Antibiotics In Hospital Research Articles

Drug Utilization Evaluation of Antibiotics in Burn Patients at a Referral Teaching Hospital

Background: Nowadays, due to the irrational and excessive use of antibiotics, antimicrobial resistance has become one of the main concerns of the medical community. Patients with burns are more prone to infections due to the loss of the skin's defense barrier and a weakened immune system. Therefore, proper antibiotic treatment is essential in these patients. In the present study, the rational use of antibiotics in the burn hospital of Imam Mousa Kazem in Isfahan was evaluated.
 Methods: This prospective cross-sectional descriptive study was performed on 102 hospitalized patients over 9 months (from January to September 2020). Adult burn patients who received at least one antibiotic were included in the study. All required information, including demographic data, the prescribed antibiotic, basis of administration (empiric vs. culture-based), dose and duration of use, microbial culture test, and treatment outcome were recorded in the data collection form by referring to patients’ medical profile and the hospital computer system. Judgments about the accuracy of the indication, dose, and duration of treatment, as well as the need for dose adjustment in renal or hepatic impairment were made using related guidelines and references.
 Results: Among the 196 antibiotic prescriptions, cefepime (40.3%) was the most frequently used antibiotic, followed by vancomycin (17.9%) and meropenem (16.8%). Most prescriptions were empirical, while the antibiotics were administered based on the microbial culture results only in two cases (1.9%). The indication of use was correct in 52.6% of prescriptions (n = 103), of which 74.8% (n = 77) had correct dose. In addition, in 47 cases (45.6%), the duration of antibiotic therapy was correct. 6.8% of the patients died, 10.75 discharged with the patient's personal consent, and the rest of the them discharged in good condition.
 Conclusion: Prescribing antibiotics in Imam Moussa Kazem Hospital is associated with many errors in various aspects, including indication, dose, de-escalation, and duration of treatment.

Practical checklist for implementation of antifungal stewardship programmes.

Introduction. Antifungal stewardship programmes are needed in healthcare facilities to limit the overuse or misuse of antifungals, which are responsible for an increase in antifungal resistance.Hypothesis/Gap Statement. Core recommendations for antifungal stewardship were published by the Mycoses Study Group Education and Research Consortium, while the Centers for Disease Control and Prevention (CDC) provided a Core Elements of Hospital Antibiotic Stewardship Programs checklist. The recommendations offer global core elements for best practices in antifungal stewardship, but do not provide a framework for the implementation of antifungal stewardship programmes in healthcare facilities.Aim. In line with the recommendations, it is of the utmost importance to establish a practical checklist that may be used to implement antifungal stewardship programmes.Methodology. The practical checklist was established by a national consensus panel of experts involved in antifungal stewardship activities. A preliminary checklist was sent to all experts. The final document was approved by the panel after discussion and the resolution of any disagreements by consensus.Results. The final checklist includes the following items: leadership support; actions to support optimal antifungal use; actions to monitor antifungal prescribing, use and resistance; and an education programme.Conclusion. This antifungal stewardship checklist offers opportunities for antifungal resistance containment, given that antifungal stewardship activities promote the optimal use of antifungals.

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China.

BackgroundThe excessive use of resources and poor quality of care are great concerns worldwide, particularly in China. In 2013, a model of systematic reforms was developed in Sanming to address the inefficiency and waste in public hospitals. However, limited empirical studies have evaluated the effect of Sanming healthcare reform on antibiotic appropriate use. This study aims to evaluate the impact of the healthcare reform on the appropriate use of antibiotics in county-level public hospitals in Sanming, China.MethodsWe conducted a retrospective observational study exploring trends in antibiotic use with an interrupted time series design. We selected three county-level hospitals in Sanming and extracted outpatient prescriptions of the Departments of Internal Medicine and the Department of Pediatrics between January 2011 and December 2017. Acute Upper Respiratory Tract Infection (AURI), Acute Bronchitis (AB) and Community Acquired Pneumonia (CAP) were selected as the sample diseases for our analysis. The primary outcome was the percentage of prescriptions conformed with standard treatment guidelines (STGs).ResultsA total of 142,180 prescriptions were included in the analysis. During the study period, the percentage of antibiotics prescriptions conformed with STGs boosted from 32.4% in 2011 to 82.3% in 2017. Moreover, after the reform, the rate of prescriptions that conformed with STGs showed significant increasing trends in children with AURI (β = 1.624, p < 0.001), children with AB (β = 3.123, p < 0.001), adult with AB (β = 1.665, p < 0.001), children with CAP (β = 3.123, p < 0.001), adult with CAP (β = 4.385, p < 0.001), but not in adult patients with AURI (β = −0.360, p = 0.022).ConclusionOur study confirmed that the Sanming healthcare reform helped to promote the appropriate use of antibiotics in county-level hospitals. This systematic approach to healthcare reform, characterized by an effective governance structure, dynamic financial compensation mechanisms, and specialized drug stewardship, is promising for future public hospital reforms.

Drug sensitivity Profile of Pseudomonas spp. isolated from a tertiary care hospital against commonly used antibiotics

Background: Antimicrobials agents are being abundantly used to control bacterial growth, like Pseudomonas, leading to resistance. Objective: To find out the drug sensitivity patterns of the Pseudomonas spp. against various antibiotics in the tertiary care hospital (Ghurki Trust &amp; Teaching Hospital). Methodology: This cross-sectional study was designed on the retrospective collection of the records of 1000 sample reports, of the patients admitted in Ghurki Trust Teaching Hospital from the period of January 2018 to December 2019, who presented with multiple infections or developed pseudomonas infections during their stay in the hospital. Tests were carried out in the clinical microbiology Laboratory of Lahore Medical &amp; Dental College for bacterial culture. Specimen included were breast tissues, pus, urine and stool culture, blood culture, wound discharge, ear discharge, abscess from the wound, various infected implants, and dead necrotic tissues from bone. Data were analyzed using SPSS version 26. Results: Out of the 1000 samples, a total of 150 (15%) were positive for bacterial growth. Among these 150, 70 were positive for gram-negative. The bacterial profiles of these 150 samples have shown that frequently (42) isolated gram-negative bacteria was Pseudomonas. On further tests, these bacteria were more sensitive to Imipenem and Cilastatin (69%) followed by levofloxacin ( 31%). No sensitivity was found against vancomycin and amoxicillin. Conclusion: In this study, the Pseudomonas were isolated and showed sensitivity to Imipenem and Cilastatin followed by levofloxacin. These studies should be conducted frequently to keep a track of the sensitivity patterns of bacteria.

Antibiotics utilization patterns and dosage appropriateness among patients receiving hemodialysis

Chronic kidney disease (CKD) is a global health challenge, with a reported prevalence of around 10%. Prescribing for patients receiving hemodialysis (HD) is challenging and complicated by polypharmacy, comorbidities, and changes in clearance of medications. The aim of this study was to evaluate antibiotics utilization patterns and dosage appropriateness in patients receiving HD at a tertiary hospital. A retrospective study was carried on 287 adult inpatients, who received HD and at least one antibiotic in a tertiary hospital in Oman. Data were extracted using the hospital’s electronic patient information system. Dosage appropriateness was assessed by identifying the dosage and frequency of prescribed antibiotics and comparing them with international guidelines. The main outcome measures were antibiotics utilization patterns and dosing inappropriateness. The most commonly prescribed parenteral antibiotic was piperacillin + tazobactam (20%), while the most common prescribed oral antibiotic was azithromycin (41.7%). For prophylaxis, cefazolin (54.6%) was the main antibiotic prescribed. The most commonly used antibiotic for external use was mupirocin ointment (38.5%). The overall dosing inappropriateness was 29.5%. Vancomycin was the most common parenteral antibiotic subjected to dosing inappropriateness (19.8%). However, trimethoprim + sulfamethoxazole was more inappropriately prescribed among the oral route (28.6%).In conclusion, the most utilized antibiotic was piperacillin + tazobactam followed by vancomycin. The study reported some inappropriate dosing of antibiotics. Such a study opens the door for the establishment of local guidelines for the improved practice of antibiotics use in HD patients.

Early-onset neonatal sepsis and antibiotic use in Indonesia: a descriptive, cross-sectional study

BackgroundEarly diagnosis and prompt antibiotic treatment are crucial to reducing morbidity and mortality of early-onset sepsis (EOS) in neonates. However, this strategy remains challenging due to non-specific clinical findings and limited facilities. Inappropriate antibiotics use is associated with ineffective therapy and adverse outcomes. This study aims to determine the characteristics of EOS and use of antibiotics in the neonatal-intensive care units (NICUs) in Indonesia, informing efforts to drive improvements in the prevention, diagnosis, and treatment of EOS.MethodsA descriptive study was conducted based on pre-intervention data of the South East Asia-Using Research for Change in Hospital-acquired Infection in Neonates project. Our study population consisted of neonates admitted within 72 h of life to the three participating NICUs. Neonates who presented with three or more clinical signs or laboratory results consistent with sepsis and who received antibiotics for 5 consecutive days were considered to have EOS. Culture-proven EOS was defined as positive blood or cerebrospinal fluid culture. Type and duration of antibiotics used were also documented.ResultsOf 2,509 neonates, 242 cases were suspected of having EOS (9.6%) with culture-proven sepsis in 83 cases (5.0% of neonatal admissions in hospitals with culture facilities). The causative organisms were mostly gram-negative bacteria (85/94; 90.4%). Ampicillin / amoxicillin and amikacin were the most frequently prescribed antibiotics in hospitals with culture facilities, while a third-generation cephalosporin was mostly administered in hospital without culture facilities. The median durations of antibiotic therapy were 19 and 9 days in culture-proven and culture-negative EOS groups, respectively.ConclusionsThe overall incidence of EOS and culture-proven EOS was high in Indonesia, with diverse and prolonged use of antibiotics. Prospective antibiotic surveillance and stewardship interventions are required.

Effect of the COVID-19 pandemic on Tennessee hospital antibiotic use

Background: On March 5, 2020, the Tennessee Department of Health (TDH) announced the first case of COVID-19 in the state. Since then, hospitals have been overwhelmed by the spike in respiratory infections. Several studies have attempted to describe the impact of the pandemic on antibiotic prescriptions. The NHSN Antimicrobial Use Option offers a platform for hospitals to report their antibiotic usage. The TDH has established access to hospital antibiotic usage data statewide through an existing NHSN user group. We compared the change in the volume of inpatient antibiotic prescriptions before and during the pandemic. Methods: An ecological study was conducted from January 2019 to December 2021. Aggregated facility-level data from the NHSN Antimicrobial Use Option were used to describe antibacterial use among Tennessee hospitals. Data from facilities that had reported at least 1 month of data during the study period were included in this study. The antimicrobial use rate was calculated by dividing the antimicrobial days of therapy (DOT) by the number of 1,000 days present. Overall antimicrobial use rates as well as specific antimicrobial use rates for azithromycin, ceftriaxone, and piperacillin–tazobactam were compared across years. Results: In total, 55 hospitals reported at least 1 month of data into the NHSN Antimicrobial Use Option during the study period. These hospitals had a median bed size of 140 (range, 12–689). Conclusions: We observed a modest increase in overall antibiotic use during the COVID-19 pandemic in Tennessee facilities. This trend appeared to be primarily attributed to agents used for community-acquired respiratory infections, such as azithromycin and ceftriaxone, earlier in the pandemic. However, both of these agents have fallen to prepandemic use levels during 2021. The fact that overall use increased in 2021 suggests that other agents not analyzed may have contributed to this effect. Further analysis may help determine which agents are responsible for this increase in 2021.Funding: NoneDisclosures: None

Prescriptions patterns and appropriateness of usage of antibiotics in small and medium- sized hospitals in Korea

Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with &lt;400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with &lt;400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,’ the prescription was considered ‘optimal.’ If only the route was ‘optimal,’ and the dose and/or class was ‘suboptimal,’ but not ‘inappropriate,’ it was considered ‘suboptimal.’ If even 1 aspect was ‘inappropriate,’ it was classified as ‘inappropriate.’ Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.Funding: NoneDisclosures: None

Impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection

ObjectiveTo investigate the impact of COVID19 pandemic on the incidence of health-care associated Clostridioides difficile infection (HA-CDI). MethodsRetrospective study conducted in the Hospital Universitario de Valme (HUV) and the Hospital General Universitario de Alicante (HGUA) in Spain between January 2019 and February 2021. The study period was divided into non-COVID19 period (2019 and months from 2020 to 2021 with ≤30 hospitalized COVID19 patients) and COVID19 period (months from 2020 to 2021 with >30 COVID19 patients). HA-CDI incidence rates (IR) were calculated as the number of new CDI cases per 10.000 occupied bed-days (OBD) and antimicrobial consumption by means of the defined daily dose (DDD) per 1000 OBD. ResultsDuring the COVID19 period, HA-CDI IR in the HUV was 2.6 per 10.000 OBD, which was lower than what was observed during the non-COVID19 period (4.1 per 10.000 OBD; p = 0.1). In the HGUA, HA-CDI IR during COVID19 period was 3.9 per 10.000 OBD, which was not significantly different to the IR observed during the non-COVID19 period (3.7 per 10.000 OBD; p = 0.8). There was a slight increase in the total antibiotic consumption during COVID19 period in both hospitals, with significant increases of certain high-risk antibiotics as cephalosporins. ConclsusionsHA-CDI incidence has not increased during the COVID19 pandemic in two tertiary centers in Spain, in spite of a slightly higher antibiotic consumption during the COVID19 period in both hospitals. These findings suggest that, in the presence of strict infection control measures, hospital antibiotic consumption might have a lower impact than expected on HA-CDI.

RESEARCH OF MULTI-RESISTANT GRAM NEGATIVE BACTERIA IN THE ORAL CAVITY OF PATIENTS SEEN IN DENTAL CLINICS

Introduction: Gram-negative bacteria are the main cause of infections ranging from pneumonia to bloodstream infection. In the oral cavity, there may be microorganisms associated with systemic and opportunistic infections. In addition, the irrational use of antibiotics related to odontogenic infections will promote the colonization of these microorganisms and contribute to antimicrobial resistance. Objective: To investigate the presence of multidrug-resistant gram-negative bacteria in the oral cavities of patients in a dental clinic. Material and Methods: The characteristic of the study is to be observational, with a laboratory and cross-sectional design. A sample of 60 patients from all Asces-Unita dental clinics was used. Samples were obtained through a swab smear on the patient’s oral mucosa. The technique for laboratory analysis follows the methodology of Winn et al. Antibiogram was performed according to the Kirby-Bauer technique. The antibiotics used followed the indications provided by CLSI 2021 and BrCAST 2021. This is a study using descriptive statistics. Results and Discussion: From 60 bacterial isolates obtained, 15 samples of gram-negative bacteria were obtained, mostly Pseudomonas aeruginosa 6 (40%), Klebsiella pneumoniae 5 (33.3%), Enterobacter sp 1 (6.66%), Citrobacter sp 1 (6.66%) and Proteus vulgaris 2 (13.33%). Multidrug resistance was observed in 20% of Klebsiella pneumoniae cases, in 83.3% of Pseudomonas aeruginosa cases, in 100% of Proteus vulgaris cases. Nowadays, antimicrobial resistance is the main problem in Intensive Care Units (ICU), the excessive use of antibiotics in communities and hospitals directly contributes to the development of bacterial resistance.Conclusion: Multidrug-resistant gram-negative bacteria were isolated in the oral cavity of patients seen at a dental clinic. In view of this finding, it is important to review the antibiotic treatment used to combat infections caused by gram-negative bacteria, based on laboratory identification and the use of an antibiogram.

Prescriptions patterns and appropriateness of usage of antibiotics in non-teaching community hospitals in South Korea: a multicentre retrospective study

BackgroundAlthough non-teaching community hospitals form the majority of healthcare providers in South Korea, there is limited data on antibiotic usage in them. To evaluate the pattern of antibiotic usage and its appropriateness in hospitals with < 400 beds in South Korea.MethodsA multicentre retrospective study was conducted in 10 hospitals (six long-term care hospitals, three acute care hospitals, and one orthopaedic hospital), with < 400 beds in South Korea. We analysed patterns of antibiotic prescription in 2019, and their appropriateness in the participating hospitals. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital, over two separate periods. Due to the heterogeneity of their characteristics, the orthopaedics hospital was excluded from the analysis.ResultsThe most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by beta-lactam/beta-lactamase inhibitor (anti-pseudomonal). In acute care hospitals, these were third generation cephalosporin, followed by first generation cephalosporin, and second generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first generation cephalosporin Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions.ConclusionsThe antibiotic usage patterns vary between non-teaching community hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.

Managing antibiotic shortages: lessons from EAHP and ECDC surveys

Aims and objectiveTo compare antibiotic shortages in Europe between 2013 and 2020 and the views of hospital pharmacists on overcoming shortages via antimicrobial stewardship.MethodsA series of European Association of Hospital...

Cost-minimisation analysis of oritavancin for the treatment of acute bacterial skin and skin structure infections from a United Kingdom perspective

BackgroundEarly discharge (ED) from hospital and outpatient parenteral antibiotic therapy (OPAT) are effective approaches for the management of a range of infections, including acute bacterial skin and skin structure infections (ABSSSI). Strategies that facilitate ED, thereby reducing complications such as healthcare-acquired infection whilst enhancing patient quality of life, are being increasingly adopted in line with good antimicrobial stewardship practice. This study presents a cost-minimisation analysis for the use of oritavancin at ED versus relevant comparators from a National Health Service (NHS) and personal and social services United Kingdom perspective.MethodsA cost-minimisation model considering adult patients with ABSSSI with suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection, was developed based on publicly available NHS costs, practice guidelines for ABSSSI and clinical expert’s opinion. Cost of treatment and treatment days were compared for oritavancin at ED to dalbavancin, teicoplanin, daptomycin and linezolid.ResultsFollowing the empiric use of either flucloxacillin or vancomycin in the inpatient setting, oritavancin was compared to OPAT with dalbavancin, teicoplanin and daptomycin, and oral linezolid from day 4 of treatment. Oritavancin at ED reduced treatment duration by 0.8 days and led to cost savings of £281 in comparison to dalbavancin. In comparison to teicoplanin, daptomycin and linezolid, oritavancin reduced treatment duration by 5 days, with marginally higher costs (£446, £137, and £1,434, respectively).ConclusionOritavancin, used to support ED, is associated with lower costs compared with dalbavancin and reduced treatment duration relative to all comparators. Its use would support an ED approach in MRSA ABSSSI management.

Antibiotic Resistant Bacteria and Antibiotic Resistance Genes in Wildlife and their Spread, Focus on the Mediterranean Basin

Overuse of antibiotics in hospitals, animal husbandry and agriculture significantly contributed to the onset of antibiotic resistance. The subsequent spread of antibiotic-resistant bacteria and antibiotic-resistant genes contributed to aggravating the problem. An important contributor to the spread of antibiotic resistance is wildlife, which is ubiquitous and can move easily, thus contributing to the global spread of antibiotic resistant bacteria and antibiotic resistance genes. The first antibiotic-resistant bacteria isolated from wildlife were strains of Escherichia coli obtained from pigeons and crows, with resistance to chloramphenicol and multi-resistance, carrying conjugative R plasmids. The same strains of Salmonella spp. resistant to tetracyclines and strains of Methicillin-Resistant Staphylococcus aureus (MRSA) have been isolated from both wildlife, livestock and humans, suggesting the presence of a common mechanism of spread. The Mediterranean basin is important for the richness and uniqueness of its wildlife. The latter represents a mechanism for spread of antibiotic-resistant bacteria and antibiotic resistant genes. This mini-review focuses on antibiotic resistance in wildlife in the Mediterranean basin, including the spread of antibiotic-resistant bacteria belonging to the priority list of pathogenicity.

Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes

Little is known about the contribution of hospital antibiotic prescribing to multidrug-resistant organism (MDRO) burden in nursing homes (NHs). To characterize antibiotic exposures across the NH patient's health care continuum (preceding health care exposure and NH stay) and to investigate whether recent antibiotic exposure is associated with MDRO colonization and room environment contamination at NH study enrollment. This is a secondary analysis of a prospective cohort study (conducted from 2013-2016) that enrolled NH patients and followed them up for as long as 6 months. The study was conducted in 6 NHs in Michigan among NH patients who were enrolled within 14 days of admission. Clinical metadata abstraction, multi-anatomical site screening, and room environment surveillance for MDROs were conducted at each study visit. Data were analyzed between May 2019 and November 2021. Antibiotic data were abstracted from NH electronic medical records by trained research staff and characterized by class, route, indication, location of therapy initiation, risk for Clostridioides difficile infection (C diffogenic agents), and 2019 World Health Organization Access, Watch, and Reserve (AWARE) antibiotic stewardship framework categories. The primary outcomes were MDRO colonization and MDRO room environment contamination at NH study enrollment, measured using standard microbiology methods. Multivariable logistic regression was used to identify whether antibiotic exposure within 60 days was associated with MDRO burden at NH study enrollment. Additionally, antibiotic exposure data were characterized using descriptive statistics. A total of 642 patients were included (mean [SD] age, 74.7 [12.2] years; 369 [57.5%] women; 402 [62.6%] White; median [IQR] NH days to enrollment, 6.0 [3.0-7.0]). Of these, 422 (65.7%) received 1191 antibiotic exposures: 368 (57.3%) received 971 hospital-associated prescriptions, and 119 (18.5%) received 198 NH-associated prescriptions. Overall, 283 patients (44.1%) received at least 1 C diffogenic agent, and 322 (50.2%) received at least 1 high-risk WHO AWARE antibiotic (watch or reserve agent). More than half of NH patients (364 [56.7%]) and room environments (437 [68.1%]) had MDRO-positive results at enrollment. In multivariable analysis, recent antibiotic exposure was positively associated with baseline MDRO colonization (odds ratio [OR], 1.70; 95% CI, 1.22-2.38) and MDRO environmental contamination (OR, 1.67; 95% CI, 1.17-2.39). Exploratory stratification by C diffogenic agent exposure increased the effect size (MDRO colonization: OR, 1.99; 95% CI, 1.33-2.96; MDRO environmental contamination: OR, 1.86; 95% CI, 1.24-2.79). Likewise, exploratory stratification by exposure to high-risk WHO AWARE antibiotics increased the effect size (MDRO colonization: OR, 2.32; 95% CI, 1.61-3.36; MDRO environmental contamination: OR, 1.86; 95% CI, 1.26-2.75). The findings of this study suggest that high-risk, hospital-based antibiotics are a potentially high-value target to reduce MDROs in postacute care NHs. This study underscores the potential utility of integrated hospital and NH stewardship programming on regional MDRO epidemiology.

Hospital Antibiotics Usage: Environmental Hazard and Promotion of Antibiotic Resistant Bacteria.

Hospitals constitute a particular source of drug residues emission, especially antibiotics considered as the most critical therapeutic classes used in hospitals. Thus, the hospital wastewater can widely spread both types of emerging pollutants, antibiotic residues and antibiotic resistance bacteria. For this reason, antibiotics usage must be monitored. This study was conducted to investigate potential antibiotic compounds which can present potential environmental hazard and promote antibiotic resistance. The consumption-based approach was adopted to calculate predicted antibiotic concentrations in hospital wastewaters. In the process, we assessed the antibiotics potential environmental hazard, with the hazard quotient between predicted concentrations and predicted no effect concentrations intended to be protective of ecological species. In order to evaluate the hospital contribution to antibiotic resistance bacteria promotion, we also compared predicted concentrations with predicted no effect concentrations as theoretical selective resistance bacteria. The highest expected concentrations in hospital wastewater were found for Penicillins and Cephalosporins being the most prescribed antibiotics in our context. We noted that among this class, Ampicillin is the most hazardous compound followed by Imipenem and Gentamicin as exclusive hospital use antibiotics, in spite of their low consumption. The results showed also that Ampicillin, Amoxicillin, and Ceftriaxone had a high ratio of potential antibiotic resistance bacteria promotion, confirming the correlation found previously between abundance of resistant bacteria and the corresponding effluent antibiotic concentrations. Nevertheless, the promotion of resistance selection can also be attributed to Imipenem and Ciprofloxacin as little-used antibiotics and occur at low to moderate levels in hospital wastewater. This study identified the profile antibiotics consumption and their potential environmental hazard contribution and antibiotic resistant bacteria promotion. It can help decision-makers make appropriate management decisions, especially preventive measures related to antibiotic use pattern, as neither dilution nor treatment can eliminate antibiotic residues and antibiotic resistance genes.

An Appraisal of Bacteriological Profile and Antibiogram Patterns among Elderly with Urinary–Tract-Infection: A Retrospective Study

Background: A urinary tract infection (UTI) is an infection that can affect any portion of the urinary system (kidneys, ureters, bladder, and urethra). It's worth noting that the majority of UTIs affect the lower urinary tract. This infection has been identified as the most frequent bacterial illnesses, accounting for a significant portion of the workload in microbiological diagnostic laboratories.&#x0D; UTIs account for 15.5 percent of hospitalizations in individuals over the age of 65, and it has been reported as one of the most common types of infection among the elderly, particularly those in institutionalized care.&#x0D; Objectives: Our aim was to retrospectively appraise and evaluate the bacteriological profile and antibiogram patterns in elderly adults visiting our private healthcare center.&#x0D; Methods: The retrospective survey was conducted on elderly patients who visited the hospital within the period of three years (October 2018- October 2021). Questionnaire designed was used to collect data from the Health Information Management unit of the hospital and these information were analyzed using SPSS 20 package with a level of significant set at p-value of &lt; 0.05.&#x0D; Results: Females made up over 70% of the study participants, while men made up 30.2 percent. A substantial percentage of the elderly (53.8%) between the ages of 60 and 65 had E. coli growth as the cause of their UTI. More than a third (33.3 percent) of the elderly between the ages of 60 and 80 had Staphylococcus and Proteus as the cause of their UTI. The majority of the elderly patients' samples showed Staphylococcus Aureus and E Coli growth, with E coli growth reported in 33.3 percent and 66.7 percent of male and female participants, respectively, and Staph. aureus growth reported in 22.2 percent and 77.8% of male and female participants' urine cultures, accordingly. The majority of the bacteria grown were susceptible to Quinolones and Ceftriazone combination medicine (Ceftriazone + Tazobactan for E. coli and Ceftriazone + Tazobactam/ Sulbactam for Staphylococcus aureus), however common hospital antibiotics such as Ceftriazone, Augmentin, Amoxicillin, Cefixime, and cefuroxime were not sensitive to the urine cultured germs.&#x0D; Conclusion: The rate of UTI in the elderly was relatively high, and antibiotic resistance to routinely administered medicines was surprising. The findings of this study have bolstered the need for comprehensive national control programs to combat antibiotic resistance, as well as the establishment of Geriatric clinics and geriatric public care programs across Nigeria's private and public health institutions, whose responsibility it is to raise awareness about the dangers of UTI and to develop robust treatment plans for the elderly.

Antimicrobial Stewardship Program: Reducing Antibiotic's Spectrum of Activity Is not the Solution to Limit the Emergence of Multidrug-Resistant Bacteria.

Overconsumption of antibiotics in hospitals has led to policy implementation, including the control of antibiotic prescriptions. The impact of these policies on the evolution of antimicrobial resistance remains uncertain. In this work, we review the possible limits of such policies and focus on the need for a more efficient approach. Establishing a causal relationship between the introduction of new antibiotics and the emergence of new resistance mechanisms is difficult. Several studies have demonstrated that many resistance mechanisms existed before the discovery of antibiotics. Overconsumption of antibiotics has worsened the phenomenon of resistance. Antibiotics are responsible for intestinal dysbiosis, which is suspected of being the source of bacterial resistance. The complexity of the intestinal microbiota composition, the impact of the pharmacokinetic properties of antibiotics, and the multiplicity of other factors involved in the acquisition and emergence of multidrug-resistant organisms, lead us to think that de-escalation, in the absence of studies proving its effectiveness, is not the solution to limiting the spread of multidrug-resistant organisms. More studies are needed to clarify the ecological risk caused by different antibiotic classes. In the meantime, we need to concentrate our efforts on limiting antibiotic prescriptions to patients who really need it, and work on reducing the duration of these treatments.

Utilization of quality tools to prevent unnecessary prescriptions of Antibiotics in hospitals

Utilization of quality tools to prevent unnecessary prescriptions of Antibiotics in hospitals

Pattern of Newborn Antibiotic Use in a Tertiary Level Maternity for Five Years

Using antibiotics in hospitals is an important objective to prevent antimicrobial resistance. The classification of antibiotics based on WHO Essential Medicines categorize into Access, Watch, and Reserve (AWaRe) categories can enable interventions which are practical worldwide. Evaluating patterns of AWaRe antibiotic use in pediatrics was our intention this will allow its use in local and national stewardship interventions. Our retrospective observational study included all neonates from County