Inappropriate Antibiotic Usage Research Articles

Antibiotic Resistance Pattern of Bacteria Isolated from Clinical Specimens: A Hospital-Based Cross-sectional Study in Kathmandu, Nepal

Antibiotics are vital in combating infectious diseases, yet their increasing use fosters resistance. Antimicrobial resistance (AMR) is rising in Nepal due to factors such as indiscriminate, inappropriate, and inadequate antibiotic usage. This study aims to explore the association between demographic factors and the prevalence of specific bacterial strains within the surveyed population. Additionally, it seeks to determine the antibiotic resistance patterns of these bacteria. Antibiotic susceptibility or resistance data were retrieved from the Medical Records Department (MRD) of the Manmohan Memorial Medical College and Teaching Hospital (MMMCTH) in Kathmandu. Samples from patients with certain types of bacterial infections were included, with 56 from sputum reports, 46 from urine, and 8 from blood samples out of 110 retrieved. Analysis revealed that sputum samples were mostly from older males, while urine samples were mostly from females. Yet, gender did not significantly influence bacterial presence across sample types. Overall, Escherichia coli was the most prevalent bacterium (74%), followed by Salmonella typhi (25%), Staphylococcus aureus (25%), and Klebsiella pneumoniae (23%) isolated from different type of clinical samples. Altogether, 6-15 antibiotics were assessed for sensitivity, with 2–6 antibiotics showing sensitivity to blood bacteria, 1-6 antibiotics demonstrating sensitivity to sputum bacteria, and 3–8 antibiotics exhibiting sensitivity to urine bacteria. Many investigated antibiotics were resistant, only gentamicin exhibited sensitivity for all types of bacteria found in blood, sputum and urine. These findings underscore the importance of discerning bacterial resistance patterns for effective antimicrobial treatment selection.

The pattern of antibiotic utilisation among intensive care unit patients hospitalised in a Gauteng (South African) provincial tertiary hospital: Comparing findings before and during COVID-19.

Various mechanisms may contribute to and direct the progression of antibiotic resistance. A prominent driver associated with antibiotic resistance is inappropriate use or consumption. The sudden emergence of coronavirus disease 2019 (COVID-19 ) changed the conventional practices related to antibiotic utilisation through repurposing the use of antibiotics. Apart from the implementation of antibiotic stewardship programmes, the pressure COVID-19 placed on healthcare systems resulted in poor prescribing and medication review practices, potentially exacerbating antibiotic resistance. Furthermore, the public health system has issues that make it difficult to routinely monitor, quantify antibiotic consumption, and offer evaluation, feedback and intervention, particularly in low- and middle- income countries such as South Africa (SA). Therefore, this study aimed to determine antibiotic utilisation before and during the COVID-19 pandemic in a Gauteng provincial tertiary hospital (GPTH) in SA. To determine, examine, and compare antibiotic consumption among intensive care unit (ICU) patients admitted to a GPTH during the pre-COVID-19 period and during the COVID-19 pandemic, in addition to determining the prevalence of the World Health Organisation (WHO) 'watch' category antibiotics before and following the emergence of COVID-19 . A retrospective cross-sectional data analysis was undertaken of 335 medical files of ICU patients hospitalised in a GPTH between January 2017 and December 2021. Descriptive statistics were used to examine patient characteristics and antibiotic prescribing variables (antibiotic selection, dosage, route of administration, frequency, duration of course and indication for which antibiotic was prescribed). The study found that the most frequently prescribed antibiotics were amoxicillin in combination with clavulanate (pre-pandemic 31.99%; amid-COVID-19 38.43%), followed by ceftriaxone (pre-pandemic 15.44%; amid-COVID-19 14.55%), piperacillin in combination with tazobactam (pre-pandemic 11.40%; amid-COVID-19 8.58%) and azithromycin (pre-pandemic 7.725%; amid-COVID-19 19.78%). The macrolide and penicillin (in combination with a beta-lactamase inhibitor) classes demonstrated an increase in consumption from the pre-pandemic period moving into the COVID-19 pandemic. This highlights the need for improved antibiotic stewardship programmes and policies to combat inappropriate and unnecessary antibiotic usage.

Patterns and drivers of antibiotic use in small-scale broiler production systems in Lilongwe District, Malawi

Reducing the inappropriate use of antibiotics in food animals is a global priority to address antimicrobial resistance (AMR). We investigated practices and factors associated with antibiotic use in small-scale commercial broiler farms in Lilongwe district, Malawi. We used structured questionnaires to collect data on recent antibiotic use practices among 128 broiler farmers, who kept between 50 and 1 000 birds, from December 2022 to March 2023. Logistic regression analysis was used to identify risk factors associated with antibiotic use. Over half (53.1 %, n=68) of the farms reported using antibiotics at least once in the previous production cycle. Overall, 11 different types of antibiotics were used either for treatment and/or preventive purposes, with oxytetracycline (88.2 %), erythromycin (29.4 %), and enrofloxacin (26.5 %) reported as the frequently used. One-third of all antibiotic formulations contained multiple active antibiotic ingredients, with 12 % containing four antibiotics. Covariates associated with an increased likelihood of antibiotic use include disease incidence (OR=13.8, 95 % CI 5.27–42.50, p<0.001) and entry of wild birds into poultry houses (OR=3.56, 95 % CI =1.44–9.61, p=0.008). Our study highlights inappropriate usage of antibiotics, largely associated with reduced biosecurity and disease incidence. These findings underscore the need to strengthen veterinary services, reinforce regulations on antibiotic access and use, and farmer education programs promoting proper husbandry, biosecurity, and responsible antibiotic use.

The importance of antibiotic treatment duration in antimicrobial resistance.

Antimicrobial resistance (AMR) poses a significant threat to global health, leading to increased deaths from drug-resistant infections and escalates healthcare costs. Often termed a "silent pandemic," AMR occurs when pathogens become resistant to antimicrobial drugs, enabling their proliferation and spread. Inappropriate antibiotic usage is a major contributor to this phenomenon, which also extends to fungal infections. In particular, the duration of antibiotic therapy is a crucial aspect, with evidence suggesting that prolonged use can heighten bacterial resistance and harm the human microbiota. In fact, studies comparing short-term versus long-term antibiotic therapies show no significant difference in traditional treatments. In addition, therapeutic drug monitoring allows personalized antibiotic regimens, optimizing dosage and duration to minimize resistance and adverse effects. As a result, clinicians should regularly reassess treatment effectiveness, utilizing techniques like antibiotic timeout and de-escalation therapy to avoid prolonged antibiotic use and mitigate resistance. All these strategies are crucial to prevent and counter the phenomenon of antimicrobial resistance.

Multidrug-Resistant Acinetobacter and Enterobacterales Causing Neonatal Sepsis at a Tertiary Healthcare Facility in Indonesia

Introduction: Increasing resistance to multiple classes of antimicrobials, leading to multidrug resistance (MDR), provides a major challenge for the management of bloodstream infections in the neonatal intensive care unit (NICU). The dissemination of Acinetobacter and Enterobacterales species were of great importance owing to their high prevalence and resistance against a broad spectrum of available antimicrobials, thereby exacerbating the prognosis for afflicted patients. This study aimed to highlight neonatal sepsis cases caused by MDR Acinetobacter and Enterobacterales in the NICU of a tertiary healthcare center in Surabaya, Indonesia. Methods: This retrospective cohort study was conducted in Dr. Soetomo General Hospital, Surabaya, from January 2020 to August 2022. Documented cases of neonatal sepsis were identified from electronic medical records under the ICD-10 P36 code. Continuous monitoring of blood culture was performed following the initial suspicion of sepsis, complemented with semiautomated antimicrobial susceptibility testing. Results: A total of 75 out of 125 culture-proven neonatal sepsis cases were reported caused by Acinetobacter baumannii ( n = 19; 15.2%) and Enterobacterales ( n = 56; 44.8%) species. These organisms exhibited the MDR rates of 78.9% and 91.1%, respectively. Klebsiella pneumoniae ( K. pneumoniae) emerged as the predominant Enterobacterales, demonstrating an MDR rate of 92.1%. Possible extensively- and possible pan-drug-resistant organisms were also identified at a concerning rate in Acinetobacter (73.7% and 21.1%, respectively) and Enterobacterales (28.6% and 1.8%, respectively). The susceptibility of Acinetobacter to carbapenems was notably low (26.3%), whereas Enterobacterales exhibited a relatively higher susceptibility rate (75%). Notably, 9 and 37 documented deaths were associated with neonatal sepsis because of MDR Acinetobacter and Enterobacterales, respectively. Lower birth weight and shorter length of NICU stay were significantly related to mortality in neonatal sepsis. Conclusion: The alarming rate of MDR underscores further investigations on the extent of inappropriate antibiotic usage in the unit, particularly concerning neonates requiring invasive medical interventions and those with foundational clinical risk factors.

Study on knowledge, attitude, and practices of general public toward antimicrobial use and antimicrobial resistance

Background: The World Health Organization (WHO) states that antibiotic resistance (AMR) is a serious public health issue that is only getting worse. Antibiotic misuse leads to serious complications such as prolonged hospital admissions, high death rates, and increased financial load. While a number of factors have been identified as contributing to the development of AMR, inappropriate antibiotic usage has been identified as the primary cause. Taking antibiotics more often than prescribed, not taking them to their full recommended dosage, sharing prescription medications, storing medication for later use to treat the same symptoms, and obtaining antibiotics without a prescription are some of the factors that contribute to antimicrobial resistance (AMR). Aims and Objectives: The aims and objectives of the study are to assess the knowledge, attitudes, and practices of public regarding the use of antimicrobial use and antimicrobial resistance; evaluating potential corrective measures to address the problem; selecting effective communication strategies to raise awareness; and to analyzing the factors associated with a higher level of knowledge about antimicrobial resistance. Materials and Methods: A descriptive cross-sectional study was carried out after obtaining approval from the Institutional Ethics Committee from July 28th, 2022, to September 28th, 2022, with a sample size of 488 voluntary participants from general public visiting outpatient departments (OPDs) of Rajiv Gandhi Government General Hospital (RGGGH), Chennai. The participants’ knowledge, attitude, and practices regarding the use of antibiotics and antimicrobial resistance were assessed through a questionnaire in English and translated into the local language (Tamil). Results: A total of 488 responses were received from patients visiting the various OPDs of RGGGH, Chennai. Among the respondents, the majority were females 257 (52.7%) of age groups, 18–25 years (172, 35.2%). The respondents were also grouped based on their level of education and found that most of them had completed class 12, 218 (44.7%). Previous history of antibiotic use was assessed and found that 417 (85.5%) participants had taken antibiotics within the past 12 months before the study. Our study found that the majority of respondents (280, 57.4%) knew that the full course of antibiotics should be taken as directed. Practices of acquiring antibiotics were also assessed in our study and found that 301 respondents (61.7%) said they have never purchased antibiotics without consulting a doctor. The proper use of antibiotics was another question that participants were asked and 288 (59%) participants answered that they had received this explanation health-care workers. The knowledge about antibiotic use was assessed and found that the majority of participants (368, 75.4%) correctly identify urinary tract infection as a disease that can be cured by antibiotics. Our study also revealed that most of the participants (317, 64.9%) had awareness about the antibiotic resistance from the given list of terms related to issue of antibiotic resistance. Conclusion: The majority of the general people who visited the RGGGH’s OPDs revealed good attitudes and awareness regarding the severity of antimicrobial resistance (AMR) and the significance of using antibiotics appropriately. Their knowledge, attitudes, and behaviors are determined to be highly satisfactory. There were a few minor fallacies, such as the idea that antibiotics work well against colds. To more accurately assess the baseline circumstances of the broader population, there is a greater need for research in this field using multicentric approaches and a modified demographic focus.

Antimicrobial resistance: A looming threat to public health and global well-being

Abstract Antimicrobial resistance (AMR) is a global issue that transcends borders and affects countries at all income levels. Various contributing factors include limited access to clean water, sanitation, and hygiene for both humans and animals; inadequate infection and disease prevention and control in households, health-care facilities, and farms; restricted access to high-quality and affordable vaccines, diagnostics, and medications; insufficient awareness and knowledge; and a lack of enforcement of relevant legislation. People in low-resource settings and vulnerable populations are disproportionately affected by both the causes and consequences of AMR. The identification and subsequent incorporation of antimicrobial agents into clinical medicine marked a significant milestone in 20th-century medical achievements, fundamentally transforming the management of bacterial diseases. Nevertheless, the gradual rise of antibiotic-resistant bacterial populations, stemming from the inappropriate usage, misapplication, and unconditional abuse of antibiotics, has evolved into a substantial global public health challenge. Today, different mechanisms of bacterial resistance have been reported in almost all the present antibiotics on the market. The international community has been striving to address and recognize AMR as a global alarming situation, as considered by the World Health Organization as well as the Centers for Disease Control and Prevention. The unrestrained utilization of antibiotics at public and commercial levels has invigorated the evolution of multi-drug resistant microbiota across the globe, leading to an elevated mortality rate due to microbial infections. This review paper explored the inception and resistance genes, provides a comprehensive overview of global antimicrobial resistance, analyzes factors promoting its dissemination, discusses control strategies, examines control challenges, and underscores the ramifications of an inability to effectively contain antimicrobial resistance in bacteria, effectively.

Monitoring the battleground: exploring antimicrobial resistance and virulence factors in wound bacterial isolates

Antibiotic resistance poses a grave global public health threat, exacerbated by widespread and often inappropriate antibiotic usage. Vigilant surveillance of antibiotic utilization and emergence of antimicrobial resistance (AMR) is essential. Of particular concern in the era of AMR is the persistent issue of chronic wound infections. To address this, we conducted a comprehensive evaluation of wound isolates from chronic wounds at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya, to identify relevant bacteria and assess their drug resistance patterns.Wound samples were collected and processed using standard microbiological methods. Bacterial isolates were identified and assessed for their susceptibility to a panel of antibiotics using the Kirby-Bauer disk diffusion method. A total of 103 bacterial isolates were obtained from the wound samples, with a higher prevalence in male patients (59%). Staphylococcus aureus (20.7 %) emerged as the most predominant pathogen, followed by Klebsiella spp. (14.8 %), Pseudomonas aeruginosa spp. (14.8 %) and Escherichia coli (4.4 %) in wound samples. High levels of antibiotic resistance were observed among the isolates, with the highest resistance rates reported for cotrimoxazole (48.1 %), clindamycin (25.9 %) and erythromycin (25.9 %). Furthermore, among the isolates, 75 % produced haemolysin and protease, while 50 % produced lipase and phospholipase, factors that enhance virulence and survival. The findings of this study highlight the alarmingly high prevalence of antibiotic resistance among bacterial pathogens isolated from chronic wounds in Kenya. This poses a major challenge to the effective management of chronic wound infections. There is an urgent need to implement effective antimicrobial stewardship programs and develop new antibiotics to combat the growing threat of antibiotic resistance.

Overlapping Physiologic Signs of Sepsis and Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: Exploring A Clinical Conundrum.

Paroxysmal sympathetic hyperactivity (PSH) occurs in a subset of patients with traumatic brain injury (TBI) and is associated with worse outcomes. Sepsis is also associated with worse outcomes after TBI and shares several physiologic features with PSH, potentially creating diagnostic confusion and suboptimal management of each. This is the first study to directly investigate the interaction between PSH and infection using robust diagnostic criteria. We performed a retrospective cohort study of patients with TBI admitted to a level I trauma center intensive care unit with hospital length of stay of at least 2weeks. From January 2016 to July 2018, 77 patients diagnosed with PSH were 1:1 matched by age and Glasgow Coma Scale to 77 patients without PSH. Trauma infectious diseases subspecialists prospectively documented assessments corroborating diagnoses of infection. Extracted data including incidence, timing, classification, and anatomical source of infections were compared according to PSH diagnosis. We also evaluated daily PSH clinical feature severity scores and systemic inflammatory response syndrome (SIRS) criteria and compared values for patients with and without confirmed infection, stratified by PSH diagnosis. During the first 2weeks of hospitalization, there were no differences in rates of suspected (62%) nor confirmed (48%) infection between patients with PSH and controls. Specific treatments for PSH were initiated on median hospital day 7 and for confirmed infections on median hospital day 8. SIRS criteria could identify infection only in patients who were not diagnosed with PSH. In the presence of brain injury-induced autonomic nervous system dysregulation, the initiation and continuation of antimicrobial therapy is a challenging clinical decision, as standard physiologic markers of sepsis do not distinguish infected from noninfected patients with PSH, and these entities often present around the same time. Clinicians should be aware that PSH is a potential driver of SIRS, and familiarity with its diagnostic criteria as proposed by the PSH assessment measure is important. Management by a multidisciplinary team attentive to these issues may reduce rates of inappropriate antibiotic usage and misdiagnoses.

Antibiotic Consumption in Primary Care in Costa Rica and Italy: A Retrospective Cross-Country Analysis.

The increasing emergence and spread of drug-resistant pathogens resulting from inappropriate antibiotic usage have become more evident in recent years, particularly with the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections.Since joining the Organization for Economic Cooperation and Development (OECD), Costa Rica can now compare its healthcare system with other countries, and similarities have been noted with Italy regarding health indicators. Both nations have universal healthcare systems, covering their entire populations, and hold similar positions in the Human Development Index (HDI). Consequently, the goal is to compare antibiotic prescribing and consumption patterns to collaboratively develop strategies against bacterial resistance. In order to compare antibiotic consumption between regions, a standardized contrast was utilized, specifically using the defined daily dose (DDD). An Orthogonal Contrast test was performed to test the means, followed by the application of the Student's t-test on these contrasts. This analysis aimed to assess the potential influence of regions on DDD values. Antibiotic consumption data were collected between January 2021 and December 2022 from the Local Health Authority of Naples 3 South (LHANS)in Italy and IMS Health, Q Quintiles, and VIA by way of (IQVIA) reports in Costa Rica. LHANS shows a considerable disparity in gross expenditure compared to Italy's overall expenditure, while the private sector of Costa Rica exhibits even lower gross expenditure than Italy. Antibiotic consumption in Italy exceeds that of Costa Rica, with Costa Rica's consumption amounting to 47.70% of Italy's total consumption. Additionally, LHANS exhibited a 22.43% higher gross expenditure compared to the Campania region, emphasizing the variability in antibiotic usage within the same country The results indicated no statistically significant differences in antibiotic consumption between the regions, as none of the null hypotheses were rejected. The study provides valuable insights into expenditure patterns and antibiotic consumption, highlighting the need for improved prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings emphasize the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.

Antimicrobial Resistance (AMR).

Antimicrobial resistance (AMR) has now emerged as a chronic public health problem globally, with the forecast of 10 million deaths per year globally by 2050. AMR occurs when viruses, bacteria, fungi and parasites do not respond to antimicrobial treatments in humans and animals, thus allowing the survival of the microorganism within the host. The prominent cause contributing to the current crisis remains to be the overuse and misuse of antimicrobials, particularly the inappropriate usage of antibiotics, increasing the global burden of antimicrobial resistance. The global consumption and usage of antibiotics are therefore closely monitored at all times. This review provides a current overview of the implications of strategies used by international governmental organisations, including the UN's 17 Sustainable Development Goals (SDGs), to address the problem of antibiotic resistance, as well as the "One Health Approach," a system incorporating a multidisciplinary effort to achieve the best possible health outcome by acknowledging the clear connections between humans, animals and their shared environment. The importance of public awareness and health literacy of lay audiences still needs to be further emphasised as part of global and local action plans. Antimicrobial resistance continues to be a major global public health dilemma of the 21st century. Already this topic is receiving substantial political input from the G7 countries and continues to be on the agenda of numerous political conferences. The consequences of failure to adequately address AMR are profound, with estimations of a return to the pre-antibiotic era, where everyday infections relating to childbirth, surgery and open fractured limbs could be potentially life-threatening. AMR itself represents a microcosm of factors, including social anthropology, civil unrest/war, diasporas, ethnic displacement, political systems, healthcare, economics, societal behaviour both at a population and individual level, health literacy, geoclimatic events, global travel and pharmaceutical innovation and investment, thus finding a solution that adequately addresses AMR and which helps stem further AMR emergence is complicated. Success will involve individuals, communities and nations all working together to ensure that the world continues to possess a sufficient armamentarium of effective antimicrobials that will sustain human and animal health, both now and in the future.

A Cross Sectional Study of Antimicrobial Resistance in Medical College Affiliated Tertiary Health Care Hospital

Background and Objectives: The study conducted involves reviewing the current scenario of antimicrobial resistance in the community by obtaining collected data from patients suffering from ongoing infective disorders andanalyzing their culture and sensitivity reports.Methods: We have collected the samples from 56 patients with infective disorders such as cellulitis, wound infection, pneumonia, cultured the samples and checked for the sensitivity of various different antibiotics using the disc diffusion methods according to CLSI standards. We have also checked for the morphology of the organism by routine microscopy using gram stain.Results: We have noted that the Gram-positive Cocci infections are more prevalent in our community settings and there was also a high level of resistance seen in both gram-negative and gram-positive organisms, towards the standard empirical antibiotic Cefotaxime used in such patients. Hence, we had to switch to a more effective antibiotic according to the patterns of resistance. The presence of resistance to other antibiotics was also noted.Interpretation &amp; Conclusion: There is an increased level of resistance towards once considered highly effective broad-spectrum antibiotics in the community. This may be a result of inappropriate and overzealous usage of antibiotics by patients. This may be a result of improper supervision or no strict guidelines when it comes to the prescription of antibiotics. Hence many different strategies must be deployed in order to tackle the development of resistance to useful antibiotics

Antibiotic Consumption in a Cohort of Hospitalized Adults with Viral Respiratory Tract Infection.

Development of antibiotic resistance, a threat to global health, is driven by inappropriate antibiotic usage. Respiratory tract infections (RTIs) are frequently treated empirically with antibiotics, despite the fact that a majority of the infections are caused by viruses. The purpose of this study was to determine the prevalence of antibiotic treatment in hospitalized adults with viral RTIs, and to investigate factors influencing the antibiotic decision-making. We conducted a retrospective observational study of patients ≥ 18 years, hospitalized in 2015-2018 with viral RTIs. Microbiological data were taken from the laboratory information system and information on antibiotic treatment drawn from the hospital records. To investigate decisions for prescribing antibiotic treatment, we evaluated relevant factors such as laboratory and radiological results, in addition to clinical signs. In 951 cases without secondary bacterial RTIs (median age 73 years, 53% female), 720 (76%) were prescribed antibiotic treatment, most frequently beta-lactamase-sensitive penicillins, but cephalosporins were prescribed as first-line in 16% of the cases. The median length of treatment (LOT) in the patients treated with antibiotics was seven days. Patients treated with antibiotics had an average of two days longer hospital stay compared to patients with no such treatment, but no difference in mortality was found. Our study revealed that there is still a role for antimicrobial stewardship to further improve antibiotic use in patients admitted for viral RTIs in a country with relatively low antibiotic consumption.

Assessing the Awareness, Attitude, and Knowledge of Senior Pharmacy Students in Jordanian Universities Regarding Antibiotic Use and Resistance: A Study of the Medical Curriculum

Inappropriate antibiotic usage is a critical issue in many countries, especially in low- and middle-income countries, where access to antibiotics may be easier but proper prescribing and use practices are often lacking. This can contribute to the development of antibiotic resistance, which poses a significant threat to global public health. The research on assessing the awareness, attitude, and knowledge of senior pharmacy students in Jordanian universities regarding antibiotic use and resistance can have several impacts. Firstly, it can shed light on the current level of knowledge and awareness among pharmacy students, who are future healthcare professionals, and identify any gaps or misconceptions that need to be addressed through education and training programs. Secondly, the research findings can be used to develop targeted interventions to improve appropriate antibiotic use and reduce the emergence and spread of antibiotic resistance in Jordan and potentially other countries with similar contexts. Finally, the study can contribute to the growing body of knowledge on antibiotic resistance and help inform global efforts to address this critical public health issue. This study aimed to assess the awareness, attitude, and knowledge of senior pharmacy students in Jordanian universities in relation to antibiotic use and antibiotic resistance (AR). A proportionate random sampling method was employed, and a questionnaire was administered to 400 final-year pharmacy students from three universities in the northern region of Jordan over a period of six months (6/3/2022- 11/3/2022). The data was distributed electronically using emails, and Excel was used for data analysis. The findings revealed that the pharmacy students displayed a high level of knowledge (mean score of 86.5%), positive attitude (mean score of 87.2%), and responsible behavior towards antibiotic use, indicative of their awareness and understanding of the risks of AR. The statistical methods used to analyze the data included descriptive statistics and inferential statistics such as t-tests and ANOVA. The study also identified some areas of potential improvement, such as enhancing knowledge about antibiotic resistance mechanisms and the importance of completing the full course of antibiotics. To address these gaps, targeted educational interventions can be developed to empower pharmacy students to promote appropriate antibiotic use and minimize the emergence of antibiotic resistance.

Synthesis of Biogenic Silver Nanoparticles (bAgNPs) Using Leaf Extract of Mirabilis jalapa and Evaluation of Anti-vibriocidal, Anti-oxidant properties and Cytotoxicity

Acute hepatopancreatic necrosis disease (AHPND) and luminescent vibriosis are two major bacterial diseases of penaeid shrimp which are caused by gram-negative pathogenic bacteria Vibrio parahaemolyticus (Vp) and Vibrio harveyi (Vh) respectively. These diseases cause massive mortality and huge economic loss worldwide in shrimp aquaculture. Extensive and inappropriate usage of antibiotics against these pathogens resulted in antibiotic-resistant strains. Drug repurposing appears to be an appropriate solution to eliminate antibiotic resistance in pathogens. In the present study, biogenic silver nanoparticles (bAgNPs) are synthesized by reducing AgNO3 using the aqueous extract of Mirabilis jalapa (MJ) leaves. The anti-oxidant, cytotoxic, and anti-vibriocidal activity of bAgNPs against Vp and Vh are evaluated. The formation of bAgNPs was confirmed by the appearance of a dark brown coloured solution and with a maximum absorption peak at 434 nm. The characterization of bAgNPs using FESEM and EDX, TEM, XRD, FTIR, and DLS has confirmed that the nanoparticles are crystalline and spherical in shape with an approximate diameter of 50 nm and have capping agents. The diameters of microbial growth inhibition zones for Vp and Vh are 26 mm and 23 mm respectively. Further, the MIC values for Vp and Vh are 31.25 µg/mL and 93.75 µg/mL respectively. The DPPH and FRAP assays showed substantial anti-oxidant activity with IC50 values of 67.39 µg/mL and 5.509 µg/mL respectively. MTT assay to check the cytotoxicity effect of bAgNPs on Vero cells resulted in very less toxicity at the maximum concentration tested with an IC50 value of 293.5 µg/mL. Therefore, the bAgNPs synthesized from leaves of MJ showed effective anti-vibriocidal and anti-oxidant properties with negligible cytotoxic effects.

Genotypic Patterns of Multidrug-Resistant Acinetobacter baumannii: A Systematic Review.

Acinetobacter baumannii (A. baumannii) is one of the most common bacteria in nosocomial infections. Inappropriate usage of antibiotics has led to expanding emergence resistance to A. baumannii as a multidrug-resistant (MDR) strain. Empirical antibiotic therapy is necessary to evaluate the resistant gene pattern of MDR A. baumannii. For this purpose, the present study evaluated the resistance genes pattern of MDR A. baumannii collected from hospitalized patients using a genotypic diagnostic technique. To find evidence related to the study objectives, databases were searched such as Google Scholar, Web of Science, Science Direct, PubMed, and Scopus from 2000 to 2022, with specified keywords in the title and text of the articles. Articles were included based on inclusion and exclusion criteria. The mentioned database displayed 284 articles. After screening, 65 eligible articles were included. The results showed that various b-lactamases genes, aminoglycoside-modifying enzymes (AMEs) genes, and pump-expressing genes are resistance gene patterns in MDR A. baumannii isolates. MDR A. baumannii has significantly become resistant to b-lactams, carbapenems, and aminoglycosides.

Detection and correlation of antimicrobial resistance pattern in Enterobacteriaceae from UTI patients in GMERS Medical College, Gujarat

Background: Bacterial resistance to antibiotics is a growing public health threat worldwide. The increasing rate of antimicrobial resistance among bacterial pathogens causing both hospital- and community-acquired infections is a serious threat to public health world-wide. This inappropriate and non-judicious usage of antibiotics has resulted in the development of worldwide antibiotic resistance in bacteria, leading to the emergence of multi-resistant strains of bacterial pathogens. This study focuses on the prevalence of antibiotic resistance in the Enterobacteriaceae group of organisms in urine samples and also detects various methods of antibiotic resistance. Antibiotic resistance detection may be useful for epidemiological and research purposes, as well as for preventing the spread of drug-resistant organisms within hospitals through good infection control practices. Aims and Objectives: The aim of the study was to detect occurrence of β-lactamases, extended-spectrum beta-lactamases (ESBL) and Carbapenemase by phenotypic methods in Enterobacteriaceae from urine samples along with pattern of antibiotic resistance for various antibiotics in them. Materials and Methods: A descriptive study was conducted at a tertiary-care hospital. Testing of ESBL and carbapenemase production detection done according to CLSI (M100) guideline by the Kirby-Bauer disk diffusion method, combination disc diffusion test, and modified Carbapenem inactivation method. Results: A total of 220 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. Rate of cephalosporin resistance in ESBL and carbapenem-resistant Enterobacteriaceae (CRE) is more than 90% while in non-ESBL more than 70% and in non-CRE 75–80%. Carbapenem resistance in ESBL and non-ESBL is the same. Resistance to fluoroquinolone group, Aminoglycoside group, and Cotrimoxazole and Tetracycline group of antibiotics were more noticed in ESBL and carbapenemase producing organisms. In our study, fosfomycin and Nitrofurantoin are effective treatment in case of ESBL and CRE producing organism. Conclusion: The ESBL and Carbapenemase producing isolates were multi-drug resistant making therapeutic choices limited. Fosfomycin and Nitrofurantoin are effective treatment in multidrug resistance urinary tract infection.

Emergence of High Antimicrobial Resistance among Critically Ill Patients with Hospital-Acquired Infections in a Tertiary Care Hospital.

Background and Objectives: Inappropriate antibiotic usage in hospitalized patients contributes to microbial resistance. Our study aimed to examine the incidence of clinical bacterial isolates and their antibiotic resistance burden among critically ill patients in different hospital units. Materials and Methods: A single-centered cross-sectional study was conducted in a 120-bed tertiary care hospital that included 221 critically ill patients with hospital-acquired infections. Bacterial cultures and sensitivity reports were obtained and followed by a formal analysis of the antibiogram results to explore recovered isolates' prevalence and antibiotic susceptibility patterns. Results: Gram-negative bacteria were the most predominant pathogens among recovered isolates from the various hospital units (71%). Klebsiella sp. was the most prevalent microbe, followed by Acinetobacter sp., with an incidence level of 28% and 16.2%, respectively. Among the Gram-positive organisms, the coagulase-negative Staphylococci were the most predominant organism (11.3%), while (6.3%) methicillin-resistant Staphylococcus aureus (MRSA) isolates were recovered from different hospital units. Antibiotic sensitivity testing showed that polymyxin B was the most effective antibiotic against Gram-negative bacteria, whereas vancomycin and linezolid were the most active antibiotics against Gram-positive pathogens. Moreover, 7% of the Gram-negative bacteria isolated from different units showed positive production of extended-spectrum beta-lactamase (ESBL). Conclusions: The current study describes the high antibiotic resistance patterns in various hospital units that need extra legislation to prevent healthcare providers from misprescription and overuse of antibiotics.

Multi-drug resistant bacteria isolates from lymphatic filariasis patients in the Ahanta West District, Ghana

BackgroundAntimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates.ResultsOf the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser extent ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively.ConclusionThe findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

Evaluation of Antibiotics Use and its Predictors at Pediatrics Ward of Jimma Medical Center: Hospital Based Prospective Cross-sectional Study

BackgroundOne of the biggest emerging public health issues is the alarming increase in the prevelance of antibiotic resistance across the globe, which is linked to significant morbidity and mortality and demands special attention. The most significant risk factor for antimicrobial resistance (AMR), which is increasing considerably in Ethiopia and is responsible for increased adverse effects, treatment failure, and rising health-care costs, is inappropriate antibiotic usage. The purpose of this study was to assess the use of antibiotics in inpatient settings at an Ethiopian teaching hospital providing tertiary care.MethodsThe hospital-based prospective cross-sectional study was undertaken at JMC in southwest Ethiopia. Data were collected by using structured checklist which contains patient’s sociodemographic characteristics and pattern of antimicrobial use. All cards of patients which fulfill the inclusion criteria were selected by using a systematic random sampling technique. Bivariate analysis was done to know the association between independent variable and the outcome variable.ResultsThe medical records of 402 pediatric patients who had taken at least one systemic antibiotic were examined. The most frequently prescribed combination antibiotics were ampicillin+gentamycin (43.33%) followed by ceftriaxone+gentamycin (15.23%). Gentamycin 116 (24.11%) was the most frequently used antimicrobial. Overall 19.29% of antibiotic use was improper. A higher percentage of participants 149 (22.41%) experienced inappropriate antibiotic usage as a result of inappropriate frequency. Pediatric patients stay in hospital ≥7 days (AOR; 2.45, 95%CI: 2.32–5.34), prescribed antibiotics ≥2 3.12 (AOR: 3.12, 95%CI: 6.32–13.37) and prescribed empirical treatment types (AOR; 2.65, 95%CI: 4.23–8.87) were independent predictors of inappropriate antibiotics use.ConclusionAntibiotics were generally used inappropriately at high rates. Gentamycin and crystalline penicillin were the most prescribed antibiotics. Longer hospital stay, antibiotics prescription ≥2, and empirical treatments were the independent predictors of inappropriate antibiotic use.