Excessive Use Of Antibiotics Research Articles

PREVALENCE OF PLASMID MEDIATED QNRA, QNRB AND QNRS AMONG CLINICAL ESCHERICHIA COLI ISOLATED FROM URINARY TRACT INFECTIONS IN DUHOK, KURDISTAN REGION OF IRAQ

Excessive use of antibiotics (such as fluoroquinolone) and inadequate infection control practices have turned antibiotics resistance (AMR) into a global, public health peril. The current study emphasizes on the prevalence of qnrA, qnrB, and qnrS plasmid in fluroquinolone (FQ) resistant Escherichia coli (E. coli) isolates from urinary tract samples and their correlation with the burden of resistance in these isolates. In this research, several E. coli strains were isolated from outpatients having urinary tract infections (UTIs) from Duhok province, Kurdistan Region of Iraq. Biochemical and Molecular confirmations were performed to confirm the isolates. Antibiotics susceptibility test was performed to detect the isolates antibiogram. Furthermore, polymerase chain reaction (PCR) amplification was used to detect the qnrA, B and S genes. Bioinformatics tools were used to perform the analysis of the results and data visualization. Forty isolates (out of 55) have been confirmed as E. coli. Antibiograms revealed that 70%, 65% and 63% of the isolates were resistant to Ciprofloxacin, Enrofloxacin and Levofloxacin, respectively. While there was variation in resistance to other antibiotics tested. The FQ resistant genes were detected in 17 (42.5%) isolates, with some isolates carrying more than one gene. The variant qnrS was the most predominant, as it has been detected in 14 isolates. The increasing rates of multidrug resistance E. coli isolates from UTIs, including FQ antibiotics, emphasizes the importance of carefully monitoring their use for UTI treatment.

Molecular Investigation of gyrA Mutations in Clinical Isolates of Methicillin-Resistant Staphylococcus aureus Derived from Diverse Sources

Background: Fluoroquinolones are the most effective antibiotics against Staphylococcus aureus isolates. In hospitals, excessive use of antibiotics has led to the emergence of highly resistant strains of S. aureus isolates. Objective: The aim of this study was to detect the mutations that occur in the gyrA gene encoding for DNA gyrase, which is one of the targets for fluoroquinolone resistance. Methods: Fifty clinical isolates were diagnosed as S. aureus according to molecular and bacteriological methods. The susceptibility tests were performed on all bacterial isolates by the disc diffusion method using methicillin and six fluoroquinolone antibiotics. Results: Out of fifty isolates, twelve were resistant to methicillin and all six antibiotics (nalidixic acid, lomefloxacin, ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin). From the fifty isolates, 12 were resistant, 3 were intermediate, and 38 were sensitive to three or more tested antibiotics. The resistance of S. aureus isolates was also confirmed by the minimum inhibitory concentration test. The main sources of isolates were burns (10%), nose (16) wounds (8%), operation room (10%), ear (20%), urine (8%), skin (6%), and throat (22%). Twelve resistant isolates were used to examine the mutations in the gyrA gene. A direct sequence analysis found eight mutations in the gyrA gene; these mutations included 2 (25% missense mutations), 1 (12.5%) deletion mutation, and 5 (62.5%) silent mutations at various sites. Conclusion: gyrA mutations resulting from the excessive use of antibiotics may be one of the mechanisms leading to fluoroquinolone resistance.

A Review on Advanced Nanomaterials for Antibacterial Applications

Abstract: The management of infectious diseases is one of the major public health challenges of the 21st century. Mutation of the microbes, biofilm formation, and other structural-morphological behaviors have resulted in pathogens acquiring multi-drug resistance. The development of advanced materials that can provide long-lasting and effective protection against harmful microbes is becoming a need of the hour. Biocompatibility, efficient microbial inactivation, thermal and chemical stability of nanomaterials help to reduce the excessive use of antibiotics and, thus, to overcome antimicrobial resistance. Metal and metal oxide nanostructures, graphene, carbon dots, and other two-dimensional materials exhibit excellent antimicrobial properties. This review provides a comprehensive overview of antibacterial mechanisms and factors that help to inactivate the bacteria by nanomaterials. It also points out the enhanced antibacterial behaviors of the modified nanomaterials for future research concerns. Abstract: The management of infectious diseases is one of the major public health challenges of the 21st century. Mutation of the microbes, biofilm formation, and other structural-morphological behaviors have resulted in pathogens acquiring multi-drug resistance. The development of advanced materials that can provide long-lasting and effective protection against harmful microbes is becoming a need of the hour. Biocompatibility, efficient microbial inactivation, thermal and chemical stability of nanomaterials help to reduce the excessive use of antibiotics and, thus, to overcome antimicrobial resistance. Metal and metal oxide nanostructures, graphene, carbon dots, and other two-dimensional materials exhibit excellent antimicrobial properties. This review provides a comprehensive overview of antibacterial mechanisms and factors that help to inactivate the bacteria by nanomaterials. It also points out the enhanced antibacterial behaviors of the modified nanomaterials for future research concerns.

Nanomaterial-based fluorescent biosensors for the detection of antibiotics in foodstuffs: A review.

Antibiotics are widely used as bacteriostatic or bactericidal agents against various microbial infections in humans and animals. The excessive use of antibiotics has led to an accumulation of their residues in food products, which ultimately poses a threat to human health. In light of the shortcomings of conventional methods for antibiotic detection (primarily cost, proficiency, and time-consuming procedures), the development of robust, accurate, on-site, and sensitive technologies for antibiotic detection in foodstuffs is important. Nanomaterials with amazing optical properties are promising materials for developing the next generation of fluorescent sensors. In this article, advances in detecting antibiotics in food products are discussed with respect to their sensing applications, with a focus on fluorescent nanomaterials such as metallic nanoparticles, upconversion nanoparticles, quantum dots, carbon-based nanomaterials, and metal-organic frameworks. Furthermore, their performance is evaluated to promote the continuation of technical advances.

A new supramolecular fluorescent probe based on cucurbit[8]uril for visual determination of norfloxacin: Multi-color, quantitative detection, and practical applications

In recent years, the excessive use of antibiotics in agricultural by-products and aquaculture has attracted great attention due to its impact on human health and damage to ecosystems. Therefore, it is of great significance to detect antibiotics with sensitive and intuitive. In this paper, we report a novel fluorescence probe based on multiple chromaticity response for the rapid and sensitive detection of norfloxacin, in which the fluorescence probe was assembled through host–guest coordination between cucurbit[8]uril (Q[8]) and dibromoxanthen-9-one phenylpyridine cationic derivative (DBXPY), named DBXPY@Q[8]. With the addition of norfloxacin, the probe DBXPY@Q[8] provides a continuous fluorescence color change from yellow to blue, and even white fluorescence appears. In the presence of amino acids, pesticides, and other antibiotics, the probe remains unaffected in the detection of norfloxacin with a low detection limit (1.08 × 10−7 M). Interestingly, combined with smart phone RGB analysis, the probe DBXPY@Q[8] enables visual and quantitative detection of norfloxacin without any precision instrument and can be applied to the detection of norfloxacin in food and water. In contrast to traditional NOF detection methods, which are time-consuming, costly, and complex to operate, the use of fluorescent probes allows for the visual analysis and detection of NOF in water and food. It’s simple to operate, responsive, and can be monitored in real time, offering a significant improvement over conventional methods and has great application potential in field and quantitative analysis.

One Health strategies for addressing antimicrobial resistance: an exclusive emphasis on Bulgaria

Abstract Antimicrobial resistance (AMR) is a public health challenge, primarily driven by the excessive use of antibiotics (ABs). While the European Union (EU) has successfully reduced ABs consumption since 2009, Bulgaria (BG) reports an increase in ABs use in both community and hospital settings. According to the 2021 Eurobarometer, the consumption rate of ABs among Bulgarians is twice as high as that in Germany, with a significant number taking ABs without a prescription. Moreover, only 41% of Bulgarians are aware that ABs do not kill viruses, and 30% took ABs for COVID-19 (as compared to 1% in Finland). This highlights an urgent need for interventions to tackle AMR in BG, using One Health (OH) approaches that consider the complex interplay between human, animal, and environmental health. The data presented aims to alert a wide range of stakeholders that AMR is not just a clinical or national issue but it has cross-border implications. It emphasizes the role that everyone must play in preserving the efficacy of ABs. Strategies for sustainable OH solutions: Researchers and educators should incorporate AMR and OH in their core responsibilities, providing relevant training and raising community awareness regarding prudent ABs use. Encouraging integrative medicine approaches, including traditional practices such as phytotherapy, can help delay the ABs prescriptions. Research is also necessary to support OH legislative changes that restrict ABs sales. Particularly, Bulgaria is among the few EU countries that have not approved an OH Action Plan against AMR or an inter-sectoral OH mechanism between veterinary, food, and health authorities. OH remains relatively unfamiliar in BG. Despite this, there is a political will to develop national OH policies, as demonstrated in the recently adopted National Health Strategy 2030. Urgent actions are needed to address AMR in BG. Using EU's AMR activities as a model, this analysis is a step towards a regional OH project. Key messages • AMR is a pressing public health problem in Bulgaria with cross-border implications. One Health strategies are needed urgently to address it. EU's AMR activities can be a model. • Bulgarian researchers, educators, and policymakers must make AMR their central responsibility. OH Action Plan against AMR and an inter-sectoral collaboration are the keys to success.

Candida species at the workplace: microbiota component, opportunistic pathogen and zoonotic agent

Candida spp. isolated from both humans and animals have a similar genotype. Properties of Candida spp. specific for different host species have not been isolated, followed by studies indicating that animals can be a reservoir of these fungi for humans. Occupational exposure concerns workers who have direct contact with farm animals, i.e., farmers, breeders, veterinarians, farm technicians. Hand dermatitis and fungal infection may be caused by prolonged exposure to water and occlusive gloves. The risk of fungal infection is estimated to be high for seafood workers, florists, hairdressers, bakers and cooks, gastronomy workers and healthcare workers. Even though Candida spp. are effective as saprophytic, in the event of a weakening of the function or disturbance of homeostasis, the risk of developing an additional form of candidiasis is increasing due to the intensification of animal production, environmental changes and the excessive use of antibiotics to treat infections in humans and animals. Employers and workers should adopt appropriate strategies to reduce factors conductive to Candida spp. infection at professional work. Med Pr Work Health Saf. 2023;74(5):425-33.

The Change in Antimicrobial Resistance During the COVID-19 Pandemic in Türkiye

Antimicrobial resistance (AMR) is one of the most important problems threatening human health worldwide. The impact of the Coronavirus disease-2019 (COVID-19) pandemic on AMR continues to be discussed. Some researchers argue that the pandemic will increase AMR rates, while others suggest the opposite. The aim of this study was to investigate the change in AMR of Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus strains in three cross-sectional periods in Türkiye, the first one before the COVID-19 pandemic, the second and the third one during the pandemic. The change in antibiotic susceptibility in Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus strains isolated from urine, blood, and lower respiratory tract samples of patients hospitalized in intensive care units and wards of hospitals before (November 2019) and during the COVID-19 pandemic (November 2020 and July 2021) was investigated in this study. A total of 17 voluntary hospitals, members of the Antibiotic Susceptibility Surveillance Study Group (ADSI) of the Society for Clinical Microbiology Specialists (KLIMUD), participated in the study. Identification of bacteria was performed with automated bacterial identification systems (VITEK2, bioMérieux, France or Phoenix, BD, USA). Antibiotic susceptibility tests were performed in one center with the Kirby-Bauer disc diffusion method and in other centers with automated antibiotic susceptibility test systems (VITEK2, bioMérieux, France or Phoenix, BD, USA), and the results were evaluated according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Antibiotic susceptibility ratios were statistically analyzed using either the chi-square or Fisher's exact test. A p-value of < 0.05 was considered statistically significant. Antibiotic susceptibility test results of a total of 4030 strains; 1152, 1139, and 1739 belonging to November 2019, November 2020, and July 2021, respectively; were examined. While cefotaxime and ceftazidime susceptibility rates in E.coli strains increased during the pandemic period compared to previous period (p= 0.04, p= 0.001, respectively); nitrofurantoin sensitivity (p= 0.02) and extended-spectrum beta-lactamase (ESBL) ratios (p< 0.001) were found to be decreased. It was determined that the susceptibility rates of all other examined antimicrobials did not change statistically. It was observed that the susceptibility rates of all antibiotics in K.pneumoniae isolates decreased during the pandemic period, but the ESBL rates increased between 2019-2020 (p= 0.01) and decreased between 2020-2021 (p= 0.02). It was found that ESBL rates increased before and after the pandemic. It was observed that the susceptibility to ciprofloxacin (p= 0.0001), levofloxacin (p= 0.003), and gentamicin (p= 0.005) in S.aureus strains increased during the pandemic period. No significant changes were observed in other antibiotic susceptibility rates. Methicillin resistance of S.aureus (MRSA) strains decreased between 2019-2020 (p= 0.03) and increased again in 2021 (p= 0.04) and returned to the pre-pandemic rate. Our study results suggest that the measures taken to reduce the spread of COVID-19 with the pandemic (such as quarantine practices, increased hand hygiene, mask use, and national/international travel restriction) may reduce the spread of bacteria such as ESBL-producing E.coli and the rate of MRSA, which is considered as a hand hygiene indicator. The increase in the later stages of the pandemic recalls the relaxation in compliance with hand hygiene rules. The decrease in the susceptibility rate of K.pneumoniae isolates to antibiotics and the increase in the ESBL rate may be due to inappropriate and excessive use of antibiotics during the pandemic period. However, we believe that these data should be supported by studies to be conducted nowadays when all the rules and measures are back as if the pandemic has ended.

Burden of Salmonella Typhi Isolated from Bloodstream Infection from 2015 to 2020: A Systematic Review and Meta-analysis

Background: Bangladesh is a major contributor to the global problem of typhoid fever, which is predominantly caused by Salmonella typhi. This is due to Bangladesh’s subpar healthcare standards, inadequate cleanliness standards, and inappropriate and excessive use of antibiotics. Objective: Salmonella typhi antibiotic resistance and the current situation of typhoid fever in Bangladesh were the subjects of this systematic review. Methodology: Finding publications about Salmonella typhi in Bangladesh published between 2015 and 2020 required searching Google Scholar, PubMed, and Bangladesh Journals Online with pertinent keywords. A predetermined set of criteria determined who would be included or excluded. Results: Initially,50 articles were retrieved. Using PRISMA flow chart 5 were selected for the study. Through forest plot, the overall effect size is found 0.28 which is represented by a diamond with confidence interval of 0.06 – 0.50. Since the confidence interval does not cross the threshold of no impact, the p value is 0.00. We can conclude that the overall effect is statistically significant. Microsoft excel was used to figure out the trend of antibiotic resistance. The effect size of an article was 0.08 (95%CI 0.05 – 0.11) and weighted 20.44%. Another study was reported with the effect size of 0.07 (95%CI 0.00 – 0.14) and weighted 20.07%. Conclusions: S. typhi was shown to be quite prevalent, and there were also significant surveillance and data gaps in the research’ methodological data. Bangladesh Journal of Infectious Diseases, June 2023;10(1):3-10

Two–step pulsed laser ablation for preparation NiO@ZnO core-shell nanostructure and evaluation of their antibacterial activity

The excessive use of antibiotics led to the appearance of many strains of resistant bacteria, so it became necessary to use new antibacterial techniques. The aim of this work is the synthesis of novel core–shell NPs (NiO@ZnO) for antibacterial applications. A novel NiO@ZnO core–shell nanomaterial with a nanosize and uniform shape has been synthesised using the two-step pulsed laser ablation in liquid (PLAL) method. The first step is the laser ablation of the nickel target and the production of NiO NPs (core) colloidal, followed by the second step, the ablation of ZnO (shell) inside NiO NPs colloidal. The transmission electron microscopy results approve the formation of NiO@ZnO core–shell NPs with an average particle size of 54.4 nm for NiO particles and 60.7 nm for the NiO@ZnO core–shell. The antibacterial activity was examined against the pathogenic bacterial strains E. coli and S. aureus. We found that in the case of NiO, the inhibition rates were 62.4 and 59.2% for E. coli and S. aureus, respectively. While with NiO@ZnO NPs, this result was improved to 74.8% for E. coli and 71.2% for S. aureus. So, it was found that using the core–shell NPs increased the antibacterial activity of NPs, and the use of NiO NPs and core approved their effect as antibacterial agents due to their special properties. This behaviour is primarily because of the accumulation of the NiO@ZnO NPs on the surface of the bacteria, which leads to cytotoxic bacteria and a relatively increased ZnO, causing cell death. Furthermore, the use of a NiO@ZnO core–shell material will inhibit the bacteria from nourishing themselves on the culture medium. Therefore, core shelling metal oxides with another metal oxide or other material improves their antibacterial activity compared with using them alone.

Pediatric orbital subperiosteal abscess outbreak in Iran: characteristics and causes.

To evaluate demographics, characteristics, and management of pediatric patients with subperiosteal abscesses (SPA) secondary to orbital cellulitis and discuss the etiology of a dramatic rise in SPA. Data were gathered by retrospective chart review of patients admitted to a tertiary referral eye hospital (Farabi Eye Hospital) diagnosed with orbital cellulitis with subperiosteal abscess from October 2022 to March 2023 (six months). Data on demographic information, clinical examination, radiographic evidence of sinusitis, orbital cellulitis, SPA, surgical and non-surgical management taken, isolated bacteria, and duration of hospital stay were gathered. 24 patients were admitted during these six months, with a diagnosis of orbital SPA secondary to paranasal sinusitis, confirmed by an orbital Computed Tomography (CT) scan. The age range was 11 months to 16 years. 75% of patients were male. All patients had a history of flu-like illness before developing orbital cellulitis. All patients had concurrent sinusitis, and 18 underwent initial surgical abscess drainage. The ethmoid sinus was the most involved, and most patients had a medially located SPA. Abscess volume ranged from 0.78 to 7.81 cm3 (mean: 3.52 cm3). One patient had concurrent central retinal artery occlusion due to orbital cellulitis. In this study, we report a dramatic increase in the incidence of SPA referred to our hospital. Larger abscess volumes and an increased number of cases that needed initial surgical drainage are also of note. An influenza outbreak in the autumn and winter, undiagnosed Corona Virus Disease 2019 (COVID-19) infection, increased antimicrobial resistance due to excessive off-label use of antibiotics during the COVID-19 pandemic, and more virulent bacterial infections are the most probable hypotheses to justify this observation.

Electromembrane extraction – capillary zone electrophoresis for the quantitative determination of β-lactam antibiotics in milk samples

Three penicillin-based β-lactam antibiotics (benzylpenicillin, amoxicillin, and ampicillin) were extracted by electromembrane extraction (EME) and determined in the resulting extracts by capillary zone electrophoresis (CZE) with UV–Vis detection. The EME was optimized for the simultaneous clean-up of complex samples and preconcentration of the three antibiotics and employed 1-octanol as the organic phase interface (impregnated in the pores of a hollow fiber), acidified donor solution (pH 3), and phosphate buffer (pH 5.6) as the acceptor solution. The EMEs were carried out for 20 min at 300 V and constant stirring (750 rpm) of the donor solution. At the optimized EME-CZE conditions, the sensitivity of the analytical method was sufficient for the determination of the three β-lactam antibiotics in undiluted cow's milk at concentrations below the EU maximum residue limits (4 μg/L) in foodstuffs. The method was simple, rapid, and convenient and offered extraction recoveries of 13.5 – 87.3 %, enrichment factors of 23.6 – 152.8, repeatability (RSD values) better than 7.6 %, linear analytical response in the 1 – 100 μg/L (3 – 100 μg/L for benzylpenicillin) concentration range with correlation coefficients ≥ 0.9997, and limits of detection from 0.2 to 1.2 μg/L. The proposed analytical concept was used for the rapid control of milk quality (i.e. assessment of excessive use of antibiotics in dairy animals), moreover, it was further extended to the trace determination of β-lactam antibiotics in other complex samples, such as in wastewater.

A Comparative Assessment of High-Throughput Quantitative Polymerase Chain Reaction versus Shotgun Metagenomic Sequencing in Sediment Resistome Profiling

Prolonged and excessive use of antibiotics has resulted in the development of antimicrobial resistance (AMR), which is considered an emerging global challenge that warrants a deeper understanding of the antibiotic-resistant gene elements (ARGEs/resistomes) involved in its rapid dissemination. Currently, advanced molecular methods such as high-throughput quantitative polymerase chain reaction (HT-qPCR) and shotgun metagenomic sequencing (SMS) are commonly applied for the surveillance and monitoring of AMR in the environment. Although both methods are considered complementary to each other, there are some appreciable differences that we wish to highlight in this communication. We compared both these approaches to map the ARGEs in the coastal sediments of Kuwait. The study area represents an excellent model as it receives recurrent emergency waste and other anthropogenic contaminants. The HT-qPCR identified about 100 ARGs, 5 integrons, and 18 MGEs (total—122). These ARGs coded for resistance against the drug classes of beta-lactams &gt; aminoglycoside &gt; tetracycline, macrolide lincosamide streptogramin B (MLSB) &gt; phenicol &gt; trimethoprim, quinolone, and sulfonamide. The SMS picked a greater number of ARGs (402), plasmid sequences (1567), and integrons (168). Based on the evidence, we feel the SMS is a better method to undertake ARG assessment to fulfil the WHO mandate of “One Health Approach.” This manuscript is a useful resource for environmental scientists involved in AMR monitoring.

Antimicrobial stewardship and clinical pharmacist interventions in an Indian tertiary care hospital

AbstractObjectiveComprehensive antimicrobial stewardship programs (ASPs) are needed in Indian healthcare settings due to high rates of communicable diseases and excessive antibiotic use. However, the implementation of both ASPs and clinical pharmacists (CPs) into the system is still in its nascent stages in India. Therefore, our study aims to evaluate the type and acceptance rates of CP interventions in the implementation of ASPs and its impact on antimicrobial utilization.MethodsA single‐center quasi‐experimental study was conducted at Jehangir Hospital, India, wherein prescribed antimicrobials were subjected to evaluation by CPs using the prospective audit and feedback approach. The antimicrobials were reviewed for loading dose, dosages as per creatinine clearance (CrCl), weight, suitability with site of infection, drug interactions, de‐escalations, and therapeutic duplications. Impact on antimicrobial utilization in pre‐intervention (April 2021 to March 2022) and intervention (April 2022 to March 2023) periods were compared using daily defined dose (DDD) per 1000 in‐patient days, following World Health Organization (WHO) guidelines.ResultsDuring the intervention period, 485 out of 609 proposed interventions (79.6%) were implemented. Of these, 417 (85.9%) pertained to intravenous (IV) antimicrobials, while the remaining 68 (14.1%) involved oral formulations. Notably, interventions proposing antibiotic de‐escalations showed higher acceptance rates on Days 3, 5, 7, and 10 compared with other days (p = 0.027). Dosing based on CrCl yielded the highest acceptance rate (50/56, 89.2%). Significant reductions were observed in the DDDs of polymyxins by 58% (3.48–1.29), carbapenems by 7% (57.09–52.85), and glycopeptides by 10% (47.44–42.73). The reduction in these three classes combined was statistically significant (p = 0.04, 95% confidence interval [CI] = 0.3–7.0).ConclusionThis study highlights the vital role of CP interventions within the healthcare team in optimizing antimicrobial pharmacotherapy. The noteworthy reduction in DDDs of restricted antimicrobials provides compelling evidence of the impact CPs can have on antimicrobial consumption and the fight against antimicrobial resistance.

Label-free and highly sensitive immunosensor based on L-cysteine capped vanadium disulfide quantum dots for amoxicillin detection

Excess and unmonitored use of antibiotics across globe is rapidly leading to antibiotics resistance. Thus, early-stage detection of antibiotics resistance has become necessary to monitor and control their use to reduce the side effects. Amoxicillin (Amoxi) is a type of beta-lactam antibiotic that is often used to treat bacterial infections. Herein, L-cysteine capped vanadium disulphide quantum dots (L-CYST-VS2QDs) were synthesized via hydrothermal method and used to construct an electrochemical immunosensor for Amoxi detection. To prepare Ab-Amoxi/L-CYST-VS2QDs/ indium tin oxide coated glass (ITO) immunoelectrode, monoclonal antibodies against Amoxi were immobilized on the L-CYST-VS2QDs/ITO followed by blocking uncovered sites with BSA. This BSA/Ab-Amoxi/L-CYST-VS2/ITO bioelectrode was revealed selective and specific interaction towards Amoxi among various other antibiotics. The immunoelectrode showed linearity within 1 pM to 100 µM range, with sensitivity of 4.827 µA nM−1 cm2, and detection limit of 0.5 pM, with better results than chitosan–TGA-VS2QDs based immunosensor. The applicability in real sample testing was proved by monitoring the response in spiked fish samples, which yielded positive outcomes.

Nanofibrous Dressing with Nanocomposite Monoporous Microspheres for Chemodynamic Antibacterial Therapy and Wound Healing.

The excessive use of antibiotics and consequent bacterial resistance have emerged as crucial public safety challenges for humanity. As a promising antibacterial treatment, using reactive oxygen species (ROS) can effectively address this problem and has the advantages of being highly efficient and having low toxicity. Herein, electrospinning and electrospraying were employed to fabricate magnesium oxide (MgO)-based nanoparticle composited polycaprolactone (PCL) nanofibrous dressings for the chemodynamic treatment of bacteria-infected wounds. By utilizing electrospraying, erythrocyte-like monoporous PCL microspheres incorporating silver (Ag)- and copper (Cu)-doped MgO nanoparticles were generated, and the unique microsphere-filament structure enabled efficient anchoring on nanofibers. The composite dressings produced high levels of ROS, as confirmed by the 2,7-dichloriflurescin fluorescent probe. The sustained generation of ROS resulted in efficient glutathione oxidation and a remarkable bacterial killing rate of approximately 99% against Staphylococcus aureus (S. aureus). These dressings were found to be effective at treating externally infected wounds. The unique properties of these composite nanofibrous dressings suggest great potential for their use in the medical treatment of bacteria-infected injuries.

The effect of a tailored message package for reducing antibiotic use among respiratory tract infection patients in rural Anhui, China: a cluster randomized controlled trial protocol

BackgroundAntibiotics are over-used for patients with respiratory tract infections (RTIs) in primary care, especially in the rural areas of China.MethodsA cluster randomized controlled trial (RCT) will be carried out to estimate the effectiveness of a tailored message package for educating patients to reduce antibiotic use for symptomatic respiratory tract infections (RTIs). In the intervention group, patients will receive 12 short messages in 12 consecutive days. The whole process of the message design, modification, translation (of substitution variables), and sending will be facilitated by a user-friendly mini-computer program. The primary measure for assessment is the reduction in number of days in which antibiotics are used by patients with symptomatic RTIs. The secondary measures include (1) patients’ knowledge about and attitude toward antibiotics; (2) patients’ quality of life (EQ-5D-5L) and symptom severity and duration; (3) times of re-visits to clinics and antibiotics re-prescription for the same RTI episode; and (4) times of re-occurrence of RTIs and related health service seeking and antibiotics consumption.DiscussionThis study will determine the efficacy of a 12-message intervention to educate patients to reduce excessive antibiotic use in rural China.Trial registrationISRCTN29801086. Registered on 23 September 2022.

Quick Detection of Proteus and Pseudomonas in Patients' Urine and Assessing Their Antibiotic Susceptibility Using Infrared Spectroscopy and Machine Learning.

Bacterial resistance to antibiotics is a primary global healthcare concern as it hampers the effectiveness of commonly used antibiotics used to treat infectious diseases. The development of bacterial resistance continues to escalate over time. Rapid identification of the infecting bacterium and determination of its antibiotic susceptibility are crucial for optimal treatment and can save lives in many cases. Classical methods for determining bacterial susceptibility take at least 48 h, leading physicians to resort to empirical antibiotic treatment based on their experience. This random and excessive use of antibiotics is one of the most significant drivers of the development of multidrug-resistant (MDR) bacteria, posing a severe threat to global healthcare. To address these challenges, considerable efforts are underway to reduce the testing time of taxonomic classification of the infecting bacterium at the species level and its antibiotic susceptibility determination. Infrared spectroscopy is considered a rapid and reliable method for detecting minor molecular changes in cells. Thus, the main goal of this study was the use of infrared spectroscopy to shorten the identification and the susceptibility testing time of Proteus mirabilis and Pseudomonas aeruginosa from 48 h to approximately 40 min, directly from patients' urine samples. It was possible to identify the Proteus mirabilis and Pseudomonas aeruginosa species with 99% accuracy and, simultaneously, to determine their susceptibility to different antibiotics with an accuracy exceeding 80%.

Antibiotics for preventing infection at the surgical site: Single dose vs. multiple doses

BackgroundSurgical site infections are common and expensive infections that can cause fatalities or poor patient outcomes. To prevent these infections, antibiotic prophylaxis is used. However, excessive antibiotic use is related to higher costs and the emergence of antimicrobial resistance. ObjectivesThe present meta-analysis aimed to compare the effectiveness of a single dosage versus several doses of antibiotics in preventing the development of surgical site infections. MethodsPubMed was used to find clinical trials evaluating the effectiveness of a single dosage versus several doses of antibiotics in avoiding the development of surgical site infections. The study included trials that were published between 1984 and 2022. Seventy-four clinical trials were included in the analysis. Odds ratios were used to compare groups with 95% confidence intervals. The data were displayed using OR to generate a forest plot. Review Manager (RevMan version 5.4) was used to do the meta-analysis. ResultsRegarding clean operations, there were 389 surgical site infections out of 5,634 patients in a single dose group (6.90%) and 349 surgical site infections out of 5,621 patients in multiple doses group (6.21%) (OR = 1.11, lower CI = 0.95, upper CI = 1.30). Regarding clean-contaminated operations, there were 137 surgical site infections out of 2,715 patients in a single dose group (5.05%) and 137 surgical site infections out of 2,355 patients in multiple doses group (5.82%) (OR = 0.87, lower CI = 0.68, upper CI = 1.11). Regarding contaminated operations, there were 302 surgical site infections out of 3,262 patients in a single dose group (9.26%) and 276 surgical site infections out of 3,212 patients in multiple doses group (8.59%) (OR = 1.11, lower CI = 0.84, upper CI = 1.47). In general, there were 828 surgical site infections out of 11,611 patients in a single dose group (7.13%) and 762 surgical site infections out of 11,188 patients in multiple doses group (6.81%) (OR = 1.05, lower CI = 0.93, upper CI = 1.20). The difference between groups was not significant. ConclusionThe present study showed that using a single-dose antimicrobial prophylaxis was equally effective as using multiple doses of antibiotics in decreasing surgical site infections.

Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative.

In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU), we launched a 5-year multidisciplinary quality improvement (QI) initiative in our NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from 22 to 17%. The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements of antibiotic stewardship and focused on improving gaps in knowledge by using updated standards of care and a multidisciplinary approach. Outcome measures included overall AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly. The AUR demonstrated a decline at the onset, and at the end of the initiative the AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR of 22%. The changes that were implemented included development of evidence-based guidelines for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds, sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and 36-hour hard stop), and periodic reviews. Our multidisciplinary approach using all the core elements of an antibiotic stewardship program significantly decreased AUR in our NICU. · Excessive use of antibiotics may cause harm to the infant's health.. · Indiscriminate use of antibiotics can lead to antibiotic resistance.. · Stewardship programs can significantly decrease AUR in NICUs..