacterial strains. The already ineffective antibiotic therapy can be made effective by converting antibiotic resistant bacteria into sensitive ones. The present review for the first time depicts the use of P. zeylanica as antimicrobial and plasmid curing agent in medicinal formulations and it is a novel approach towards the spread of antibiotic resistance especially in the hospital environment.

Production loss and sick leave caused by antibiotic resistance: a register-based cohort study

BackgroundAdverse economic consequences of antibiotic resistance, both in health care systems and in society at large, have been estimated to emerge and significantly affect the global economy. To date, most studies of the societal costs of antibiotic resistance have had a macroeconomic perspective, using the number of attributable deaths as a quantifier for production loss. In contrast, there have been few studies of the consequences of antibiotic resistance in terms of the length of sick leave and hence the impact of morbidity on production loss. The aim of our study was to estimate the production loss from ill health caused by antibiotic resistance.MethodTo estimate additional production loss due to antibiotic resistance, we used Swedish register-based cohort data to determine days of long-term sick leave (LTSL) for episodes of infection caused by resistant and susceptible bacteria respectively. We collected patient data for four common infection types (bloodstream infection, urinary tract infection, skin and soft tissue infection, and pneumonia), as well as, antibiotic susceptibility test data, and total days of LTSL. We used a two-part model to estimate the number of LTSL days attributable to resistance, and controlled for comorbidities and demographic variables such as age and gender.ResultsThe results show that antibiotic resistance adds an additional 8.19 days of LTSL compared with a similar infection caused by susceptible bacteria, independent of infection type and resistance type. Furthermore, the results suggest that production loss due to temporary sick leave caused by antibiotic resistance in a working-age population amounts to about 7% of total health care costs attributable to antibiotic resistance in Sweden.ConclusionEstimating the effect of antibiotic resistance in terms of temporary production loss is important to gain a better understanding of the economic consequences of antibiotic resistance in society and, by extension, enable more effective resource allocation to combat further emergence of resistance. Society’s economic costs of antibiotic resistance are, however, probably much greater than those of sick leave due to disease alone.

Prevalence, Pattern, Risks Factors and Consequences of Antibiotic Resistance in COPD: A Systematic Review

A concern of antibiotic use in chronic obstructive pulmonary disease (COPD) is the emergence and propagation of antimicrobial resistance (AMR). A systematic review was conducted to determine prevalence, pattern, risk factors and consequences of AMR in COPD. Bibliographic databases were searched from inception to November 2020, with no language restrictions, including studies of any design that included patients with COPD and reported prevalence and pattern of AMR. 2748 unique titles and abstracts were identified, of which 63 articles, comprising 26,387 patients, met inclusion criteria. Forty-four (69.8%) studies were performed during acute exacerbation. The median prevalence of AMR ranged from 0–100% for Pseudomonas aeruginosa, Moraxella catarrhalis, Klebsiella pneumoniae and Acinetobacter baumannii. Median resistance rates of H influenzae and S pneumoniae were lower by comparison, with maximum rates ≤40% and ≤46%, respectively, and higher for Staphylococcus aureus. There was a trend towards higher rates of AMR in patients with poorer lung function and greater incidence of previous antibiotic exposure and hospitalisation. The impact of AMR on mortality was unclear. Data regarding antimicrobial susceptibility testing techniques and the impact of other risk factors or consequences of AMR were variable or not reported. This is the first review to systematically unify data regarding AMR in COPD. AMR is relatively common and strategies to optimise antibiotic use could be valuable to prevent the currently under-investigated potential adverse consequences of AMR. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2000957 .

Identification of microbes from textile dye wastewater and its antibiotic resistance from local textile factory

This study is to identify local isolates from textile dye wastewater and its antibiotic resistance effects on the environment. The textile dye wastewater was collected from local factories and microbes were extracted from wastewater and grown on the bacterial agar. Both biochemical tests and molecular studies were performed where Gram staining, DNA extraction, PCR and Gel electrophoresis were conducted for the bacterial identification. Gram staining tests indicated the characteristics of Gram-positive bacteria. Three microbial isolates were identified as Bacillus species, Bacillus aerius (1312 bp) and Bacillus cereus (1492 bp and 1355 bp). Antibiotic resistance test was performed to observe the antibiotic resistance of these microbes. Six antibiotics were used, i.e., streptomycin, penicillin G., rifampicin, tetracycline, chloramphenicol and gentamicin. From the results, it was concluded that the local isolates were sensitive to the antibiotics introduced in the culture, indicating that they are harmless to humans and the environment.

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

SummaryBackgroundSepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis.MethodsIn BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability.FindingsBetween Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis.InterpretationOur data raise questions about the empirical use of combined ampicillin–gentamicin for neonatal sepsis in LMICs because of its high resistance and high rates of frequency of resistance and low probability of target attainment. Accessibility and affordability need to be considered when advocating antibiotic treatments with variance in economic health structures across LMICs.FundingThe Bill & Melinda Gates Foundation.

Impact of Antimicrobial Resistance Rates on Eradication of Helicobacter pylori in a US Population

See editorial on page 1936. Helicobacter pylori Antibiotic Resistance: Stewardship, Tailored Therapies, and Future PerspectivesGastroenterologyVol. 161Issue 3PreviewWe read with great interest the brief communication by Argueta et al,1 pointing out the effect of antibiotic resistance, detected by molecular analysis of bacterial DNA on gastric biopsy samples, on Helicobacter pylori eradication. We believe that this report is worthwhile for 3 main reasons. Full-Text PDF

Pathogenetic effects of antibiotic resistance on a woman’s reproductive health

Background. Over the last decade, women in many countries around the world have seen an increase in the number of urogenital infections, which occupy the first place in the structure of obstetric and gynecological morbidity. Risk factors for the development of inflammatory diseases include the invasive procedures and irrigations, sexual activity, unreasonable treatment, refusal to restore eubiosis after antimicrobial and antifungal therapy, the presence of intrauterine devices, etc.
 Objective. To characterize the influence of the spread of antibiotic-resistant pathogens on the course of gynecological diseases.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Peculiarities of the vaginal infections course’ nowadays include prevalence of self-treatment, uncontrolled antibiotics (AB) use, the development of AB resistance, and the presence of extragenital pathology. Pelvic inflammatory disease (PID) comprise 75 % of all gynecological diseases. PID cause such complications as chronic pelvic pain syndrome, purulent tubo-ovarian tumors, cervical neoplasia, and infertility. The risk of the latter increases depending on the number of episodes of PID. Principles of PID treatment include comprehensiveness, etiopathogenetic orientation, individualization and recurrence prevention. Antibacterial therapy (ABT), nonsteroidal anti-inflammatory drugs, infusions, transfusions, detoxification therapy, medications aimed at the improvement of hemodynamics and microcirculation, immunotherapy, and topical therapy are used in the treatment of PID. The consequences of irrational ABT include an increase in the resistance of pathogenic flora, disruption of the normal body biocenosis, increased risk of adverse reactions, impaired immune function and increased treatment costs. Macrolides, cephalosporins, fluoroquinolones and aminoglycosides are the main groups of AB used for the systemic ABT in PID. Tobramycin (one of the latter group) is active against 83.4 % of pathogens that cause urogenital infections. Other advantages of tobramycin include synergism with β-lactams and high activity against Pseudomonas aeruginosa – a bacterium with a high and dangerous potential for AB resistance. In turn, fluoroquinolones are active against 94 % of pathogens that cause urogenital infections; they are able to penetrate cell membranes and have a low potential for the formation of AB resistance. The combination of fluoroquinolone levofloxacin with ornidazole (Grandazole, “Yuria-Pharm”) can improve the general condition and reduce pain on the 3rd day of treatment of PID, normalize the temperature, reduce hospital stay. Co-administration of levofloxacin and ornidazole as part of an infusion solution is more rational than their separate use. Such treatment minimizes the risk of allergic reactions and side effects. For local sanitation of vagina and vulva, it is advisable to use decamethoxine (Dekasan, “Yuria-Pharm”) – a basic antiseptic that acts on various types of bacteria, viruses, fungi and protozoa. Additional benefits are anti-inflammatory, desensitizing and antispasmodic action. Decamethoxine also effectively reduces the adhesion of staphylococci and Escherichia coli. One of the main advantages of decamethoxine is the lack of effect on human cells.
 Conclusions. 1. PID are the most common diseases in the field of obstetrics and gynecology. 2. Care should be taken when choosing a drug for ABT. 3. The combination of levofloxacin and ornidazole can effectively treat PID, reducing the duration of inpatient treatment. 4. For local sanitation of the vagina and vulva, it is advisable to use decamethoxine.

The Effect of Antibiotic Resistance on Therapeutic Outcomes of Urinary Tract Infections in Hospitalized Patients with UTI

The Effect of Antibiotic Resistance on Therapeutic Outcomes of Urinary Tract Infections in Hospitalized Patients with UTI

Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach.

Background: The consequences of antibiotic resistance are projected to be most severe in low and middle income countries with high infectious disease burden. This study examined determinants of inappropriate antibiotic use at the community level in rural Ghana.Methods: An observational study involving qualitative and quantitative methods was conducted between July, 2016 and September, 2018 in Ghana. Two household surveys were conducted at two time points (2017 and 2018) among 1,100 randomly selected households over 1 year. The surveys focused on antibiotic use episodes in the past month. Four in-depth interviews and two focus group discussions were performed to further explain the survey results. Determinants of inappropriate antibiotic use were assessed using a mixed effect logistic regression analysis (multilevel analysis) to account for the clustered nature of data. We defined inappropriate antibiotic use as either use without prescription, not completing treatment course or non-adherence to instruction for use. Qualitative data were thematically analyzed.Results: A total of 1,100 households was enrolled in which antibiotics were used in 585 (53.2%) households in the month prior to the surveys. A total of 676 (21.2%) participants out of 3,193 members from the 585 reportedly used antibiotics for 761 episodes of illness. Out of the 761 antibiotic use episodes, 659 (86.6%) were used inappropriately. Paying for healthcare without health insurance (Odds Ratio (OR): 2.10, 95% CI: 1.1–7.4, p-value: 0.026), not seeking healthcare from health centers (OR: 2.4, 95% CI: 1.2–5.0, p-value: 0.018), or pharmacies (OR: 4.6, 95% CI: 1.7–13.0, p-value: 0.003) were significantly associated with inappropriate antibiotic use. Socio-demographic characteristics were not significantly associated with inappropriate antibiotic use. However, the qualitative study described the influence of cost of medicines on inappropriate antibiotic use. It also revealed that antibiotic users with low socioeconomic status purchased antibiotics in installments which, could facilitate inappropriate use.Conclusion: Inappropriate antibiotic use was high and influenced by out-of-pocket payment for healthcare, seeking healthcare outside health centers, pharmacies, and buying antibiotics in installments due to cost. To improve appropriate antibiotic use, there is the need for ministry of health and healthcare agencies in Ghana to enhance healthcare access and healthcare insurance, and to provide affordable antibiotics.

Knowledge and self-confidence of antibiotic resistance, appropriate antibiotic therapy, and antibiotic stewardship among pharmacy undergraduate students in three Asian countries

Background and purposeTraining pharmacy students in infectious diseases (ID) is important to enable them to participate in antibiotic stewardship programs. This study evaluated knowledge and self-confidence regarding antibiotic resistance, appropriate antibiotic therapy, and antibiotic stewardship among final year pharmacy undergraduate students. MethodsA cross-sectional electronic survey was conducted at universities in Indonesia, Malaysia, and Pakistan. A 59-item survey was administered between October 2017 and December 2017. FindingsThe survey was completed by 211 students (response rate 77.8%). The mean knowledge score for antibiotic resistance, appropriate antibiotic therapy, and antibiotic stewardship was 5.6 ± 1.5, 4.7 ± 1.8 (maximum scores 10.0) and 3.1 ± 1.4 (maximum score 5.0), respectively. Significant variations were noted among the schools. There was poor awareness about the consequences of antibiotic resistance and cases with no need for an antibiotic. The knowledge of antibiotic resistance was higher among male respondents (6.1 vs. 5.4) and those who had attended antibiotic resistance (5.7 vs. 5.2) and antibiotic therapy (5.8 vs. 4.9) courses (p < 0.05). Students with ID clerkship experience (5.2 vs. 4.5) had significantly higher score for appropriate antibiotic therapy. ConclusionsFinal year pharmacy undergraduate students in Indonesia, Malaysia, and Pakistan had moderate knowledge of antibiotic resistance and antibiotic stewardship. However, the knowledge of appropriate antibiotic therapy was poor.

Awareness of Antibiotic Use and Resistance in Jordanian Community.

BackgroundThe public awareness toward the causes and consequences of antibiotic resistance (AR) is crucial to mitigate the inappropriate use of antibiotics (ABs), particularly in the low- and middle-income countries. There was no previous study that assessed the awareness, attitude, and knowledge about antibiotic use and AR among the Jordanian public in affluent and deprived areas.ObjectiveThis study aimed to assess the awareness, attitude, and knowledge about antibiotic use and AR in affluent and deprived areas in Jordan.SettingThe survey was conducted in November 2019 in Amman, the capital of Jordan.MethodA cross-sectional questionnaire was used to survey households in their areas in each of West Amman (affluent region) and East Amman (deprived region), Households were selected using proportionate random sampling method.ResultsA total of 620 householders (310 per area) completed the questionnaire. Pharmacists were perceived as strong influencers on householders’ decision, as 80.32% (n = 465/580) of those who used antibiotics in the last year follow pharmacists’ advice. Our results showed poor understanding of antibiotic usage among the Jordanian public, as only 14.2% (n = 44/310) of the sample in West Amman and 2.9% (n = 9/310) in East Amman disagreed with the statement “Antibiotics work on most coughs and colds.” Householders in West Amman showed much better understanding of AR compared to those in East Amman; 82.3% (n = 255/310) of West Amman respondents agreed with the statement “Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of the antibiotic.” compared to 31.9% (n = 99/310) of East Amman respondents on the same statement (P < .05).ConclusionThe Jordanian community generally had poor knowledge and awareness toward antibiotics use and AR. Socio-economic factors could influence the public’s attitude toward antibiotics use and AR.

Potential effects of natural dietary compounds on trimethylamine Noxide (TMAO) formation and TMAO-induced atherosclerosis

Cardiovascular disease (CVD) is the leading cause of death worldwide. Recently, trimethylamine N-oxide (TMAO) is identified to be highly associated with CVD development and exacerbates atherosclerosis by several mechanisms. TMAO is a gut microbiota-dependent metabolite formed from dietary quaternary amines, mainly choline and carnitine. These trimethylamine (TMA)-containing compounds are first converted to TMA by enzymes in gut microbiota and subsequently metabolized by the host hepatic enzymes to TMAO. As the microbiome is the source of TMAO, administration of broad spectrum antibiotics shows marked decrease in TMAO levels. However, antibiotics may possess many possible undesirable side effects and chronic treatment consideration effects of antibiotic resistance in bacteria. Thus, studies have focused on the alternative strategies, including use of natural dietary compounds to reduce elevated TMAO levels and prevent atherogenesis. Natural dietary compounds have been studied for their beneficial health effects for decades. Diet and nutritional interventions based on the use of natural bioactive compounds is an effective strategy for remodeling gut microbiota composition and improving human health. This review focuses on the mechanisms by which TMAO promote atherosclerosis, the microbes that contribute to TMA formation, the enzymes involved, and the potential of natural dietary compounds that contribute to TMAO reduction and attenuate TMAO-induced atherosclerosis.

Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections.

There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic-resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non-drug approaches to reduce bacteria functions related to orthopedic implant-associated infections. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:22-32, 2018.