High Antibiotic Consumption Research Articles

Evaluation of the Impact of the Tiny Earth Project on the Knowledge About Antibiotics of Pre-university Students in the Province of Valencia on Three Different School Years (2017-2020).

According to the World Health Organization (WHO), antibacterial resistance is a serious problem worldwide. In Spain, knowledge about the use of antibiotics is scarce, being the third country with the highest consumption of antibiotics in the world and the first in Europe. This problem is due, partly, to the abusive use of these drugs in human medicine, livestock, and agriculture. The objective of this study was to evaluate the impact that the Tiny Earth project has had on the antibiotic knowledge in pre-university students. To do this, a survey was conducted before and after the Tiny Earth project in three different school years (2017–2020) to 322 pre-university students belonging to seven schools in the province of Valencia. The survey consisted of 12 multiple-choice questions with a single valid answer. We observed 67.6% success at the beginning and 81.2% at the end. These data indicate that they correctly answered an average of 1.64 more questions after completing the project. In view of the results, we can affirm that the Tiny Earth project has contributed to an improvement in scientific knowledge and awareness of the correct use of antibiotics and the emergence of resistances by pre-university students, which could also be transmitted to their social environment, thus improving awareness global on these issues.

Antibiotic Use and Antibiotic Resistance: Public Awareness Survey in the Republic of Cyprus

We aimed to assess the knowledge and understanding of antibiotic use and resistance in the general population of Cyprus, in order to inform future antibiotic awareness campaigns with local evidence. Cross-sectional survey following the methodology of the “Antibiotic resistance: Multi-country public awareness survey” of the World Health Organization, during December 2019–January 2020. A total of 614 respondents participated: 64.3% were female and most were aged 35–44 years (33.2%) or 25–34 years (31.8%). One-third had used antibiotics >1 year ago and 91.6% reported receiving advice on appropriate use from a medical professional. Despite high awareness on correct use of antibiotics, lack of knowledge was noted for specific indications, where approximately one-third believed that viral infections respond to antibiotics and 70.7% lack understanding of how antibiotic resistance develops. Higher education graduates exhibited significantly higher knowledge rates. As high as 72.3% were informed about “antibiotic resistant bacteria” from healthcare professionals or social media. Most agreed on the usefulness of most suggested actions to address antibiotic resistance, with higher proportions acknowledging the role of prescribers. Up to 47% could not identify their role in decreasing antibiotic resistance. Our study provides local evidence to inform future efforts in a country characterized by high antibiotic consumption rates.

Antibiotic Consumption Patterns in European Countries May Be Associated with the Incidence of Major Carcinomas

The possible role of the altered intestinal microbiome in the development of malignancies has been raised recently in several publications. Among external factors, antibiotics are considered to be the most important agent capable of producing dysbiosis in the gut flora, either temporally or permanently. The human microbiome has several beneficial effects in terms of maintaining appropriate human health, but its alteration has been implicated in the development of many illnesses. Our basic aim was to explore a possible relationship between the consumption of different antibiotic classes and the incidence of the most common cancer types (male, female) in European countries. A database of the average, yearly antibiotic consumption (1997–2018) has been developed and the consumption figures were compared to the eight, most frequent cancer incidence calculated for 2018 in 30 European countries. Pearson correlation has indicated different degrees of positive (supportive) and negative (inhibitor) significant associations between antibiotic consumption figures and cancer prevalence. It has been observed that certain antibiotic classes with positive correlation probably augment the incidence of certain cancer types, while others, with negative correlation, may show some inhibitory effect. The relatively higher or lower consumption pattern of different classes of antibiotics could be related to certain cancer prevalence figures in different European countries. Our results indicated that countries with relatively high consumption of narrow-spectrum penicillin (J01CE, J01CF) and tetracycline (J01A), like certain Scandinavian countries, showed a higher incidence of female colorectal cancer, female lung cancer, melanoma, breast, prostate and uterus corpus cancer. Countries with relatively higher consumption of broad-spectrum penicillin (J01CA, J01CR) and some broad-spectrum antibiotics (J01D, J01F, J01M), like Greece, Hungary, Slovakia, France, etc. showed a higher incidence rate of male lung cancer and male bladder cancer. The higher incidence rate of different cancer types showed association with the higher consumption of antibiotics with “augmenting” properties and with less consumption of antibiotics with “inhibitory” properties.

Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey

Abstract Background Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption. Methods This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393). Results Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education. Conclusions Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care. Key messages Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.

From Point-of-Care Testing (PoCT) and vaccination to changing the care paradigm: the role of primary care

Abstract The speaker will discuss the role of primary care for all patients and cancer patients, elaborating on prescribing patterns vaccinations, recommendations for Over-The-Counter medicines (OTCs) nutritional supplements, and as well as its contribution of behavioural change to raise awareness and change prescription practice. The role of PoCT for reducing the threat of AMR and for improving the differential diagnosis will be discussed, according to the WHO Approach of “diagnostic stewardship” for the appropriate use of microbiological diagnostics to guide therapeutic decisions. In the context of syndromic surveillance and preparedness, as well as in terms of protecting cancer patients at times of epidemics, methods of specimen collection for limited community transmission and for the timely pathogen identification along with accurate, timely reporting of results to guide patient treatment will be discussed. The role of behavioural modification interventions will be discussed, incl. in relation to vaccination and the role it can play in AMR. Improvement of the survivorship experience will be examined in the context of improving health literacy. The case of Greece, currently having the highest antibiotic consumption in Europe and the fourth highest globally, along with an increasing trend on antibiotic use will also be discussed.

Antibiotic consumption and healthcare associated infection in a third level Italian hospital

Abstract Background The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital Methods Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12 Results Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%) Conclusions PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high. Key messages The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.

Antibacterial Activity of Bacteriocinogenic Commensal Escherichia coli against Zoonotic Strains Resistant and Sensitive to Antibiotics.

Antibiotic resistance concerns various areas with high consumption of antibiotics, including husbandry. Resistant strains are transmitted to humans from livestock and agricultural products via the food chain and may pose a health risk. The commensal microbiota protects against the invasion of environmental strains by secretion of bacteriocins, among other mechanisms. The present study aims to characterize the bactericidal potential of bacteriocinogenic Escherichia coli from healthy humans against multidrug-resistant and antibiotic-sensitive strains from pigs and cattle. Bacteriocin production was tested by the double-layer plate method, and bacteriocin genes were identified by the PCR method. At least one bacteriocinogenic E. coli was detected in the fecal samples of 55% of tested individuals, adults and children. Among all isolates (n = 210), 37.1% were bacteriocinogenic and contained genes of colicin (Col) Ib, ColE1, microcin (Mcc) H47, ColIa, ColM, MccV, ColK, ColB, and single ColE2 and ColE7. Twenty-five E. coli carrying various sets of bacteriocin genes were further characterized and tested for their activity against zoonotic strains (n = 60). Strains with ColE7 (88%), ColE1-ColIa-ColK-MccH47 (85%), MccH47-MccV (85%), ColE1-ColIa-ColM (82%), ColE1 (75%), ColM (67%), and ColK (65%) were most active against zoonotic strains. Statistically significant differences in activity toward antibiotic-resistant strains were shown by commensal E. coli carrying MccV, ColK-MccV, and ColIb-ColK. The study demonstrates that bacteriocinogenic commensal E. coli exerts antagonistic activity against zoonotic strains and may constitute a defense line against multidrug-resistant strains.

Lythrum salicaria L. herb and gut microbiota of healthy post-weaning piglets. Focus on prebiotic properties and formation of postbiotic metabolites in ex vivo cultures.

Herb of purple loosestrife (Lythrum salicaria L. from Lythraceae family) (LSH) was used in Europe since ancient times till early-20th century in the therapy of diarrhea and dysentery in human and veterinary medicine. Post-weaning diarrhea is a main problem affecting global piglet production, which leads to significant economic losses because of increased morbidity and mortality, reduced average daily gain, and high antibiotic consumption. Post-weaning diarrhea has various causes, all of which have been linked to imbalances of intestinal microbiota. The aim of the present study was to determine the interaction of LSH with the gut microbiota of healthy post-weaning piglets in order to evaluate its influence on microbiota composition and metabolism as well as production of potentially bioactive postbiotic metabolites from the extract constituents. Ex vivo anaerobic cultures of piglets intestinal microbiota obtained from jejunum, ileum, caecum and distal colon were conducted in various culture media supplemented with LSH. The production of postbiotic metabolites was determined using UPLC-DAD-MSn method. Bacterial genomic DNA was extracted and examined by sequencing by amplification of the 16S rDNA V3-V4 hypervariable regions followed by bioinformatic analysis. The production of SCFA in cultures was determined by GC analysis. Only the caecal and distal colon microbiota was able to hydrolyze and metabolize ellagitannins present in LSH to urolithins. Urolithin M6, M7, urolithin C, A and iso-urolithin A were detected together with a previously not described metabolite originating from the flavogalloyl moiety of C-glucosylic ellagitannins. LSH had no significant influence on microbiota diversity and metabolic activity, but was able to modulate its composition by significant decrease in Collinsella, Senegalimassilia, uncultured bacteria belonging to Porphyromonadaceae, Rikenellaceae RC9 gut group, Mogibacterium, Dorea, Lachnoclostridium, Lachnospiraceae UCG-004 group, Moryella, [Eubacterium] coprostanoligenes, Intestinimonas, Ruminococcaceae UCG-005, uncultured bacteria belonging to Ruminococcaceae, Acidaminococcus and Allisonella, while the relative abundance of Prevotella, Agathobacter, [Eubacterium] hallii group, Lachnospiraceae NK3A20 group, [Ruminococcus] torques group, Catenibacterium, Catenisphaera and Megasphaera increased. Significant correlations between taxa abundance and production of urolithins were determined. In the present study we have shown, that Lythrum salicaria herb fulfills the criteria of a potential candidate for antidiarrheal agent, which could be applied as therapy or prevention of post-weaning diarrhea in piglets. It not only modulates the gut microbiota composition without causing the dysbiosis and impairing metabolic activity, but is also a source of postbiotic metabolites, namely urolithins, which anti-inflammatory properties can be beneficial for gut health of piglets during the weaning period.

Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy

IntroductionThe overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to...

Employment of Mapping Technology in Antimicrobial Resistance Reporting in Saudi Arabia.

Although Antimicrobial Resistance (AMR) is a worldwide threat, local AMR databases do not exist. Unlike other health disasters, developing containment strategies for AMR cannot be started without a representative, local, updated AMR data. However, Geographical Information Systems (GIS) mapping technology is capable of visualizing AMR data integrated with geographical regions. Due to the absence of AMR databases in Saudi Arabia, we searched Medline and Embase databases from inception until May 28, 2018, including literature that reported AMR data on the most prevalent gram-negative bacterial strains in Saudi Arabia. These data were extracted into Microsoft Excel file and inserted into STATA software, version 13 and ArcMap 10.6 software platform for mapping. We found particularly high levels of AMR in Makkah (Mecca), possibly due to high antibiotic consumption because of the influx of pilgrims, with Pseudomonas aeruginosa isolates showing the highest resistance rate against amikacin, aztreonam, cefepime, ceftazidime, ciprolfloxacin, gentamicin, imipenem, meropenem and pipracillin/tazobactam, and Enterobacteriaceae isolates against cefuroxime, ciprofloxacin, ampicillin, imipenem and ertapenem. The cause is, however, multifactorial since Acinetobacter baumannii isolates showed a variable resistance rate throughout the country. The employment of mapping technology in displaying AMR data extracted from published literature is a practically useful approach, and advanced GIS analyses should help stakeholders create containment strategies and allocate resources to slow down the emergence of AMR.

Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006-2017.

Elderly people are a particularly important population with regard to antibiotic overuse, using around 50% more antibiotics per capita than younger adults. The aim of this study was to analyze the prevalence, associated factors and evolution over time of antibiotic consumption among the Spanish population aged ≥ 65 years from 2006 to 2017. A descriptive cross-sectional study was conducted using data from the Spanish National Health Survey in 2006, 2011/2012 and 2017, and from the European Health Survey in Spain in 2009 and 2014. The sample consisted of 26,891 non-institutionalized individuals ≥ 65 years. Antibiotic consumption was the dependent variable, and sociodemographic variables, lifestyle habits and health status were analyzed using a logistic regression model. The prevalence of antibiotic consumption was 4.94%, with a marked increase from 2006 (4.64%) to 2017 (5.81%) (p < 0.0001). Higher antibiotic consumption was associated with poor or very poor self-perceived health status, no polypharmacy and not having been in hospital during the previous twelve months, while a lower consumption was linked to being limited but not severely due to a health problem and not being at all limited.

Patterns of Inpatient Antibiotic Use Among Public Hospitals in Hong Kong from 2000 to 2015.

BackgroundStudies have demonstrated that higher rates of antibiotic resistance are found in countries with higher antibiotic consumption. The global increase in antibiotic consumption is a major public health concern.ObjectivesThe objective of this study was to describe the antibiotic dispensing patterns in public hospitals in Hong Kong from 2000 to 2015.MethodsWe acquired data on all hospital admissions with any antibiotics dispensed from 2000 to 2015 from the Hong Kong public hospitals. The annual proportion of hospital admissions with antibiotics dispensed was estimated and stratified by age group. An interrupted time series analysis was conducted to examine any potential change in tetracycline dispensing after the release of the new clinical practice guideline.ResultsA total of 35,535,506 antibiotic prescriptions were dispensed among 2,161,360 unique hospitalized patients from 2000 to 2015. Antibiotics were dispensed in 29.2% of all hospital admissions in the public hospitals, the annual proportions of hospital admissions with antibiotics dispensed increased over the study period from 27.87% in 2000 to 31.39% in 2015, ranging from 27.17 to 31.39%. However, a significant increase was only observed in age groups of 5–19, 20–44, and 85 years or above when stratifying by age. In the interrupted time series analysis, a change in trend was detected for tetracycline dispensing that coincided with the time of publication of the new clinical practice guideline.ConclusionsWe found that the overall volume of antibiotic use increased between 2000 and 2015. The rise in the dispensing of carbapenems in our study is concerning. The significant change in tetracycline use after being recommended as one of the preferred regimens demonstrated that the change in the clinical practice guideline had an immediate effect on the antibiotic prescribing practice in Hong Kong public hospitals.

Effects of an Antimicrobial Stewardship (AMS) Program, on the Prevalence of Multidrug-resistant Gram - Negative Pathogens, in an Area of High Consumption of Antibiotics and High Resistance Rates

Effects of an Antimicrobial Stewardship (AMS) Program, on the Prevalence of Multidrug-resistant Gram - Negative Pathogens, in an Area of High Consumption of Antibiotics and High Resistance Rates

Methodology Development and Validation of Amphotericin B Stability by HPLC‑DAD

The high worldwide consumption of antibiotics and their complex impurity profiles has drawn the attention of the scientific community to the development and validation of stability methods for these drugs. Amphotericin B is an antibiotic that is a natural fermentation product of bacterium Streptomyces nodosus, used as a broad-spectrum antifungal agent, and is highly unstable. For this reason, the objective of this work is the development and validation of an indicative method of stability by high performance liquid chromatography (HPLC) associated to diode array detector (DAD) for amphotericin B (AMB). To achieve this, the chromatographic profiles of acid, basic, oxidative and thermal degradation caused by AMB exposure to water and light were verified by HPLC-DAD, using an isocratic method under the following conditions: C18 chromatographic column (200 × 4.6 mm-5 µm), mobile phase composed of 65:35 of organic phase (methanol/acetonitrile in 41:18)/aqueous phase (2.5 mmol L-1 of disodium edetate, pH 5.0), flow rate of 1.0 mL min-1, injection volume of 20 µL, column temperature 30 ± 2 °C and wavelength of 383 nm. After identification of these profiles, the method was validated according to recommendations of the International Conference on Harmonization guidelines, and then, the active pharmaceutical ingredient (API) peak purity grade, percentage of drug degradation, occurrence of impurities peak and its identification by mass spectrometry (MS) with electrospray ionization (ESI), under positive ionization mode, were evaluated. It is suggested that the main degradation products were amphotericin B (2), degradation product 1 (DP1) and degradation product 2 (DP2) in acid and oxidative medium. Amphotericin B was stable in the presence of water and at 70 ± 2 °C for seven days.

Antibiotic Consumption in Hospitals and Resistance Rate of Klebsiella pneumoniae and Escherichia coli in Montenegro.

SUMMARYInappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. We used the national data on antibiotic consumption from 2009 to 2015, Point Prevalence Survey data on inpatient antibiotic consumption from 2015, and national AMR data on 79 Klebsiella pneumoniae and 68 Escherichia coli isolates collected from 8 hospitals from 2016 to 2018. The most commonly used antibiotics were third-generation cephalosporins with a median annual consumption of 0.66 DDD/1000/day. Ceftriaxone was the most frequently prescribed antibiotic in the treatment of community/hospital acquired infections and surgical/medical prophylaxis. The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broad-spectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.

Continuous rise in cephalosporin and fluoroquinolone consumption in Pakistan: a 5 year analysis (2014-18).

BackgroundPakistan was third on the list of the highest antibiotic-consuming countries among low- and middle-income countries in 2015. Studies have suggested that areas with higher consumption of antibiotics are likely to have higher antibiotic resistance rates.ObjectivesWith limited surveillance data on consumption and resistance in Pakistan, this study investigated the 5 year trends (April 2014 to March 2019) in consumption of the two highest-sold antibiotic classes, cephalosporins [Anatomical Therapeutic Chemical (ATC) group J01D] and fluoroquinolones (ATC group J01MA).MethodsIQVIA Pakistan data (retail) on antibiotic sales presented in units were used. These data were standardized and a DDD was assigned to all formulations, based on WHO’s ATC/DDD index, and the data expressed as DIDs (DDDs per 1000 inhabitants per day). WHO’s AWaRe classification of antimicrobials was used for the analyses, especially of those categorized as ‘Watch’.ResultsThe findings showed a significant increase in consumption trends for ‘Watch’ cephalosporins (61.5%) while the use of ‘Reserve’ cephalosporins doubled during the studied period. In 2018, combined consumption of second- and third-generation cephalosporins (both in the ‘Watch’ group) was nearly five times higher than that of the first-generation cephalosporins. For fluoroquinolones, the total consumption only showed a major increase for ciprofloxacin, with 127 820 more persons per day. The consumption of cephalosporins and fluoroquinolones in Pakistan increased by 1.86 DIDs in just 5 years.ConclusionsIt is urgent to establish a National Antimicrobial Commission in Pakistan, to critically analyse the pharmaceutical market offerings and implement surveillance systems and antimicrobial stewardship.

Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil.

Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.

From oxidative stress to inflammation: redox balance and immune system

Important intestinal diseases in young pigs and chickens, such as diarrhea and enteritis, may be associated with oxidative stress and inflammatory reactions. Especially enteric infectious diseases of weaned pigs and broiler chickens are responsible for a high antibiotic consumption, and there is a major request for alternative strategies to enhance animal disease resistance and robustness. The aim of this presentation was to address the role of oxidative stress and inflammation to combat infectious pathogens, and to elucidate how the reactive processes will contribute to normal immune defense mechanisms of the animal. Furthermore, factors that can enhance oxidative stress (e.g., intensive production, heat stress, polyunsaturated fatty acids, and impaired fat quality), uncontrolled inflammatory reactions (e.g., high ratio of n-6 and n-3 in cellular membranes), and limited immune development (such as micronutrient deficiency) are addressed. In addition, the presentation reviews how micronutrient supplementation during critical phases can support a normal immune system and modulate resistance to infectious diseases of pigs and poultry. The mechanisms concern especially modulation of signal transduction in leukocytes (fat-soluble vitamins and fatty acids) and protection against immunopathology, as exerted by the antioxidative vitamins and selenium. Substantial advances in optimized gut health could be expected by increasing our understanding on how to foster or inhibit production of reactive oxygen species and inflammatory reaction; the relation to enteric pathogens, and how to monitor the effect of disease prevention in farm animals by the use of antioxidant therapy and antibacterial feed components.

Culture of antibiotic use in Kosovo - an interview study with patients and health professionals.

Background:Kosovo is a new state and has a high consumption of antibiotics in relation to other European countries. Existing quantitative studies have shown that practices exist that is not optimal when it comes to antibiotic use in Kosovo, this includes citizens’ use of antibiotics, pharmacy practices of selling antibiotics without prescriptions and physicians’ prescribing behaviours. To address these problems, there is a need for a deeper understanding of why antibiotics are handled in a suboptimal way.Objective:The objective was to explore antibiotic users’, community pharmacists’ and prescribers’ attitudes towards, experiences of, and knowledge about antibiotics in Kosovo.Methods:Semi-structured interviews were conducted with patients who recently received an antibiotic prescription for an upper respiratory tract infection (URTI), patients who recently received antibiotics for a URTI without a prescription, community pharmacists, and physicians. Interviews were recorded, translated into English, and analysed using deductive content analysis.Results:In total, 16 interviews were conducted in the period from 2015-2016. Five themes were identified: Obtaining antibiotics, Choice of antibiotics, Patient information, Patients’ knowledge and views on when to use antibiotics, and Professionals’ knowledge and attitudes towards antimicrobial resistance. Antibiotics were sometimes obtained without a prescription, also by patients who currently had received one. The specific antibiotic could be chosen by a physician, a pharmacist or the patient him/herself. Former experience was one reason given by patients for their choice. Patients’ knowledge on antibiotics was mixed, however health professionals were knowledgeable about e.g. antimicrobial resistance.Conclusions:There is currently a culture of antibiotic use in Kosovo, including attitudes and behaviours, and hence also experiences, which is possibly underlying the high consumption of antibiotics in the country. The culture is reproduced by patients, pharmacists and physicians. There is, however, an awareness of the current problematic situation among practitioners and policy makers; and as Kosovo is a new country, opportunities to effectively tackle antimicrobial resistance exist.

Association between urinary community-acquired fluoroquinolone-resistant Escherichia coli and neighbourhood antibiotic consumption: a population-based case-control study

It is unknown whether increased use of antibiotics in a community increases the risk of acquiring antibiotic resistance by individuals living in that community, regardless of prior individual antibiotic consumption and other risk factors for antibiotic resistance. We used a hierarchical multivariate logistic regression approach to evaluate the association between neighbourhood fluoroquinolone consumption and individual risk of colonisation or infection of the urinary tract with fluoroquinolone-resistant Escherichia coli. We did a population-based case-control study of adults (aged ≥22 years) living in 1733 predefined geographical statistical areas (neighbourhoods) in Israel. A multilevel study design was used to analyse data derived from electronic medical records of patients enrolled in the Clalit state-mandated health service. 300 105 events with E coli growth and 1 899 168 cultures with no growth were identified from medical records and included in the analysis. 45 427 (16·8%) of 270 190 women and 8835 (29·5%) of 29 915 men had fluoroquinolone-resistant E coli events. We found an independent association between residence in a neighbourhood with higher antibiotic consumption and an increased risk of bacteriuria caused by fluoroquinolone-resistant E coli. Odds ratios (ORs) for the quintiles with higher neighbourhood consumption (compared with the lowest quintile) were 1·15 (95% CI 1·06-1·24), 1·31 (1·20-1·43), 1·41 (1·29-1·54), and 1·51 (1·38-1·65) for women, and 1·17 (1·02-1·35), 1·24 (1·06-1·45), 1·35 (1·15-1·59), and 1·50 (1·26-1·77) for men. Results remained significant when the analysis was restricted to patients who had not consumed fluoroquinolones themselves. These data suggest that increased use of antibiotics in specific geographical areas is associated with an increased personal risk of acquiring antibiotic-resistant bacteria, independent of personal history of antibiotic consumption and other known risk factors for antimicrobial resistance. None.