Judicious Use Of Antibiotics Research Articles

A survey of the usage (frequency and pattern) of antibiotics at the University of Maiduguri Veterinary Teaching Hospital, Maiduguri, Borno State, Nigeria.

Background and Aim:Veterinary antibiotics are widely used to treat bacterial diseases in various species of animals. However, despite the importance of these chemotherapeutic agents, their indiscriminate or extensive use can pose dangers to the animals or humans that consume edible tissues from animals contaminated with antibiotic residues. Therefore, concerns regarding their appropriate and judicious use in animals are of public health significance. This is because of the tendencies of developing resistance to targeted microbes and the ability of the parent compound or its metabolites to persist as residues in the animal tissues. This study aimed to determine the frequency and pattern of antibiotic usage and ascertain the level of awareness of clinicians on the judicious use of antibiotics at the University of Maiduguri Veterinary Teaching Hospital, Maiduguri, Borno State, Nigeria.Materials and Methods:Data related to the administration of antibiotics in all species of animals presented for treatment from January 2009 to December 2018 were obtained from the hospital archives, with permission from the office of the hospital directorate. The diseases, hospital units, antibiotics used, and years were parameters that were recorded for each case. Furthermore, 47 questionnaires were administered to clinicians who render services to the hospital.Results:A total of 63.9% of all cases brought to the hospital within the 10 years under study were infectious, and as such, were treated with antibiotics. The highest recorded use of antibiotics was observed in the poultry unit (38.4%), followed by the large animal unit (24.1%), with the lowest used recorded in the ambulatory unit (9.3%). Furthermore, regarding the antibiotics used, oxytetracycline had the highest occurrence (55%), followed by penicillin-streptomycin combination (12.2%), with the lowest being metronidazole (0.30%). The highest number of cases treated with antibiotics was recorded in 2018 (22.5%), and the lowest was recorded in 2014 (1.3%). Regarding the questionnaire administered to the clinicians, 78.7% of the respondents preferred oxytetracycline as their drug of choice, whereas only 2.1%, 4.3%, 2.1%, and 4.3% preferred amoxicillin, penicillin, streptomycin, and penicillin-streptomycin, respectively. Moreover, 65.9% of the respondents used a particular antibiotic because of its availability at the hospital, 8.5% because of cost, and 27.7% because of clinician preference. Furthermore, 74.5% of the clinicians offered palliative intervention while awaiting laboratory reports, whereas 8.5% treated the animals without requesting laboratory analyses.Conclusion:In this study, oxytetracycline was found to be the most used antibiotic for treating infectious diseases at the hospital because of its availability. The observed pattern appeared in the following order of frequency: Oxytetracycline, penicillin-streptomycin combination, neomycin, erythromycin, amoxicillin, tylosin, streptomycin, and gentamicin with metronidazole being the least frequent. There might also be antibiotic resistance, which requires a change to another antibiotic because of the lack of response to the initial antibiotic. Non-judicious antibiotic use can also have a negative impact on public health because of the development of multidrug-resistant “superbugs” and the problem of drug residue.

CE: Pediatric Antibiotic Stewardship.

With the rise of antibiotic resistance, antimicrobial stewardship programs can now be found in the ambulatory setting, where nearly 95% of antibiotic prescriptions originate. Judicious use of antibiotics is of particular importance to the ambulatory pediatric provider, as the annual antibiotic prescription rate is highest among children ages two and younger and inappropriate early-life antibiotic use is associated with elevated childhood risk of several medical conditions. While most ambulatory antibiotic stewardship programs have focused on shaping clinician behaviors to prevent unnecessary antibiotic prescribing, duration of antibiotic therapy has been found to be a critical, yet underexamined, facet of antibiotic use. In the past, duration of antibiotic therapy was largely based on convention and expert opinion, with little scientific evidence supporting many of the recommendations. Research suggests that many common pediatric infections such as acute otitis media, community-acquired pneumonia, streptococcal pharyngitis, and urinary tract infections can be effectively and safely treated with reduced courses of antibiotic therapy. In addition to reducing the incidence of antibiotic resistance, a shorter duration of antibiotic therapy may help prevent many adverse effects associated with antibiotic treatment. Current studies on the duration of antibiotic therapy, especially in pediatrics, are limited as they often rely on data extrapolated from adult studies that fail to consider the effects of age-related growth and development on both pharmacokinetics and pharmacodynamics. Future investigation into this topic is also limited by researchers' reliance on subsidies from pharmaceutical companies; clinicians' fear of undertreating infection; and hesitancy to deviate from current standards of care, even when such standards are not evidence based. Despite these challenges, the dangers of inappropriate antibiotic use in the pediatric population warrant further evaluation.

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children.

The diagnosis of pneumonia in children is challenging, given the wide overlap of many of the symptoms and physical examination findings with other common respiratory illnesses. We sought to derive and validate the novel Pneumonia Risk Score (PRS), a clinical tool utilizing signs and symptoms available to clinicians to determine a child's risk of radiographic pneumonia. We prospectively enrolled children 3 months to 18 years in whom a chest radiograph (CXR) was obtained in the emergency department to evaluate for pneumonia. Before CXR, we collected information regarding symptoms, physical examination findings, and the physician-estimated probability of radiographic pneumonia. Logistic regression was used to predict the presence of radiographic pneumonia, and the PRS was validated in a distinct cohort of children with suspected pneumonia. Among 1181 children included in the study, 206 (17%) had radiographic pneumonia. The PRS included age in years, triage oxygen saturation, presence of fever, presence of rales, and presence of wheeze. The area under the curve (AUC) of the PRS was 0.71 (95% confidence interval [CI]: 0.68-0.75), while the AUC of clinician judgment was 0.61 (95% CI: 0.56-0.66) (P < 0.001). Among 2132 children included in the validation cohort, the PRS demonstrated an AUC of 0.69 (95% CI: 0.65-0.73). In children with suspected pneumonia, the PRS is superior to clinician judgment in predicting the presence of radiographic pneumonia. Use of the PRS may help efforts to support the judicious use of antibiotics and chest radiography among children with suspected pneumonia.

Surgical Site Infections are the Pool of Antibiotic Resistant Bacteria: Evidence from a Tertiary Hospital in Nepal

Background: Surgical site infections (SSIs) are the leading nosocomial infections and important cause of morbidity and mortality in surgical patients. Objective: The present study was conducted to investigate the bacterial etiology of SSIs and determine the antibiotic susceptibility patterns of the isolates. Methodology: A cross-sectional study was conducted between July to November 2019 on 105 patients suspected of having SSIs. Wound swabs were collected aseptically using sterile cotton swabs and processed in suitable culture media following the standard operative protocols. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion technique following Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 105 samples collected, 69 showed growth and 77 bacterial isolates were documented altogether. The most frequently isolated bacteria were Staphylococcus aureus 46 (59.74%) followed by E. coli 9 (11.68%). The antimicrobial profile of the isolates revealed that 61.04% were MDR, 25.80% were ESBL producers and 9.68% were carbapenemase producers. Conclusion: High prevalence of antibiotic-resistant bacterial isolates associated with SSIs warrants the need for aseptic techniques during and after surgical procedures and judicious use of antibiotics.

A prospective study of post-operative surgical site infections after abdominal surgeries

Background: Surgical site infections have plagued surgeons since time immemorial. There is significant morbidity and mortality associated with surgical site infections. In this study we tried to identify the incidence, various patient and procedure related factors, which could have led to SSIs, the various organism associated with the SSIs and their pattern of sensitivity and resistance to various antibiotics.Methods: This study was conducted in the department of general surgery, Gandhi medical college and Hamidia hospital Bhopal. In this prospective study, we included all patients more than 12 years of age undergoing abdominal surgeries between 2018-2020. Patient data was recorded in a case recording form and all patients were examined post-operatively for soakage along with culture and antibiotic testing.Results: A total of 299 patients were included. Overall incidence of SSI was 23.07%, elective surgeries showed 19.5% incidence and elective showed 26.08% incidence. Higher incidence of SSI was found in, male patients (25.9%), contaminated and dirty surgeries, higher ASA scores, smokers, alcoholics diabetics, anaemics, and malnourished patients. E. coli and klebsiella were the most common organisms isolated in both elective and emergency setting. Organisms isolated were highly sensitive to colistin, meropenem, imipenem, gentamicin and amikacin. Amoxycillin, ceftriaxone, doxycycline were fairly resistant in the current study.Conclusions: Modifiable risk factors like smoking, alcoholism, anaemia, malnourishment, contaminated wound class and emergency surgeries should be addressed systematically along with judicious use of antibiotics and tailoring then according to culture profile whenever possible is needed to reduce SSI rate.

Aerobic Bacterial Isolates and Their Antibiotic Susceptibility Patterns of Pus Samples at Tertiary Healthcare Center of Northern India

Introduction: Emerging resistance in microorganisms is a matter of great concern in health care setups. Bacterial isolate and AMR pattern changes from place to place and time to time. Unprofessional use of antibiotics has resulted in an increasing burden of antibiotic resistance. This study focused over the aerobic bacteriological profile and antibiotic resistance pattern in pus isolates. Materials and Methods: A retrospective study was carried out from June, 2020 to May 2021. 1174 pus samples collected during the study period were included. The samples were cultured on Blood and MacConkey agar. After aerobic incubation at 37°C for 18-24 hrs, organisms were identified by biochemical reactions, gram staining and antibiotic susceptibility was tested by Kirby Bauer disc diffusion method. Result: Among the total 1174 pus samples, 712 (60.6%) were male and 462 (39.3%) were females. 857(72.9%) samples showed positive results. Among them, Staphylococcus aureus was the most common isolate followed by Escherichia coli, Pseudomonas spp. and Klebsiella spp. The sensitivity of Staphylococcus aureus was highest with Vancomycin and Linezolid, whereas Enterobacterales and Pseudomonas were sensitive with Piperacillin tazobactam. Conclusion: Increasing resistance always poses a challenge in treating infections. The development of resistant strains of pathogens can be limited by the judicious use of antibiotics. This study shows the infecting bacterial isolates and their antibiogram from this area. Keywords: Pus, antimicrobial resistance, bacterial isolates.

Antibiotic residues in cattle and sheep meat and human exposure assessment in southern Xinjiang, China.

In recent years, antibiotics have become widely used in animal breeding. The application of antibiotics in livestock may lead to the presence of antibiotic residues in animal‐derived foods, especially meat, that may pose a threat to human health. In this study, 26 common antibiotics (eight sulfonamides, nine fluoroquinolones, four tetracyclines, and five macrolides) were screened in 88 meat samples (cattle muscles and sheep muscles, kidneys, and livers) obtained from southern Xinjiang. The antibiotics were screened via the clean‐up step based on solid‐phase extraction and determined through ultraperformance liquid chromatography–tandem mass spectrometry. Moreover, their risk to human health was analyzed. Overall, 16 antibiotics were detected with a total detection rate of 95.46%. The percentage of noncompliant samples was 28.41% with an exceedance maximum residue limit of 1.14%. The illegal use rate of the antibiotic norfloxacin was 27.27%. The estimated daily exposure doses of all compounds in adults were <102.218 ng/kg bw/day even after applying the worst‐case scenario approach. This result demonstrated that the antibiotic residues in the tested samples imposed negligible harm to people's health and had an acceptable level of food safety risk. However, the high detection frequencies found in this work indicated that the risk of antibiotic residues could not be ignored given the cumulative risk of antibiotics, particularly the emergence of bacterial resistance, to the human body. The need for effective strategies and publicity for the judicious use of antibiotics to safeguard residents’ health is immediate.

A novel framework to guide antibiotic stewardship nursing practice

BackgroundThere is a pervasive view among some nurses and health care disciplines that antibiotic stewardship (AS) is solely a physician or pharmacist responsibility. There is an urgent need to alter this view so that nurses can seize every opportunity to prevent patient harm from antibiotics and optimize antibiotic use. One challenge to achieving full nurse engagement as equal members of the AS team is lack of an organizing framework to illustrate relationships of phenomena and concepts inherent to adoption of AS nursing practices. MethodsWe sought to create a framework derived from the peer-reviewed literature, systematic and scoping reviews, and professional standards, consensus statements and white papers. The emerging framework went through multiple iterations as it was vetted with nurse clinicians, scholars and educators, physicians, pharmacists, infection preventionists and AS subject matter experts. ResultsOur evidence-based Antibiotic Stewardship Nursing Practice SCAN-P Framework provides the much-needed context and clarity to help guide local-level nurses to participate in and lead AS nursing practice. ConclusionsNurses worldwide are ideally situated to provide holistic person-centered care, advocate for judicious use of antibiotics to minimize antibiotic resistance, and be AS educators of their patients, communities and the general public. The Antibiotic Stewardship Nursing Practice SCAN-P Framework provides a tool to do so.

FIGHT AGAINST SUPERBUGS IN A BURN CENTRE: ARE WE DOING ENOUGH

Objective: To determine the superbug infection in a burn centre, its impact on mortality/morbidity and to review all preventive/therapeutic steps taken to fight this menace.&#x0D; Study Design: Retrospective cross sectional study.&#x0D; Place and Duration of Study: Department of Burns &amp; Plastic Surgery, Army Burn Centre, Combined Military Hospital Kharian, from Oct 2018 to Sep 2019.&#x0D; Methodology: A detailed retrospective audit of departmental data was carried out. Parameters like direct admission vs transferred patient, percentage of burns (Total Burn Surface Area-TBSA%), records of all burns related deaths and all culture/sensitivity reports were analysed using SPSS-20. As a standard practice in our unit blood, tracheal secretions and pus culture specimens of all patients are collected at the time of admission and then periodically fresh samples are taken every week or earlier when-ever required.&#x0D; Results: Out of 515 patients, 283 (54.95%) were children under the age of 12 years. The overall survival rate improved by 13.43% as compared to last year. Out of 584 bacteriology reports 396 (67.81%) were positive and 188 (32.19%) were negative. On culture 508 organisms were isolated, majority of which were Carbapenem Resistant Pseudomonas, Acinetobacter, Enterobacteriaceae and Methicillin resistant staphylococcus aureus.&#x0D; Conclusion: Multi drug resistant superbug infection is a worldwide menace. The best clinical practices, strict contact isolation, enhanced environmental cleaning and judicious use of appropriate antibiotics are the main strategies in this war. Need for newer more effective antibiotics cannot be overemphasized.

Antibiotic Susceptibility Patterns of Bacteria Isolated from Hospital Surfaces and Environment in Kenya

Objective: Control of hospital environment is key to success of healthcare quality. Increasing emergence and spread of pathogenic bacteria is of great concern and continues to challenge infection prevention and epidemiology practice. This study aimed at providing information about the management of hospital environment and wastes in selected hospitals in Kenya, determine prevalence of pathogenic bacteria and their antibiotic susceptibility.&#x0D; Methods: A cross sectional study was conducted at Kenyatta National Hospital (KNH) (public) and Kikuyu Mission Hospital (KMH) (private) in Kenya from May 2015 to April 2017. In microbiological analysis, a total of 246 samples from each of the two hospitals was obtained using sterile cotton swabs from random sampling of hospital different surfaces, drainages, hands of healthcare givers and hospital waste dump site among others.&#x0D; Results: A total of 471 bacterial isolates were recovered, and were distributed as follows; Providentia spp, Staphylococcus aureus spp, Escherichia coli spp (E. coli), other Gram negative bacteria were, Pseudomonas spp, coagulase negative Staphylococcus (CONS), Serratia spp, Klebsiella spp, Proteus spp and Enterobacter spp. Susceptibility test revealed that Escherichia coli isolates were the most sensitive isolate to antibiotics. Imipenem drug showed 100% sensitivity for Gram negative, while Gram-positive isolates, linezolid antibiotic was the most sensitive drug.&#x0D; Discussion: There is need for stringent review of hospital waste management system in Kenya. The frequency of ESBL producing strains among clinical isolates has been steadily increasing.&#x0D; Conclusion: Continued drug resistance surveillance of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use.

Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31-2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10-1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56-2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09-2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09-2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

Escalating antimicrobial resistance among Enterobacteriaceae: focus on carbapenemases

ABSTRACT Introduction: Over the past few decades, antimicrobial resistance (AMR) has skyrocketed globally among bacteria within the Family Enterobacteriaceae (i.e. Enterobacter spp, Klebsiella spp, Escherichia coli, Proteus spp, Serratia marcescens, Citrobacter spp, and others). Enterobacteriaceae are intestinal flora and are important pathogens in nosocomial and community settings. Enterobacteriaceae spread easily between humans and may acquire AMR via plasmids or other mobile resistance elements. The emergence and spread of multidrug resistant (MDR) clones have greatly limited therapeutic options. Some infections are untreatable with existing antimicrobials. Areas covered: The authors discuss the escalation of CRE globally, the epidemiology and outcomes of CRE infections, the optimal therapy, and the potential role of several new antimicrobials to combat MDR organisms. An exhaustive search for literature related to Enterobacteriaceae was performed using PubMed, using the following key words: antimicrobial resistance; carbapenemases; Enterobacterales; Enterobacteriaceae; Klebsiella pneumoniae; Escherichia coli; global epidemiology; metallo-β-lactamases; multidrug resistance; New Delhi Metalloproteinase-1 (NDM-1); plasmids Expert opinion: Innovation and development of new classes of antibacterial agents are critical to expand effective therapeutic options. The authors encourage the judicious use of antibiotics and aggressive infection-control measures are essential to minimize the spread of AMR.

Arthroscopic rotator cuff repair without antibiotic prophylaxis does not increase the infection rate

Rotator cuff repair is a commonly performed shoulder procedure. In the past 20years, there has been a shift from mini-open towards arthroscopic repair, and many units exclusively use arthroscopic techniques for rotator cuff surgery. The aim of this study was to find out whether withholding antibiotics had any effect on the infection rate in patients undergoing arthroscopic rotator cuff repair. A retrospective analysis of 336 consecutive patients with an arthroscopic rotator cuff repair (RCR) and a minimum 2-year follow-up was performed. The control group received prophylactic antibiotics (controls) and the cases of interest did not receive perioperative antibiotics. A power analysis was performed according to literature regarding infection proportions. The primary outcome was an infection (superficial or deep) in the operated shoulder. There were 336 patients who underwent a RCR. Two-hundred-and-twelve in the control group and 124 in the non-antibiotic group. Average ages were 57.3 ± 12.5 and 56.8 ± 13.2years in each group, respectively. The follow-up times ranged from 24 to 76months. Equipment used and surgical techniques were identical, only operating times were statistically different between the groups (control 77.2 ± 41.3min versus no antibiotic cases 52.9 ± 16.7min) (p = 0.000009). There was no recorded infection in either group. Infection following arthroscopic surgery is uncommon. Small incisions, constant lavage with saline, minimal hardware insertion and short operating times all combine to minimise the risks. Current results point towards no detriment in withholding prophylactic antibiotics in low-risk patients undergoing routine rotator cuff repair surgery. Therefore, judicious use of prophylactic antibiotics in patients undergoing this procedure is advocated to prevent potential harm to those it is administered to. Level III.

Outpatient antibiotic use in British Columbia, Canada: reviewing major trends since 2000.

BackgroundWith 90% of all antibiotics in Canada being used in the community setting, tracking outpatient prescribing is integral to mitigate the issue of antimicrobial resistance. In 2005, a provincial programme was launched in British Columbia (BC) to disseminate information regarding the judicious use of antibiotics. These efforts include educational campaigns, updated practitioner guidelines and academic detailing. The impact of provincial stewardship on community prescribing requires ongoing evaluation.ObjectivesThis study examines outpatient prescribing to quantify rates of antibiotic use, evaluate major trends over time and identify new targets for stewardship.MethodsA retrospective cohort design using population-level data.ResultsThis study included over 3.5 million unique individuals with a total of 51 367 938 oral antibiotic prescriptions dispensed over a 19 year period (2000–18). Overall antibiotic utilization decreased by 23% over the course of the study period. This trend in the reduction of antibiotic prescription was observed across all major antibiotic classes, apart from the class of other antibacterials, which was mostly related to use of nitrofurantoin. The largest magnitudes of decreased prescribing were observed in the paediatric population. Prescribing across two distinct eras of provincial stewardship reaffirmed preliminary findings of programme efficacy, when compared with pre-stewardship levels of antibiotic use.ConclusionsOutpatient prescribing in BC is decreasing overall, and this study confirms an association between provincial stewardship interventions and improvements in antibiotic use. Pronounced declines in paediatric populations are promising, and further research is underway to examine prescribing quality.

Identification and Antibiogram Assay of Escherichia Coli Isolated From Chicken Eggs

Chicken eggs contain all the essential components such as proteins, lipids, vitamins, minerals, carbohydrates, and growth factors required by the human being. Despite of their nutritional values eggs can cause health problems through consumption of contaminated eggs with pathogenic microorganisms. Therefore, the present study was undertaken to identify Escherichia coli isolated from chicken eggs with their antibiogram assay in Rajshahi district of Bangladesh. E. coli was isolated from 180 chicken eggs collected from different areas of Rajshahi district and identified based on cultural, staining, and biochemical characteristics. Antibiogram assay of all the isolates were done by disk diffusion method. The overall prevalence of E. coli was 38.89% in chicken eggs of which 27.78% was on egg shells and 11.11% was in egg content. The prevalence of E. coli was 58.33% in commercial layer farm eggs, 41.66% in whole seller eggs, and 16.67% in retailer eggs. In antibiogram study, isolated E. coli showed 64.28% to 92.85% sensitivity to chloramphenicol, gentamycin, and ceftriaxone. The highest sensitivity was found to meropenem (100%). Isolated E. coli showed resistance to ciprofloxacin, tetracycline, amoxicillin, ampicillin, and erythromycin ranging from 50% to 71.42%. Judicious use of antibiotics and public awareness will help to reduce the development of antibiotic resistance. J. Bio-Sci. 29(1): 123-133, 2021 (June)

Assessing Baccalaureate Nursing Students’ Antibiotic Stewardship Knowledge Using Virtual Standardized Patient Simulations

Background: According to the Centers for Disease Control and Prevention, the single most important factor leading to the development of antibiotic resistance (AMR) is the use of antibiotics. Studies indicate that up to 50% of hospitalized patients receive at least 1 antibiotic, half of which are inappropriate. The outpatient setting accounts for &gt;60% of antibiotic use and over half of these prescriptions are inappropriate. Antibiotic stewardship programs improve appropriate antibiotic use, reduce AMR, decrease complications of antibiotic use, and improve patient outcomes. Building a nursing workforce with necessary AMR and antibiotic stewardship knowledge and skill is critical. Nursing graduates can translate knowledge into practice, promoting the judicious use of antibiotics to keep patients safe from antibiotic harm. Methods: Third-year baccalaureate nursing students enrolled in a fall 2020 health promotion course at an urban university affiliated with an academic medical center participated. Students received a 3-hour lecture on antibiotics, AMR and antibiotic stewardship nursing practices and actively engaged in antibiotic stewardship simulations using standardized patient (SP) encounters. The SP participants were specifically trained for these activities. Simulations included a 30-minute brief before and a 60-minute briefing after the activities. All activities occurred via video conferencing. Case scenarios, developed by the authors, focused on penicillin-allergy delabeling of an adolescent prior to elective surgery and appropriate use of antibiotics in managing pediatric urinary tract infections and acute otitis media (AOM). Before-and-after tests were used to assess the impact on AMR and antibiotic stewardship knowledge. Results: Over a period of 4 days, all enrolled students (n = 165) participated in 1 three-hour virtual simulation session. Using Zoom video conferencing with multiple breakout rooms, the activities were easily managed. During the simulations, students often struggled with reading an antibiogram and applying the concept of “watchful waiting” in AOM management. Significant differences were found in before-and-after test results, with significant improvement in students’ general and specific knowledge and awareness of antibiotics (P &lt; .01). During the debriefing sessions, students reported increased awareness related to their role in advancing the judicious use of antibiotics. Conclusions: Initially, we planned to conduct in-person SP simulations. Due to the COVID-19 pandemic, faculty and students demonstrated remarkable flexibility and resilience as we successfully converted to a virtual format. Virtual lecture and SP simulations, followed by debriefing, was an effective approach to educate baccalaureate nursing students about AMR and their role in antibiotic stewardship. Areas for course content improvement were identified.Funding: NoDisclosures: None

#3: Gram-Negative Antibacterial Resistance Prevalence at a Tertiary Care Hospital in Central America

Abstract Background Latin America has some of the highest rates of multi-drug resistant gram-negative bacteria worldwide. However, local surveillance registries to compare rates of resistance among countries are lacking, particularly in Central America. Awareness of local resistance patterns in this region is critical to improve antibiotic use and patient outcomes. We sought to measure the prevalence of resistant gram-negative bacilli (GNB) at a tertiary hospital in Guatemala. Methods We retrospectively conducted a single-center study to measure the percentage of GNB that were non-susceptible to various antibiotics between April and October of 2017. All cultures (blood, urine, cerebrospinal fluid, and other body fluids) were collected as part of routine clinical care during the study period. Duplicate isolates, defined as multiple specimens with the same organism from the same patient, were excluded. Antibiotic susceptibility testing was performed by disk diffusion method. Bacterial isolates were categorized as susceptible, intermediate, or resistant based upon the Clinical Laboratory Standard Institute 27th edition per guidance from the National Laboratory of Guatemala. Results A total of 969 unique gram-negative isolates from 818 patients were included. Urine was the most common culture type. The most frequently isolated bacteria were Escherichia coli and Klebsiella species. The percentage of GNB which were non-susceptible to individual antibiotics are detailed in Table 1. Of the isolates tested, 12 – 66% of GNB were non-susceptible to cephalosporins, 7 – 31% were non-susceptible to carbapenems, and 14 – 44% were non-susceptible to fluroquinolones. Conclusions The prevalence of multi-drug resistant GNB is high in Escuintla, Guatemala. Continued surveillance is vital to guide judicious and appropriate empiric antibiotic use in the setting of rising rates of antibiotic resistance. Local and regional resistance rates are known to vary, underlying the importance of developing more regional and national antibiotic resistance surveillance networks within Guatemala and other countries in Central America where there is a paucity of data.

Routine Use of Biomarkers to Rationalize Antibiotic Use During Febrile Episodes in Pediatric Bone Marrow Transplantation Units.

Children frequently develop fever after hematopoietic stem cell transplant (HSCT). Although the etiology of many febrile episodes (FEs) is not an infection, patients often receive broad-spectrum antibiotics in response. To improve the judicious use of antibiotics in pediatric HSCT patients, we performed a prospective cohort study of children receiving an HSCT in Clínica Imbanaco (Cali, Colombia) between September 2016 and December 2019. We assessed all FEs occurring during 3 periods (infusion, neutropenic and engraftment). We measured procalcitonin and C-reactive protein (CRP) sequentially during each FE and compared levels among patients with fever due to significant infection (FSI) versus fever not attributable to infection (FNI) in each transplant period. There were 166 FEs in 95 patients. FSI accounted for 12%, 42% and 42% of FE during infusion, neutropenic and engraftment periods, respectively. CRP had better discriminatory capacity for FSI versus FNI in the infusion period [area under the curve (AUC) 0.80 (95% confidence interval [CI], 0.62-0.96) for a CRP level of 50 mg/L]. Neither biomarker performed well in the neutropenic period. During the engraftment period, a CRP of 65 mg/L had an AUC of 0.81 (95% CI, 0.65-0.96), while a procalcitonin level of 0.25 ng/mL had an AUC of 0.83 (95% CI, 0.63-1.0). In contrast to procalcitonin, the CRP's pattern of change throughout the first 3 days of fever in each transplant period was different in FSI compared with FNI. Sequential measurement of biomarkers, especially CRP, may allow clinicians to more appropriately manage antibiotic use in pediatric HSCT units.

A visual representation of microbiological culture data improves comprehension: a randomized controlled trial.

While the judicious use of antibiotics takes past microbiological culture results into consideration, this data's typical format in the electronic health record (EHR) may be unwieldy when incorporated into clinical decision-making. We hypothesize that a visual representation of sensitivities may aid in their comprehension. A prospective parallel unblinded randomized controlled trial was undertaken at an academic urban tertiary care center. Providers managing emergency department (ED) patients receiving antibiotics and having previous culture sensitivity testing were included. Providers were randomly selected to use standard EHR functionality or a visual representation of patients' past culture data as they answered questions about previous sensitivities. Concordance between provider responses and past cultures was assessed using the kappa statistic. Providers were surveyed about their decision-making and the usability of the tool using Likert scales. 518 ED encounters were screened from 3/5/2018 to 9/30/18, with providers from 144 visits enrolled and analyzed in the intervention arm and 129 in the control arm. Providers using the visualization tool had a kappa of 0.69 (95% CI: 0.65-0.73) when asked about past culture results while the control group had a kappa of 0.16 (95% CI: 0.12-0.20). Providers using the tool expressed improved understanding of previous cultures and found the tool easy to use (P < .001). Secondary outcomes showed no differences in prescribing practices. A visual representation of culture sensitivities improves comprehension when compared to standard text-based representations.

Prevalence of CTX-M β-Lactamases Producing Multidrug Resistant Escherichia coli and Klebsiella pneumoniae among Patients Attending Bir Hospital, Nepal.

The emergence of multidrug resistant (MDR) bacteria which is attributable to extended spectrum β-lactamases (ESBLs) production of CTX-M types is an obvious problem worldwide. This study is aimed at determining the prevalence of CTX-M β-lactamases producing multidrug resistant Escherichia coli and Klebsiella pneumoniae among patients attending Bir Hospital. A cross-sectional study was conducted between April and September 2019 at Bir Hospital, Kathmandu, and Department of Microbiology, National College, Kathmandu, Nepal. A total of 5,690 different clinical specimens were subjected to cultural, microscopic, and biochemical analyses for the identification of the isolates. Antimicrobial susceptibility testing of the isolates was done, and MDR isolates were selected and processed for further ESBL confirmation by the combination disks method. All confirmed ESBL isolates were screened for CTX-M type β-lactamases (blaCTX-M) by PCR. Of the total 345 isolates (227 Escherichia coli and 118 Klebsiella pneumoniae), 232 were MDR. All 232 (67.24%) MDR isolates were suspected as ESBL producers on the screening test. However, on the phenotypic test, 135 (58.18%) of total MDR bacteria were confirmed as ESBL producers with the highest proportion in K. pneumoniae (59.37%). The major source of ESBL producers was urine. ESBL producing isolates were mostly identified from outpatients and patients belonging to age group 41-60. Gentamicin was found to be effective against ESBL producers. The prevalence of blaCTX-M was (89.62%) with the highest frequency for E. coli (93.81%). High prevalence of ESBL of CTX-M types among MDR E. coli and K. pneumoniae was detected from clinical specimens of patients in Bir Hospital. This study warrants the need for the judicious use of antibiotics as well as emphasize the use of modern diagnostic tools for the early detection of MDR and ESBL producers to curb the emergence and spread of MDR and ESBL producing bacteria in the clinical settings of Nepal.