Irrational Use Of Antimicrobials Research Articles

Knowledge, attitudes, and practices on antimicrobial use and antimicrobial resistance among poultry practitioner veterinarians.

Antimicrobial resistance (AMR) poses a serious global threat to human and animal health. In the context of antimicrobial usage (AMU) in livestock production, veterinarians are key stakeholders. However, there is a lack of comprehensive situational analysis regarding the current Knowledge, Attitudes, and Practices (KAP) among veterinarians concerning AMU and AMR in poultry production in Nepal. The primary objective of this study was to evaluate the situation of AMU and KAP regarding AMU and AMR of among poultry practitioner veterinarians in Nepal. A total of 327 respondents from 56 districts across seven provinces participated. Demographic information and AMU situation were collected and analyzed using descriptive statistics, and factors affecting KAP on AMU and AMR were performed using logistic regression analysis. Nearly half of veterinarians (49.2%) were from Bagmati, followed by Lumbini (16.5%) and Gandaki (8.9%) provinces. Most of the respondents (85.0%) identified themselves as male with a mean age of 31.9 ± 7.8 years, with a range of 24-74 years. A large proportion of veterinarians held a master's degree (43.8%). Regarding reasons for AMR, 51.1% of them attributed it to the irrational use of antimicrobials. Other identified reasons for AMR, including over-the-counter sales (27.8%), low-dose administration (12.3%), and low-quality antimicrobials (6.7%). Based on antibiotic prescription rates, most veterinarians (50.8%) prescribed antimicrobials at a rate of 20-40%, while 25.9% prescribed at a rate of less than 20.0 and 18.9% at a rate of 40-60%. Approximately 89.0% of veterinarians agreed that vaccination could reduce the use of antimicrobials in poultry, and 75.6% preferred narrow-spectrum antimicrobials than broad-spectrum antimicrobials. A combination of broad-spectrum antimicrobials such as colistin with amoxicillin, gentamicin, tylosin, and tetracycline was commonly used in poultry production. In logistic regression analysis, it was observed that veterinarians aged 45-60 years demonstrated significantly higher levels of knowledge concerning AMU and AMR (p = 0.02) compared to those in the 24-30 age group. This study indicates that the need for robust regulatory mechanisms in veterinary drug administration and increased awareness among veterinarians to address the AMR issue livestock production.

Antimicrobial Use and Adverse Drug Reaction in Newborns with Neonatal Sepsis: A Prospective Observational Study from a Tertiary Care Teaching Hospital

Introduction: Neonatal Sepsis (NS) is a major cause of morbidity and mortality worldwide, especially in developing countries like India. The role of antimicrobials is life-saving in NS. To achieve a good prognosis, early diagnosis and appropriate treatment are required. Data related to the irrational use of antimicrobials in neonates are limited. Aim: To evaluate the drug usage pattern and Adverse Drug Reactions (ADRs) of antimicrobials in NS. Materials and Methods: A prospective observational study was conducted among 350 neonates who were admitted and diagnosed with NS from January to December 2021 in the Neonatal Intensive Care Unit (NICU) of PDU Medical College and Civil Hospital, Rajkot, Gujarat, India. Demographic data such as age, sex, birth weight, and clinical data such as type of delivery, type of sepsis, culture-sensitivity status, and antimicrobials used were recorded. Suspected ADRs were reported in the pharmacovigilance database. Categorical data were analysed in percentage, whereas some clinical data were analysed with mean and median using Microsoft Office Excel-2019. Results: In the present study, 172 (49.15%) male and 178 (50.85%) female neonates were almost equally affected. The mean gestational age and birth weight were 35 ± 3.6 weeks and 2 ± 0.7 kg, respectively. Early-Onset Neonatal Sepsis (EONS) cases were more at 273 (78%) compared to Late-Onset Neonatal Sepsis (LONS). Seventeen different antimicrobials were used. The average number of antimicrobials used per case was 2.9. The Piperacillin Tazobactam was the most commonly used antimicrobial in 173 cases (49.43%) in early-onset sepsis, while Meropenem was used in 40 cases (11.43%) in late-onset sepsis. Coagulase-negative Staphylococcus was the most commonly isolated organism in 15 cases (4.2%), followed by Klebsiella Pneumoniae in 13 cases (3.7%). Twelve out of 17 antimicrobials (70.59%) were not included in the first list of essential medicines for children of India in 2011. Six ADRs were reported in the present study. Conclusion: In all admitted cases of sepsis, empirical therapy was given, but variations from standard recommendations were observed in dose and frequency. A periodic survey of antimicrobial use patterns in NS will be useful in the rational selection of empirical therapy.

Microbial Profile and Antibiotic Sensitivity Pattern in Urinary Tract Infections among Children Attending a Tertiary Care Center, Idukki District, Kerala: A Cross-sectional Study

Introduction: Over the recent decades, the importance of Urinary Tract Infections (UTI) has been increasingly recognised in children. The occurrence of UTI during childhood may lead to acute and/or chronic consequences, such as impaired renal function, renal scarring, and hypertension. Due to the irrational use of antimicrobials, multidrug resistant bacterial strains are frequent. Hence, there is an urgent need for continuous surveillance of the microbiological profile of UTI. Aim: To investigate the microbial profile and antibiotic sensitivity pattern from the urine of paediatric patients suspected to have UTI in Idukki district, Kerala and to explore its association with seasonal variations. Materials and Methods: This clinical cross-sectional study was conducted in Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Idukki, Kerala, India, from January 2019 to December 2021. The study involved 882 paediatric patients in the age group 0-15 years with symptoms and signs suggestive of UTI. Data regarding age, gender, season, laboratory and culture results, and antibiotic sensitivity pattern were considered as variables of interest. Analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. The statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The study involved 882 patients, of which 399 were males (45.2%) and 483 were females (54.8%) with a male-tofemale ratio of 0.8:1. The mean age of patients was four years, and a peak incidence was observed in children in the age group of 1-3 years, with 333 (37.8%) children. Microbial growth was observed in the urine of 325 (36.8%) patients. After excluding normal commensal perineal flora and insignificant bacteriuria, 233 samples had significant growth, with males accounting for 106 (45.5%) and females 127 (54.5%). The male-to-female ratio was 0.8 to 1. These samples mostly exhibited growth of aerobic bacteria (232, 99.6%) and Candida albicans (1, 0.4%). E. coli (106, 45.5%) was identified as the most predominant aetiological agent for paediatric UTI. Conclusion: The results of this study suggest that it would be advisable for paediatricians in Idukki district to refrain from using Ampicillin to treat cases suspected to have UTI. Preventive measures should be advised to all patients, with emphasis on urinary hygiene during the monsoon and winter seasons.

Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India.

Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.

Glimpse into the biosecurity, antimicrobial usage, and antimicrobial resistance of fecal <em>Escherichia coli</em> associated with commercial chicken layer farms in a poultry dense area in Sri Lanka

Industrial food animal production plays an essential role in the global food supply chain. In parallel with the growth of the Sri Lankan poultry sector, antimicrobial usage has also been increased with the aim of reducing disease incidents. The development of antimicrobial resistance due to the irrational use of antimicrobials is a global problem. Commensals like Escherichia coli (E. coli) can easily acquire and transfer resistance to pathogenic and zoonotic bacteria which cause treatment failures in both humans and animals. The present study was conducted in 50 poultry layer (commercial chicken layers) farms in Kurunegala district of Sri Lanka during the period from November 2016 to January 2017. A questionnaire-based survey was conducted to collect information mainly on the management, biosecurity, and antimicrobial usage of selected farms. Further, E. coli were isolated from the fecal samples collected from 26 farms among those 50 farms, and their antimicrobial-resistant profiles (AMR) were investigated. Results revealed that 98% of the farms had poor biosecurity management practices while using at least one antimicrobial drug (98%). The most commonly used antimicrobial drug was enrofloxacin (79.6%) followed by amoxicillin (61.2%), both sulfamethoxazole and trimethoprim (49%), tetracycline (26.5%), neomycin (22.4%), and tylosin (4.1%). AMR profile of fecal E. coli revealed that the highest resistance is for tetracycline(81.8%) followed by nalidixic acid (54.5%), trimethoprim-sulfamethoxazole (40.9%), ampicillin (45.5%) and ciprofloxacin (31.8%). Lower levels of resistance, 13.6%, 9.1%, and 4.5% were observed for streptomycin, ceftazidime, and imipenem respectively. All the isolates were susceptible to amikacin and gentamycin; while 68.18% of isolated E. coli were multidrug-resistant (MDR). AMR and MDR findings of this study highlight the need of implementing strategies to regulate the usage of antimicrobial drugs in poultry farms in Sri Lanka, to prevent and control the emergence of antimicrobial-resistant pathogens and diseases from a ‘one health’ perspective.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

Clinically significant and colonizing <em>Enterobacteria</em> isolates with extended spectrum beta-lactamase production and their significance in horse breeding

This review article is devoted to the problem of the emergence and spread of antibiotic-resistant enterobacteria producing beta-lactamase in horse breeding. Foal colibacillosis is an acute infectious disease of young animals, manifested by diarrhea, signs of severe intoxication and dehydration of the body, caused by pathogenic Escherichia coli. Foals get sick in the first 3-7 days after birth. Infection occurs alimentary, less often – aerogenic and intrauterine transmission. The source of infection are sick and recovered animals. The duration of the disease is 2-3 days with a mortality rate of up to 90%, which leads to multiple economic losses. Multiresistant Escherichia coli can accumulate in the intestines of healthy animals and be excreted with fecal matter into the environment, which leads to the spread of pathogenic microflora among livestock. In this case, the animals are latent or hidden carriers that do not show clinical signs of the disease. Clinically significant isolates are causative agents of infectious and inflammatory diseases. These microorganisms represent a potential hazard for the development of an infectious process, they exhibit virulent properties that lead to damage to the tissues of the host organism, which significantly limits the possibility of their eradication. Along with clinically significant isolates, there are colonizing isolates that do not cause infection at a specific site. It should be noted that under certain conditions, the colonizing isolate can cause an infectious process. Irrational use of antimicrobials is a key reason for the development of tolerance. Also, the untimely detection of enzyme inactivation of antibiotics by laboratory methods and the spread of resistance genes play an important role. Currently, disks and media with antibacterial drugs are widely used to detect multidrug resistance of microorganisms. Along with these methods, PCR diagnostics and sequencing are used to accurately determine antibiotic resistance genes. Due to the importance and relevance of this topic, many scientists are conducting research to detect and study the multiresistance of enterobacteria such as E. coli, and their spread among animals.

Functional molecular characterization and the assessment of the transmission route of multidrug-resistant Helicobacter pullorum isolates from free-range and broiler chickens

BackgroundSome of the life-threatening, food-borne, and zoonotic infections are transmitted through poultry birds. Inappropriate and irrational use of antimicrobials in the livestock industry has resulted in an increased incidence of multi-drug resistant bacteria of epidemic potentials. Materials and methodsThe adhesion and invasion properties of 11 free-range and broiler chicken derived Helicobacterpullorum isolates were evaluated. To examine the biofilm formation of H. pullorum isolates, crystal violet assay was performed. A quantitative assay of invasion-associated genes was carried out after infecting HepG2 cells with two different representative (broiler and free-range chicken) H. pullorum isolates, using RT-PCR assay. Furthermore, we investigated the prevalence of H. pullorum, Campylobacter jejuni and Salmonella spp. in chicken caeca and oviducts to determine the possibility of trans-ovarian transmission. ResultsAll H. pullorum isolates adhered to HepG2 cells significantly but a notable difference towards their invasion potential was observed between free-range and broiler chicken isolates wherein broiler isolates were found to be more invasive compared to free-range isolates. Furthermore, cdtB, flhA and flaB genes of H. pullorum were upregulated post infection of HepG2 cells, in broiler chicken isolates compared to free-range chicken isolates. Moreover, all isolates of H. pullorum were found to form biofilm on the liquid-air interface of the glass coverslips and sidewalls of the wells with similar propensities. Despite presence of H. pullorum and C. jejuni in high concentrations in the caecum, they were completely absent in oviduct samples, thus ruling out the possibility of vertical transmission of these bacterial species. In contrast, Salmonella spp. was found to be present in a significant proportion in the oviduct samples of egg-laying hens suggesting its vertical transmission. ConclusionsOur findings suggest that H. pullorum, an emerging multi-drug resistant (MDR) pathogen could be transmitted from poultry sources to humans. In addition to this, its strong functional similarity with C. jejuni provides a firm basis for H. pullorum to be an emerging food-associated, MDR pathogenic bacterium that could pose risk to public health.

The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections.

The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during the COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram-positive and -negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the intensive care unit (ICU). Additionally, bloodstream infections with requested infectious disease consultations were reported (n = 400), determining whether these were carried out via telephone contact or at the patient's bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization, and clinical outcome were analyzed. A total of 4569 strains of Gram-positive and -negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018-2019, a total of 246 infectious disease consultations were carried out, while during the period 2020-2022, the number was 154, with the percentage of telephone consultations 15% and 76%, respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic, and 28-day mortality was significantly reduced in cases with bedside consultations. The empowering of infectious disease surveillance programs and committees, rational use of antimicrobials agents, and bedside infectious disease consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains.

Preface

The Second International Conference of Advance Veterinary Science and Technologies for Sustainable Development (2nd ICAVESS) 17 -18 September 2022 [Virtual Conference] https://icavess.ugm.ac.idThe Second International Conference of Advance Veterinary Science and Technologies for Sustainable Development is an academic platform organised by Faculty of Veterinary Medicine, Universitas Gadjah Mada, Indonesia in collaboration with Asian Association of Veterinary Schools and World Organisation of Animal Health Regional Representation for Asia and the Pacific (WOAH-RRAP). Following the success of the first ICAVESS, The 2nd ICAVESS held virtually on September 17-18, 2022 with theme “Multidiscipline Collaboration for The Innovative and Productive Development in Veterinary Science”.With the development of the era, the challenges faced by researchers, academics, practitioners, community institutions, industry, and stakeholders are also becoming more complex. This is what then drives the urgency to implement integrated collaboration from various backgrounds in expertise. The United Nations in the agenda for sustainable development has set 17 goals, including good health and well-being, affordable and clean energy, responsible consumption and production, climate action, life below water, life on land, and partnerships for the goals. These goal points are further elaborated as the aspiration to achieve a healthy and prosperous life, conservation and sustainability as well as resource utilization in the waters and on land, biodiversity sustainability, and the need to fight the climate change and its impacts,Cases such as COVID-19, genetic mutation, dynamics of disease transmission, and zoonotic cases require various parties with different disciplines to handle them. As another example, the occurrence of emerging and re-emerging diseases is triggered by various factors. These factors include human population expansion, urbanization, globalization, climate change, poverty, social inequality, migration, trade and consumption of wildlife, livestock production industry, irrational use of antimicrobials, development of antimicrobial resistance in humans and live stocks, and the implementation of public health measures such as vaccination and sanitation. The scope of aspects of predisposing factors for emerging and re-emerging diseases illustrates the breadth and dynamics of the problems that must be resolved, and these may not be achievable by only involving a single contribution from certain parties. The dynamics and variety of challenges faced require productive development. Solving these matters requires a multidisciplinary teamwork. In addition, the 2nd ICAVESS is expected to include a multidisciplinary approach to improve quality, productivity, and opportunities for publications. Thus, the collaboration results not only end in this conference but can also benefit various parties.The committee successfully hosted the event as the plenary sessions, AAVS veterinary education session, AAVS-UGM-WOAH joint session and parallel presentation sessions in a virtual way due to COVID 19 pandemic. This conference presented insightful talks from 6 invited speakers from Finland, Indonesia, America, Thailand, Germany, Japan, inspiring innovation sharing from 3 presenters in AAVS Vet Education Session, and great session from speakers of AAVS-WOAH-UGM Sessions.List of Keynote Speakers, Invited Speakers, AAVS Vet Education Session, AAVS Vet Edu Day 2 (AAVS-WOAH-UGM Session), Committee are available in this Pdf.

Antimicrobial resistance in Democratic Republic of Congo: the way forward

Antimicrobial resistance in Democratic Republic of Congo: the way forward

Multidrug-resistant Salmonella spp. in fecal samples of pigs with suspected salmonellosis in Antioquia, Colombia, 2019-2021.

To determine the proportion of Salmonella enterica in fecal samples of live pigs with suspected salmonellosis analyzed at the diagnostic unit of the University of Antioquia, Colombia between 2019 and 2021, and examine the serotypes and antimicrobial resistance patterns. This was a laboratory-based cross-sectional study of routine data on fecal samples received from pig farms in all nine subregions of Antioquia state, Colombia. Salmonella spp. detection at the university is done using enrichment, selective culture, and polymerase chain reaction. Serotypes were identified using the Kauffmann-White scheme and isolates were tested for antimicrobial susceptibility using broth microdilution. Of 653 samples tested, 149 (23%) were positive for S. enterica. Nine serotypes were identified. The most common were Salmonella Typhimurium (56%) and its monophasic variant (35%). Resistance to ampicillin (70%) was most frequently observed, followed by ciprofloxacin (55%), and sulfamethoxazole-trimethoprim (52%). No isolates were resistant to amikacin and gentamicin. Multidrug resistance (resistance to ≥ 3 classes of antibiotics) was observed in 61 (44%) isolates. Multidrug resistance was highest in S. Typhimurium (57%) compared with the other serotypes. Serotype was associated with multidrug resistance (p = 0.01), but age of the pig and sub-region were not. The proportion of Salmonella spp. and the associated high levels of multidrug resistance are of concern and may indicate irrational use of antimicrobials and poor management practices in pig production systems in the region. Strengthened surveillance is needed to monitor and improve farm management practices and the use of antimicrobials in farms in Colombia.

Antimicrobial Prescription Pattern in ENT Outpatient Department in a Tertiary Care Teaching Hospital, Telangana, India

Introduction Otorhinolaryngological infections are very common in adults and in children also. These infections are caused by various microorganisms and to treat these infections, antimicrobial agents are used frequently. As irrational use of antimicrobials leads to the development of antibiotic resistance and it is a big threat to the society, the present study was planned to get awareness among the practitioners regarding the antimicrobial prescription pattern. Aim To study the prescription pattern of antimicrobial agents in outpatient department of otorhinolaryngology in a tertiary care teaching hospital. Materials and Methods An observational study was planned over a period of 8 months from July 2019 to February 2020 in ENT outpatient department (OPD) at Mamata General Hospital, Khammam in Telangana. In total, 562 prescriptions were collected. Patient's details, probable diagnosis, prescribed medication details such as generic name, dose, and dosage forms were taken. The collected data was analyzed and the conclusions were drawn using descriptive analysis. Results Total number of prescriptions were 562. The majority of the prescriptions belonged to the 21 to 40 years of age group. Males were included more than females (males 320 and females 242). Chronic suppurative otitis media (CSOM) (16.2%) was the commonest infection. Most commonly prescribed antimicrobial was amoxicillin and clavulanic acid combination (26.17%), followed by cefpodoxime with clavulanic acid (21.9%) and ciprofloxacin (19.06%). In 371 (66.01%) prescriptions, only one antimicrobial was prescribed, whereas in 36 (6.40%) prescriptions no antibiotic was given. The average number of drugs per prescription was 3.18 and the average number of antimicrobials per prescription was 1.25. Tablet form (52.9%) was the commonest dosage form and most of the drugs were prescribed by generic name (74.06%). Conclusion The present study though prescription pattern of antibiotics and adherence to the hospital formulary by the physicians in the hospital is encouraging, still there is a chance in reducing the number of drugs prescribed per patient. The findings of this study will be useful to prescribe antimicrobials rationally so that the patient and health care system on the whole will be benefited.

Microbiology of Active Mucosal Chronic Otitis Media and Shifting Trends in Etiology in Idukki, Kerala: A Prospective Observational Study.

Active mucosal Chronic Otitis Media (COM) is an important cause of preventable hearing loss particularly in the developing world and may have long term effects on early communication, language development, school performance and social interaction. This study aimed to isolate the bacterial flora in the middle ear of patients suffering from active mucosal COM in Idukki district of Kerala and also to study the antibiotic sensitivity pattern of these organisms to commonly used antimicrobial agents. This was a clinical prospective observational study conducted over a period of 3 years involving 137 patients of all age groups, who were clinically diagnosed with active mucosal COM. The inclusion criteria were patients presenting with a central tympanic membrane perforation and ear discharge (either unilateral or bilateral) of more than 3 months duration. Microbial growth was seen in 128 (94.1%) patients with aerobic bacteria (83.5%), anaerobic bacteria (6.25%) and fungi (7%), of which Pseudomonas aeruginosa (39.8%) and Staphylococcus aureus (31.2%) were the most predominant etiological agents for active mucosal COM. Pseudomonas aeruginosa showed highest susceptibility to Piperacillin-Tazobactam combination and highest resistance to Ampicillin, while Staphylococcus aureus showed highest susceptibility to Gentamicin and highest resistance to Ampicillin and Ceftriaxone. The increasing trends in the antibiotic resistance pattern in Staphylococcus aureus over the years poses a threat to Idukki district, Kerala. Due to the irrational use of antimicrobials, multi-drug resistant bacterial strains are frequent, and so, there is need for continuous surveillance of the local microbiological profile of active mucosal COM.

Prevalence of drug-resistant uropathogenic bacteria in canines in the city of Merida, Yucatan

Antibiotic treatment is key to the improvement of canine patients with urinary tract infections; however, the irrational use of antimicrobials has led to the emergence of resistance mechanisms in uropathogenic bacteria. The objective of the study was to identify the bacteria present in urine cultures from canines in the state of Yucatán, determine their sensitivity to antibiotics, the prevalence of resistance to methicillin (MR) and production of extended-spectrum beta-lactamase (ESBL). Identification and sensitivity to antibiotics were performed using the MicroScan commercial kit and the Kirby-Bauer technique. MR was determined by sensitivity to oxacillin/cefoxitin and ESBL production through synergy techniques with beta-lactamase inhibitors. The most frequently isolated bacteria was Proteus mirabilis and the antibiotic with the highest percentage of resistant strains was norfloxacin; 30.2% of the Enterobacterales strains manifested ESBL production and 39.4% of the Staphylococcus spp. showed MR. The development of drug resistance is an important problem, only the knowledge about the prevalence of these uropathogenic bacteria and their drug-resistant strains in our state will allow us to propose effective treatment protocols.

Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic.

Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.

Knowledge, attitude and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates in a tertiary care hospital

Background: Irrational use of antimicrobials and inaccurate practicing behavior leads to the issue of antibiotic resistance. This can be tackled by spreading awareness with the assistance of future medical practitioners. Hence, the present study was taken to determine the knowledge, attitude, and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates.Methods: The study was conducted on interns and postgraduates in a tertiary care hospital. A standardized questionnaire was distributed to 120 participants and Ethical approval was taken before the study. Data was analyzed using SPSS software. For data comparisons, Chi-square tests were used, p≤0.05 is considered significant.Results: The study showed a majority in the 25 to 34 years of age group with female predominance. The subject of antibiotic resistance was moderately relevant to a majority, which highlighted a need for an increase in awareness workshops. The actual knowledge of respondents seems to be accurate in the study, a fair amount of attitude and practicing behavior was observed as well. A significant difference between the interns and postgraduates in knowledge (χ2=13.736, p=0.03), attitude (χ2=68.091, p=0.01), and practice (χ2=34.821, p=0.01) were noticed.Conclusions: Accurate knowledge and practicing behavior were observed in postgraduates and a fair attitude was observed in interns towards antimicrobial use and resistance. The awareness must be extended regarding this issue by conducting educational programs and by updating guidelines. Advancement in antibiotic prescribing pattern is required.

Profiling of antimicrobial dispensing practices in accredited drug dispensing outlets in Tanzania: a mixed-method cross-sectional study focusing on pediatric patients

BackgroundThe emergency of antimicrobial resistance due to irrational antimicrobial use has put public health under threat. Accredited Drug Dispensing Outlets (ADDOs) play an important role in enhancing availability and accessibility of antimicrobials, however, there is a scarcity of studies assessing antimicrobial dispensing practices in these outlets, focusing on children in Tanzania.ObjectiveThis study was conducted to assess the antimicrobial dispensing practices among ADDO dispensers and explore the factors influencing the use of antimicrobials for children in Tanzania.MethodsA community-based cross-sectional study utilizing both qualitative (interviews) and quantitative (simulated clients) methods was conducted between June and September 2020 in seven zones and 14 regions in Tanzania.ResultsThe study found inappropriate dispensing and use of antimicrobials for children, influenced by multiple factors such as patient’s and dispenser’s knowledge and attitude, financial constraints, and product-related factors. Only 8% (62/773) of dispensers asked for prescriptions, while the majority (90%) were willing to dispense without prescriptions. Most dispensers, 83% (426/513), supplied incomplete doses of antimicrobials and only 60.5% (345/570) of the dispensers gave proper instructions for antimicrobial use to clients. Over 75% of ADDO dispensers displayed poor practice in taking patient history.ConclusionADDO dispensers demonstrated poor practices in dispensing and promoting rational antimicrobial use for children. Training, support, and regulatory interventions are required to improve antimicrobial dispensing practices in community drug outlets.

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos en pediatría hospitalaria

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.