Guidelines For Antibiotic Use Research Articles

Obstetric Anal Sphincter Injury Management at a Tertiary Academic Birthing Center: A Quality Improvement Initiative [ID 2683441

INTRODUCTION: As a quality improvement project, we implemented an evidence-based management protocol to optimize outcomes after obstetric anal sphincter injuries (OASIS). The aim was to evaluate compliance with practice guidelines for antibiotic use, standardized surgical technique and documentation, utilization of a bowel regimen, and short-term outpatient follow-up after a resident educational OASIS program. METHODS: An OASIS practice guideline was implemented via a curriculum utilizing didactics and simulation with porcine sphincter models to demonstrate primary prevention, proper diagnosis, repair technique, documentation, and post-procedure OASIS management. Pre (August 2018 to July 2022) and post-intervention (August 2022 to July 2023) cohorts were compared for characteristics and provider adherence to guidelines. We used control charts, chi-squared, and Student's t-tests to estimate the effect of the intervention. RESULTS: Among 226 OASIS cases, 168 were pre-intervention and 58 were post-intervention. Proper documentation of OASIS repair increased from 13 (7.7%) pre-intervention to 24 (41.4%) post-intervention (risk ratio [RR] 7.57; 95% CI, 4.3–13.1); proper antibiotic use increased from 79 (47.0%) pre-intervention to 39 (67.2%) post-intervention (RR 1.42; CI, 1.12–1.18); and utilization of bowel regimen increased from 147 (87.5%) to 56 (96.6%) post-intervention (RR 1.1; CI, 1.02–1.18). There was no change in close follow-up appointment attendance (81.0% for both groups; P=.98). Control charts showed a process change in bowel regimen use and OASIS documentation, but no significant change in antibiotic use or close follow-up appointments. CONCLUSION: Implementation of an evidence-based management guideline was associated with increased compliance with evidence-based practices. Future improvement cycles are necessary to optimize outpatient follow-up after OASIS.

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices-5-Year National Study.

Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period. This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient's and prescriber's characteristics. The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications. The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary.

The case for the access, watch, and reserve (AWaRe) universal guidelines for antibiotic use

The case for the access, watch, and reserve (AWaRe) universal guidelines for antibiotic use

Examining antibiotic use in Kenya: farmers’ knowledge and practices in addressing antibiotic resistance

BackgroundAntibiotics hold the promise of mitigating the spread of livestock diseases while enhancing productivity. However, there is global concerns surrounding the improper handling and administration of antibiotics, which has led to an alarming rise in antimicrobial resistance (AMR). Kenya is currently listed as an AMR hotspot. This study assesses farmers’ knowledge and practices on antibiotics in livestock production, knowledge on AMR as well as factors influencing farmers’ knowledge of antibiotic safety and resistance, and antibiotics use.MethodsA across-sectional, quantitative survey was employed with 319 farming households in five counties in Kenya. Multivariate regression analysis was used to identify explanatory factors.ResultsAbout 80% of households use antibiotics in their livestock, and 58% administer the antibiotics themselves. The vast majority of farmers buy antibiotics without a prescription. Antibiotics are used for both therapeutic and non-therapeutic purposes, the latter mainly in form of growth promoters and feed enhancers in poultry. The withdrawal periods reported by farmers are shorter than the officially recommended periods. Although the majority of farmers reported risky antibiotic practices, most (76%) were well aware of bacterial AMR. Nineteen of 21 knowledge statements on AMR and safe use of antibiotics were answered correctly by 55–89% of respondents, indicating considerable farmer knowledge on different aspects of antibiotics risk, while certain knowledge gaps remain. Number of livestock owned was the factor most positively influencing farmers’ knowledge on AMR and safe use.ConclusionKenya has made notable progress towards creating knowledge and awareness of farming communities on the risks and requirements associated with antibiotic use in livestock. Nonetheless, farmers’ antibiotics practices continue to constitute considerable risk of further AMR development. This shows that knowledge is not enough to ensure fundamental behavioral change. There needs to be an enabling environment driven by (1) effective policy interventions and enforcement to ensure compliance with set guidelines for antibiotic use; (2) research on and deployment of alternatives, such as probiotics, vaccinations and disease prevention measures, (3) continued public awareness raising and education using multiple channels to reach farmers and, (4) strengthened cross-sector, multi-stakeholder collaboration to address the multi-dimensional complexities of AMR.

Clostridioides Difficile in Latin America: An Epidemiological Overview.

Clostridioides difficile infection is one of the most significant causes of nosocomial diarrhea associated with antibiotic use worldwide. In recent years, the incidence of Clostridioides difficile infection in Latin American countries has increased due to the emergence and spread of epidemic Clostridioides difficile strains, such as RT027/NAP1/ST1, RT078/ST11, and RT017/ST37; additionally, endemic multi-drug-resistant strains have recently appeared due to the lack of heterogeneous diagnostic algorithms and guidelines for antibiotic use in each country. The aim of this review is to present the latest information regarding Clostridioides difficile and emphasize the importance of epidemiological surveillance of this pathogen in Latin American countries.

Therapies for people hospitalized with COVID-19 and alignment with national clinical guidelines in a large hospital, Almaty, Kazakhstan, 2020-2021.

Clinical practice guidelines were continually changing during the COVID-19 pandemic to reflect the best available evidence for a novel virus. In Kazakhstan, the national clinical guidelines for COVID-19 patient care were regularly modified and it was not known if and to what extent these guidelines were being followed in practice. We conducted a sub-analysis of data collected from an observational study among people hospitalized with COVID-19 in a large infectious disease hospital in Almaty in four cross-sections of increased COVID-19 incidence: T1 (1 June-30 August 2020); T2 (1 October-31 December 2020); T3 (1 April-31 May 2021); and T4 (1 July-26 October 2021). Modifications to the national COVID-19 treatment guidelines were identified and clinical data were abstracted from electronic medical records. We assessed frequency of antibiotic, glucocorticoid, anticoagulant, and antiviral administered in each period and determined if these aligned with national clinical guidelines. We used multivariable logistic regression to compare practices across periods. Six modifications were made to national COVID-19 treatment guidelines during this study. Of 1,146 people hospitalized with COVID-19, 14% were in T1, 14% in T2, 22% in T3, and 50% in T4. Anticoagulant treatment was administered to 87% (range: 56%-95%), antibiotic treatment to 60% (range: 58%-64%), glucocorticoid to 55% (range: 43%-64%) and antiviral therapy 15% (range: 7%-22%). Majority of treatments were not aligned with national guidelines, including 98% of anticoagulant use, 95% of antibiotic use, 56% of glucocorticoid use, and 56% of antiviral use. There were no significant changes in practice following changes in guidelines for antibiotic use (64% in T1 to 58% in T2, p = 0.30). There was significant increase in use of anticoagulant (84% in T2 vs. 95% in T3, p < 0.01), glucocorticoid (43% in T2 vs. 64% in T3, p < 0.01), and antiviral treatment (7% in T3 vs. 15% in T4, p < 0.01) after guidelines updates. The majority of treatments administered to people hospitalized with COVID-19 in four periods of high incidence in Almaty were not aligned with updated clinical guidelines. Antibiotic misuse was markedly high throughout. Increased awareness and training on clinical practice guidelines as updates are released may help improve adoption of evidence-based practices.

Surgical Infection Society Guidelines: 2022 Updated Guidelines for Antibiotic Use in Open Extremity Fractures.

Background: Open fractures, defined as fractures communicating with the environment through a skin wound, cause substantial morbidity after traumatic injury. Current evidence supports administration of prophylactic systemic antibiotic agents to patients with open extremity fractures to decrease infectious complications. Methods: The Therapeutic and Guidelines Committee of The Surgical Infection Society convened to revise guidelines for antibiotic use in open fractures. PubMed was queried for pertinent studies. Evaluation of the published evidence was performed using the GRADE framework. All committee members voted to accept or reject each recommendation. Results: In type I or II open extremity fractures, we recommend against administration of extended-spectrum antibiotic coverage compared with gram-positive coverage alone to decrease infections complications, hospital length of stay or mortality. In type III open extremity fractures, we recommend antibiotic therapy for no more than 24 hrs after injury, in the absence of clinical signs of active infection, to decrease infectious complications, hospital length of stay or mortality, and we recommend against extended antimicrobial coverage beyond gram-positive organisms to decrease infectious complications, hospital length of stay or mortality. In type III open extremity fractures with associated bone loss, we recommend antibiotic therapy in addition to systemic therapy to decrease infectious complications. Conclusions: Although antibiotic agents remain a standard of care for infection prevention after open extremity fractures, our findings and surveys of clinical practice patterns clearly show that additional robust clinical trials are needed to provide stronger corroborating evidence.

The Antibiotic Prescription Trend of Dentists for Endodontic Treatment from a Region of Pakistan: An Online Survey.

Purpose: Globally the overuse of systemic antibiotics is now a serious concern for the health professionals. The increase in antimicrobial resistant bacteria because of this practice has made treatment of infections ever more difficult. In providing endodontic treatment it has been found that many dentists are either misusing or overusing systemic antibiotics. The objective of this study was to assess the antibiotic prescribing trends of dentists in a region of Pakistan and if any association could be made of such practices with the experience of the dentist.&#x0D; Methodology: This cross sectional study was based on an on line questionnaire. A total of 150 invitation were sent by emails and social media groups like ’Whattsapp’. This estimation of respondents was made by calculating the total fresh graduates and clinical dental faculty of the three dental institute of the region. The online survey was designed on the checklist based on Checklist for Reporting Results of Internet E-surveys (CHERRIES). SPSS version 20 was used to analyze the data. Chi square test was used with p- value&lt; 0-05.&#x0D; Results: There was an 84% response rate on this online questionnaire. Most of the participants (71.5%) were aware of guidelines for antibiotic use. Only 12.30% participants as a whole had attended a seminar or workshop in the last one year on recent guidelines for antibiotic prescription. Of the total, 42.30% of the respondents were prescribing antibiotics to 2-3 patients on a daily basis. Majority of the respondents (63.84%) would prefer penicillin’s as the first choice of antibiotic if needed. But 62.7% of the fresh graduates would advise systemic antibiotics in a case of endodontic flare up where there is no recommendation or justification. With 44.7% dental practitioners’ prescribing antibiotics in the same scenario it was statistically significant (p=0.0480).&#x0D; Recommendations: Globally, the overuse of antibiotics is a trend which is concerning, here in the region of Abbottabad, Pakistan this same trend is present. Dental health care providers must understand that prescription of systemic antibiotics when not recommended may lead to antimicrobial resistance, whereas non-prescription when necessary may have detrimental health consequences. So the practitioners’ knowledge of guidelines is irrelevant as long as they are not practicing it. Hence the rationale for not practicing on the guidelines is what needs to be further investigated in future studies.

Surgical Infection Society Guidelines for Antibiotic Use in Patients Undergoing Cholecystectomy for Gallbladder Disease.

Background: Manifestations of gallbladder disease range from intermittent abdominal pain (symptomatic cholelithiasis) to potentially life-threatening illness (gangrenous cholecystitis). Although surgical intervention to treat acute cholecystitis is well defined, the role of antibiotic administration before or after cholecystectomy to decrease morbidity or mortality is less clear. Methods: The Surgical Infection Society's Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic use in patients undergoing cholecystectomy for gallbladder disease to prevent surgical site infection, other infection, hospital length of stay, or mortality. PubMed, Embase, and the Cochrane Database were searched for relevant studies. Evaluation of the published evidence was performed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Using a process of iterative consensus, all authors voted to accept or reject each recommendation. Results: We recommend against routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy. We recommend use of peri-operative antibiotic agents for patients undergoing laparoscopic cholecystectomy for acute cholecystitis. We recommend against use of post-operative antibiotic agents after elective laparoscopic cholecystectomy for symptomatic cholelithiasis. We recommend against use of post-operative antibiotic agents in patients undergoing laparoscopic cholecystectomy for mild or moderate acute cholecystitis. We recommend a maximum of four days of antibiotic agents, and perhaps a shorter duration in patients undergoing cholecystectomy for severe (Tokyo Guidelines grade III) cholecystitis. Conclusions: This guideline summarizes the current Surgical Infection Society recommendations for antibiotic use in patients undergoing cholecystectomy for gallbladder disease.

Perioperative antibiotic prophylaxis in Australian burns patients

Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance. Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms. Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics. Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.

Delayed antibiotic prescribing to reduce antibiotic use: an urgent care practice change

BackgroundAntibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated with worse clinical outcomes and increased healthcare costs. Studies suggest...

Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults.

The guidelines are intended to provide practical information for the correct use of antibiotics for intra-abdominal infections in Korea. With the aim of realizing evidence-based treatment, these guidelines for the use of antibiotics were written to help clinicians find answers to key clinical questions that arise in the course of patient care, using the latest research results based on systematic literature review. The guidelines were prepared in consideration of the data on the causative pathogens of intra-abdominal infections in Korea, the antibiotic susceptibility of the causative pathogens, and the antibiotics available in Korea.

Assessment of Antibiotics Susceptibility Pattern of Vancomycin Resistant Enterococci Isolated from Clinical Specimens in Port Harcourt

Aim: The aim of this study was to assess the prevalence of vancomycin resistance among Enterococcal species isolated from clinical specimens of patients attending two hospitals in Port Harcourt, Rivers State.&#x0D; Study Design: The study employs statistical analysis of the data and interpretation.&#x0D; Place and Duration of Study: Two hospitals which are Meridian hospital Port Harcourt and University of Port Harcourt Teaching Hospital, located in the city of Port-Harcourt, Rivers State were used for this study. Specimen collection lasted for 3 weeks and the analysis was carried out daily and it lasted for six months.&#x0D; Methodology: A total of one hundred and eighteen (118) urine and stool specimens (60 urine and 58 stool specimens) were collected from Fifty nine (59) patients for a period of three months from Meridian hospital and University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State. The specimens collected were grouped inpatients and outpatients and were subjected to standard microbiological procedures which include standard plate counts, identification, and sensitivity testing using Kirby-Bauer disk diffusion method, Minimum inhibitory concentration and molecular identification of the isolates.&#x0D; Results: A total of 48 enterococcal isolates were isolated from the different specimens (hospitalized and non-hospitalized patients) of urine and stool specimens. All Enterococcal isolates showed high level of resistance to Ceftazidime and Cefuroxime (100%) followed by cloxacillin (95.8%), augumentin (85.4%) and Ceftriaxone (75.0%). The isolates showed higher sensitive rates to Ofloxacin (95.5%), followed by Gentamicin (77.1%) and Vancomycin (39.6%). All Enterococal isolates from this study had a MAR index &gt; 0.2. A total of the 48 Enterococci were isolated, the 23 (47.9%) isolates were identified as vancomyin resistant during this study were subjected to MIC (Minimum Inhibitory Concentration) for vancomycin as a confirmatory test. Of the 23 isolates, 12 isolates were vancomycin resistant with 11 isolates showing vancomycin MIC values of 8-16μg /ml (vancomycin intermediate).&#x0D; Conclusion: Conclusively, this study revealed varying Antibiotic susceptibility pattern of the isolated bacteria. Treatment guidelines for use of antibiotics should be based on the hospital formulary and the sensitivity patterns is advocated. This should be reviewed occasionally to ensure rational use of antibiotics

TitleAntibiogram of Key Microorganisms of Health Importance, Found on Different Species of Banana (Musa spp.)

Aim: The aim of this study was to isolate, enumerate, identify and ascertain the antibiotic profile of the bacterial isolates associated with key body parts (Cut stalk, Tip, Endocarp, Vascular Tissue and Epicarp) of Banana fruits (Cavendish, Dwarf Cavendish, Red, Lady Finger and Grand Nain Banana) collected from Port-Harcourt, Rivers State.&#x0D; Study Design: The study employs statistical analysis of the data and interpretation.&#x0D; Place and Duration of Study: Five local markets which includes Oil Mill, Fruit Garden, Creek Road, Mile One and Mile Three Markets, all located in the city of Port-Harcourt, Rivers State were used for this study. Sample collection lasted for a week and the analysis was carried out every day and it lasted for six months.&#x0D; Methodology: A total of seventy-five (75) banana (Cavendish, Dwarf Cavendish, Red, Lady Finger and Grand Nain Banana) fruit samples were collected randomly, for a period of three months from five different markets (Oil Mill, Fruit Garden, Creek Road, Mile One and Mile Three Markets) in Rivers State. The collected samples were grouped into three groups (Unripe, Healthy-Looking and Spoiled) and were subjected to standard microbiological procedures which includes standard plate counts, identification, sensitivity testing using Kirby-Bauer disk diffusion method and molecular identification of the isolates.&#x0D; Results: A total of 83 bacteria were isolated from the different sampled parts (Cut stalk, Tip, Endocarp, Vascular Tissue and Epicarp) of the banana fruit samples. 18.88%. Escherichia coli showed high level of resistance to Cefotaxime (100%) &gt; Augmentin (94.7%) &gt; Gentamycin (78.9%) &gt; Levofloxacin (10.5%). There was complete resistance to Cefotaxime, Levofloxacin, Imipenem/Cilastatin, Ofloxacin and Azithromycin in all isolates of Staphylococcus aureus and susceptibility at 70.8%, 79.2% and 20.8% to Augmentin, Ceftriaxone sulbactarm and Erythromycin, respectively. Pseudomonas aeruginosa were susceptible to Augmentin (25.0%), Imipenem/Cilastatin (66.7%), Gentamycin (83.3%) and Ceftriaxone Sulbactarm at 8.3%. While complete resistance was seen in Cefotaxime, Nalidixic Acid, Nitrofurantoin and Cefexime. The antimicrobial susceptibility pattern of all isolates of Bacillus flexus which shows complete resistance to Cefotaxime, Ceftriaxone Sulbactarm, Cefexime, Imipenem/Cilastatin and Azithromycin. While susceptibility was seen in Levofloxacin at 100% and 22.2%, 33.3% and 11.1% seen in Ciprofloxacin, Gentamycin and Augmentin, respectively. The isolates of Proteus mirabilis showed complete susceptibility in Imipenem/Cilastatin and CefrtiaxoneSulbactarm and complete resistance in Augmentin, Cefotaxime, Gentamycin, Nalidixic Acid, Nitrofurantoin, Cefuroxime, Ampiclox, Cefexime and Levofloxacin. Klebsiella pneumoniae to Levofloxacin and 45.5% susceptibility to Augmentin, Ofloxacin, Ceftriaxone and Ampiclox at 54.5%, 27.3% and 18.2%, respectively. While complete resistance was seen in Cefotaxime, Nalidixic Acid, Nitrofurantoin, Cefuroxime and Cefexime.&#x0D; Conclusion: Conclusively, this study revealed the Antibiotic susceptibility pattern of the isolated bacteria. Treatment guidelines for use of antibiotics should be formulated based on the hospital formulary and the sensitivity patterns. This should be reviewed occasionally to ensure rational use of antibiotics

From the Farms to the Dining Table: The Distribution and Molecular Characteristics of Antibiotic-Resistant Enterococcus spp. in Intensive Pig Farming in South Africa.

Foodborne pathogens, including antibiotic-resistant species, constitute a severe menace to food safety globally, especially food animals. Identifying points of concern that need immediate mitigation measures to prevent these bacteria from reaching households requires a broad understanding of these pathogens’ spread along the food production chain. We investigated the distribution, antibiotic susceptibility, molecular characterization and clonality of Enterococcus spp. in an intensive pig production continuum in South Africa, using the farm-to-fork approach. Enterococcus spp. were isolated from 452 samples obtained along the pig farm-to-fork continuum (farm, transport, abattoir, and retail meat) using the IDEXX Enterolert®/Quanti-Tray® 2000 system. Pure colonies were obtained on selective media and confirmed by real-time PCR, targeting genus- and species-specific genes. The susceptibility to antibiotics was determined by the Kirby–Bauer disk diffusion method against 16 antibiotics recommended by the WHO-AGISAR using EUCAST guidelines. Selected antibiotic resistance and virulence genes were detected by real-time PCR. Clonal relatedness between isolates across the continuum was evaluated by REP-PCR. A total of 284 isolates, consisting of 79.2% E. faecalis, 6.7% E. faecium, 2.5% E. casseliflavus, 0.4% E. gallinarum, and 11.2% other Enterococcus spp., were collected along the farm-to-fork continuum. The isolates were most resistant to sulfamethoxazole-trimethoprim (78.8%) and least resistant to levofloxacin (5.6%). No resistance was observed to vancomycin, teicoplanin, tigecycline and linezolid. E. faecium displayed 44.4% resistance to quinupristin-dalfopristin. Also, 78% of the isolates were multidrug-resistant. Phenotypic resistance to tetracycline, aminoglycosides, and macrolides was corroborated by the presence of the tetM, aph(3′)-IIIa, and ermB genes in 99.1%, 96.1%, and 88.3% of the isolates, respectively. The most detected virulence gene was gelE. Clonality revealed that E. faecalis isolates belonged to diverse clones along the continuum with major REP-types, mainly isolates from the same sampling source but different sampling rounds (on the farm). E. faecium isolates revealed a less diverse profile. The results suggest that intensive pig farming could serve as a reservoir of antibiotic-resistant bacteria that could be transmitted to occupationally exposed workers via direct contact with animals or consumers through animal products/food. This highlights the need for more robust guidelines for antibiotic use in intensive farming practices and the necessity of including Enterococcus spp. as an indicator in antibiotic resistance surveillance systems in food animals.

Antimicrobial resistance and virulence characteristics of Vibrio vulnificus, Vibrio parahaemolyticus and Vibrio harveyi from natural disease outbreaks of marine/estuarine fishes

Vibrio vulnificus, Vibrio parahaemolyticus and Vibrio harveyi are the causative agents of the most severe diseases of marine and brackish aquaculture systems. These are also associated with serious ailments in humans. The present paper unravels the virulence features/genes and antimicrobial resistance (AMR) phenotypes/genes of these Vibrio spp. isolated from natural disease outbreaks of marine/estuarine fishes of India for the first time. Results on virulence features showed that V. vulnificus infected fish can pose public health risk. While, it has been found clinically that V. parahaemolyticus without tdh and trh genes are pathogenic to fish, even though they are reported to be, not associated with human diseases. It was significant to note that virulence features of V. harveyi were induced at increased salinity. Analysis based on the percentage prevalence of susceptible isolates and variation coefficient of zone diameters categorized 17 antibiotics in terms of their efficiency against each fish pathogenic species. Multiple antibiotic resistance index (MARi) of the isolates ranged between 0.058 and 0.47. Results on MARi and percentage of multidrug resistance strains indicated that >50% of the isolates were from low antibiotic usage area. The study generated tetH sequence from V. parahaemolyticus for the first time, and the sequence revealed high identity to that of clinical strains. Presence of tetB/ tetH gene was identified as the predictor for the resistance against the first generation tetracycline, the most commonly used antibiotic against Vibrio spp. in aquaculture practices. The data on associations between AMR features predicted certain cross-resistance between antimicrobials within Vibrio spp. Altogether, the paper serves as the baseline for epizootic tracking of public health significant vibrios from diseased fishes, to devise practical guidelines for antibiotic use and to formulate efficient control measures against three Vibrio spp. in aquaculture, targeting final applications in the implementation of national green and healthy aquaculture practices.

Oral and parenteral antibiotic use in Norwegian nursing homes: are primary care institutions becoming our new local hospitals?

BackgroundNorwegian nursing homes (NHs) have over the last 10 years increasingly applied the use of parenteral treatment, which in turn allows more broad-spectrum use of antibiotics. Previous studies from Norwegian NHs have for the most part not described parenteral formulations.ObjectivesTo describe systemic antibiotic use in Norwegian NHs.MethodsThirty-seven NHs in the county of Østfold, Norway, were invited to participate in this retrospective cross-sectional study. Associated pharmacies provided sales data for systemic antibiotic use for the participating NHs for 1 year (October 2015 to October 2016). General institutional characteristics were collected through a questionnaire.ResultsThirty-four NHs participated in the study. Mean use of antibiotics was 9.5 DDD/100 bed days (range 0.6–30.9 DDD/100 bed days). Oral antibiotics accounted for 83% and parenteral antibiotics for 17% of the total antibiotic use. Of parenteral antibiotics, ampicillin was most used (31.1%) followed by cefotaxime (17.7%) and penicillin G (16.6%). The proportion of antibiotics compliant with guideline recommendations was 60%. Being a short-term NH was associated with increased antibiotic use, with an unstandardized coefficient of 13.1 (95% CI 4.2–21.9; P = 0.005).ConclusionsWe found a high level of total and parenteral antibiotic use compared with previous studies from Norwegian NHs. Data showed wide variations in total antibiotic use and that only a moderate proportion of the antibiotic use was considered guideline compliant. This highlights the necessity of further implementation strategies regarding the national guidelines for antibiotic use in NHs.

Antibiotics impair immunotherapy for urothelial cancer.

Pooled clinical trial data reveal that antibiotics worsen progression-free survival and overall survival in patients with locally advanced and metastatic urothelial cancer receiving anti-PDL1 therapy. Consensus guidelines for antibiotic use in these patients, as well as diagnostic tools and corrective measures, are needed to decrease primary resistance to immune checkpoint inhibitors.

Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey.

BackgroundAntibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection.ObjectivesTo investigate antibiotic prescribing practices in patients with COVID-19.MethodsWe performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis.ResultsThe survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of β-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days.ConclusionsThe study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.

Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures.

Background: Facial fractures are common in traumatic injury. Antibiotic administration practices for traumatic facial fractures differ widely. Methods: The Surgical Infection Society's (SIS's) Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic administration in the management of traumatic facial fractures. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Pre-operative antibiotics were defined as those administered more than 1 hour before surgery. Peri-operative antibiotics were those administered within 1 hour of the start of surgery depending on the type of antibiotic and as late as ≤24 hours after surgery. Post-operative antibiotics were defined as those administered >24 hours after surgery. Prophylactic antibiotics were those administered for >24 hours without a documented infection. Evaluation of the published evidence was performed with the GRADE system. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: We recommend that in adult patients with non-operative upper face, midface, or mandibular fractures, prophylactic antibiotics not be prescribed and that in adult patients with operative, non-mandibular fractures, pre-operative antibiotics likewise not be prescribed. We recommend that in adult patients with operative, mandibular fractures, pre-operative antibiotics not be prescribed; and in adult patients with operative, non-mandibular facial fractures, post-operative (>24 hours) antibiotics again not be prescribed. We recommend that in adult patients with operative, mandibular facial fractures, post-operative antibiotics (> 24 hours) not be prescribed. Conclusions: This guideline summarizes the current SIS recommendations regarding antibiotic management of patients with traumatic facial fractures.