Irrational Use Of Antibiotics Research Articles

Topical issues of antibiotic resistance: modern methods of identification of bacterial pathogens and determination of their qualities

One of the most urgent problems in medicine today is the problem of antibiotic resistance. Why this problem? After all, scientists around the world proclaimed victory over microorganisms in the 50-60s of the last century? And since the 70s already began to appear information about resistant strains. Everything turned out to be not so simple. Due to uncontrolled and irrational use of antibiotics, mankind is rapidly approaching the so-called "post-antibiotic era". How to stop this "approach"? It is necessary to clearly follow the principles of rational antibiotic therapy.
 Rational antibiotic therapy requires identifying the bacterial nature of the disease, determining the sensitivity of the microorganisms to the antibiotic and starting treatment as soon as possible. To comply with these principles, rapid and accurate methods of identification of microorganisms are necessary, because it is on the basis of these methods that the most effective antimicrobial agent is selected.
 There are standard methods of identification, which include the disk-diffusion method and the serial dilution method. The main disadvantage of these methods is the length of time it takes to obtain results.
 So what are the alternative methods available? There are many methods of microbial identification, but not all of them are suitable for widespread use due to the high cost, the need for expensive equipment.
 Of all the current methods, three methods are emphasized in this review: 16S rRNA gene sequencing, MALDI-TOF MS and EUCAST RAST. Sequencing of the 16S rRNA gene is based on decoding the region of the gene, which in bacteria carries information on resistance mechanisms and structure features. MALDI-TOF MS is a desorption method of "soft" ionization caused by exposure of the matrix with the analyzed substance to pulses of laser radiation. The EUCAST RAST method is an accelerated disk-diffusion method.
 This review describes the problem of antibiotic resistance, mechanisms of bacterial resistance, as well as modern and standard methods of bacterial identification and antibiotic sensitivity.
 The aim of this review was to compare routine methods of identification of species and qualitative properties of microorganisms, causative agents of nosocomial infections, with modern technologies of microbiological testing as an important step in solving the problem of priority selection of effective antimicrobial agents.
 So, the main question of this review is: can modern methods displace standard methods of microorganism identification?

Pattern and predictors of antibiotic prescriptions by physicians to paediatric outpatients in a Nigerian Tertiary Care Hospital: A call for antibiotic stewardship

Background: Irrational antibiotic use for childhood illnesses is prevalent, especially in developing countries. There is a need to provide evidence-based data for the implementation of antimicrobial stewardship programmes (ASP) in healthcare facilities. This study was conducted to describe the pattern and predictors of antibiotic prescriptions to paediatric patients at the outpatient clinic of Federal Medical Centre Umuahia Abia State, Southeast Nigeria.Method: We conducted a retrospective review of patients’ encounters in one year at the outpatient paediatric clinics (2022). An electronic data extraction form was used to collect information from patient’s case notes. Descriptive, bivariate and multivariate analyses were done using SPSS version 26. The level of significance was set at 5%.Results: Records of 722 encounters were retrieved. A total of 694 antibiotics were prescribed. The antibiotic prescription rate was 74.4% (95% CI: 71.2–77.6). The most frequently prescribed antibiotic was amoxicillin/clavulanic acid (34.9%). Most prescribed antibiotics (53.6%) were in the ‘access’ group of antibiotics. The commonest indication for the use of antibiotics was the treatment of respiratory infections (28.1%). The predictors of antibiotic prescription included younger age (aOR = 2.48; 95% CI: 1.50–3.80), four or more drugs prescribed (aOR = 9.43; 95% CI: 3.90 - 22.10), and therapeutic treatment type (aOR = 3.24; 95% CI: 1.10–9.40).Conclusion: Irrational prescriptions of antibiotics by physicians were prevalent in the paediatric outpatient clinic of the facility. We recommend the implementation of the ASP in the hospital to address irrational antibiotic prescriptions in line with rational drug policy.

Perceptions of antibiotic stewardship programmes and determinants of antibiotic prescribing patterns among physicians in tertiary hospitals in Bangladesh: implications for future policy and practice

The concerning growth of antimicrobial resistance (AMR) renders common infections life-threatening due to irrational antibiotic use and a lack of effective antimicrobial stewardship programmes (ASPs). To investigate the awareness, perceptions and practices of physicians regarding ASPs, AMR and antibiotic prescribing in tertiary care hospitals in Bangladesh. This hospital-based cross-sectional survey was conducted in 11 tertiary care hospitals across Bangladesh between September 2020 and January 2021. A semi-structured questionnaire was administered through face-to-face interviews for data collection. Descriptive and multi-variate analyses were performed using STATA Version 13. In total, 559 physicians were enrolled in this survey. Overall, 40.6% [95% confidence interval (CI) 36.5-44.8] of physicians reported being aware of ASPs, and this figure was higher in public hospitals compared with private hospitals (43.8% vs 27.1%). None of the study hospitals had any ASP initiatives. More than half (55.1%) of the participants were willing to receive feedback from an ASP on their antibiotic selection. Only 30.9% of respondents stated that they wait for the findings of microbiological tests before prescribing antibiotics, although challenges included empiric use of broad-spectrum antibiotics, delayed laboratory results and the existence of drug-resistant patients. In contrast, physicians aware of ASPs were 33% (adjusted odds ratio 0.67, 95% CI 0.45-0.98; P=0.033) less likely to wait for laboratory results before prescribing antibiotics. However, 42.5% of physicians considered patient affordability of purchasing antibiotics when prescribing. Physicians' fundamental knowledge of ASPs and rational antibiotic prescription were found to fall short of the standard. Context-specific and integrated ASP activities, availability and use of guidelines, and improved laboratory facilities are required to battle AMR in Bangladesh.

Barriers and Facilitators in Pricing and Funding Policies of European Countries That Impact the Use of Point-of-Care Diagnostics for Acute Respiratory Tract Infections in Outpatient Practices

Antimicrobial resistance is a major global health threat, which is increased by the irrational use of antibiotics, for example, in the treatment of respiratory tract infections in community care. By using rapid point-of-care diagnostics, overuse can be avoided. However, the diagnostic tests are rarely used in most European countries. We mapped potential barriers and facilitators in health technology assessment (HTA), pricing, and funding policies related to the use of rapid diagnostics in patients with community-acquired acute respiratory tract infections. Expert interviews were conducted with representatives of public authorities from five European case study countries: Austria, Estonia, France, Poland, and Sweden. Barriers to the HTA process include the lack of evidence and limited transferability of methods established for medicines to diagnostics. There was no price regulation for the studied diagnostics in the case study countries, but prices were usually indirectly determined via procurement. The lack of price regulation and weak purchasing power due to regional procurement processes were mentioned as pricing-related barriers. Regarding funding, coverage (reimbursement) of the diagnostic tests and the optimized remuneration of physicians in their use were mentioned as facilitators. There is potential to strengthen peri-launch policies, as optimized policies may promote the uptake of POCT.

Determining the Prevalence of Nosocomial Infections in Lordegan Shohada Hospital, 21 March 2017 to 19 March 2020

Background and Objectives: Currently, Nosocomial Infections (NIs) or Health Care Worker Infections (HCWIs) have become one of the important health issues in many countries of the world, including Iran. This study was conducted to determine Prevalence of NIs in Shahada Lordegan Hospital from March 21, 2017 to March 19, 2020. Methods: In this cross-sectional descriptive study, the files of 45,830 patients who were at risk of NIs (cases that were hospitalized for at least 48 hours) were examined and cases of NIs were diagnosed based on references (definitions of the US Center for Communicable Disease Control and the surveillance system NIs of this type of infections) and the case finding form of NIs and then registered in the hospital infection care system. All stages of data analysis were performed in the hospital infection care system software version 2-2-4. Results: The overall incidence of NIs was equal to 0.6%, the incidence in men was 54.9% and in women 45.1%. The most common type of NIs in this center was surgical site infection (SSI) (0.2%), non-ventilation- associated pneumonia (0.17%) and ventilation-Associated (VAE) event (0.16%), and there are the highest rate of infections a hospital in intensive care. Conclusions NIs are a major problem for patients hospitalized in the ICU in In this center. Furthermore, according to this review and other studies conducted in Iran, It seems that the rate or NIs in is much fewer than Global rate of NIs, and the probably irrational use of antibiotics and as a result hinding these types of infections as well as underreporting are important factors of this problem.

OVERVIEW OF ANTIBIOTIC USE USING ATC/DDD METHOD IN KUALA LEMPUING HEALTH CENTER, BENGKULU CITY, 2020-2021

The high use of antibiotics in every region of Indonesia causes a high possibility of irrational use of antibiotics. this study is to find out how the use of antibiotics using the ATC/DDD method is described at the Kuala Lempuing Health Center, Bengkulu City in 2020 and 2021. The type of research is descriptive in nature with a purposive sampling technique using the ATC/DDD method on outpatient prescriptions containing antibiotics. The results of this study showed The most widely used antibiotic is amoxicillin. The total value of DDD/1000 KPRJ at the Kuala Lempuing Health Center the total DDD/1000 KPRJ value during 2020 was 3873.4 and in 2021 it increased to 4591.3. This study concludes Amoxicillin is the most widely used antibiotic. The highest total value of DDD/1000 KPRJ at the Kuala Lempuing Health Center occurred in 2021.

Overuse of Antibiotics: Who is to Blame? A Qualitative Study.

The irrational use of antibiotics seriously threatens global health. Clinicians undoubtedly play an essential role in consuming antibiotics in hospitals and communities, and their attitudes may help the health system's optimal treatment of antibiotics. In this study, we reported clinicians' experiences with antibiotics used in Isfahan, Iran. In a qualitative study conducted from October 2020 to March 2021, the experiences of 13 clinicians with different clinical specialties were collected through one-to-one interviews. Participants were selected through purposive sampling until data saturation; data collection was conducted through semi-structured interviews. Conventional content analysis was used to analyze the transcribed interviews. The main category was recognized and subcategorized and coded by three researchers. Eight women and five men with a mean work experience of 12.54 ± 10.047 years participated in the study. All of them worried about the overuse of antibiotics and antibiotic resistance. Clinicians believe that the antimicrobial stewardship committee is not active in our country. Laboratory challenges, healthcare providers, the poor performance of the health system, and marketing and business were the main categories of the study. Subcategrories of main categories included inefficiency in the function of laboratories, harmful profit, challenges in medical education, ups and downs of disease treatment, the unacceptable performance of hospitals, failure to upgrade the health system, threats and opportunities, and jobbery. The participants of this study believed that excessive use of antibiotics is a serious challenge in our country. Physicians were concerned about antibiotic resistance and believed that the pattern of antibiotic resistance was not routinely reported. Therefore, in our region, we should make more efforts to collect data in this field and provide this information to physicians. Also, this study confirmed many obstacles to implementing the antimicrobial stewardship program, and the infrastructure needs strengthening. There is also a need for cultural changes and the views of physicians.

Beyond the regulatory radar: knowledge and practices of rural medical practitioners in Bangladesh

BackgroundInformal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service.MethodsWe conducted a cross-sectional study in 2015–16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline.ResultsWe invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together.ConclusionsInappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.

Akılcı Antibiyotik Kullanımına Yönelik Eğitim programının Sağlık tekniker Adaylarına Etkisi

Aim: The aim of this study is to measure the effect of the education program concerning rational antibiotic use on the knowledge-attitude levels of health technician students towards rational antibiotic use.
 Method: This intervention study has been conducted with vocational school students (control group: 437, intervention group: 403) enrolled in the same health services program at two universities in Ankara. The dependent variable of the study was the Knowledge-Attitude Scale towards Rational Antibiotic Use and the independent variables were the control and intervention groups. The educational program applied in this study included the definitions of and distinction between infections, the flu and a cold, the effect mechanism and types of antibiotics, the consequences of irrational antibiotic use, antibiotic resistance and rational and irrational use of antibiotics.
 Result: Both the knowledge and attitude mean scores of the intervention group on the final test were found to be statistically significant and higher than the mean scores of the pre-test. When the final test and retention test score averages of the intervention group were examined, it was found that there was no statistically significant difference between the mean knowledge score and mean attitude score on the final tests and retention tests 
 Conclusion: This study is the first educational intervention study in Turkey concerning the rational use of antibiotics by health technician candidates. As a result of this study, a significant increase was observed in knowledge-attitude levels on rational antibiotic use after the intervention training concerning rational antibiotic use and in terms of retention.

Results of a pilot project of microbial therapy management at the children’s hospital

Introduction. In multidisciplinary pediatric hospitals in Russia, the prerequisite for the formation of principles of antimicrobial therapy management as a medical technology, implemented with the participation of a clinical pharmacologist became possible on the basis of updated clinical and pharmacological tools proposed by the World Health Organization (WHO) in 2019. 
 Purpose. The project goal is to show the possibilities of control of antimicrobial therapy, as a medical technology in multidisciplinary children’s hospitals to improve adherence to domestic clinical recommendations in the actual clinical practice of implementing antibiotic therapy management programs in children on the profile of «Pediatrics». 
 Material and methods. The pilot scheme was implemented from 2019 to 2021 on the basis of the Morozov Children’s Clinical Hospital by methods of WHO AWaRe and points estimation of prevalence of antibiotic use according to WHO tool checklist in dynamics. Regulatory documents of medical organization (MO) were formed, which ensured transition from traditional to new approaches within 3 years from 2019 to 2021 to maintain clinical practice of antibiotic use based on clinical guidelines. 
 Results. A comparative study of clinical antibiotic use in children “before” the project in 2019 and “after” in 2021 showed a 2.7-fold decrease in antibiotic use by absolute DDDs from 65.99 in 2019 to 24.34 in 2021. DDDs per 100 p/d. By WHO AWaRe method for absolute values of antibiotics in the “Tolerance” category, a 2-fold decrease in consumption and a 5-fold decrease in consumption for absolute values of antibiotics in the “Control” category: in 2019. — 41.13% (abs. 27.55 PDT per 100 p/d) and in 2021. — 60.1% (abs. 4.64 PDT per 100 p/d). Consumption of “Reserve” category antibiotics by absolute values has not changed.
 Limitations. This publication describes one medical institution in which this project was implemented, which somewhat reduces the value of the results obtained.
 Conclusion. As a result of the implementation of the principles of managing antimicrobial therapy, this pilot project was able to reduce the irrational use of antibiotics in the pediatric hospital.

Impact of Irrational Use of Antibiotics Among Patients in the Intensive Care Unit on Clinical Outcomes in Sudan.

Intensive Care Unit (ICU) is a specialized ward where critically ill patients are admitted to provide intensive health care Inappropriate antimicrobial therapy (AMT) and high mortality rates were documented in the ICU. The influence of irrational use of empiric antibiotics on clinical outcomes in ICU patients is not well studied in Sudan. This study aims to determine the rational use of antibiotics and its impact on clinical outcomes among ICU patients. Using data collection form, a retrospective longitudinal study was conducted among ICU patients at Omdurman Military Hospital, Khartoum State. Patients admitted from January 2019 to December 2019 were included in the study. Patients who stayed in ICU < 48 hr were excluded. Appropriateness of AMT is assessed using culture sensitivity test (CST) and the American Society of Infectious Diseases (IDSA) guideline. Among 102 patients, 54.9% male, one-third of patients developed nosocomial infections, 80.4% received empiric therapy with broad-spectrum antibiotics. The CST is done in 19%, and 43% patients are prescribed inappropriate AMT. Inappropriate AMT is associated with recurrent infections 38.4% (p=0.028) and high mortality 33.8% (p=0.014). Overall mortality rate 63.7% ICU patients. Elevated mortality in nosocomial 57.8%, decreased with inappropriate AMT in 21.6% patients. Significantly higher mortality rates 90.7% among uncontrolled infections (p<0.001), 80.6% nosocomial infections (p=0.001), and 76.7% renal compromised (p=0.002). Empirical AMT reduces the frequency of nosocomial infections, which has an impact on mortality. Inappropriate AMT is significantly associated with uncontrolled infections and lower mortality. Implementing a restrictive infectious control system and effective stewardship programs in hospital ICU wards is recommended.

Analysis of Adverse Drug Reactions (ADRs) Using Antibiotic for Community Acquired Penumonia (CAP) Disease of Toddler

Pneumonia is an infection that causes inflammation of the lung tissue so that the lung sacs are filled with infectious agents and are the main cause of infant mortality in the world. The initial therapy for pneumonia is the use of antibiotics. Irrational use of antibiotics can lead to ADRs. Adverse Drug Reactions (ADRs) often cause obstacles in the implementation of treatment. The purpose of this study was to see how ADRs influence the use of antibiotics on the clinical outcomes of pneumonia patients. The method analytic observational study using a cross-sectional design which is carried out prospectively, by collecting data on inpatients. Data were obtained from interviews with patients and/or patient families using the Naranjo questionnaire, as well as searches of patient medical records during the period January - March 2023. Analysis of ADRs on the use of antibiotics on outcomes was analyzed by the Likelihood ratio. This study was dominated by patients aged &lt;2 years (61.5%) with improved outcomes (97.15%). The results obtained showed that there was no significant relationship between ADRs using antibiotics and patient outcomes with a p&gt;0.05 (p=0.798). The conclusion of this study is that there is no effect of ADRs using antibiotics on patient outcomes.

POTENSI KOMPOSIT OKSIDA LOGAM-KITOSAN SEBAGAI AGEN ANTIDIARE

Diarrhea is a defecation disorder characterized by defecating more than three times a day with a liquid stool consistencBABy, which may be accompanied by blood and/or mucus. Infection is still the main cause of diarrhea. The large number of cases of diarrhea due to infection means that antibiotics are still widely used in treating diarrhea. Irrational use of antibiotics can result in the emergence of side effects and resistance. To prevent this, diarrhea treatment can use materials that are able to absorb toxins and bacteria in the digestive tract, and are safe for the human body. Chitosan is an environmentally friendly material that has a large network of pores. Some metal oxides have been found to have good chemical affinity. The metal oxide-chitosan composite in nano size is predicted to allow the absorption of toxins and bacteria, but is easily released again by the body. In this research, metal oxide (Fe)-chitosan composite material was synthesized using 2 methods designed to have an antidiarrheal effect. The antidiarrheal effect is observed by its ability to absorb liquids containing natural ingredients. The results of this research showed that the composite material synthesized using a liquid reaction (13,861 ppm to 11,082 ppm) produced a stronger adsorption capacity compared to the composite material synthesized using a solid reaction (13,861 ppm to 11,265 ppm).

Extended-Spectrum β-Lactamases (ESBL): Challenges and Opportunities.

The rise of antimicrobial resistance, particularly from extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E), poses a significant global health challenge as it frequently causes the failure of empirical antibiotic therapy, leading to morbidity and mortality. The E. coli- and K. pneumoniae-derived CTX-M genotype is one of the major types of ESBL. Mobile genetic elements (MGEs) are involved in spreading ESBL genes among the bacterial population. Due to the rapidly evolving nature of ESBL-E, there is a lack of specific standard examination methods. Carbapenem has been considered the drug of first choice against ESBL-E. However, carbapenem-sparing strategies and alternative treatment options are needed due to the emergence of carbapenem resistance. In South Asian countries, the irrational use of antibiotics might have played a significant role in aggravating the problem of ESBL-induced AMR. Superbugs showing resistance to last-resort antibiotics carbapenem and colistin have been reported in South Asian regions, indicating a future bleak picture if no urgent action is taken. To counteract the crisis, we need rapid diagnostic tools along with efficient treatment options. Detailed studies on ESBL and the implementation of the One Health approach including systematic surveillance across the public and animal health sectors are strongly recommended. This review provides an overview of the background, associated risk factors, transmission, and therapy of ESBL with a focus on the current situation and future threat in the developing countries of the South Asian region and beyond.

Prescription pattern of antibiotics in various clinical departments of a tertiary care health institution: a retrospective observational study

Background: Antimicrobial resistance has been considered as one of the greatest challenges to the general public health today. The Antibiotic Stewardship Program has emphasized on prevention of drug resistant bacterial infection, targeted therapy against susceptible or resistant microorganism and to curtail unnecessary and irrational use of antibiotics. Present study aimed to evaluate the pattern of antibiotic prescription amongst the hospitalized patients of IGMC Shimla in Himachal Pradesh. Methods: It was a retrospective observational study. Data was collected from hospital records of admitted patients in medicine and Surgical wards. Patient data like demographic profile, average hospital stay and number of antibiotics prescribed were extracted from their hospital records. Also, the data about oral/parenteral, generic/branded empirical/definitive and therapeutic/prophylaxis prescription in each patient were collected. Results: In medicine ward, the number of generic prescriptions 78 (71.5%) were more as compared to branded 31 (28.5%) and majority were given the parenteral 61 (55.9%) than the oral 48 (44.1%) dosage form. In surgery ward, the branded prescriptions 61 (91%) out-numbered the generic prescription 6 (9%). The route of administration was mostly oral; 56 (83.5%), while only few had parenteral prescription; 11 (16.5%) in this ward. Conclusions: It was found that majority of patients in medicine ward received generic named antibiotics for definitive management, while in surgical ward branded named antibiotics were prescribed for surgical prophylaxis. The cephalosporin was the most commonly prescribed antibiotic group. Majority of antibiotics belonged to “watch” category as far as WHO’s AWaRe classification is concerned.

Pseudomembranous colitis complicated by toxic megacolon in oncological patients

In recent years, information on the increase in the incidence of infection associated with Clostridioides difficile (CDI) has appeared in the literature. It is known that C. difficile which causes pseudomembranous colitis (PMC) most often affects debilitated patients who receive treatment for the main pathology for a long time. That is why PMC is most common in cancer patients receiving long-term and aggressive anticancer treatment, which is often accompanied by the use of several courses of antibiotics. The result of the irrational use of antibiotics, incorrect PMC therapy may be the formation of toxic megacolon, intestinal perforation, sepsis, which in turn is fraught with a fatal outcome. It is this state of affairs that aroused our interest in the study of this topic. The steady increase in the incidence of Clostridioides difficile infection makes it particularly relevant to study CDI problem in relation to cancer patients, since they most often have a wide range of risk factors for developing clostridial infection. The article presents an overview of domestic and foreign sources describing this pathology, discusses epidemiology, pathogenesis, clinical picture and current understanding of the CDI treatment. At the end of the review, we present a case of successful treatment of pseudomembranous colitis after stoma closure, which was complicated by the development of toxic megacolon. Colproctectomy was performed as part of the complex treatment of this pathology. The patient received respiratory, renal replacement, hepatoprotective, antibiotic and antifungal therapy and other treatments.

Antibiotic Resistance Profiling and Phylogenicity of Uropathogenic Bacteria Isolated from Patients with Urinary Tract Infections.

Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.

Presence of Multidrug Resistance (MDR) Escherichia coli in the Citarum River located in Greater Bandung Area, Indonesia

Background: One of the main problems of the Citarum River is the contamination of E. coli due to livestock activities, washing toilets, and industry. In addition, irrational use of antibiotics in the community and livestock can increase E. coli resistant strains to antibiotics. This study aimed to identify the presence of multidrug resistance (MDR) and extended-spectrum β-lactamase (ESBL) E. coli strains in Citarum river clusters, namely industrial, livestock, and residential clusters.Methods: This was a descriptive study. A sample of 100 mL surface water from each Citarum cluster. Culture, antibiotic sensitivity test, and PCR to identify blaCTX-M-15 gene carriers of ESBL E. coli were carried out in the sample.Results: There were 37 isolates of E. coli, with 24% of these isolates showing MDR properties, which can be found in industrial, livestock, and residential clusters at 13%, 8%, and 3% respectively. The most E. coli-resistant antibiotics found in these samples were ampicillin (45%), followed by tetracycline (37%), and azithromycin (29%). The PCR examination did not find the blaCTX-M-15 gene carrying ESBL properties in all three Citarum river clusters.Conclusion: The presence of E. coli isolates in each Citarum river cluster suggests the occurrence of river pollution due to animal, human or industrial waste. Therefore, it is necessary to make better government regulations regarding sanitation and education for the surrounding community regarding the importance of keeping the river clean.

Assessment of Awareness and Approach Regarding Antibiotic Prescription and Resistance among Different Level of Dental Students in a Tertiary Care Dental College, Karachi

OBJECTIVE: To evaluate the awareness and approach of dental students regarding antibiotic prescription and its resistance due to irrational use of antibiotics. Antibiotic resistance is spreading alarmingly throughout the world, including developed countries. The common causes of antibiotic resistance include over prescription, incomplete treatment and inappropriate self medication.Among different causes of antimicrobial resistance, irrational use of antibiotic is the most prominent one. METHODOLOGY: After approved by the Institutional Ethics Committee of Ziauddin University this cross-sectional study was conducted from 1st April, 2020 to 30th July,2020 at Ziauddin University. Third and final year dental students as well as house officers were enrolled and the computed sample size was 133 to which 5% non-response rate was added, therefore total 139 dental students were approached. Non-probability convenience sampling technique was used. A self- designed, self administered questionnaire was prepared to collect the demographic data and information regarding the prescription pattern of antibiotics amongst study subjects. All questions in the questionnaire were close ended. The questionnaire comprised information pertaining to demographic characteristics, standard guideline for antibiotic prescriptions, antibiotic stewardship and resistance, improper prescription and its consequences. The dental students were briefed about the purpose of the study and the significance of participation and a written informed consent was obtained from them. The awareness of dental students regarding antibiotics was the outcome factor. The data was analyzed by using SPSS version 22. RESULTS: Out of total 139 dental students majority (79.1%)were familiar to standard antibiotic prescription guidelines .(87.8%) responded amoxicillin is beta lactam, for probability of antibiotic abuse and antibiotics aid in recovery of infections majority showed awareness (92.1% and 84.9% respectively). Almost equal students inquire recent antibiotic course prior to prescription (90.6%) as well as take extra caution prescribing antibiotic in immune compromised patients (89.9%). CONCLUSION: This study concluded that majority of the dental students had good awareness regarding antibiotics and factors related to it, as participants responded positively to the 70% of awareness - based questions. KEYWORDS: Awareness. Antibiotics, Resistance, Prescription, Dental Students

Point prevalence probing of antimicrobial prescription patterns from a developing country

ABSTRACT Background Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. Research Design and Methods This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. Results In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. Conclusion Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.