Guidelines For Antimicrobial Use Research Articles

European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) guidelines for antimicrobial use in canine acute diarrhoea

Acute diarrhoea is a common presentation in dogs, and a common reason for antimicrobial prescription and nutraceutical use. This evidence-based guideline provides recommendations for antimicrobial and probiotic treatment of canine acute diarrhoea (CAD). A multidisciplinary panel developed the recommendations by adhering to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The opinions of stakeholders (general veterinary practitioners and dog owners) were collected and incorporated to ensure the applicability of this guideline. Four strong recommendations informed by high certainty evidence, and three conditional recommendations informed by very low or low certainty evidence, were drafted by the panel, along with an ungraded section on diagnostic work-up of dogs with acute diarrhoea. The ENOVAT guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document, and the supporting systematic review, to draft national or local guidance documents.

Dental antibiotic policies, stewardship, and implementation in India: A policy document analysis.

Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice. The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship. Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents. This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR.

Validation, visibility, vagueness and variation: A qualitative assessment of existing veterinary guidelines for antimicrobial use in cattle and sheep in the UK.

Antimicrobials are essential in veterinary medicine to treat and control bacterial disease in animals. Their prudent use in food-producing animals has been encouraged to reduce the development and spread of antimicrobial resistance. National and international guidelines for responsible antimicrobial use have been developed as tools to guide and rationalise antimicrobial prescribing decisions by veterinarians and usage decisions by farmers. Yet, there is little understanding of whether these existing guidelines are fit for purpose. Accordingly, this study rigorously assessed 128 veterinary guidelines for antimicrobial use in ruminants in the UK, following established qualitative methodologies. Findings revealed four pertinent themes: validation of the veterinarian as the prescriber, visibility of responsible use realities, vagueness in interpretation and variation in directing behaviour. These themes encompassed the roles and responsibilities of the veterinarian and the realities of prescribing scenarios, alongside concerns relating to the specificity within and variation between guidelines. Resultant recommendations to inform and support the future development of guidelines include establishing species-specific and disease-specific guidelines, expanding guidelines to include disease prevention measures, including definitions to resolve vagueness and promoting congruence in interpretation, encouraging the development of practice-level guidelines to endorse collaboration and ownership, and fostering active working between stakeholders to align priorities and messaging.

Detection of Antimicrobial Resistance and Biofilm Production Among Staphylococcus pseudintermedius from Canine Skin Lesions.

Aims: Staphylococcus pseudintermedius is an opportunistic pathogen also indicated as one of the major causes of skin infections in dogs. This study aimed to identify S. pseudintermedius isolated from canine skin lesions, evaluate their antibiotic resistance profile and biofilm production ability. Methodology: Lesions from 50 rural dogs with different skin lesions were sampled after pyoderma diagnosis by private practices. Bacterial species determination was investigated and susceptibility to nine antimicrobials were determined by means of Kirby-Bauer assay. Then seven antibiotic resistance genes, including mecA, blaZ, tetK, tetM, blaSHV, blaOXA-1, and blaTEM were screened by PCR. Moreover, biofilm formation ability of the strains was determined using the microtiter plate assay along with the presence of icaADBC genes. Results: A total of 37 (74%) isolates were identified as S. pseudintermedius. All S. pseudintermedius isolates were resistant to multiple drugs. Resistance to penicillin, amoxicillin-clavulanic acid, and cefazolin were higher than other antimicrobials. All the beta-lactam-resistant isolates carried blaZ, whereas mecA was found in 6 (16.21%) of them. Among tetracycline-resistant strains, the frequency of tetK and tetM determinants were 19 (90.47%) and 21 (100%), respectively. Finally, most cefazolin-resistant strains 31 (91.89%) were positive for blaTEM gene. The rate of biofilm production ability among S. pseudintermedius isolates was 35 (94.59%). Furthermore, the presence of icaA/D genes was detected in 35 (100%) and 29 (82.85%) of S. pseudintermedius strains, respectively. Conclusion: The high rates of antimicrobial resistance and biofilm production ability among S. pseudintermedius isolates, emphasize the urgent need to use more effective infection control policies and guidelines for antimicrobial use.

Prescription Practices and Outcome Analysis of PICU Patients at a Newly Established Tertiary Care Hospital—A Retrospective Study

AbstractPrescription analysis studies play a crucial role in monitoring prescription patterns and establishing guidelines for effective drug delivery and health care management. Given the physiological differences between the pediatric and adult populations, it is essential to analyze the prescription records specifically for pediatric patients, considering their unique diseases, drugs, and dosages. The objectives of this study were to analyze the prescribing patterns of drugs, rationality, outcomes, and antimicrobial use and drugs from National List of Essential Medicines (NLEM) in pediatric intensive care unit (PICU) patients. A retrospective study design was employed, and data were collected from medical records, including demographic information, diagnoses, drug details, and treatment outcomes of PICU patients. The collected data were then analyzed according to the World Health Organization (WHO) indicators for rational drug use, WHO Access, Watch, and Reserve (AWaRe) guidelines for antimicrobial use, and the proportion of essential drugs prescribed. Descriptive statistics was used to express the data in this study. A total of 184 patient records were analyzed, with 57.6% were males. On average, 4.5 drugs were prescribed per prescription, with injections and syrups comprising nearly 28% each. Approximately 71.5% of prescriptions contained generic drug names. Furthermore, 49% of the prescribed drugs were listed in the NLEM. Antibiotics were present in 50% of the prescriptions, with 50% of them falling under the WHO AWaRe Watch category and 31% in Access category. Majority of the drugs being prescribed in the PICU were with generic names, and less than half the prescriptions contained antibiotics. Watch class of antibiotics was most commonly prescribed.

Ecological Distribution of Virulent Multidrug-Resistant Staphylococcus aureus in Livestock, Environment, and Dairy Products.

Staphylococcus aureus is one of the most common causes of mastitis, leading to severe economic losses in the dairy industry. It is also zoonotic, with potential risks to public health. This study aimed to detect the occurrence of S. aureus-resistant strains isolated from cattle, buffalo, their environment, milk and dairy products; and to investigate the extent of animal, ecological, and food contamination by methicillin-resistant (MRSA) or enterotoxigenic S. aureus. Samples (n = 350) were collected from four animal (two cattle and two buffalo) farms, i.e., their environment. Thirty Karish cheese samples were collected from 10 markets in Mansoura, Egypt. S. aureus was detected in 17.9%, 17.6%, and 16.7% of samples collected from cattle, buffalo and Karish cheese, respectively. About 19% of isolated S. aureus strains carried the mecA gene. The distribution of the mecA gene was high in isolates from Karish cheese (60%), followed by samples collected from buffalo (16.2%) and cattle (16%). More than 34% of isolated S. aureus strains were enterotoxigenic, and the presence of enterotoxin genes was higher in isolates from Karish cheese (80%) than those from cattle (48%) and buffalo (18.9%). The most predominant enterotoxin gene among isolated S. aureus strains was the sea gene (26.9%), followed by sec (4.5%) and sed (3%) genes. Isolated strains were resistant to clindamycin (100%), kanamycin (97%), nalidixic acid (86.6%), cefotaxime (73.1%) sulphamethazole-trimethoprim (65.6%). Meanwhile, 95.5%, 94%, 86.6% and 77.7% of S. aureus strains were sensitive to ciprofloxacin, amikacin, imipenem and both cefoxitin and gentamycin, respectively. In conclusion, the presence of enterotoxigenic- and methicillin-resistant S. aureus strains in animals, their environment, and dairy products represents a public health concern, particularly in small-scale dairy farms in Egypt. To reduce the risk of infection of livestock and humans with resistant strains, strict regulations and guidelines for antimicrobial use in such a system are urgently required.

Practical Guidelines for the Appropriate Use of Antimicrobial Agents for Prevention of Surgical Site Infection in Various Neurosurgical Fields

Preoperative shaving and disinfection; postoperative wound care; and preoperative, intraoperative, and postoperative antibiotic use are the main methods used to prevent perioperative surgical site infection(SSI); however, a survey of neurosurgeons in Japan did not indicate that these guidelines were followed. There are several types of surgical procedures in the field of neurosurgery, including implant insertion, with little evidence of use of antimicrobial agents in such surgeries. Hence, there had been no guidelines for antimicrobial use in neurosurgery in Japan. However, practice guidelines for the appropriate use of antimicrobial agents for the prevention of postoperative infection in neurosurgery were published in 2020 and are discussed in this section.

Evaluation of antibiotic consumption and compliance to hospital antibiotic policy in the surgery, orthopedics and gynecology wards of a tertiary care hospital

ObjectivesTo evaluate antibiotic consumption and compliance to hospital antibiotic policy in the surgery, orthopedics and gynecology wards of a tertiary care hospital. MethodsA prospective observational study was conducted over eight months on adult inpatients prescribed with antibiotics. Data were collected using a predesigned antibiotic form and evaluated using Defined Daily Dose per 100 bed-days. Antibiotics prescribed were classified using World Health Organization Access, Watch and Reserve classification (WHO AWaRe) and assessed for compliance to the hospital antibiotic policy which is in accordance with the National Treatment Guidelines for Antimicrobial use in Infectious Diseases (version 1.0.2016). ResultsOut of 2653 patients enrolled, 44.3% were males and 55.7% were females. The antibiotic usage rate was 29%. Cephalosporins were the most frequently prescribed class of antibiotics. The top three antibiotics prescribed were cefuroxime, metronidazole, and ceftriaxone. Classification of antibiotics using WHO AWaRe policy showed that 36% of antibiotics were prescribed from the Access group and 53% from the Watch group. The use of antibiotic combinations from the not recommended group of AWaRe was also observed. Total compliance observed towards the hospital's antibiotic policy was 77.7%. The most common reason for non-compliance to hospital policy was inappropriate duration of antibiotic therapy. ConclusionsThe use of watch group of antibiotics over access group due to concerns of antimicrobial resistance shows the need for local adaptation of WHO AWaRe classification. Despite good adherence to the hospital's antibiotic policy, extended duration of antibiotic therapy requires special attention. Further optimization of antibiotic use can be achieved by timely revision and implementation of hospital antibiotic policy.

Point-prevalence surveys of antimicrobial consumption and resistance at a paediatric and an adult tertiary referral hospital in Yangon, Myanmar

SummaryBackgroundAntimicrobial resistance is increasingly prevalent worldwide. The inappropriate use of antimicrobials, including in the hospital setting, is considered a major driver of antimicrobial resistance.AimTo inform improvements in antimicrobial stewardship, we undertook point prevalence surveys of antimicrobial prescribing at Yangon Children's Hospital and Yangon General Hospital in Yangon, Myanmar.MethodsWe conducted our surveys using the Global Point-Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) method. All inpatients who were prescribed an antimicrobial on the day of the survey were included in the analysis.FindingsWe evaluated a total of 1,980 patients admitted to two hospitals during December 2019. Of these, 1,255 (63.4%) patients were prescribed a total of 2,108 antimicrobials. Among antimicrobials prescribed, 722 (34.3%) were third-generation cephalosporins, the most commonly prescribed antimicrobial class. A total of 940 (44.6%) antimicrobials were prescribed for community-acquired infection, and 724 (34.3%) for surgical prophylaxis. Of 2,108 antimicrobials, 317 (15.0%) were prescribed for gastrointestinal tract prophylaxis, 305 (14.5%) for skin, soft tissue, bone and joint prophylaxis, and 303 (14.4%) for pneumonia treatment. A stop or review date was documented for 350 (16.6%) antimicrobial prescriptions, 673 (31.9%) antimicrobial prescriptions were guideline compliant, and 1,335 (63.3%) antimicrobials were administered via the parenteral route. Of 1,083 antimicrobials prescribed for a therapeutic use, 221 (20.4%) were targeted therapy.ConclusionOur findings underscore the need to update and expand evidence-based guidelines for antimicrobial use, promote the benefits of targeted antimicrobial therapy, and support the implementation of hospital-based antimicrobial stewardship programmes at the hospitals surveyed.

Towards a Better and Harmonized Education in Antimicrobial Stewardship in European Veterinary Curricula.

Education in antimicrobial stewardship (AMS) in veterinary medicine is essential to foster responsible antimicrobial use and control of antimicrobial resistance (AMR) in animals. AMS is listed by the EU and international organizations among the basic ‘Day One Competences’ required of veterinary students upon graduation. Our aim was to evaluate the quality of education of European veterinary students in AMS. We distributed a 27-item survey addressing the perceptions of preparedness and acquired skills on key topics related to AMS to final-year veterinary students in Europe. We collected 3423 complete answers from 89 veterinary schools in 30 countries. Selection of treatment strategies and awareness of emerging AMR problems were markedly different between countries. Overall, only one in four students was familiar with guidelines for antimicrobial use. The students perceived a medium-high impact of veterinary antimicrobial use on AMR in humans. Notably, 75% of the students felt the need for improved teaching on AMS, half of which also demanded more teaching on general antimicrobial therapy. Our results highlight several possible strategies to improve the quality of education, ranging from a better link between clinical rotations and the theory taught in pre-clinical modules, to a more effective introduction into best practices for antimicrobial use.

The world-wide spread of carbapenem-resistant Enterobacterales

Introduction. Gram-negative bacilli belonging to the order Enterobacterales are normal inhabitants of the human gut, which also are the most common causative agents of both nosocomial and community-acquired infections in patients of all ages. Although not even a century has passed since Fleming's discovery of penicillin, the scientists have been alarmed by the fact that the "last resort antibiotics" viz. carbapenems have been compromised. 
 Material and methods. The analysis of fifty-two articles and documents regarding this topic was performed. 
 Results. The main mechanism of resistance to carbapenems in Enterobacterales is the production of carbapenemases, being enzymes that destroy all or almost all β-lactam antibiotics including carbapenems. According to Ambler’s classification β-lactamases can be distributed into four classes (A, B, C, and D) being based on primary amino acid sequence homology. The most important carbapenemases produced by Enterobacterales belong to class A (KPC), class B (metallo-β-lactamases NDM, VIM, IMP) and class D (OXA-48-like). Unlike other mechanisms of resistance, carbapenemase production is easily spread via plasmids making carbapenemase-producing Enterobacterales (CPE) a global challenge for healthcare providers. 
 Conclusions. CPE is not readily detected in the laboratory but the ability to detect carbapenemase production in Enterobacterales has very important infection control implications and therefore is essential for local infection control programs and national and international surveillance systems. Furthermore, local epidemiology of multidrug-resistant organisms has a major influence on the development of national clinical guidelines for antimicrobial use.

Tackling AMR crisis in India: Changing paradigm

Antimicrobial resistance (AMR) is an important public health concern globally. For India, undoubtedly, AMR has had profound impact on its health & socioeconomic parameters. Several hospital and community-based surveys have indicated alarming rise in incidence of multidrug resistant microbes, especially ‘superbugs’, having direct links with antibiotic use/misuse. Additionally, paucity in data with regards to quantification of AMR crisis & its determinants has been concerning. However, the national commitment to address AMR has steadily increased of late, with an oft-restated realization – it is time to act. Recent initiatives like National Policy for Containment of AMR (2011), Chennai Declaration (2012), Anti-microbial Resistance Surveillance and Research Network (2013), The Red Line Campaign (2016), National Action Plan (NAP) for AMR (2017), ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) are promising measures expected to have positive impact on both clinical and economic outcome in India. This paper provides a snapshot of major strategies proposed in recent years, including educational and awareness initiatives, infection control guidelines, audit and feedback, antimicrobial stewardship, surveillance projects etc. It also identifies technical challenges & opportunities for improved AMR mitigation in India.

Variation in UK guidelines for the first-line antimicrobial management of paediatric orbital cellulitis-time for national recommendations.

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The authors declare that they have no conflict of interest. Publisher’s note Springer...

A comparison of five paediatric dosing guidelines for antibiotics.

ObjectiveTo compare dosing guidance in the paediatric formularies of high- and middle-income countries for 32 commonly prescribed antibiotics on the World Health Organization’s (WHO’s) 2017 Model list of essential medicines for children.MethodsWe identified paediatric antibiotic guidelines that were either widely used internationally or originated from countries in which antibiotic use has increased markedly in recent years (i.e. Brazil, China, India, the Russian Federation and South Africa).FindingsThe study analysis considered five leading antibiotic guidelines: (i) the Manual of childhood infections: the blue book; (ii) the BNF (British national formulary) for children; (iii) the Red book®: 2018–2021 report of the committee on infectious diseases; (iv) WHO’s Pocket book of hospital care for children; and (v) Indian National treatment guidelines for antimicrobial use in infectious diseases. There was marked heterogeneity in the recommended dosing (i.e. daily dose, age dosing bands and dose frequency) for most commonly used antibiotics. The rationale for dosing recommendations was generally unclear.ConclusionThe pharmacokinetic, pharmacodynamic and clinical evidence supporting paediatric antibiotic dosing, particularly on total doses and on age or weight dosing bands, needs to be improved. Future research should consider whether the variations in guidance identified stem from different clinical disease patterns, varying levels of antibiotic resistance or drug availability rather than historical preferences. Interested global parties could collaborate with WHO’s Model list of essential medicines antibiotic working group to develop an evidence-based consensus and identify research priorities.

Anti-microbial Resistance surveillance in typhoidal Salmonella in Ahmedabad Objective

Anti-microbial Resistance surveillance in typhoidal Salmonella in Ahmedabad Objective

Pattern of antimicrobial usage in neonatal septicemia at neonatal intensive care unit of a tertiary care hospital in Kolkata

Introduction: Antimicrobials are the mainstay treatment in neonatal septicemia (NS). National treatment guidelines for antimicrobial use in infectious diseases issued by the Government of India has paved the way for rationalizing antibiotic use, but it needs tailoring according to the prevalent local microbiota and individual patient's needs. A periodic surveillance of the microbial etiology and antibiotic use patterns in NS may be useful in rational selection of empirical antimicrobial therapy. Aims and Objectives: We observed the utilization pattern of antimicrobials and quantified the same in neonates admitted to neonatal intensive care unit (NICU) with septicemia along with the prospective follow-up of the clinical response to individual regimen. Materials and Methods: This hospital-based prospective observational study was conducted from January 2017 to June 2017 on 102 consecutive cases of NS admitted to NICU. Data regarding demographic parameters, antimicrobials used, and outcome were collected through a predesigned case record form. Antimicrobial usage was quantified as days of therapy (DOT) per 1000 patient days. Results: Common antimicrobials used in descending order of DOT were amikacin, colistin, and meropenem. Ampicillin, cefotaxime, and gentamicin were rarely found suitable for use based on the reported antibiograms. Piperacillin-tazobactam + amikacin regimen was the most commonly used empirical regimen. The case fatality rate was 4% in our study sample. Conclusion: Ampicillin, cefotaxime, and gentamicin had limited effectiveness in the majority of cases. Although there is a need of alignment with national treatment guidelines in NS, yet, the concurrent scope of periodic survey and research must be available for changeover to evidence-based local individualization of empirical antimicrobial therapy wherever required.

Outcome assessment of intervention on appropriateness of antibiotic use among geriatric patients: A prospective interventional study from a tertiary care referral hospital

ObjectiveTo assess the inappropriate use of antibiotics in geriatric patients and to assess the impact of clinical pharmacist intervention in reducing the inappropriate use of antibiotics. MethodologyA prospective intervention study of 12 months duration was conducted among 180 geriatric patients who were on treatment with antibiotics for more than 2 days. The outcome measures were compliance with Gyssens criteria and National guidelines for antimicrobial use 1.0(2016). Reason for inappropriateness and quality indicators were also assessed to optimize the antibiotic use and to develop adult traffic light signal for antibiotics. ResultsThe mean stay duration was found to be 7.52 ± 4.47 days, reduced to 4.93 ± 1.72 days in after intervention. Most of indication for antibiotics was respiratory tract infections (30.6%). In the pre intervention, 70% antibiotic therapy proved inappropriate which reduced to 48.8% inappropriateness in the post intervention (p = 0.004). Most common reason given for inappropriateness was wrong drug duration (pre: 41.2%, post: 27.8%). There was a poor compliance with the national guidelines for antibiotic use in the pre intervention (15%) which increased to 25.6% in post intervention. Most of the therapy was given prophylactically and only 30.55% ordered bacteriological test before starting treatment. ConclusionThe study concluded that prescribing patterns do not comply with the recommended standards of care. Since the intervention has a positive impact on inappropriateness the hospital should develop a system to monitor and regulate the use of antibiotics in geriatrics to promote the rational use of antibiotics.

Dynamism in Resistance Pattern of Escherichia coli - A Drift from Indian Council of Medical Research (ICMR) - Antimicrobial Use Guidelines

Background/Purpose: Combating Antibiotic resistance has become a great challenge for clinicians due to inappropriate use of antibiotics. Antibiotics once considered being magic bullet is no more having that title. Recommendation in AMR situation in by Department of Biotechnology (DBT) and Treatment Guidelines for Antimicrobial Use by Indian Council of Medical Research (ICMR) India emphasized the need for regional surveillance starting from the level of state to an individual hospital has been motivation behind the study. Method: Three hospitals in region of Cuddalore in Tamilnadu (India) have been the source of specimen for isolation of Escherichia coli during the period of January to July 2017. Antibiogram reports were collected during the study period and utilized for the study. Result: Among 124 isolates Urine, High vaginal swab, Pus, Serum, Oral swab and Amniotic fluid occupied 81.45%(n-101), 08.06%(n-10), 5.64%(n-7), 2.41%(n-3), 1.62%(n-2) and 0.81%(n-1) respectively. Antibiogram for the Escherichia coli isolates revealed 90% of resistance to Cefepime, 68% to Ciprofloxacin, 50% to Tetracyclin, 30% to Meropenum etc., Similarly high percentage of sensitiveness was evident in Cefotaxime (95.94%), Imipenum (95.91%), Piperacillin/Tazobactem (86%), Meropenum (70%) etc. Conclusion: On comparison with the 2014 ICMR (Antimicrobial Susceptibility) data percentage of resistance and susceptibility has a drastic change both in resistance and sensitivity. From the study it is clear that the generic recommendations on antibiotic use at national level can't be a desirable solution or recommendations to clinicians. The study signifies the importance of local surveillance and infection control programs. Funding Statement: No funding was obtained for this study. Declaration of Interest: The authors report no conflict of interest. Ethics Approval Statement: The samples were not collected exclusively for this study, and since it is a retrospective study where we have analysed the sensitivity pattern of the isolates in reference to ICMR-Antimicrobial use guidelines. Similarly international guidelines such as Consolidated Standards of Reporting trials (CONSORT) and uniform requirements for manuscripts submitted to biomedical journals(URM) states that ethics approval is required when animal or human are to be used for teaching or new intervention research. Since our study is not coming under prospective randomised trials we have not gone for Ethical clearance.

Therapeutic guidelines for antimicrobial use in chronic suppurative otitis media for a tertiary care hospital in Sub Himalayan region

Background: The battle against micro-organisms, in their role as primary cause of the disease and infective complications of medical and surgical techniques, has not decreased in spite of modern antimicrobial therapy. Chronic suppurative otitis media (CSOM) is a disease with worldwide prevalence having potentially serious long term effects. The disease remains an important global public health problem leading to hearing impairment, and due to wide spread irrational use microbial resistance is very common to these antibiotics, thereby leading to treatment failure. Hence it is important to know the type of bacteria and their sensitivity pattern so that appropriate antibiotics may be given for treatment and prevention of complications.Methods: 428 patients of otitis media were enrolled from ENT OPD of Tertiary Care Hospital. Ear swab was taken from diagnosed cases of CSOM and culture and sensitivity were done.Results: The microbiology of the swab showed no growth in (25.4%) of samples. Staphylococcus aureus (26%) and Pseudomonas (25%) were the main organisms isolated. Staphylococcus aureus isolated was sensitive to vancomycin, clindamycin, cefixime, gentamicin and cefipime in descending order. Pseudomonas aeruginosa was sensitive to ceftazidime, imipenem, piperacillin, gentamicin, cefipime. In the present study Staph. aureus and Pseudomonas were the predominant bacteria, it is suggested to undertake a gram staining in all patients. If gram positive organisms are isolated it is suggested that presumptive treatment should be directed against Staphylococcus aureus and if gram negative then against Pseudomonas aeruginosa. Such a treatment is not only likely to be effective but will also go a long way in preventing emergence of drug resistance.Conclusions: The antimicrobial therapy should be based on locally determined microbiological isolates and local sensitivity patterns to a particular antimicrobial agent. The presumptive antimicrobial therapy should therefore be directed against these organisms.

Trends and molecular mechanisms of antimicrobial resistance in clinical staphylococci isolated from companion animals over a 16 year period.

The objective of this study was to investigate the evolution of resistance to antimicrobials, corresponding mechanisms and molecular characteristics of Staphylococcus spp., between 1999 and 2014. Susceptibility to 38 antimicrobials was determined for 632 clinical staphylococcal isolates obtained from companion animals (dogs, cats, horses and other animals). Twenty antimicrobial resistance genes, including mecA and mecC, were screened by PCR. Methicillin-resistant staphylococci were characterized by spa (Staphylococcus aureus), SCCmec, MLST and PFGE typing. Statistical analyses were performed using SAS v9.3 and differences were considered relevant if P ≤ 0.05. The mecA gene was identified in 74 staphylococcal isolates (11.6%): 11 MRSA (40.7%), 40 methicillin-resistant Staphylococcus pseudintermedius (MRSP; 8.7%) and 23 methicillin-resistant CoNS (26.7%). Resistance to the majority of antimicrobials and the number of mecA-positive isolates increased significantly over time. Eighteen spa types were identified, including two new ones. MRSA isolates were divided into three PFGE clusters that included ST22-IV, ST105-II, ST398-V and ST5-VI. Most methicillin-resistant Staphylococcus epidermidis isolates were of clonal complex (CC) 5, including a new ST, and clustered in eight PFGE clusters. MRSP were grouped into five PFGE clusters and included ST45-NT, ST71-II-III, ST195-III, ST196-V, ST339-NT, ST342-IV and the new ST400-III. Methicillin-resistant Staphylococcus haemolyticus clustered in two PFGE clusters. The significant increase in antimicrobial-resistant and mecA-positive isolates in recent years is worrying. Furthermore, several isolates are MDR, which complicates antimicrobial treatment and increases the risk of transfer to humans or human isolates. Several clonal lineages of MRSA and methicillin-resistant S. epidermidis circulating in human hospitals and the community were found, suggesting that companion animals can become infected with and contribute to the dissemination of highly successful human clones. Urgent measures, such as determination of clinical breakpoints and guidelines for antimicrobial use, are needed.