Injudicious Use Of Antibiotics Research Articles

Antibiotic usage patterns in COVID-19 patients in five tertiary hospitals from Bangladesh: A countrywide picture

ObjectivesIrrational and injudicious use of antibiotics in COVID-19 patients could be detrimental in a tropical country with a weak antibiotic stewardship policy such as Bangladesh. This study aimed to focus on the antibiotic usage patterns in COVID-19 patients in Bangladesh. MethodsThis prospective observational study was performed from July 2020 to June 2021 in five tertiary hospitals in Bangladesh. Data on demographic profile, disease severity, and antibiotic usage were collected directly from the patients’ hospital documents. ResultsA total of 3486 (94.4%) patients were treated with at least one antibiotic; 3261 (93.6%) patients received a single antibiotic, and 225 (6.5%) received multiple antibiotics. The most used antibiotics were ceftriaxone (37.3%), co-amoxiclav (26.3%), azithromycin (10.6%), and meropenem (10.3%). According to the World Health Organization AWaRe categorization, most (2260; 69.6%) of the antibiotics prescribed in this study belonged to the “Watch” group. Culture and sensitivity reports were available in 111 cases from one center. Only 18.9% of the patients were found to be co-infected with multi-drug-resistant bacteria (52.4% yield from sputum, 28.6% from urine, and 14.3% from blood). ConclusionsStrict antibiotic prescribing policy and antibiotic stewardship should be implemented immediately to limit the future threat of antimicrobial resistance in countries such as Bangladesh.

Critical appraisal of the SIBO hypothesis and breath testing: A clinical practice update endorsed by the European society of neurogastroenterology and motility (ESNM) and the American neurogastroenterology and motility society (ANMS).

There is compelling evidence that microbe-host interactions in the intestinal tract underlie many human disorders, including disorders of gut-brain interactions (previously termed functional bowel disorders), such as irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) has been recognized for over a century in patients with predisposing conditions causing intestinal stasis, such as surgical alteration of the small bowel or chronic diseases, including scleroderma and is associated with diarrhea and signs of malabsorption. Over 20 years ago, it was hypothesized that increased numbers of small intestine bacteria might also account for symptoms in the absence of malabsorption in IBS and related disorders. This SIBO-IBS hypothesis stimulated significant research and helped focus the profession's attention on the importance of microbe-host interactions as a potential pathophysiological mechanism in IBS. However, after two decades, this hypothesis remains unproven. Moreover, it has led to serious unintended consequences, namely the widespread use of unreliable and unvalidated breath tests as a diagnostic test for SIBO and a resultant injudicious use of antibiotics. In this review, we examine why the SIBO hypothesis remains unproven and, given the unintended consequences, discuss why it is time to reject this hypothesis and its reliance on breath testing. We also examine recent IBS studies of bacterial communities in the GI tract, their composition and functions, and their interactions with the host. While these studies provide important insights to guide future research, they highlight the need for further mechanistic studies of microbe-host interactions in IBS patients before we can understand their possible role in diagnosis and treatment of patient with IBS and related disorders.

Green Synthesized Chitosan Nanoparticles for Controlling Multidrug-Resistant mecA- and blaZ-Positive Staphylococcus aureus and aadA1-Positive Escherichia coli.

Antimicrobial resistance has recently been considered an emerging catastrophe globally. The public health and environmental threats were aggravated by the injudicious use of antibiotics in animal farming, aquaculture, and croup fields, etc. Consequently, failure of antibiotic therapies is common because of the emergence of multidrug-resistant (MDR) bacteria in the environment. Thus, the reduction in antibiotic spillage in the environment could be an important step for overcoming this situation. Bear in mind, this research was focused on the green synthesis of chitosan nanoparticles (ChiNPs) using Citrus lemon (Assam lemon) extract as a cross-linker and application in controlling MDR bacteria to reduce the antibiotic spillage in that sector. For evaluating antibacterial activity, Staphylococcus aureus and Escherichia coli were isolated from environmental specimens, and their multidrug-resistant pattern were identified both phenotypically by disk diffusion and genotypically by detecting methicillin- (mecA), penicillin- (blaZ), and streptomycin (aadA1)-resistance encoding genes. The inhibitory zone's diameter was employed as a parameter for determining the antibacterial effect against MDR bacteria revealing 30 ± 0.4 mm, 34 ± 0.2 mm, and 36 ± 0.8 mm zones of inhibition against methicillin- (mecA) and penicillin (blaZ)-resistant S. aureus, and streptomycin (aadA1)-resistant E. coli, respectively. The minimum inhibitory concentration at 0.31 mg/mL and minimum bactericidal concentration at 0.62 mg/mL of yielded ChiNPs were used as the broad-spectrum application against MDR bacteria. Finally, the biocompatibility of ChiNPs was confirmed by showing a negligible decrease in BHK-21 cell viability at doses less than 2 MIC, suggesting their potential for future application in antibiotic-free farming practices.

The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households

BackgroundAntimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households. Study designA cross-sectional study of the Lebanese population was conducted between March and October 2022. MethodsThrough random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables. ResultsAmong selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33–3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14–4.56) had significantly higher odds of having LA. ConclusionLeftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

Knowledge of Medical Students Regarding Antimicrobial Resistance

The discovery of antibiotics has enhanced the treatment outcomes of infectious diseases. Nevertheless, the injudicious use of antibiotics has triggered a global public health crisis and caused a worldwide spread of antimicrobial-resistant microorganisms. Antimicrobial resistance is slowly becoming a major health problem all around the world, especially in our country, and this might be due to the incorrect, unwise prescription of antimicrobial agents among some doctors, which gives rise to this problem. The present study aimed to estimate the knowledge of medical students in Baghdad regarding antimicrobial usage and resistance and to find the association of sociodemographic factors with knowledge scores. A descriptive cross-sectional study was conducted in six medical colleges in Baghdad. An online- based questionnaire was published and used in collecting the data. The data were reviewed and entered to be statistically analyzed in SPSS using the Chi-square test and were presented as frequencies, percentages, graphs and tables. The results showed that 44.1% of the studied sample had a fair knowledge of antimicrobial resistance. There was a statistical significance between gender and knowledge about antimicrobial resistance as the P-value was 0.006. In addition, there was a statistically significant association between the stage and the knowledge about antimicrobial resistance, where the P-value was (0.000). It was concluded that most of the participants had fair to good knowledge regarding antimicrobial resistance that was significantly associated with gender and stage.

Pouring Cold Water on Fake News: A Qualitative Review of Misinformation Related to Burns First Aid.

Health misinformation is pervasive on the internet and social media and can have wide-ranging and devastating repercussions. Burn injuries are highly prevalent, especially in resource-poor countries with less rigorous health and safety regulations and reduced access to quality healthcare, and especially among the pediatric population who rely on caregivers to tend to their injuries. Correct first aid is crucial to improving burn outcomes and avoiding further complications. The aim of this study was to qualitatively assess the content of misinformation related to burns online. A literature search was conducted on PubMed using the search terms "burns" OR "burn injury" OR "burns trauma" OR "major burns" AND "first aid" AND "conspiracy" OR "disinformation" OR "misinformation" OR "fake news." Combinations of these terms were searched via Google, YouTube, Facebook, Instagram, TikTok, and PubMed. Key areas of misinformation included unfounded use of "natural" remedies, injudicious use of antibiotics, omission of key steps of first aid, and errors in specific details of first aid. Clinicians should be aware of misinformation available online related to first aid for burns, be aware that patients presenting with burns may have caused further injury with insufficient first aid or inappropriate home remedies, and lead public health campaigns to educate on the initial emergency management of burns.

What is the current evidence for antibiotic prophylaxis in orthopaedic surgery?

Surgical site infections (SSI) continue to represent a significant postoperative burden. SSI is associated with an increased risk of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) is used to reduce the risk of SSI. Several factors must be considered for appropriate antibiotic use: antibiotic selection, timing, and duration. The evidence and use of antibiotics differs between closed fractures, open fractures, arthroplasty and percutaneous fixation. The use of SAP is a balance between reducing the incidence of SSI whilst maintaining proper antibiotic stewardship to limit adverse effects and the emergence of antibiotic resistance. This paper will discuss the evidence for the use of SAP in orthopaedic surgery and the potential adverse effects of the injudicious use of antibiotics.

Comparative study of antibiotic sensitivity pattern of bacterial isolates from ocular infections among patients with and without diabetes mellitus

Antibiotic sensitivity pattern of bacterial isolates varies from place to place and time to time. This study is aimed at determining the sensitivity patterns in our setup. In the era of emerging resistance to antibiotics, there is a need to determine the antibiotic sensitivity pattern of bacterial isolates from ocular infections and to compare the antibiotic sensitivity pattern of bacterial isolates in ocular infections among patients with and without diabetes mellitus. 1. To determine the antibiotic sensitivity pattern of bacterial isolates in ocular infections. 2. To compare the antibiotic sensitivity pattern of bacterial isolates from ocular infections among patients with and without diabetes mellitus. 3. To study the predisposing factors for development of the multidrug resistant bacteria in ocular infections.: It was a hospital based cross-sectional study carried out among the patients presenting to Outpatient department of Hassan Institute of Medical Sciences, Hassan, Karnataka from January 2022 to June 2022. The aims and objectives of the intended study were explained to the subjects and informed written consent was taken. Institutional ethical clearance was obtained. Data was collected as per the proforma sheet. 110 samples were divided into two groups- Diabetics (Group A) & Non diabetics (Group B). Majority70(63.6%) of samples sent were from ocular pathology Chronic dacryocystitis. Positivity rate of cultures was 31.8%. Most common isolate in both groups was Staphylococcus aureus. 89% of positive culture patients had history of antibiotic abuse. Highest sensitivity was seen with aminoglycosides and resistance was seen with macrolide like azithromycin and fluroquinolone like ciprofloxacin. Antibiotic sensitivity and resistance patterns of bacterial isolates in ocular infections was similar in both Diabetics (Group A) and Non diabetics (Group B). Highest sensitivity was seen for Amikacin, Gentamicin and Tobramycin in both groups. Highest resistance was seen for Azithromycin, Amoxicillin clavulanic acid, Ciprofloxacin in both groups.Multidrug resistance was due to previous history of use of antibiotics, injudicious use of antibiotics for viral, allergic and other conditions, incomplete treatment for ocular infections and extended duration of antibiotic usage.

Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance

Aims• To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess.• To understand the risk factors for the same.• To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. MethodsThis is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FindingsA total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. ConclusionSAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.

Rethinking Prophylaxis: Evaluating Surgical Site Infection Rates in Pediatric Orchidopexy without Prophylactic Antibiotics

Introduction: Undescended testes (UDT) is the most common congenital anomaly of the urogenital system in male newborns. Testicular descent into scrotum is necessary for normal spermatogenesis. The scrotal temperature is 2-7 degrees below body temperature. UDT are prone to impaired spermatogenesis, Surgical site infection (SSI) is a leading cause of postoperative morbidity and mortality. It is the third most common cause of hospital acquired infections. However injudicious use of antibiotics is responsible for increased costs, unwanted drug side effects like Clostridium difficile infection as well as the emergence of resistant strains and multidrug resistant infections. Objective: To determine the frequency of surgical site infection in pediatric patients undergoing orchidopexy without the administration of prophylactic antibiotics. Study Design: Descriptive Study Setting: Department of pediatrics, Lady Reading Hospital Peshawar. Duration of Study: From 08-July-2020 to 08-January-2021. Materials and Methods: In overall 126 respondents of undescended testis were selected in a consecutive manner OPD and subjected to orchidopexy. Follow up was done to detect the presence or absence or SSI. Results: The average age of the sample was 12.9+6.8 months. Mean weight of the included children was 12.8 4.9 kg and mean height was 73.1+ 13.5 cm. 50.8% Presented with right side undescended testis and 57.1% were in ASA class Mean operative time for orchidopexy was 44.4 10.3 minutes. SSI was recorded in 31 (24.6%) of children. Conclusion: Surgical site infection (SSI) is a significant concern in pediatric patients undergoing orchidopexy for unilateral undescended testis. Additional investigation is required to determine the factors that contribute to surgical site infections (SSI) in children and create successful measures for prevention. The use of prophylactic antibiotics should be carefully considered, considering the potential risks and benefits. Addressing SSI in this population is crucial for improving patient outcomes and reducing the burden of complications. Keywords: Orchidopexy, pediatrics, surgical site infection

Microplastics and Antibiotic Resistance: The Magnitude of the Problem and the Emerging Role of Hospital Wastewater.

The role of microplastics (MPs) in the spread of antibiotic resistance genes (ARGs) is increasingly attracting global research attention due to their unique ecological and environmental effects. The ubiquitous use of plastics and their release into the environment by anthropic/industrial activities are the main sources for MP contamination, especially of water bodies. Because of their physical and chemical characteristics, MPs represent an ideal substrate for microbial colonization and formation of biofilm, where horizontal gene transfer is facilitated. In addition, the widespread and often injudicious use of antibiotics in various human activities leads to their release into the environment, mainly through wastewater. For these reasons, wastewater treatment plants, in particular hospital plants, are considered hotspots for the selection of ARGs and their diffusion in the environment. As a result, the interaction of MPs with drug-resistant bacteria and ARGs make them vectors for the transport and spread of ARGs and harmful microorganisms. Microplastic-associated antimicrobial resistance is an emerging threat to the environment and consequently for human health. More studies are required to better understand the interaction of these pollutants with the environment as well as to identify effective management systems to reduce the related risk.

Antimicrobial stewardship program activities in India: an appraisal

Human antimicrobial misuse/overuse/irrational use is one of the main drivers of antimicrobial resistance (AMR) and in the presence of a rapidly drying up antibiotic pipeline, it becomes imperative that we learn to use antibiotics judiciously and responsibly. In 2010, India was adjudicated to be the world’s largest consumer of antibiotics and hence curbing injudicious use of antibiotics is a must. Antibiotic abuse happens due to common fallacies such as a belief that broad spectrum antibiotics are “safer” and failure to distinguish between bacterial infections and non-bacterial infections and non-infectious syndromes. In addition, antibiotics for durations longer than necessary, redundant cover (like double gram negative or double anaerobic cover) or treatment of colonizers or contaminants also constitute inappropriate antibiotic use. A stewardship program implementing rational antibiotic use is mandatory to curb irrational antibiotic use. Antimicrobial stewardship is defined as a set of coordinated interventions designed to measure and improve the appropriate use of antibiotics by promoting the selection of the optimal choice, dose, duration and route of the antibiotic which in turn lead to improved patient outcomes and decreased adverse effects.

Qualitative Study on Antimicrobial Usage and Resistance in the Dairy Chain: A Situation Analysis and Solutions by Stakeholders from Punjab, India.

The rising prevalence of antimicrobial resistance in animal foods and injudicious antibiotic use in the dairy sector pose significant threats to public health. Focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with a strategic sample of four stakeholder groups (114 participants) associated with antibiotic usage in the dairy sector of Punjab. The FGDs were conducted among veterinarians (n = 56), para-veterinarians (n = 28), and KIIs were conducted among chemists (n = 18) and dairy quality managers (n = 12) during 2020–2021. FGDs and qualitative interviews of various stakeholders depict existing risk practices in the fields that may promote antimicrobial resistance. The present study revealed that widely prevalent quackery (treatment practices carried out by unauthorized persons without any recognized diploma/degree) and self-treatment by farmers, over-the-counter availability of antibiotics, low veterinarian per animal ratio, and lack of awareness among the society about the potential public health effects of antimicrobial resistance were the main risk factors for injudicious antibiotic use in the dairy sector. The present study involved a comprehensive approach targeting the stakeholders in the dairy sector and their reflections on judicious antimicrobial usage and antimicrobial resistance adapted to the dairy farming of Punjab. There is an urgent need for the advocation of policies that consider the specific challenges faced by the dairy sector to simultaneously improve access to veterinary services as well as strengthen antibiotic stewardship.

ANTIBIOTIC RESISTANCE PATTERN OF BACTERIAL PATHOGENS ISOLATED FROM PUS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA

Pyogenic infections are commonly caused by various microorganisms and mixed infections that require antibiotic therapy. Emergence of antimicrobial drug resistance among susceptible individuals due to injudicious use of antibiotics has made the treatment of wound infections very difcult. This study was undertaken to determine the antibiotic resistance pattern among aerobic bacteria isolated from pus samples. A total of 312 pus samples were received in the Department of Microbiology, GMCH Nagpur from January to March 2021. The pus isolates were identied and processed by standard bacteriological techniques. The Antimicrobial Susceptibility Testing (AST) was performed by Kirby-Bauer disc diffusion technique and the drugs used were in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines 2020.Out of total 312 pus samples, 182 (58.33%) yielded signicant bacterial growth. The most prevalent pathogen isolated were Klebsiella pneumoniae 60 (19.23%) followed by Escherichia coli 42 (13.46%). Further, the study shows that Methicillin Resistant Staphylococcus Aureus (MRSA) and Inducible Clindamycin Resistance (ICR) were 29.41% and 11.76% respectively; moreover 70% isolates were Multi Drug Resistant (MDR). Therefore, this study indicates the prevalence of resistance to different classes of antibiotics in bacterial isolates and highlights the need for effective surveillance, regular reporting and antibiogram-guided antibiotic prescription.

199 An Audit Cycle of Antibiotic Prophylaxis for Laparoscopic Cholecystectomy

Abstract Aim Due to the lack of clinical benefit and the risks of unnecessary antimicrobial use, current national guidelines do not recommend prophylactic antibiotic use in low-risk elective laparoscopic cholecystectomies, reserving their use for high-risk patients only. The aim of this audit was to assess compliance with local and national guidelines for antibiotic usage for laparoscopic cholecystectomies, to identify areas of improvement, implement change and re-audit to assess the effectiveness of this change. Method Data was collected retrospectively between 01/05/2021 and 01/08/2021 for patients undergoing elective laparoscopic cholecystectomies. Following the initial data collection, we implemented change by attaching pre-printed stickers of local antibiotic prophylaxis guidance to pre-operative notes. We prospectively re-audited between 01/11/21 and 01/12/21 to assess the effectiveness of this change. Results In the initial three-month period, 24.4% (10/41) of elective cases received correct antibiotic prophylaxis, with 58.5% of patients prescribed unnecessary post-operative antibiotics in the post-operative plan. Following the implementation of change, in the re-audit period there was a significant improvement, with 55% (11/20) of elective cases receiving correct antibiotic prophylaxis, and only 25% prescribed unnecessary post-operative antibiotics. Conclusions We show that pre-printed stickers are a simple intervention that can improve adherence to local guidance and reduce injudicious use of antibiotics in the pre- and post-operative periods. Improving antibiotic prescribing for laparoscopic cholecystectomies, one of the United Kingdom's most common surgical procedures, highlights the potential for significant cost savings and improved antimicrobial stewardship. We will re-audit again in the coming months to assess if this improvement has been sustained.

Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children.

Acute otitis media (AOM) is the most common infectious disease encountered by children under the age of two years and the most common cause of antibiotic use in children in the United States. AOM causes irritability, sleeplessness, decreased appetite, imbalance, and dizziness in patients, especially young children. This assessment was conducted to measure the effectiveness of surgical interventions in treating AOM. We reviewed the present findings regarding the etiology, clinical presentations, diagnosis, treatment, and surgical treatment of complications of AOM. Pain associated with AOM (otalgia) can be severe enough to cause parents to seek treatment for their infants or children. Various suggested measures have been used to treat AOM; antibiotic treatment with amoxicillin is still the treatment of choice for AOM, yet other antibiotics may be used in cases of allergy to penicillin or recent use of amoxicillin. Surgical intervention has been introduced and studied as a diagnostic, therapeutic, and preventive measure for AOM; nevertheless, a few studies have shown that surgical interventions are beneficial in treating and preventing AOM compared to the common practice of using antibiotics. Overdiagnosis of AOM is widespread, leading to injudicious antibiotic use, which contributes to antibiotic resistance. Further management should be determined together with the parent, particularly if observation is the primary intervention.

In Silico Characterization of Uncharacterized Proteins From Multiple Strains of Clostridium Difficile.

Clostridium difficile (C. difficile) is a multi-strain, spore-forming, Gram-positive, opportunistic enteropathogen bacteria, majorly associated with nosocomial infections, resulting in severe diarrhoea and colon inflammation. Several antibiotics including penicillin, tetracycline, and clindamycin have been employed to control C. difficile infection, but studies have suggested that injudicious use of antibiotics has led to the development of resistance in C. difficile strains. However, many proteins from its genome are still considered uncharacterized proteins that might serve crucial functions and assist in the biological understanding of the organism. In this study, we aimed to annotate and characterise the 6 C. difficile strains using in silico approaches. We first analysed the complete genome of 6 C. difficile strains using standardised approaches and analysed hypothetical proteins (HPs) employing various bioinformatics approaches coalescing, including identifying contigs, coding sequences, phage sequences, CRISPR-Cas9 systems, antimicrobial resistance determination, membrane helices, instability index, secretory nature, conserved domain, and vaccine target properties like comparative homology analysis, allergenicity, antigenicity determination along with structure prediction and binding-site analysis. This study provides crucial supporting information about the functional characterization of the HPs involved in the pathophysiology of the disease. Moreover, this information also aims to assist in mechanisms associated with bacterial pathogenesis and further design candidate inhibitors and bona fide pharmaceutical targets.

Prescribing Pattern of Antibiotics in Respiratory Tract Infections in the Pediatric Indoor Patients at Manipal Teaching Hospital

Introduction: Respiratory tract infections are the most frequently occurring illness in childhood and antibiotics are the key drugs for its treatment which account for three-quarters of all antibiotics prescriptions. Injudicious use of antibiotics leads to the development of resistance, patients are at high risk for opportunistic infections or prolonged hospitalization. This study aimed to assess the prescribing pattern of antibiotics for respiratory tract infections in the pediatric indoor patients of Manipal Teaching Hospital.
 Methods: This study is a prospective cross-sectional study done in the paediatrics ward of Manipal Teaching Hospital Pokhara, conducted for six months. Patients aged range from 1 day to 14 years who meet the inclusion criteria were taken in this study. Data were collected from the inpatient ward and analysed using various statistical tools.
 Results: Among 170 patients, a maximum(43.3%) were in the age group of 1 day to 11 months with male predominance(74.1%). Bronchopneumonia was the most common respiratory tract infection (51.8%) followed by bronchiolitis (13%). Chest x-ray was done in all patients however blood culture was done only in 60.6% and an antibiotic sensitivity test (27.6%) before prescribing antibiotics. Cefotaxime was prescribed in maximum patients (62.4%) followed by ceftriaxone (17.1%). All the patients received at least one antibiotic by i.v route during the hospital stay.
 Conclusion: Since culture and sensitivity tests were not carried out on most of the patients before prescribing antibiotics in this study, which might lead to an increased chance of bacterial resistance and treatment failure in the future.

Subinhibitory Concentrations of Antibiotics Exacerbate Staphylococcal Infection by Inducing Bacterial Virulence.

ABSTRACTAntibiotics are widely used for the treatment of bacterial infections. However, injudicious use of antibiotics based on an empirical method may lead to the emergence of resistant strains. Despite appropriate administration of antibiotics, their concentrations may remain subinhibitory in the body, due to individual variations in tissue distribution and metabolism rates. This may promote bacterial virulence and complicate the treatment strategies. To investigate whether the administration of certain classes of antibiotics will induce bacterial virulence and worsen the infection under in vivo conditions. Different classes of antibiotics were tested in vitro for their ability to induce virulence in a methicillin-resistant S. aureus strain Mu3 and clinical isolates. Antibiotic-induced pathogenicity was assessed in vivo using mouse peritonitis and bacteremia models. In vitro, β-lactam antibiotics and tetracyclines induced the expression of multiple surface-associated virulence factors as well as the secretion of toxins. In peritonitis and bacteremia models, mice infected with MRSA and treated with ampicillin, ceftazidime, or tetracycline showed enhanced bacterial pathogenicity. The release of induced virulence factors in vivo was confirmed in a histological examination. Subinhibitory concentrations of antibiotics belonging to β-lactam and tetracycline aggravated infection by inducing staphylococcal virulence in vivo. Thus, when antibiotics are required, it is preferable to employ combination therapy and to initiate the appropriate treatment plan, following diagnosis. Our findings emphasize the risks associated with antibiotic-based therapy and underline the need for alternative therapeutic options.IMPORTANCE Antibiotics are widely applied to treat infectious diseases. Empirically treatment with incorrect antibiotics, or even correct antibiotics always falls into subinhibitory concentrations, due to dosing, distribution, or secretion. In this study, we have systematically evaluated in vitro virulence induction effect of antibiotics and in vivo exacerbated infection. The major highlight of this work is to prove the β-lactam and tetracyclines antibiotics exacerbated disease is due to their induction effect on staphylococcal virulence. This phenomenon is common and suggests that if β-lactam antibiotics remain the first line of defense during empirical therapy, we either need to increase patient reliability or the treatment approach may improve in the future when paired with anti-virulence drugs.

Resurgence of mucormycosis during COVID-19 pandemic

ObjectiveTo explore the literature on corona-associated mucormycosis and explain its relevance to dentists and oral surgeons. MethodsA literature search was carried out to identify reported cases on corona-associated mucormycosis since the start of COVID-19 pandemic. ResultsA review of literature identified 265 published papers on CAM between March 2020 and September 2021. Careful screening of abstracts and full texts revealed 29 studies reporting case series of CAM and, 27 case reports on CAM. ConclusionsA multitude of factors may be responsible for the alarming rise in the incidence of corona-associated mycosis including reduced access to routine medical services during the pandemic, injudicious use of antibiotics, steroids and nutritional supplements. Risk factors contributing to corona-associated mucormycosis need to be recognized. Dentists and oral surgeons can contribute to early recognition of corona-associated mucormycosis involving the maxilla, and palate. Prioritizing research focus on optimal management of mucormycosis may reduce the morbidity and mortality associated with this debilitating infection.