Inadequate Use Of Antibiotics Research Articles

Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

Introduction: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. Objective: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. Methods: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. Results: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. Conclusion: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use.

Subinhibitory concentrations of florfenicol increase the biofilm formation of Piscirickettsia salmonis.

Public health is facing a new challenge due to the increased bacterial resistance to most of the conventional antibacterial agents. Inadequate use of antibiotics in the Chilean aquaculture industry leads to the generation of multidrug resistance bacteria. Many fish pathogenic bacteria produce biofilm upon various sources of stress such as antibiotics, which provides several survival advantages for the bacterial life in community and can constitute a reservoir of pathogens in the marine environment. Being florfenicol a broad-spectrum antibiotic commonly used to treat infections in aquaculture, the aim of this study was to assess whether this antibiotic modulates in vitro the biofilm formation in several isolates of Piscirickettsia salmonis. Standard antibiotic-micro broth 96-flat well plates were used to determinate the minimal inhibitory concentration of florfenicol in eight different P. salmonis isolates. In vitro findings, with P. salmonis growing in the presence and absence of the antibiotic, exhibited a statistically significantly increase (p < .05) in biofilm formation in all the bacterial isolates cultivated with sub-MIC (defined as the half of the minimal inhibitory concentration in the presence of antibiotic) of florfenicol compared with controls (antibiotic-free broth). In conclusion, sub-MIC of florfenicol induced an increased biofilm formation in all P. salmonis isolates tested.

Identification of novel inhibitors against Escherichia coli utilizing HisC as a target from histidine biosynthesis pathway

Escherichia coli is a gram-negative bacterial pathogen that poses a significant challenge both clinically and epidemiologically. Large numbers of multi-drug resistant E. coli have emerged in the last decade, because of the selection pressure generated by the inadequate use of antibiotics. Although research to combat antibiotic resistance has been going on extensively but still lags in the rate of development of newer antibiotics. Therefore, newer approaches are required to speed up the rate of discovery of antibiotics. Computational methods for screening of inhibitors have made a significant contribution to the discovery of novel antimicrobials. The present study utilized histidinol-phospho aminotransferase (HisC) as a target. HisC is an enzyme that plays a crucial role in the biosynthesis of histidine and its absence in mammals makes it an attractive drug target. A ZINC library of 5000 natural compounds was screened against HisC (PDB ID: 1FG7) using PyRx and the first 500 hits were selected for secondary screening after sorting the result on the basis of binding score. Fifteen compounds passed the secondary filter ADME and out of these five passed toxicity filters; the best among five hits was selected on the basis of its binding score and inhibition constants. Further, molecular dynamics simulations and free binding were computed of selected five compounds and two natural compounds ZINC402598829 and ZINC31157928 complexed with HisC were found as highly stable. Overall, our results indicated that these natural sources could be used as potential HisC inhibitors. Communicated by Ramaswamy H. Sarma

Improving Pharmacists' Awareness of Inadequate Antibiotic Use for URTIs through an Educational Intervention: A Pilot Study.

The inadequate use of antibiotics led to the development of multi-resistant bacteria that are now causing millions of deaths worldwide. Since most antibiotics are prescribed/dispensed to treat respiratory tract infections, it is important to raise awareness among health professionals to optimize antibiotic use, especially within the primary care context. Thus, this pilot study aimed to evaluate pharmacists’ feedback about the eHealthResp platform, composed by an online course and a mobile application (app) to help in the management of upper respiratory tract infections (URTIs). Ten community pharmacists were invited to participate in this study, exploring the contents of the eHealthResp platforms and answering a content validation questionnaire composed by eight qualitative and thirty-five quantitative questions about the online course and mobile app. The eHealthResp platform is a comprehensive, consistent, and high-quality e-learning tool. Median scores of 5.00 were attributed to the course contents’ and clinical cases’ adequacy and correction. Most qualitative feedback was about completeness and objectivity of the course, and its usefulness for clinical practice. This study showed that eHealthResp has great potential as an e-health tool for the management of URTIs’ symptoms, which may ultimately aid in reducing inappropriate antibiotic use.

Use of linezolid in a high complexity hospital of Bogotá city

Introduction: Studying the prescription of last generation antibiotics helps to identify the causes and consequences of the inadequate use of antibiotics. These include the appearance of antibacterial resistance, a situation declared by the WHO as a global public health problem. Aim: To describe the prescription of linezolid in a high complexity hospital in Bogotá, Colombia,considering the follow-up of the recommendations for the use of the drug included in clinical practice guidelines (CPG) and its indications. Methods: A descriptive observational study of longitudinal section was performed with retrospective collection of the information of all patients who were prescribed linezolid, at a minimum dose of 600 mg every 12 h during their hospitalization in the period from January 1st, 2017, to December 31st, 2018. The characteristics of linezolid prescription were described. Results: 133 prescriptions were reviewed. The most frequently diagnosed were sepsis of different origin (pulmonary abdominal, urinary) with 22.6 % (30/133), followed by skin and soft tissue infection 16.5 % (22/133), the pneumonia with 12.8 % (17/133) and urinary tract infections with 9.8 % (13/133). Two days treatment was the most frequent (range 1-30 days). In 33 % (44/133) of the patients, linezolid was used empirically (without using a previous antibiotic), while in 40.6 % (54/133) it was used as a second option (a previous antibiotic scheme). It was used as a third option in 20.3 % (27/133). Finally, in 6 % (8/133) of the patients, linezolid was prescribed after three previous antibiotics. It was necessary to use another antibiotic in near fifty percent of patients because linezolid did not work. Conclusions: The present study shows that there is little adherence to the institutional CPGs in relation to the treatment time, the microorganism identification, and the use as first option. The absence of a full-time infectious disease specialist, the high workload and the continuous rotation of prescribing staff may be the causeof these results. Some cases of inappropriate use may be related to the clinicalcondition of the patient which requires empirical treatments.

Frequency and Antibiotic Susceptibility of Pathogens from Cases of Urinary Tract Infection: A Prospective Observational Study.

Objectives Urinary tract infection (UTI) is one of the most common diagnoses in patients visiting urology clinics. Rampant use of empiric and inadequate doses of antibiotics leads to an increase in resistance and poses a huge financial burden. We evaluated UTI in relation to antibiotics used, frequency, susceptibility, and resistance pattern of different pathogens at a tertiary care center and made some important observations. Methods Prospectively 729 patients diagnosed with UTI attending a urology outpatient department from July 2018 to January 2020 were managed accordingly. Antibiotics were started on the basis of urine culture and sensitivity (c/s) or empirically and changed according to subsequent urine c/s. Repeat urine c/s was performed after 5 to 7 days of starting therapy and 10 days after completion of therapy. Results Out of 729 subjects, 417 (57.2%) were males and 312 (42.8%) were females. The most common symptom at diagnosis was dysuria 512 (70.2%), whereas 221 (30.3%) patients presented with fever. Escherichia coli was the most common organism isolated, 453 (62.1%). Among 729 patients, 239 took antibiotics without c/s report, whereas in 490 patients antibiotics were prescribed after the report. A total of 431 (59.1%) patients required one antibiotic session for clearance of pathogen, whereas 135 (18.5%) required two sessions, and three sessions were required in 66 (9%) cases. Among 239 patients whose culture came out to be positive, 145 (60.6%) were found to be resistant to the previously given antibiotic and the common pathogens isolated were E. coli (61 [42%]), Pseudomonas (28 [19.3%]), Enterococcus (22 [15.1%]), Klebsiella (14 [9.6%]), and others. Conclusion Unchecked, rampant, and inadequate use of antibiotics leads to complicated UTI with the increasing share of Pseudomonas, Klebsiella , or other dangerous microbes, which are difficult to treat as well as pose threat in the future.

Antibiotics prescription habits of Spanish endodontists: Impact of the ESE awareness campaign and position statement.

BackgroundThe inadequate use of antibiotics by dentists can contribute to antibiotic resistance. The European Society of Endodontology (ESE) has published a scientific evidence-based position on antibiotic use in endodontic infec-tions. The aim of this study was to analyze the antibiotics prescription habits of Spanish endodontists in the management of endodontic infections, comparing them with those they had 10 years ago, to assess the impact of the ESE awareness campaign and position statement on antibiotics in endodontics. Material and MethodsOne hundred Spanish endodontists were requested to answer to a one-page survey, similar to that used previously ten years ago in another study, on indications for systemic antibiotics in the management of endodontic infections. Data were analyzed using descriptive statistics and chi-square test. Seventy-seven endodontists (77%) completed satisfactorily the survey and were included in the study. ResultsThe average duration of antibiotic therapy was 5.64 ± 1.75 days. In patients with no medical allergies, 97.1% selected amoxicillin as the first-choice antibiotic. The first drug of choice for patients with an allergy to penicillin, was clindamycin 300 mg (74.03%). For cases of pulp necrosis with asymptomatic apical periodontitis, fistulous tract and mild/symptomatic symptoms, 100% of endodontists would prescribe antibiotics. For the scenario of a pulp necrosis with symptomatic periodontitis apical and no swelling, 20% endodontists would prescribe antibiotics. ConclusionsAntibiotics prescription habits of Spanish endodontists has improved after the ESE awareness campaign and position statement on antibiotics in endodontics. Even so, there are a percentage of professionals that still prescribe antibiotics erro-neously. Key words:Antibiotic, antibiotics resistance, dentistry, endodontists, endodontics, prescription habits, primary care

Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy

BackgroundSince December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection.MethodsThis work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality.ResultsOf 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21–1.62; p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64–0.76; p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often.ConclusionsBacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.

Antibacterial susceptability of E. coli strains isolated from raw milk

ntroduction. The processing of most raw milk products can lead to contamination with unwanted microflora due to poor sanitation and hygienic conditions. The inadequate antibiotic use over the past decades has led to the emergence and wide spread of bacterial populations, particularly of Escherichia coli, which developed resistance to antibacterial drugs.Material and methods. Raw milk samples were obtained from clinically healthy cows on farms from Kiev and Poltava regions to identify E . coli, Staphylococcus spp., Enterococcus spp. isolates. Antimicrobial susceptibility testing was performed using the EUCAST disk diffusion method and MU on “Determination of microbial susceptibility to antibacterial drugs”. Results. The examined milk samples revealed the presence of E . coli, Staphylococcus spp. and Enterococcus spp. isolates, which proves poor sanitary and hygienic conditions of milk production process. Escherichia coli isolates were found susceptible to Ampicillin/sulbactam, Cefoxitin (100%), Meropenem, Tobramycin (100%), Netilin, Tigecycline, Nitroxoline (100%), Gatifloxacin, and Nitrofurantoin (100%). The studied E. coli isolates were found resistant to Ampicillin (100%), Imipenem, Tetracycline, and Doxycycline (100%). 41.7% of isolates of Staphylococcus epidermidis, Staphylococcus aureus were found resistant to Oxacillin, of which 90% were resistant to Benzylpenicillin and 20% to Rifampicin. Conclusions.The circulation of antibiotic-resistant Enterobacteriaceae strains among farm animals is a major problem requiring a strategy development aimed to prevent the emergence and spread of antibiotic resistance worldwide.

Serodiagnosis of Lyme borreliosis\u2014is IgM in serum more harmful than helpful?

Interpretation of serological findings in suspected Lyme borreliosis (LB) may be challenging and IgM reactivities in serum are often unspecific (false positive). There is a risk for overdiagnosis of LB, inadequate use of antibiotics, and potential delay of proper diagnosis. In this study, we evaluated the diagnostic value of IgM analysis in serum and IgM antibody index (AI) in LB diagnosis. This was a retrospective observational study regarding Borrelia-specific antibodies in serum and Borrelia-specific AI in LB investigations being made during 2017 in Jönköping County, Sweden. Medical records of 610 patients with detectable anti-Borrelia antibodies in serum (IgM and/or IgG) and 15 patients with elevated Borrelia-specific AI were retrospectively scrutinized, and the compliance to current European recommendations was assessed. Among the 610 patients, only 30% were tested according to the European recommendations. Within this group of tests taken correctly, 50% of the LB diagnoses in patients with isolated IgM reactivity in serum were retrospectively assessed as incorrect (LB unlikely). Three pediatric patients with clinical and laboratory findings suggestive of Lyme neuroborreliosis (LNB) had elevated IgM AI alone. Serological testing without distinct clinical signs/symptoms consistent with LB contributes to most misdiagnoses. Isolated IgM positivity in serum shows limited clinical value and needs further assessment before being reported by the laboratory. Detection of IgM in combination with IgG antibodies in serum shows no clinical enhancement for correct LB diagnosis compared to isolated IgG positivity. However, Borrelia-specific IgM AI may be important for sensitivity in early LNB.

Инфекции респираторного тракта моно- и сочетанной этиологии у детей – актуальность проблемы в период пандемии COVID-19

Acute respiratory infections are one of the most common infections in children worldwide. The implementation of novel highly accurate diagnostic methods demonstrated that a significant proportion of respiratory tract infections are caused by more than one pathogen (virus plus virus or virus plus bacterium). Most frequently, mixed infections are observed in young children, which, in addition to non-specificity of most clinical manifestations, necessitates pathogen identification in order to prevent inadequate use of antibiotics. Key words: respiratory infections, children, respiratory pathogen

CLINICAL ISOLATES OF E.coli IN PIGS – ANTIMICROBIAL RESISTANCE AND PERSPECTIVES TO OPTIMIZE ANTIBIOTIC ADMINISTRATION

Modern livestock production inevitably involves the use of antimicrobial drugs. Adequate application thereof depends on the application of appropriate biosafety measures as well as timely and accurate diagnostics of the diseases. Administration of antimicrobial drugs without previous identification of “zootechnical errors” or relevant laboratory analysis may lead to the development of antimicrobial resistance (AMR). Surveillance and monitoring of AMR is conducted according to prescribed procedures and includes sampling at slaughter line. Quite often, such procedures are missed out during production cycle, which results in an inadequate use of antibiotics and consequent development of antimicrobial resistance and resistance gene transfer. In this research, we monitored the presence of specific bacterial species from the family Enterobacteriaceae and their sensitivity to particular antibiotics in diverse animal categories at pig farms over the breeding period. The aim of the study was to establish the following: development of antimicrobial resistance by isolated bacteria, occurrence of the resistance towards several diverse groups of antibiotics, and possible alternatives to antibiotics in cases when therapy is required. The research confirmed the development of AMR during pig production process, which is often manifested as multiple resistance (group of penicillin and synthetic penicillin drugs, aminoglycosides, fluoroquinolones, tetracyclines).

Reduced graphene oxide-chitosan flexible nanocomposites for efficient bacteria capture and photothermal ablation

AbstractOne of the major public health concerns today is bacterial infection-associated diseases. Traditional antibacterial therapies are becoming less efficient because frequent and inadequate use of antibiotics has caused mutations in bacteria that led to many antibiotic-resistant bacterial strains. It is, therefore, crucial to develop novel antibacterial materials and strategies that will successfully combat both gram-positive and gram-negative bacteria. In the present study, we will demonstrate a simple and efficient method for bacteria capture and elimination through photothermal ablation. The developed material consists of a flexible Kapton substrate, coated with reduced graphene oxide-chitosan (rGO-CS) thin films. Reduced graphene oxide has strong absorption in the near-infrared (NIR) region, while chitosan has the ability to bind bacteria through electrostatic interactions. The K/rGO-CS device proved to capture and efficiently eradicate both planktonic Gram-positive Staphylococcus aureus (S. aureus) and Gram-negative Escherichia coli (E. coli) bacteria after 10 min of NIR (980 nm) irradiation.

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING ANTIBIOTICS MISUSE AMONG THE PUBLIC IN SAUDI ARABIA

Background: improper use of antibiotics lead to one of the serious problems of bacterial resistance.&#x0D; Aim: to assess the frequency of antibiotic use and to obtain information about antibiotic prescription, in two centers in Northern Lima, Peru.&#x0D; Methods: it is cross sectional study using a self-administered questionnaire.&#x0D; Results: 1961surveys were considered, Two thirds received antibiotics in the last year, to obtain these drugs, were prescribed by a physician, most of physicians agreed in the importance of inadequate use of antibiotics and 85.1%prescribed antibiotics more than once every day. Internet is a useful resource of information as suggested by physicians to develop educative programs about use of antibiotics.&#x0D; Conclusions: No enough knowledge about adequate use of antibiotics in the community, three quarters would go to hospital if they presented upper respiratory tract symptoms and half received an antibiotic prescription by the physician, if physicians prescribed antibiotics more than once every day, it leads to resistance.&#x0D; Keywords: Knowledge, attitudes, practices, antibiotics, resistance

Cultivable Actinobacteria First Found in Baikal Endemic Algae Is a New Source of Natural Products with Antibiotic Activity.

Inadequate use of antibiotics has led to spread of microorganisms resistant to effective antimicrobial compounds for humans and animals. This study was aimed to isolate cultivable strains of actinobacteria associated with Baikal endemic alga Draparnaldioides baicalensis and estimate their antibiotic properties. During this study, we isolated both widespread and dominant strains related to the genus Streptomyces and representatives of the genera Saccharopolyspora, Nonomuraea, Rhodococcus, and Micromonospora. For the first time, actinobacteria belonging to the genera Nonomuraea and Saccharopolyspora were isolated from Baikal ecosystem. Also, it was the first time when actinobacteria of the genus Nonomuraea were isolated from freshwater algae. Some rare strains demonstrated activity inhibiting growth of bacteria and yeasts. Also, it has been shown that the strains associated with Baikal alga D. baicalensis are active against both Gram-positive and Gram-negative bacteria. According to this study and previously published materials, diversity of cultivable actinobacteria and rare strains isolated from D. baicalensis is comparable to that of cultivable actinobacteria previously isolated from plant sources of Lake Baikal. Also, it exceeds the cultivable actinobacteria diversity previously described for macroinvertebrates, water, or sediments of Lake Baikal. The large number of rare and active strains associated with the endemic alga D. baicalensis could be the promising sources for biopharmaceutical and biotechnological developments and discovery of new natural compounds.

Caracterización del uso inapropiado de antibióticos en faringoamigdalitis según los criterios de McIsaac

Objetivo: Describir el uso irracional de antibióticos en base a criterios de McIsaac (criterios de Centor modificados por McIsaac), en una unidad de salud de primer nivel de atención. Métodos: Se realizó un estudio descriptivo transversal con los registros de pacientes de 3 a 19 años atendidos en el servicio de emergencia (246), con los diagnósticos de faringitis aguda, amigdalitis aguda, e infecciones respiratorias superiores agudas de múltiples sitios y sin especificar. Se estableció como prescripción inadecuada si el facultativo indicó antibióticos con un puntaje menor o igual a 1 sobre 5 puntos o si no prescribió antibióticos con puntaje mayor o 4 sobre 5 puntos. Resultados: Se estimó 24,29% de uso inadecuado de antibióticos de los registros de emergencia. Se prescribió antibióticos en 160 pacientes, de los cuales se encontró que, amoxicilina fue el más utilizado (61,87%); seguido de benzilpenicilina benzatina (28,12%) y en tercer lugar macrólidos (8,12%). Conclusión: En la unidad de primer nivel analizada se encontró que el uso inadecuado de antibióticos es superior a la prevalecía estimada de faringoamigdalitis estreptocócica para el grupo de edad estudiado. Por esto, es imperativo que se tomen las medidas necesarias a nivel institucional y comunitario para lograr su reducción y evitar las complicaciones que se derivan de esta.

Nursing Students' Knowledge and Awareness of Antibiotic Use, Resistance and Stewardship: A Descriptive Cross-Sectional Study.

Antibiotic resistance is an emerging worldwide concern with serious repercussions in terms of morbi-mortality. Bearing in mind that the inadequate use of antibiotics, by healthcare staff as well as by the general population, is one of its main causes, a multidisciplinary approach is required to try to combat it. The aim of the present study was to determine nursing students’ knowledge and awareness of antibiotic use, resistance and stewardship. A cross-sectional design was used. A total of 578 nursing students from the University of Santiago de Compostela (Spain), ≥18 years old of both sexes were invited to complete the Spanish version of the questionnaire “Knowledge and awareness of the use, resistance and administration of antibiotics” between February and April 2019. Students had a low level of knowledge about antibiotics, 4.1 (CI95% = 3.4–4.8), especially in relation to antibiotic resistance. As the students were aware of this deficiency, the majority affirmed (>90%) that the current curriculum of nursing degree should have more training on antibiotics and infection control. Nursing staff play an important role in the rational use of antibiotics and as teachers of patients, so their training could be key in fighting antibiotic resistance.

Mangel an Informationen und deren Bereitstellung am Arbeitsplatz als mögliche Gründe für inkorrekte Antibiotikatherapien in Deutschland

BackgroundThe increased use of antibiotics leads to a rise in drug-resistant bacteria. It is critical to reduce inadequate prescribing of antibiotics in order to prevent a post-antibiotic era. Aim of the studyTo explore if healthcare providers in Germany have access to current treatment guidelines, information about antibiotics and local resistance data at their workplace and how they access the information in their daily routine. MethodsAn anonymous online survey was performed with hospital-based physicians, office-based medical doctors and medical students in their last year of medical training in Germany. Results1,428 participants completed the questionnaire with a return rate of 8.4 % (n=1,428/17,055). Lack of knowledge, preexisting prescription patterns and lack of data (local resistance data, drug information) were the most frequent reasons for the inadequate use of antibiotics given by the participants. 37 % of hospital doctors (n=404/1,091) cannot access local resistance data at their workplace, 26.2 % (n=286/1,091) lack standard operating procedures (SOP), 23.2 % (n=253/1,090) have no access to a database of national guidelines and 23.7 % (n=259/1,091) cannot access a drug information database. When asked about the sources of information they frequently used when prescribing antibiotics, 27.3 % (n=341/1,251) of the participants said that they used digital media at least once a day, 17.8 % (n=223/1,251) asked their colleagues, and 11.5 % (n=143/1,249) resorted to analogue media (e.g., print media). In order to improve antibiotic prescribing practices, participants were asked to rate the effectiveness of a potential clinical decision support system (CDSS) integrating local resistance data, drug information and local SOPs at their workplace. On a scale of 1 (= very useful) to 6 (= very useless), the anticipated effectiveness of such a tool was rated as “useful” or “very useful” with 1.67±1.01. ConclusionIn our study, lack of knowledge and lack of local data at the workplace were considered the most important reasons for the inadequate prescribing of antibiotics. Because the majority of healthcare providers use digital media as an information source, there is a clear desire for an easily accessible CDSS integrating all necessary data. Further studies will have to show whether a CDSS can improve and sustain the quality of antibiotic prescribing.

Emergency surgeons\u2019 perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional survey

BackgroundAntibiotic resistance (AMR) is a growing public health problem worldwide, in part related to inadequate antibiotic use. A better knowledge of physicians’ motivations, attitudes and practice about AMR and prescribing should enable the design and implementation of effective antibiotic stewardship programs (ASPs). The objective of the study was to assess attitudes and perceptions concerning AMR and use of antibiotics among surgeons who regularly perform emergency or trauma surgery.MethodsA cross-sectional web-based survey was conducted contacting 4904 individuals belonging to a mailing list provided by the World Society of Emergency Surgery. Participation was voluntary and anonymous. The survey was open for 5 weeks (from May 3, 2017, to June 6, 2017), within which two reminders were sent. The self-administered questionnaire was developed by a multidisciplinary team; reliability and validity were assessed.ResultsThe overall response rate was 12.5%. Almost all participants considered AMR an important worldwide problem, but 45.6% of them underrated the problem in their own hospitals. Surgeons provided with periodic reports on local AMR demonstrated a lower underrating in their hospital. Only 66.3% of the surgeons stated to receive periodic reports on local AMR data, and among them, 56.2% had consulted them to select an antibiotic in the previous month. Availability of systematic reports about AMR, availability of guidelines for therapy of infections, and advice from an infectious diseases specialist were considered very helpful measures to improve antibiotic prescribing by 68.0, 65.7, and 64.9%, respectively. Persuasive and restrictive ASPs were both considered helpful measures by 64.5%. Moreover, 86.3% considered locally developed guidelines more useful than national ones. Only 21.9% received formal training in antibiotic prescribing in the previous year; among them, 86.6% declared to be interested in receiving more training.ConclusionsAvailability of periodic reports on local AMR data was considered an important tool to guide surgeons in choosing the correct antibiotic and to increase awareness of the problem of AMR. Local guidelines for therapy of infections should be implemented in every emergency surgery setting, and developed by a multidisciplinary team directly involving surgeons, infectious diseases specialists, and microbiologists, and formally established in an ASP.

Prevalencia de bacterias aisladas con resistencia antibiótica extendida en los cultivos de orina durante 8 años en un hospital de segundo nivel en México

IntroductionUrinary tract infections caused by organisms that are extensively drug-resistant has become an important and difficult-to-manage health problem that requires our attention, given its notable increase in recent years. Urinary tract infections are the most frequent group of bacterial infections, with Escherichia coli continuing to be the most common causative agent, and they have very significant economic implications. Urinary tract infections are the third cause of notifiable disease in Mexico and there is very little information on extensively drug-resistant bacteria. AimThe aim of this study was to provide evidence on the current situation of extensively drug-resistant bacteria in urine cultures in our region. Materials and methodsA retrospective study was conducted on urine cultures from 2007 to the first quarter of 2015. A statistical analysis of the information was carried out utilizing circle and dispersion graphs. ResultsFrom the database, we filtered 8,164 urine cultures by complete resistance results in the antibiogram and found 44 extensively drug-resistant bacteria (0.53%). The most frequent was Pseudomonas aeruginosa in 38 cases (86.36% of the drug-resistant bacteria), followed by Acinetobacter baumannii in 3 cases (6.81%). The information was filtered by year and we found that the presence of these types of super bacteria has increased in the urinary tract over the last few years. ConclusionExtensively drug-resistant bacteria are a serious health problem and it is necessary to know their epidemiology in our region. Their alarming increase in recent years, most likely due to inadequate antibiotic use, makes it essential for us to be aware of the therapeutic options with which we can control these bacteria, as well as highlighting the need for new antibiotics.