Frequent Use Of Antibiotics Research Articles

Evaluation of risk factors, causative pathogens, and treatment in recurrent percutaneous nephrostomy catheter-related urinary tract infections in cancer patients

In cancer patients, percutaneous nephrostomy (PN) catheters can be used to relieve obstruction from chemotherapy, radiation therapy, or surgery, thereby improving kidney function and preventing further kidney damage. One of the complications of PN catheters is infections. Recurrent infections may delay chemotherapy, increase antimicrobial resistance with frequent antibiotic use, deteriorate the quality of life of patients, and increase costs. In this study, it was aimed to evaluate risk factors, causative pathogens, and treatment in recurrent PN catheter-related urinary tract infections in cancer patients. Cancer patients with PN catheter-associated urinary tract infection who were followed-up in the Infectious Diseases and Clinical Microbiology Clinic between January 1, 2012 and December 31, 2021 were included in the study. The total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were significantly higher in patients with recurrent infection when compared to the other group (P = .000, P = .000, P = .007, and P = .018, respectively). ESBL-positive Escherichia coli and ESBL-positive Klebsiella pneumoniae were most commonly isolated from the PN catheter urine cultures of patients with recurrent infections. Long-term use of the PN catheter increases the risk of urinary tract infection and sepsis. In this study, the total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were found to be risk factors for the development of recurrent PN catheter-related urinary tract infection in cancer patients. It is important to know the risk factors in recurrent PN catheter-related urinary tract infections in cancer patients, take maximum protective measures, and follow-up. Knowing both the causative profile and the resistance rates will increase the chance of success in the treatment when empirical treatment is required. It should also be noted that these patients should be included in the group of patients who need prophylaxis for urinary tract infection.

Antibiotic Resistance pattern/ Multiple drug Resistance Index of Water-borne Bacteria isolated from Underground well Water of some Wards in Gusau Metropolis Zamfara State

Resistance of bacteria to many antibiotics is now a challenge that has become a source of mortality in many countries. Pathogens that are previously susceptible are now becoming resistant and are spreading among water bodies. This study will determine the Antibiotic Resistance pattern and Multiple drug Resistance Index of Water-borne bacteria isolated from Underground well Water of some Wards in Gusau metropolis. Eighteen water samples were collected from 6 locations (three from each) in Gusau. These samples were plated, cultured and emerging strain of bacteria were isolated and characterized using standard biochemical method. 24 bacterial isolates were found and characterized into eight genera. The bacteria with the highest frequency was Pseudomonas spp. (29.2%) followed by Shigella spp.and Alicaligenes with (16.7%) then (12.5%) Citrobacter freudii, Salmonella spp and Proteus mirabilis with (8.3%) followed finally by Serratia and Yersinia (4.2%). Antibiotic resistance patterns were determined using disk-diffusion method. Twelve antibiotics belonging to the class B-lactams were tested. The isolates show 96 % resistance to Cefotaxime, 92% Ampiclox, 87.5% Cefuroxime, 75% Amoxicillin and Imipenem, 50% Nalidixic acid, 33.3% Gentamycin, 8.3% Oflaxacin and 4.2 % Cefexime. It was observed that the isolates were 100% susceptible to Lovofloxacin, 96% Cefexime, 92% Ofloxacin, 75% Ceftriaxone sulbactarm, 66.7% Gentamycin, 58% Nitrofurantoin, 50% Nalidixic acid, 25% Amoxicillin, 12.5% Cefuroxime, 8.3% Ampiclox, and 4.2% Cefotaxime. A MAR index > 0.2 was observed for the isolates, indicating frequent antibiotic use in the area.

Carbonaceous Catalyst Activated Persulfate for Degradation of Antibiotic Pollutants in Water

In recent years, the frequent use of antibiotics has led to the continuous release of antibiotics into the water environment, which not only poses a potential threat to public health, but also contributes to the generation and spread of antibiotic resistance. In addition, due to the high environmental persistence and low biodegradability of antibiotics, it is difficult to be effectively degraded by traditional water treatment processes. Therefore, it is urgent to develop clean and efficient treatment technologies. Advanced oxidation processes (AOPs), which can effectively remove refractory organic pollutants from water, has become a promising water treatment technology. In this regard, persulfate (PS)-based AOPs (PS-AOPs) has attracted extensive attention of researchers. In this system, PS can be activated by energy and catalysts to produce highly oxidizing active species, and achieve efficient degradation of antibiotics. Due to its rich surface functional groups, high specific surface area and high adsorption properties, researches on the activation of PS by carbonaceous materials have been reported continuously. In this paper, the research progress of carbon nanotubes, graphene, biological carbon, active carbon and hetero-atom doped carbon materials as catalysts to activate PS and degrade antibiotics is reviewed. In addition, the structure and properties of different carbon materials and the activation mechanism of free radical and non-free radical mediated by carbon materials were introduced, and the effects of PS dosage, catalyst dosage, temperature and pH on the degradation of antibiotics were discussed. Finally, this paper points out the important development direction in the future, that is, the development of environmental protection, high efficiency, low cost carbon materials and further research on the actual wastewater treatment performance.

Simultaneous determination of 22 antibiotics in environmental water samples by solid phase extraction-high performance liquid chromatography-tandem mass spectrometry

The widespread and frequent use of antibiotics to treat diseases or encourage animal growth has resulted in their persistence and accumulation in water, soil, and sediments. As a typical emerging pollutant in the environment, antibiotics have become an important research focus in recent years. Antibiotics are commonly found at trace levels in water environments. Unfortunately, the determination of various types of antibiotics, all of which exhibit different physicochemical properties, remains a challenging endeavor. Thus, developing pretreatment and analytical techniques to achieve the rapid, sensitive, and accurate analysis of these emerging contaminants in various water samples is an essential undertaking.In this paper, a solid phase extraction-high performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS) method for the simultaneous determination of 22 antibiotics including 4 penicillins, 12 quinolones and 6 macrolides in environmental water samples was developed. Based on the characteristics of the screened antibiotics and sample matrix, the pretreatment method was optimized, focusing on the SPE column, pH of the water sample, and amount of ethylene diamine tetra-acetic acid disodium (Na2EDTA) added to the water sample. Prior to extraction, a 200 mL water sample was added with 0.5 g of Na2EDTA and pH-adjusted to 3 using sulfuric acid or sodium hydroxide solution. Water sample enrichment and purification were achieved using an HLB column. HPLC separation was carried out on a C18 column (100 mm×2.1 mm, 3.5 μm) via gradient elution with a mobile phase composed of acetonitrile and 0.15% (v/v) formic acid aqueous solution. Qualitative and quantitative analyses were performed on a triple quadrupole mass spectrometer in multiple reaction monitoring mode using an electrospray ionization source. The results showed correlation coefficients greater than 0.995, indicating good linear relationships. The method detection limits (MDLs) and limits of quantification (LOQs) were in the ranges of 2.3-10.7 ng/L and 9.2-42.8 ng/L, respectively. The recoveries of target compounds in surface water at three spiked levels ranged from 61.2% to 157%, with relative standard deviations (RSDs) of 1.0%-21.9%. The recoveries of target compounds in wastewater at three spiked levels were 50.1%-129%, with RSDs of 1.2%-16.9%. The method was successfully applied to the simultaneous determination of antibiotics in reservoir water, surface water, sewage treatment plant outfall, and livestock wastewater. Most of the antibiotics were detected in watershed and livestock wastewater. Lincomycin was detected in 10 surface water samples, with a detection frequency of 90%, and ofloxacin showed the highest contents (127 ng/L) in livestock wastewater. Therefore, the present method exhibits excellent performance in terms of MDLs and recoveries compared with previously reported methods. The developed method presents the advantages of small water sample volumes, wide applicability, and fast analysis times; thus, it can be considered a rapid, efficient, and sensitive analytical method with excellent potential for monitoring emergency environmental pollution. The method could also provide a reliable reference for formulating antibiotic residue standards. The results provide strong support for and an improved understanding of the environmental occurrence, treatment, and control of emerging pollutants.

Aminoquinoline-triazine Conjugates: Design, Synthesis, Antibacterial Activity, and SAR Analysis

Aim: Frequent use of antibiotics is responsible for the development of antibiotic resistance; thus, there is an urgent need for the development of new antibacterial agents that act by novel mechanism pathways. Objective: The aim of the study was to develop hybrid novel 4-aminoquinoline 1,3 5-triazine derivatives and determine their antibacterial activity. Methods: Novel hybrid 4-aminoquinoline 1,3,5-triazine derivatives were synthesized by nucleophilic substitution and characterized by different spectroscopic methods. Furthermore, in silico study was carried out with 16S-rRNA A-site (PDB id: 1J7T using Discovery Studio 2018 software) to exemplify key structural interactions. In vitro antibacterial activity of target compounds was evaluated against three Gram-positive and three Gram-negative bacterial strains. Result: In silico results have shown compound 8c to have both hydrophobic interactions (conventional hydrogen bond interactions with A A:16, A A:17 and carbon hydrogen bond with U A:14, G A:15) and hydrophilic interactions (G A:18G A:13, G A:15 and U A:19) along with excellent CDocker energy (- 28.2942). In vitro antibacterial results revealed that compound 8c showed better zone of inhibition against S. aureus (gram-positive) and E. coli (gram-negative) as compared to standard drug Cefixime. Conclusion: Our study demonstrated that in silico study supported the experimental study, and the developed 1,3,5-triazine-4-aminoquinoline derivatives may be used as potential leads for future antibacterial drug development.

Emergence of OXA-484-Producing Klebsiella variicola in China.

The frequent and inappropriate use of antibiotics has caused a dramatic rise in the number, species, and degree of multi-drug resistant bacteria, making them more prevalent and difficult to treat. In this context, the aim of the present study was to characterize the OXA-484-producing strains isolated from a perianal swab of a patient by using whole-genome analysis. In this study, carbapenemase-producing Klebsiella variicola was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), average nucleotide identity (ANI) and PCR. S1 nuclease pulsed-field gel electrophoresis (S1-PFGE) and Southern blotting were utilized to characterize the plasmid profiles of K. variicola 4717. In particular, WGS was performed to obtain genomic information on this clinical isolate, and assemble all the plasmids of the bla OXA-484-harboring strain. The antimicrobial susceptibility pattern of K. variicola 4717 revealed that it was resistant to a range of antibiotics, including aztreonam, imipenem, meropenem, ceftriaxone, cefotaxime, ceftazidime, levofloxacin, ciprofloxacin, piperacillin-tazobactam, methylene-sulfamer oxazole, amoxicillin-clavulanic acid, cefepime, and tigecycline. Its susceptibility to chloromycin was intermediate, while it was still susceptible to amikacin, gentamicin, fosfomycin, and polymyxin B. The presence of two companion plasmids, p4717_1 and p4717_2, together with a plasmid carrying the bla OXA-484 gene was observed. An in-depth investigation of p4717-OXA-484 uncovered that it is an IncX3-type plasmid and shares a similar segment encoded by IS26. Given the similar genetic background, it was conceivable that bla OXA-484 could have developed from bla OXA-181 through a series of mutations. Herein, we described the first genome sequence of K. variicola strain harbouring the class D β-actamase bla OXA-484 in an Inc-X3-type plasmid. Our work also uncovered the genetic characterization of K. variicola 4717 and the importance of initiating antimicrobial detection promptly.

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

Frequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19. We did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344). We included 148 studies of 362 976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I2=95%). Although infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed. WHO.

Orange peel-derived Cu2O/RGO nanocomposite: Mesoporous binary system for degradation of doxycycline in water.

The online version contains supplementary material available at 10.1007/s10668-022-02895-2.

Intestinal parasite infections among internal war refugees and inhabitants of the Ternopil region, Western Ukraine.

The armed aggression of the Russian Federation against Ukraine resulted in the destruction of the country's infrastructure and a decline in the standard of living for many citizens (e.g. shortages of electricity and safe drinking water, limited access to healthcare, living in unsuitable cold basements). A lot of Ukrainians living in the eastern, southern and central parts of the country were forced to flee their homes. The aim of this study was to assess the prevalence of intestinal parasite infections among internal war refugees and residents of Ternopil, a city in Western Ukraine, in response to the worsening of the epidemiological situation in the country. Parasitological diagnostics was carried out in June 2023 and involved 127 adult Ukrainian citizens aged 19-80 years old, including 80 internal war refugees (most of the participants came from Donetsk, Luhansk, Dnipro, Kherson regions) and 47 residents of Ternopil region, Western Ukraine. Surveys and parasitological examination of stool samples by three different light microscopy testing methods (direct smear, decantation, flotation) were performed. The samples were then tested for the presence of Giardia intestinalis intestinal protozoa by molecular tests (reverse transcription polymerase chain reaction [RT-PCR]) and immunochromatographic rapid diagnostic tests (RDTs). All RT-PCR and RDT tests to detect Giardia intestinalis were found to be negative. The examination of faecal samples taken from 127 patients showed no infections with nematodes, cestodes or trematodes. The examinations only revealed infections with potentially pathogenic Blastocystis spp.: 18/80 infections in the population of internal war refugees (22.5%) and 7/47 infections among residents of the Ternopil region (14.9%). Survey results demonstrated frequent use of antibiotics and antiparasitic drugs without physician advise or prescription: 43.9% of the study participants (n = 127) were taking antibiotics, and 25.2% were taking antiparasitic drugs during the period of 3 months prior to the study. An absence of intestinal parasite pathogens was detected in the studied population. The authors may explain it by the fact, that many Ukrainian patients have unlimited access to antimicrobial drugs (drugs sold without a valid prescription and taken without consultation with a physician), which could have contributed to the low incidence of intestinal parasite infections.

Antibacterial Chemodynamic Therapy: Materials and Strategies.

The wide and frequent use of antibiotics in the treatment of bacterial infection can cause the occurrence of multidrug-resistant bacteria, which becomes a serious health threat. Therefore, it is necessary to develop antibiotic-independent treatment modalities. Chemodynamic therapy (CDT) is defined as the approach employing Fenton and/or Fenton-like reactions for generating hydroxyl radical (•OH) that can kill target cells. Recently, CDT has been successfully employed for antibacterial applications. Apart from the common Fe-mediated CDT strategy, antibacterial CDT strategies mediated by other metal elements such as copper, manganese, cobalt, molybdenum, platinum, tungsten, nickel, silver, ruthenium, and zinc have also been proposed. Furthermore, different types of materials like nanomaterials and hydrogels can be adopted for constructing CDT-involved antibacterial platforms. Besides, CDT can introduce some toxic metal elements and then achieve synergistic antibacterial effects together with reactive oxygen species. Finally, CDT can be combined with other therapies such as starvation therapy, phototherapy, and sonodynamic therapy for achieving improved antibacterial performance. This review first summarizes the advancements in antibacterial CDT and then discusses the present limitations and future research directions in this field, hoping to promote the development of more effective materials and strategies for achieving potentiated CDT.

Prevalence of Multidrug Resistance Gram Negative Bacteria among Patients with Bacteremia in Erbil, Iraq

Background: The presence of microorganisms in a patient's blood is a critical determinant of the severity of the patient's illness and its complication is one of the main infective causes of mortality and morbidity. Early and prompt antibiotic therapy based on the knowledge of the prevalent microorganisms can help reduce this rate.
 Objectives: Our study aimed to carry out prevalence study on bacteremia isolated from blood samples among patients in Erbil city and analyze its antibiotics susceptibility pattern test and multi-drug resistance.
 Materials and Methods: A total of 1023 from 2015 until 2021 bacteremia were isolated from patients blood samples attending (Nanakali, Raparin, Maryamana) hospitals and BIO lab from both male and female. Only 57 cases had been identified as bacteremia isolates which were identified by using microscopical, macroscopical identification, cultural, BacT/ALERT and vitek 2 compact system. Also antibiotic susceptibility test was performed by vitek 2 compact on 13 antibiotics.
 Results: Only 57 bacteremia isolates were isolated from 1023 samples from (2015-2021), in our study the percentage of females infected with bacteremia were more than the males, females being 29/1023 (2.84%) and males being 28/1023 (2.74%), about the age groups in (2015-2021) infections by bacteremia were increased in (21-30) age people being 13/57 ( 22.81%) in total, in (2015-2021) the most common bacteria that cause bacteremia were Escherichia coli being 28/57(49.12%) followed by Klebsiella pneumonia being 11/57 (19.3%) , Enterobacter spp. being 7/57 (12.28%) , Salmonella typhi and Serratia marcescens both had 1/57 (1.75%) , Acinetobacter baumanni had 7/57 (12.3%) and finally Pseudomonas aeruginosa had 2/57 (3.5%) . Escherichia coli this bacteria mainly found in females 16/28 (57.14%), in ( 2015-2021), for cancer patients with bacteremia Escherichia coli was the most common isolated bacteria being 24/732 (3.30%), bacteremia mostly infected patients with acute myeloid leukemia were 12/38(31.58%) in Nanakali hospital, the bacteria that isolated from patients with bacteremia had resistance to more than three classes of antibiotics they were highly resistance to vancomycin 15 (100%), tetracycline12 (80%) followed by sulfamethoxazole 11 (73.33%) then to erythromycin 9 (60%) and both amoxicillin and clindamycin had 8 (53.33%) antibiotic resistance.
 Conclusions: The study showed that the rate of bacteremia increased in last few years in Erbil city especially in cancer patient and those having weak immunity, bacteria acquired resistance to antibiotics and this due to frequent use of antibiotics, morbidity attribute to antibiotic resistant is significant, if prevailing resistance trends continue, high societal and economic costs can be expected. Better management of antibiotic use, and infection control is needed to avoid infections that caused by drug resistant pathogens bacteremia.

Detection of Heavy Metal-Resistance Gene in Bacteria Isolated from Clinical and Environmental Sources Using Polymerase Chain Reaction (PCR)


 Background: Global proliferation of the pharmaceutical industry in response to devastating health challenges has led to several ecological and environmental problems. Heavy metal contamination is one of the most dangerous factors that affect ecosystems and human health. This study aimed to detect the presence of heavy-metal resistance genes in clinical and environmental sources using polymerase chain reaction (PCR).
 Method: This study employed an experimental design. The samples included 40 clinical isolates (blood, urine, throat, wound, and sputum) and 40 environmental isolates (pharmaceutical effluents).The isolates were collected and subcultured in nutrient broth for analysis.
 Results: The result shows that heavy metal-resistant genes were not detected in the clinical isolates whereas 65% and 60% of the environmental isolates harbored silver (Ag) and arsenic (As) respectively. However, the clinical isolates in this study showed higher rates of resistance than the environmental isolates did. This may be due to the frequent use of broad-spectrum antibiotics during clinical sessions, leading to the development of antibiotic-resistant strains.
 Conclusion: Heavy metal-resistant genes are present in bacteria in the environment and may cause severe health issues (drug resistance) when these genes are transmitted to pathogenic organisms that affect humans and animals. The association between bacterial drug resistance and heavy metal acquisition may greatly influence treatment outcomes in the event of infection. Therefore, control measures should be implemented to reduce the dissemination of these metals in the environment.

Intravesical gentamicin treatment for recurrent urinary tract infections: A systematic review over the last two decades

Objectives: Recurrent urinary tract infections (rUTIs) have a significant effect on a patient’s quality of life and frequent use of antibiotics increases multi-drug resistance. Previous research on intravesical antibiotics suggests that this has a local effect on bacteria with reduced systemic absorption and associated side effects. We conducted a systematic review to assess the effectiveness and adverse effects of intravesical gentamicin treatment. Methods: Systematic review of all English published articles from January 2001 to October 2021 according to the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 139 studies were identified, 20 full-text articles were screened and 6 subsequently included totalling 166 patients. All studies reported a decrease in the mean number of urinary tract infections (UTIs) with a significant reduction ( p = 0.0025 and p < 0.004) in two studies. When the number of breakthrough UTIs on prophylactic gentamicin installations was assessed, 65% ( n = 86/133) remained UTI free. Throughout treatment, 99% of serum gentamicin levels were <0.3 ng/dL, and reported instances of increased creatinine were low (2%). A decrease in the growth of multi-drug-resistant bacteria was reported in two papers ( p = 0.065 and p = 0.04). Conclusion: Intravesical gentamicin seems to be an effective treatment in patients with symptomatic rUTIs. The evidence suggests it also reduces UTIs caused by multi-drug-resistant bacteria with no systemic absorption and minimal renal toxicity. Level of evidence: 2a

Feasibility and Efficacy Study of Spices in Meat Preservation

The systematic application of spices as natural food preservatives could be the key to withstanding different food-borne diseases and the frequent use of antibiotics could be reduced thereby. Eight indigenous spices were tested against six food-borne pathogens. The spice extracts were prepared by drying, grinding, and soaking into 95% ethanol and the antibacterial activity was evaluated by the well-diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined by the broth dilution method. The feasibility of spices as natural meat preservatives was then assessed through the application. The ethanol extracts of the spices potentially inhibited the test organisms. Maximum activity (zone of inhibition- ZOI) was recorded for garlic (17.83±2.48 mm) followed by black pepper (17±8.9 mm), black cumin (15.83±10.87 mm), and ginger (15.16±7.68 mm). For pathogens, the most susceptible was B. cereus (19.57±8.05 mm) followed by Acinetobacter sp. (18.14±1.34 mm), E. coli (16.28±1.88 mm), S. aureus (14.28±9.91 mm), V. cholerae (10.85±7.94 mm) and Salmonella enterica ser. Typhi (6.85±8.55 mm). Garlic exhibited the most effective and consistent inhibitory activity whereas black cumin exhibited the highest activity against B. cereus (34 mm). These results were highly comparable to the commercial antibiotics, e.g. Meropenem (28 mm). Against the Salmonella spp., ginger, cumin, and garlic demonstrated moderate inhibition (16 mm) whereas complete resistance was observed against other spices. The lowest MIC and MBC were recorded for black cumin against B. cereus (32 mg/ml and 64 mg/ml, respectively). But garlic was found to be the best candidate due to its lowest mean MIC (85.33±33 mg/ml), and MBC (170.66±66 mg/ml). Black cumin, garlic, and black pepper were efficient in reducing the total viable count of meat at 72 hours and hence could be developed as natural food preservatives. Stamford Journal of Microbiology, Vol.12 (1) 2022: 31-36

Parent-Reported Rate of the Use of Antibiotics in Children: A Cross-Sectional Study.

Background Antibiotic resistance is growingworldwide due to the magnitude of the rational and irrational use of antibiotics, particularly in children. Evidence regarding the use of antibiotics without a prescription in Saudi children is limited, and the factors that affect frequent antibiotic use in children are poorly understood. Therefore, we investigated the rate of the use of antibiotics in Saudi children reported by their parents and the factors associated with parents that affect the use of antibiotics in children. Methods A cross-sectional survey using a 27-item self-administered questionnaire was conducted among parents living in Saudi Arabia. Parents with at least one child aged 16 years or less were eligible to participate in the study. The results were analyzed via descriptive and inferential statistics. Results A total of 284 parents participated in the study. Of the participants, 81% (n = 230) had given their children at least one course of antibiotics, and 57% of their children were male (n = 164). Many parents did not have a regular general practitioner (GP) for providing care to their children (n = 201, 70%). Further, 164 (n = 71%)parents administered antibiotics without consulting a general practitioner. Neither the parent and child demographics nor the parent knowledge and behavioral variables were significantly associated with the parent's variable of interest in the administration of antibiotics. Conclusions Generally, parents reported alarmingly high rates of antibiotic use among their children. Reducing the unnecessary use of antibiotics in children is crucial for preventing antimicrobial resistance. No apparent statistically significant factor was identified as being associated with antibiotic use. The need for additional measures to limit antibiotic use in children may be warranted. Initiatives to educate parents for consulting a regular general practitioner for their children before administering antibiotics may improve the health outcomes of children.

Last Resort Antibiotics Costs and Reimbursement Analysis of Real-Life ICU Patients with Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Germany.

Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.

685: EFFICACY OF LACTOBACILLUS GG FOR PREVENTION OF ANTIBIOTIC ASSOCIATED DIARRHEA IN THE PICU

Introduction: Antibiotic associated diarrhea (AAD) is a common adverse effect in pediatric patients. Previous meta-analysis on probiotic use for AAD have reported that lactobacillus GG (LGG) has potential for more protective effects compared to other strains of probiotics. There is limited data on the use of LGG for the prophylaxis of AAD in the pediatric intensive care unit (PICU) where there is frequent use of broad-spectrum antibiotics. The objective of this study was to assess the efficacy of LGG to prevent AAD in the PICU. Methods: This prospective randomized, double-blind, placebo-controlled trial occurred in a 15-bed PICU. Inclusion criteria was age ≤ 17 years and required antibiotic therapy ≥ 72hrs. Exclusion criteria included but was not limited to antibiotics ≥ 48 hrs prior, prior probiotics, pre-existing diarrhea, laxative therapy, immunocompromise, and GI disorders. Treatment with LGG (30 x 109 CFU) or a matching placebo capsule was administered twice daily, initiated within 24 hours of starting antibiotic therapy and continued for the duration of therapy. Diarrhea was defined as stools >200 mL or 200 g per day in a patient over 10 kg and > 20 mL/kg/day or > 20 g/kg/day in a patient < 10 kg or 3 or more loose stools in 24 hours. Patients that experienced diarrhea > 72 hours were crossed over. The primary outcome was the incidence of AAD in the LLG versus placebo groups. Potential adverse effects were monitored daily. Statistics were conducted with SPSS. Results: Thirty-one patients met the initial inclusion/exclusion criteria and were enrolled in the study. Nineteen patients were eligible for final analysis with 9 in the LGG group and 10 in the placebo group. Mean age was 0.96±1.3 and 4.7±6.4 years for the LGG and placebo groups, respectively. Mean weight was 6.95±4.21 and 22.76±29.38 kg for LGG and placebo groups, respectively. 30% vs 70% of patients experienced diarrhea in the LGG groups vs placebo (p=0.35). The median length of stay for the patients with AAD was 7.5 days compared to 6 days in placebo group (p=0.093). The odds ratio for AAD was 0.29 [95%CI 0.039-2.11]. No adverse events were reported or attributed to LGG. Conclusions: Results of this study indicate that LGG is safe and effective in reducing the incidence of AAD in the critically ill pediatric patients at our institution.

2172. Closing the CAP Gap: Improving the Management of Community Acquired Pneumonia (CAP)

Abstract Background In October 2019 updated community acquired pneumonia (CAP) guidelines were published, highlighting indications for empiric anti-MRSA and antipseudomonal antibiotics and use of MRSA nares screens. During a review of patients receiving vancomycin and piperacillin-tazobactam at our institution in 2020 we noted frequent use of anti-MRSA and antipseudomonal antibiotics and infrequent use of MRSA nares screens for CAP. In May 2020 we initiated a multifaceted intervention, including prospective audit and feedback, an updated pneumonia order set, and system-wide education. In this study we sought to describe gaps in the care of patients with CAP at our institution and to evaluate the impact of a multifaceted intervention on those gaps in care. Methods We performed a retrospective cohort study on a random sample of unique adult patients admitted with pneumonia from January 1, 2020 through June 30, 2021. Exclusion criteria included COVID infection within 4 weeks of admission, no antibiotics for pneumonia given during admission, immunocompromised condition, and diagnosis of hospital-acquired or ventilator-associated pneumonia. The primary objective was to describe the percentage of patients receiving appropriate anti-MRSA and antipseudomonal therapy and MRSA nares testing during the study period. The secondary objective was to compare appropriateness of these outcomes before and after the intervention. Study groups Results For the 126 patients reviewed, 68.3% received the appropriate empiric spectrum of activity for MRSA and Pseudomonas aeruginosa, improving from 60% to 80% before and after the intervention respectively. The percentage of patients screened for MRSA increased from 6 to 34%; however, the percentage of appropriate MRSA screens decreased from 71 to 54% because screens were often collected despite absence of MRSA risk factors. Results Conclusion The percentage of patients receiving appropriate anti-MRSA and antipseudomonal therapy for CAP improved after a multifaceted stewardship intervention. The percentage of patients for whom appropriate MRSA nares screens was performed worsened, mainly due to use of MRSA nares screens when not needed. Disclosures All Authors: No reported disclosures.

The impact of using a multistrain probiotic supplement on gastrointestinal function in children and adolescents with severe recessive dystrophic epidermolysis bullosa.

Children and adolescents with severe recessive dystrophic epidermolysis bullosa (RDEB-S) often have severe constipation in addition to gastrointestinal dysbiosis, due to frequent antibiotic use and reduced oral diet. Constipation is treated with long-term use of high daily doses of macrogol gel (Movicol Paediatric PlainTM or LaxidoTM). Constipation is refractory to increases in fibre and fluids, and impacts severely on quality of life. To study the initial impact andefficacy of using amultistrainprobiotic supplement daily for 12 weeks in patients with RDEB-S.The authors sought to determine the impact of such a supplement on gastrointestinal symptoms, stool consistencyand the use of macrogol gel to treat constipation, as well asunderstandingpatient reaction, palability andease of use. Patients were identified through the epidermolysis bullosa tertiary multidisciplinary team clinic in July 2021. Patients were included if they had a diagnosis of RDEB-S, prescribed at least one sachet of macrogol gel and provided written consent to take part. Patients were provided, proprietary liquid multistrain probiotic supplement (Symprove™) with a high bacterial count, at a dose of 1 mL kg-1 once a day. Each patient completed an anonymous, nine-question, electronic survey to document symptoms and report overall findings at the start and end of a 12-week trial period. Four patients with RDEB-S (two boys and two girls; age range 7-14 years) who met the inclusion criteria were approached to take part. All patients had chronic constipation requiring daily macrogol gel use (range 2-5 sachets per day). Three out of four (75%) completed the 12-week course. At baseline (before supplementation commenced), all three (100%) patients reported poor oral appetite, constipation, flatulence, abdominal bloating and pain, and frequent skin infections requiring oral antibiotics, with two of the three (66%) patients also having nausea. After 12 weeks of supplementation, all three patients (100%) reported a significant improvement in abdominal pain and bloating, nausea, stool consistency, stool frequency, flatulence and increased appetite. Two of the three patients (66%) were able to reduce their macrogol gel usage and the third patient (33%) was able to stop macrogol gel usage altogether during the study period. All three patients said they would choose to continue using the supplement if it was available. We have shown in this case series that giving a multistrain probiotic supplement in patients with RDEB-S has the potential to improve stool consistency and reduce or prevent the need for chronic macrogol gel use. Future larger-scale, placebo-controlled trials are needed to confirm these results.

Cysteamine capped silver nanoclusters: A potential antimicrobial agent for antibiotic-resistant bacteria

The world has witnessed a phenomenal increase in the frequent use of antibiotics and antimicrobial resistance for pathogens, which now are a great challenge for scientists and researchers. Consequently, there is an urgent need for novel antibacterial agents to combat pathogenic bacterial infections. This work sheds light on the relatively scarce application of silver nanoclusters (AgNCs) for the development of novel antimicrobial agents for antibiotic-resistant bacteria. We have prepared noble metal NCs (comprising 5 Ag atoms per cluster) by using a small scaffold,viz. cysteamine (CyA). Various spectroscopic and microscopic techniques were used to characterize the synthesized luminescent AgNCs. The composition of the NCs has been substantiated by mass spectral analyses which were well-supported by the Jellium model. The as-prepared NCs display efficacious antibacterial activity against common bacteria (both Gram-negative and Gram-positive) and also demonstrate promising bactericidal effects against ampicillin and kanamycin-resistant transformed strains of Escherichia coli bacteria. From in-depth systematic studies, the bactericidal activity was found due to the generation of reactive oxygen species (ROS) and cellular membrane disruption in the presence of AgNCs which resulted in the leakage of intracellular components, like proteins. Our study suggests that cysteamine-capped AgNCs might be used as effective antimicrobial agents in eliminating antibiotic-resistant bacteria for the development of a new kind of nanobiotics to combat multidrug-resistant deadly bacteria.