Judicious Use Of Antibiotics Research Articles

Prevalence and Multidrug Resistance in Non-Typhoidal Salmonella in India: A 20-Year Outlook

Non-typhoidal Salmonella (NTS) infection poses a significant public health challenge globally, particularly in developing countries like India. NTS, predominantly represented by S. enterica serovars, is a major cause of intestinal and extra-intestinal infections. This review provides a comprehensive overview of longitudinal analyses of the prevalence of NTS in different regions of India encountered in the last 20 years and their antimicrobial resistance patterns. We followed several research investigations published during 2000–2024 to examine the incidence and prevalence of different serovars of NTS in several parts of India and followed published articles on NTS showing resistance to different antibiotics. We pointed out NTS serovars, which are predominantly isolated in various human and non-human sources, as observed in several investigations conducted in different regions of India. Our analysis revealed that, among serovars detected from various sources, S. Typhimurium is the most predominant one occurring across both human and non-human sources, followed by S. Enteritidis and S. Weltevreden. The occurrence of similar serovars of Salmonella in both human and non-human sources may be due to zoonotic transmission between animals and humans. Extensive research conducted across many geographic locations reveals that NTS isolates exhibit resistance to several antibiotics, with multidrug-resistance (MDR) being more common. These MDR strains basically show resistance to three or more classes of antibiotics, including critically important antimicrobials such as nalidixic acid, ciprofloxacin, and third-generation cephalosporins. Temporal trends suggest an alarming increase in resistance to these antibiotics, particularly in serovars such as S. Typhimurium and S. Enteritidis. Overall, the current article sheds light on the urgent need for surveillance, judicious antibiotic use, and the development of alternative treatment strategies to combat the rising tide of antibiotic-resistant NTS strains.

P-367. Containment of an Outbreak of Carbapenem-Resistant Acinetobacter baumanii in a Burn Intensive Care Unit

Abstract Background Acinetobacter baumanii is a cause of serious infections in hospital settings. Carbapenem-resistant Acinetobacter baumanii (CRAB) is especially difficult to treat. Patients in a burn unit are particularly vulnerable to colonization and infection with few reports describing CRAB outbreaks in a burn intensive care unit and measures required for containment. This study highlights the infection control measures successful in controlling an outbreak. Methods After detection of a patient with CRAB in an urban burn unit in January 2023, all patients in the burn unit were screened for carbapenem resistant organisms. Six patients with CRAB were identified between January 2023 and May 2023. Whole genomic sequencing was used for confirmation of clonal relatedness. All patients with a positive CRAB culture of sterile or non-sterile sites are included in this retrospective study. Results Six patients ages 29-53 tested positive for CRAB between January 2023 and May 2023. Case 1 was admitted from a long term acute care facility, with sputum culture positive for CRAB. One had CRAB from a blood culture, and four in wound cultures. Longer length of stay, 80 days vs 13 days was seen with CRAB positive patients because of partial skin graft failure, slower to heal wounds, and barriers to placement. After judicious use of antibiotics, following infection control practices were implemented: 1. Screening for carbapenem resistant organisms (CPOs) on admission, weekly, and on discharge. 2. Fluorescent markers added to adenosine triphosphate (ATP) testing of environmental surfaces and equipment. 3. Double terminal cleaning of rooms with CRAB. 4. A cleaning process for every piece of equipment. 5. Hand hygiene education and proper use of personal protective equipment. With the above measures, no cases of CRAB were seen after May 2023. Conclusion The CRAB outbreak was associated with patients with burn wounds, antibiotic use, similarities in age and demographics, slower wound healing, partial skin graft loss, and longer length of stay. The control measures listed were successful in controlling the outbreak. Disclosures All Authors: No reported disclosures

P-2289. Gut Colonization With Multidrug-Resistant Organism And Its Impact On Bloodstream Infection In Children With Hematological Malignancies, A Prospective Observational Study

Abstract Background Preventing infections due to MDR pathogens is particularly important in the era of MDR pathogens. Once colonization with an MDR strain occurs, the risk of subsequent infection is exceptionally high in neutropenic patients. For carbapenem-resistant Enterobacteriaceae, rectal colonization by resistant pathogens was followed by BSIs in 45% of neutropenic patients. The association between colonization and subsequent infection has been reported for many MDR bacteria, such as VRE, ESBL-producing Enterobacteriaceae, P.aeruginosa, S. maltophilia, and carbapenem or colistin-resistant K. pneumoniae Methods A prospective observational study was conducted at the National Cancer Institute on 70 children with hematological malignancies. Rectal swabs were collected at admission and weekly to screen for MDRO colonization. Demographic, clinical, and microbiological data were collected. Results At admission, 60% of children were colonized with MDROs. The most common MDROs were Escherichia coli (66%) [with CRE comprising 60% and ESBL 40%], Klebsiella CRE (16%), and methicillin-resistant Staphylococcus aureus (MRSA) (5%). Risk factors for MDRO colonization included previous antibiotic exposure, intensive chemotherapy, and prolonged hospitalization. During the study period, (28%) of the children developed BSI. Of these, (60 %) were caused by MDROs. MDRO colonization was significantly associated with an increased risk of MDRO BSI. Also, intrabdominal infection (Typlitis ) and Perianal Infection were reported in 15% and 14% of the MDRO-colonised children. Conclusion Gut colonization with MDROs is common in children with hematological malignancies and is associated with an increased risk of MDRO BSI. Strict infection control measures and judicious antibiotic use are crucial to prevent MDRO colonization and subsequent BSI in this vulnerable population. Disclosures All Authors: No reported disclosures

P-2292. The Usual Suspect? Prevalence of Pseudomonas aeruginosa in Diabetic Foot Infections among Kidney Transplant Recipients

Abstract Background Diabetic foot infections (DFIs) are a significant cause of morbidity in kidney transplant recipients (KTRs) with underlying diabetes. While empiric antibiotic coverage with an antipseudomonal antibiotic is common practice, recent studies of DFIs in non-transplant patients have found a relatively low prevalence of Pseudomonas aeruginosa (PSA). We hypothesize that the prevalence of PSA in DFIs is also low among KTRs. Organisms isolated in cultures from diabetic foot infections (DFI) among kidney transplant recipients (KTR) Methods We performed a review of all positive microbiologic isolates from clinically relevant DFIs in KTRs requiring hospitalization at an urban transplant center from 1/2018-12/2023. All patients were > 18 years of age and underwent renal transplantation between 2015-2023. Patients could be included for more than 1 DFI if these occurred > 6 months apart or on non-contiguous sites. Patients without cultures or with cultures that yielded negative results were excluded. The primary outcome was the prevalence of PSA in microbiologic cultures, including bone, tissue, and fluid sources. The study was approved by our Institutional Review Board and results were reported using descriptive statistics. Patient characteristics and demographics Results Forty-eight DFIs occurring in 40 KTRs were included. Median age was 62 and 83% (40/48) occurred in men. Average time from transplant to DFI was 1075.5 days. Additional demographic data is shown in Table 1. Eighty organisms were isolated with 42% (20/48) of infections being polymicrobial. PSA represented 5% of organisms isolated (4/80) and was present in cultures from 4 unique patients (10%). Streptococcus species and Staphylococcus aureus were the most commonly isolated organisms, representing 20% (16/80) and 29% (23/80), respectively. Among Staphylococcus aureus isolates, 47% were methicillin-resistant. Additional microbiologic data is shown in Figure 1. Conclusion The prevalence of PSA in DFIs was low among KTRs. Typical skin pathogens including Streptococcus species and Staphylococcus aureus were most common. While larger studies are needed to confirm these results, judicious use of antipseudomonal antibiotics should be considered in DFI management. Disclosures All Authors: No reported disclosures

P-1137. Decreasing Empiric Vancomycin use for Orbital Cellulitis in Children

Abstract Background Orbital cellulitis in children is often caused by Staphylococcus aureus, Streptococcus viridans group, and Streptococcus pyogenes. Oral, respiratory, and skin commensals are also considered in empiric antibiotic choice. MRSA is becoming less prevalent nationally. In 2015, our hospital implemented an evidence-based orbital cellulitis guideline to standardize care and promote antibiotic and surgical stewardship. The guidance calls for empiric clindamycin and ceftriaxone, reserving vancomycin for cases with signs of optic nerve or CNS involvement. Here we evaluate results of this guidance and summarize isolated bacteria.Fig 1.Empiric use of vancomycin pre and post guideline Methods Cases were pulled from the hospital chart by diagnosis code and positive computed tomography scan for orbital cellulitis for 4 years pre-guideline and (2009-2013) 7 years post-guideline (2015-2021) implementation and were manually reviewed for clinical diagnosis of orbital cellulitis. Variables collected included demographics, empiric antibiotics, presence of abscess, surgical intervention, bacterial identification by blood or surgical culture, length of stay, and related readmission. Statistic analysis included chi square, fisher's exact test and Wilcoxon ranked sum.Fig 2.Bacteria isolated from blood or surgical culture in all cases*13 cases were polymicrobial Results 134 cases were included in the analysis (46 pre and 88 post guideline). Median age was 7 in both groups; there was incidentally a significantly higher proportion of males in the post-guideline group (54% v 75%, p=0.025). Post guideline, empiric use of vancomycin significantly decreased from 54% to 23% (p< 0.001) (fig 1). Among cases with vancomycin use post-guidance, 60% of use was concordant with the guideline. Length of stay was reduced from a median of 4 days to 3 days (p=0.001). Rate of abscesses and surgical intervention were nearly identical in pre and post populations (63% with abscess, and 24% with surgery in both groups). Overall, bacterial cultures from blood or abscess were positive in 26% of cases (10 (22%) pre, 25 (28%) post guideline); 13 (37%) were polymicrobial. All 3 MRSA cases were susceptible to clindamycin. Conclusion Implementation of a hospital-wide guideline can result in more judicious use of broad spectrum antibiotics. Reduction in vancomycin occurred without increased length of stay, need for surgical intervention, or readmission. Disclosures All Authors: No reported disclosures

Optimizing antibiotic stewardship and reducing antimicrobial resistance in Central Asia: A study protocol for evidence-based practice and policy.

Antimicrobial resistance (AMR) poses a significant global health challenge, prompting the World Health Organization (WHO) to stress the importance of monitoring antibiotic consumption and sales to address AMR effectively. This study protocol aims to optimize antibiotic stewardship and combat AMR in Central Asia through evidence-based practices and policies. The protocol includes objectives such as conducting systematic reviews of interventions to promote judicious antibiotic use, assessing antibiotic consumption trends, and investigating antibiotic overuse practices among healthcare providers. The study aims to raise awareness among stakeholders to enhance appropriate antibiotic prescribing practices. By establishing regulatory frameworks, monitoring policies' effectiveness, and providing training programs for healthcare professionals, this study seeks to contribute to the global efforts in combating AMR and promoting prudent antibiotic use.

Bad practices of administering antibiotics via drinking water in Algerian broiler chicken farms

The incorrect use of antibiotics in livestock has contributed to the emergence and dissemination of resistant bacteria that can be transmitted from animals to humans. In this context, our research aimed to identify the poor practices of antibiotic administration via drinking water in broiler chicken farms in two wilayas of Algeria, to urge farmers to take the necessary corrective measures and to encourage the judicious use of antibiotics. We found inappropriate management of drinking water, as well as inadequate practices in the preparation and distribution of medications in the majority of the visited chicken farms, which can significantly affect the efficacy of antibiotic therapy via drinking water. Furthermore, in farms utilizing modern management practices, we noted irregularities in the maintenance protocols of the pipelines and gaps in the dissolution of medications.

Nasal carriage of multi-drug resistance Staphylococcus aureus constitutes potential zoonosis from poultry farmers and butchers in slaughterhouses in Abakaliki, Ebonyi state, Nigeria

BackgroundIn Nigeria, poultry farming contributes significantly to the economy. Antibiotic use in poultry farming may promote the emergence of multidrug-resistant Staphylococcus aureus, a pathogen of human diseases that inhabit body cavities like the nostrils. This study assessed multi-drug-resistant Staphylococcus aureus in nasal carriage among poultry farmers and butchers in Abakaliki, Ebonyi State, Nigeria.MethodsA total of 300 nasal swabs of poultry farmers and butchers in slaughters from New Layout Market and Josephine Elechi Poultry Farm were analyzed in the Microbiology Laboratory Unit of Ebonyi State University.ResultsResults showed that Staphylococcus aureus occurrence rates were 20% (poultry farm A), 17% (poultry farm B), 15% (poultry slaughter A), and 16% (poultry slaughter B). Methicillin-resistant Staphylococcus aureus (MRSA) prevalence rates were 11% (39 handlers) and 14% (39 butchers). Antibiotic sensitivity tests revealed high resistance to lincomycin (100%), clindamycin (100%), doxycycline (94.7%), vancomycin (89.5%), erythromycin (89.5%), trimethoprim (73.3%), and ciprofloxacin (60.5%) in poultry farm A. Poultry Farm B samples exhibited resistance to doxycycline (93%), trimethoprim (72%), vancomycin (86.1%), erythromycin (83.7%), lincomycin (100%), and piperacillin-tazobactam (95.4%). Poultry slaughter A samples displayed resistance to doxycycline (100%), trimethoprim-sulfamethoxazole (80%), vancomycin (86.7%), erythromycin (93.3%), lincomycin (100%), and clindamycin (100%), while samples from poultry slaughter B showed resistance to erythromycin (100%), lincomycin (100%), clindamycin (100%), doxycycline (92.6%), vancomycin (88.9%), and trimethoprim-sulfamethoxazole (74.1%). Multiple antibiotics resistance index (MARI) was 0.7 among poultry farmers and 0.6 among poultry butchers provokes great concern.ConclusionTherefore, our findings emphasized the importance of judicious antibiotic use and preventive measures to control MRSA spread in the poultry industry.

Prevalence of methicillin resistant Staphylococcus aureus in a tertiary hospital of Nepal

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is one of the leading causes of healthcare associated infection. It causes different types of difficult-to-treat infections as these pathogens are resistant to β-lactam antibiotics. The changing epidemiology, ever-increasing prevalence and changing trends of susceptible antibiotics is a global concern. The aim of this study was to evaluate the prevalence of MRSA isolated from various samples. Method: It was a hospital based descriptive cross-sectional study conducted at Patan Hospital, Patan Academy of Health Sciences. All the records of the patient whose culture and sensitivity report yielded Staphylococcus aureus from 1st January 2021 to 31st December of 2023 was extracted from the hospital electronic database and analyzed. Ethical approval was taken from the Institutional Review Committee. Result: Out of 1259 Staphylococcus aureus isolates, 570(45.14%) were MRSA out of which, 380(66.67%) were identified from samples collected through outpatient department visits. MRSA had higher sensitivity to vancomycin (100%), linezolid (97.57%), doxycycline (93.17%) and chloramphenicol (84.67%). The sensitivity was concerning to clindamycin (39.57%), trimethoprim-sulfamethoxazole (36.23%), azithromycin (32.73%) and erythromycin (27.87%) and very alarming to gentamicin (19.00%), ofloxacin (5.57%) and ciprofloxacin (4.40%). Conclusion: The prevalence of MRSA infection is alarming in the patients visiting our outpatient departments and has shown no signs of improvement over the past three years. Gradual decline to once sensitive drugs is now being observed. To address this issue, continuous surveillance, good Infection control practices and judicious antibiotic use are needed not only in hospitals but also in community settings.

A Comprehensive Analysis of the Epidemiological and Genomic Characteristics of Global Serratia marcescens

BackgroundSerratia marcescens outbreaks present significant challenges in clinical treatment, necessitating a deeper understanding of its epidemiological and genomic traits. ObjectiveTo analyze the epidemiological and genomic characteristics of S. marcescens at a global scale. MethodsHigh-quality genomes of S. marcescens were retrieved from NCBI and annotated using Prodigal. Antibiotic resistance genes (ARGs) were identified via Blastn, sequence types (STs) were determined with a proprietary tool, and phylogenetic analysis was conducted to explore evolutionary relationships. ResultsThe study analyzed genomes from 33 countries, with major contributions from the USA (27.8%), UK (15.3%), Italy (14.7%), and Japan (10.7%). Human clinical samples accounted for 73.5% of the isolates, primarily from blood (44.8%) and sputum (19.3%). Eleven ARGs were identified, with sde being the most prevalent. Carbapenemase genes included blaSME, blaKPC, and blaNDM-1, though co-occurrence in individual strains was absent. Novel ARGs, including armA, rmtC, and fosA7.2, were reported. Among 855 genomes with identified STs, ST366, ST367, ST365, and ST423 were most common. Phylogenetic analysis highlighted significant genetic diversity and distinct evolutionary lineages. ConclusionTemporal analysis showed a genome peak in 2019, underscoring the global prevalence and adaptability of S. marcescens. The distribution of ARGs across diverse STs emphasizes horizontal gene transfer as a key driver of resistance. Judicious antibiotic use is essential to mitigate further resistance.

Antibiotic use prior to attending a large diarrheal disease hospital among preschool children suffering from bloody or non-bloody diarrhea: A cross-sectional study conducted in Bangladesh.

Among diarrheal children, injudicious use of antibiotics is a major public health concern particularly in low- and middle-income countries. There are evidence-based guidelines by the World Health Organization (WHO) to prescribe antibiotics for bloody diarrhea in children. There is a scarcity of published data regarding the judicious use of antibiotics for bloody diarrhea in children. So, we aimed to evaluate the presenting features of bloody diarrhea at hospital with prior antibiotic use at home and the prevalence of injudicious antibiotic use for bloody diarrhea in children. We screened 7,289 children aged 24-59 months with diarrhea (≥3 loose stools in the last 24 h) at Dhaka Hospital, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), from December 5, 2021 to February 16, 2023. Antibiotic intake at home due to current diarrheal illness was evaluated and confirmed by direct observation of a prescription, the bottle of antibiotics, or asking the caregiver about the name of antibiotics. Out of 7,289 children presented with diarrhea, 3,823 (52.45%) children consumed antibiotics before visiting hospital. 254 (3.48%) children presented with bloody diarrhea, among which 162 ingested antibiotics. Among 162 children, 88 (54.32%) received inappropriate antibiotics due to bloody diarrhea, according to the WHO guidelines. The most prevalent single antibiotic consumed in bloody diarrhea was metronidazole (n = 45, 27.78%), followed by ciprofloxacin (n = 39, 24.07%) and azithromycin (n = 32, 19.75%). After adjusting for relevant covariates like age, sex, presence of straining/tenesmus, fever during admission, history of cough, stunting, wasting, and underweight; children suffering from bloody diarrhea had 1.55 times higher odds of using metronidazole alone or in combination with other antibiotics (aOR:1.55, 95% CI: 1.10-2.19, p-value = 0.012) and 1.93 times higher odds of using multiple antibiotics (aOR:1.93, 95% CI: 1.23-3.02, p-value = 0.004) compared to children with non-bloody diarrhea. The study underscores the excessive use of antimicrobials among children with diarrheal illnesses. It is also evident that metronidazole use and multiple antibiotic use are increasing among children due to bloody diarrhea, which is alarming and calls for antibiotic stewardship by regulating bodies in the country.

Exploring comparative analysis of antibiotic resistance patterns in E.coli bacterial strains through the agar plate method

Abstract Introduction Antibiotic effectiveness varies across classes and bacteria, complicating the fight against infections. Utilising E. coli as a model organism offers insights into the microbial response to antibiotics. The agar plate method is crucial for visualising and assessing antibiotic resistance efficacy1. The looming threat of antibiotic resistance, with a potential death toll of 10 million by 2050, emphasises the urgency2. Investigating E. coli's role in gut health and its interaction with antibiotics via agar plate assays informs the selective use of broad-spectrum and narrow-spectrum antibiotics, vital for medical and agricultural applications3. Aim This study aims to explore the differential efficacy of broad-spectrum and narrow-spectrum antibiotics, including ampicillin, chloramphenicol, cefoxitin, and erythromycin, against E. coli using the agar plate method. The study aims to evaluate the effects of different antibiotics on E. coli to identify patterns of resistance and susceptibility, providing insights into the bacterial response to these drugs. Methods To maintain aseptic conditions, all equipment was sterilised, and a sterile workspace was established, as illustrated. The agar plates were carefully labelled with the specific bacterial strains and antibiotics slated for evaluation. Employing sterile techniques, the E. coli strains were swabbed onto these agar plates to ensure an even distribution. Antibiotic discs were then methodically placed onto the agar, spaced appropriately to prevent overlap, and gently pressed to ensure contact with the medium. These plates were subsequently incubated at 37°C for 24-48 hours, allowing for bacterial growth and antibiotic diffusion. Post-incubation, the diameters of the inhibition zones around each antibiotic disc were meticulously measured. Following the experimental procedures, biohazard materials were disposed of in accordance with safety protocols, and equipment was re-sterilised. To uphold the experiment’s validity and reliability, it was repeated over four weeks, with the average results compiled and analysed. Results This study evaluates the antibacterial effectiveness of four antibiotics over four weeks, measuring the area of inhibition against E. coli. Ampicillin's inhibition varied significantly, with a peak of 2358.58 mm² in Week 3 after a drop to 1468.46 mm² in Week 2. Chloramphenicol also showed variability, peaking at 897.27 mm² in Week 3. Cefoxitin displayed a consistent increase in effectiveness, with an inhibition area of 2317.44 mm² in Week 2. Erythromycin showed no inhibitory effect throughout the study. The data emphasises the dynamic bacterial response to these treatments. Discussion or Conclusions This study provides valuable insights into the relationship between antibiotic use and bacterial resistance in E. coli strains, utilising the agar plate method to assess antibiotic effectiveness and predict future resistance trends. By analysing inhibition zone patterns over time, the study identifies emerging resistance, suggesting this method’s utility in forecasting bacterial evolution. However, the approach is limited by its focus on in vitro conditions, which may not fully capture in vivo complexities, and it does not consider genetic mutations or environmental influences. These limitations highlight the need for more comprehensive research. The study advocates for integrated global strategies, combining judicious antibiotic use with novel antimicrobial developments.

Harnessing the microbiome: probiotics, antibiotics and their role in canine and feline gastrointestinal disease.

Unfavourable alterations of the host microbial environment, known as dysbiosis, have been identified in many canine and feline gastrointestinal (GI) diseases. As a result, normalisation of microbial composition and function has become an important therapeutic target. Given the complex and individualistic interplay between the resident microbiota, host and environment, a multimodal approach is often necessary when addressing dysbiosis in dogs and cats with GI disease. Systemic antibiotics are often empirically used to treat acute and chronic GI diseases. However, with modern genomic techniques demonstrating the profound negative effect antibiotics can have on the GI microbiota and the rapid emergence of resistant bacteria globally, there has been an increased focus on identifying antibiotic alternatives for use in small animal practice. Biotics, such as prebiotics, probiotics and synbiotics, are of growing interest due to their potential supportive effect on the microbiota. This article reviews the evidence for the use of biotics in canine and feline GI disease, highlighting how judicious use of antibiotics and targeted probiotic supplementation can enhance patient outcomes by promoting a balanced gut microbial environment.

Hypervirulent Carbapenem-Susceptible Klebsiella pneumoniae ST412/K57 with Strong Biofilm Formation: Association with gas gangrene and sepsis

Hypervirulent Klebsiella pneumoniae (hvKp) poses a serious public health threat. Gas gangrene caused by hvKp is rarely reported and potentially results in a poor prognosis. This study describes the case of a hospitalised patient with gas gangrene and sepsis caused by hvKP. Carbapenem-susceptible hypervirulent Klebsiella pneumoniae (CS-hvKp) strains KPLSN and KPLSX were isolated from the knee joint pus and blood specimens of the patient for further investigations. Whole genome sequencing revealed that KPLSN and KPLSX were highly homologous (single nucleotide polymorphisms [SNPs]<10) and belonged to ST412/K57. The minimum inhibitory concentration and minimum bactericidal concentration under biofilm values of meropenem in KPLSN and KPLSX were significantly higher than in the planktonic state (>128 mg/L vs. 0.25 mg/L, P<0.0001). These two strains had high biofilm formation ability, and the results from fluorescence staining experiments showed that they were not easily killed by meropenem in the biofilm state. KPLSN and KPLSX showed high capsule production and were confirmed to have high virulence through experiments with the Galleria mellonella infection model and the BALB/c mice abdominal infection model. The persistent symptoms may be due to enhanced biofilm and capsule formation. Phylogenetic analysis of global ST412 strains showed their evolution towards higher virulence and resistance. These results emphasise the critical need for judicious antibiotic use and novel therapeutic approaches to combat special infections caused by these pathogens.

Multi-layered factors contribute to irrational use of antibiotics among pediatric patients in Tanzania: ADDO dispensers perspective

BackgroundAntimicrobial resistance (AMR) is a major public health problem affecting both current and future generations. Development of resistance to the commonly available antibiotics has been directly linked to their irrational use. The World Health Organization (WHO) has clearly stated on the Global Strategy on AMR, judicious antibiotic use as well as adequate knowledge and awareness about AMR, as important tools in curbing the existing problem. Therefore, this study aimed to explore the level of knowledge among accredited drug dispensing outlet (ADDO) dispensers on factors contributing to irrational use of antibiotics among Tanzanian pediatric patients.MethodsA qualitative study employing focused group discussions was conducted among 6–10 ADDO dispensers with at least 6 months dispensing experience in 14 regions between July and August 2020. Thematic analysis was used to analyze the data.ResultsFindings from this study indicate that the ADDO dispensers have adequate knowledge on antimicrobial resistance. Participants were aware of the general meaning and the use of antimicrobials. They were aware that antimicrobials are used for treating infections caused by microbes such as bacteria, fungi, and viruses. Participants knew AMR increases health related costs and that the increasing burden of AMR is not an outcome of a specific group of people such as health care providers or patients, rather a contribution of many factors that bring change in microorganism behavior. Despite this knowledge, participants felt that most of the private health care facilities are profit-oriented; they practice polypharmacy to maximize profit rather than focusing on providing quality health services. Participants revealed that dose shortage after symptomatic relief strongly contributes to AMR. Lastly, the ADDO dispensers expressed that continuous medical education and community education to patients is necessary in the efforts to fight against AMR.ConclusionsTo mitigate the increasing AMR burden in our society, integrated interventions must include both communities, ADDOs as first point of contact and other healthcare providers. Periodic refresher training with an emphasis on proper practices is crucial to help the dispensers transform their knowledge into action. Responsible authorities should ensure that ADDOs and other private health care facilities adhere to regulations.

Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults.

Evidence is limited about the comparative safety of antibiotic regimens for treatment of community-acquired pneumonia (CAP). We compared the risk of adverse drug events (ADEs) associated with antibiotic regimens for CAP treatment among otherwise healthy, non-elderly adults. We conducted an active comparator new-user cohort study (2007-2019) of commercially-insured adults 18-64 years diagnosed with outpatient CAP, evaluated via chest x-ray, and dispensed a same-day CAP-related oral antibiotic regimen. ADE follow-up duration ranged from 2-90 days (e.g., renal failure [14 days]). We estimated risk differences [RD] per 100 treatment episodes and risk ratios using propensity score weighted Kaplan-Meier functions. Ankle/knee sprain and influenza vaccination were considered as negative control outcomes. Of 145,137 otherwise healthy CAP patients without comorbidities, 52% received narrow-spectrum regimens (44% macrolide, 8% doxycycline) and 48% received broad-spectrum regimens (39% fluoroquinolone, 7% β-lactam, 3% β-lactam + macrolide). Compared to macrolide monotherapy, each broad-spectrum antibiotic regimen was associated with increased risk of several ADEs (e.g., β-lactam: nausea/vomiting/abdominal pain [RD per 100, 0.32; 95% CI, 0.10-0.57]; non-Clostridioides difficile diarrhea [RD per 100, 0.46; 95% CI, 0.25-0.68]; vulvovaginal candidiasis/vaginitis [RD per 100, 0.36; 95% CI, 0.09-0.69]). Narrow-spectrum antibiotic regimens largely conferred similar risk of ADEs. We generally observed similar risks of each negative control outcome, indicating minimal confounding. Broad-spectrum antibiotics were associated with increased risk of ADEs among otherwise healthy adults treated for CAP in the outpatient setting. Antimicrobial stewardship is needed to promote judicious use of broad-spectrum antibiotics and ultimately decrease antibiotic-related ADEs.

Antibiotic Overuse in Pediatric Patients Hospitalized with RSV, COVID-19, and Influenza

Abstract Background Children hospitalized with viral respiratory tract infections (RTIs) are often treated with antibiotics due to concern for bacterial co-infection, although most do not have concurrent bacterial infections. This practice leads to unnecessary antibiotic treatment, which can lead to development of resistant bacteria and adverse events. The extent of antibiotic overuse in hospitalized children with community-onset viral RTI has not been well-quantified in recent years and may have worsened during the COVID-19 pandemic. The objectives of this study were to quantify and compare the extent of antibiotic overtreatment and to determine predictors of antibiotic use post-COVID-19 pandemic in children hospitalized with RSV, COVID-19, and influenza. Methods We performed a single center retrospective study evaluating percentages of antibiotic use and bacterial co-infection among children and adolescents aged &amp;lt;19 years old, hospitalized with respiratory syncytial virus (RSV), influenza, or SARS-CoV-2 between April 2020 and May 2023. Bacterial infection was defined as growth of bacteria from any specimen source, including blood, urine, pleural fluid, cerebrospinal fluid, and respiratory secretions, excluding common contaminants like coagulase-negative Staphylococci. Predictors of antibiotic treatment were determined using multivariable logistic regression. Results During the study period 1,718 patients were included (1022 with RSV, 188 with influenza, 535 with COVID-19). RSV patients were younger and more likely to be in the ICU than influenza or COVID-19 patients. The overall proportion of patients with culture-confirmed bacterial co-infection was low at 8% and did not differ greatly by virus type (8% for influenza, 6.9% for RSV, 10.3% for COVID-19, p=0.03). The proportion of children receiving antibiotics was higher for influenza than for other viruses (60.6% for influenza, 41.2% for RSV, and 48.6% for COVID-19, p &amp;lt; 0.001). Among patients with the lowest severity of illness (with normal inflammatory markers [PCT &amp;lt;0.5 ug/mL or CRP &amp;lt;50 mg/L] and not admitted to the ICU), 7.3% had a culture-confirmed bacterial infection while 48.1% received antibiotics. Independent predictors for receiving antibiotics were elevated inflammatory markers (C-reactive protein or procalcitonin), having &amp;gt;3 comorbidities, mechanical ventilation, and influenza diagnosis. Conclusion In children hospitalized with community-onset viral RTIs, antibiotic treatment is substantially higher than the burden of culture-confirmed bacterial infection, suggesting antibiotic overuse. Antibiotic use was greater for patients with influenza than for those with RSV or COVID-19. Antibiotic overuse was estimated to occur in over 40% of patients with low severity of illness. Stewardship programs can use this data to design interventions to promote more judicious antibiotic use. Figure 1. Rates of bacterial co-infection and antibiotic utilization among patients hospitalized with influenza, RSV, and COVID. Blue, percentage of patients who had a culture-confirmed bacterial infection; orange, percentage of patients who received any antibiotics; green, percentage of patients who received &amp;gt;3 days of antibiotics.

Distribution and Antimicrobial Susceptibility Profile of Extended Spectrum Beta-Lactamase Producing-Escherichia coli from Ruminants in Maiduguri, Nigeria: Public Health Implications

Extended spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli) is resistant to many antibiotics, including cephalosporins and penicillin. The emergence of ESBL-E. coli poses a threat to the entire animal and human community, not just individuals with direct exposure to ruminants but also to the environment. The study evaluated the isolation rate and antimicrobial susceptibility profile of ESBL-producing E. coli from 128 ruminants in the University of Maiduguri campus. E. coli was isolated from 32 (25%) of the rectal swabs collected from cattle, goats, and sheep. ESBL-producing E. coli was more common in young animals 8(30.8%) than in adult animals 12 (11.8%). More than 80% of the isolates were resistant to all of the beta-lactam antibiotics used in the study. The study suggests that the high prevalence of ESBL-producing E. coli in ruminants may be associated with the unregulated use of beta-lactam antibiotics in veterinary practice and animal husbandry. We recommend public health awareness about the dangers of antimicrobial resistance. Also, continued monitoring of BL-E. coli prevalence in both animals and humans is crucial to track trends and guide interventions. Promoting the judicious use of antibiotics in both human and veterinary medicine is essential to reduce selective pressure for resistance development. Improved hygiene practices at farms, slaughterhouses, and food processing facilities can minimize contamination and human exposure.

ROLE OF FUNGI IN COVID-19 PATIENTS WITH CHRONIC LUNG DISEASE IN RANI DURGAVATI MEDICAL COLLEGE, BANDA (FORMERLY GOVERNMENT ALLOPATHIC MEDICAL COLLEGE, BANDA 210001 (UP) INDIA.)

Background: Fungal infections of the lung have gained increasing recognition in the field of infectious disease and they are difficult to diagnosis. Advances in modern treatment like antibiotics corticosteroids, Immunosupressants and anticancer drugs have lead to increase in opportunistic fungal infections including bronchopulmonary Candidiasis and Bronchopulmonary aspergillosis has also increased, commonly occurs in COVID-19 patients of pre existing bronchial asthma. In India there is high prevalence of chronic lung diseases including bronchial Asthma, yet the diagnosis of aspergillosis and Candidiasis. An association between asthma and aspergillosis was noted and confirmed by isolation of Aspergillus species more commonly in sputum of Asthma patients (Lum et al., 2020 Singla, N. et al., 2019). Subject and Methods: To find out the role of fungi in 50 Corona virus (RTPCR test) positive patients of chronic lung disease (non tubercular) like COPD, Chronic Bronchitis with or without emphysema, Broncheichtasis, Bronchial Asthma were included. Patients were attended and admitted in Rani Durgavati Medical College (RDMC) and Hospital, Banda (UP) India, in a one year period was taken up from December 2020 till December 2021. The diagnosis of these cases v/as established by clinical features, radiological examination of chest, ECG, pulmonary function tests. Laboratory procedure for isolation and identification of fungi in bronchoalveoiar lavage. Each specimen of Bronchoalveloar Lavage (BAL) was subjected to various laboratory procedures for isolation and identification of fungi. Result: Different fungal species were cultured in 26% total cases. 20% isolates were positive for fungi alone whereas rest 6% cases showed both bacterial and fungal pathogens amongst fungi Candida was the predominant isolate in 16% cases followed by Aspergillus in 8% cases and Histopfasms capsulatum in just1(2%) case. Fungal isolates in bronchial aspirates were sensitive to Amphotericin B, Fluconazole, etc. Conclusion: COVID-19 Patients which are already containing chronic lung diseases especially COPD, bronchiectasis is more common in elderly males. The Bronchiectatic patients are also at risk of getting, fungal infections Patients of chronic lung disease who are on long-term antibiotic therapy, and or steroids are more predisposed to get these opportunistic infections. Another conclusion from it is clear that there is great need better and judicious use of antibiotics in patients to prevent drug resistance, to prevent further progression of the diseases.

Escherichia coli, an important Uropathogen: Characteristics and antimicrobial susceptibility pattern at Prof. Dr. I.G.N.G. Ngoerah General Hospital, period January 2020 – December, 2021

Background: Urinary tract infections (UTIs) are among the most common infections globally, often treated empirically with broad-spectrum antibiotics without prior culture and sensitivity testing. This practice has contributed to the rise in antibiotic resistance. Escherichia coli (E. coli) is the primary pathogen in uncomplicated UTIs, accounting for 70–90% of cases. However, other bacteria such as Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis are also significant, especially in complicated or healthcare-associated UTIs. This study examines the resistance patterns of E. coli in UTI cases. Method: A descriptive cross-sectional study was conducted using secondary data from medical records of UTI patients treated at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2020 to December 2021. E. coli isolates were identified, and antibiotic sensitivity tests were performed using the VITEK® 2 compact automatic system, with antimicrobial sensitivity and resistance determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Result: Analysis of 639 UTI patients revealed that E. coli exhibited high resistance to cefixime (13.3%), ciprofloxacin (23.8%), and trimethoprim-sulfamethoxazole (35.2%). The highest levels of susceptibility were observed with Tigecycline, Meropenem, and Ertapenem, with rates ranging from 99.2% to 99.8%. The demographic data showed a higher incidence of UTIs in female patients (70.9%) compared to males (29.1%), with the majority of cases occurring in adults (94.52%). Additionally, 52.26% of the E. coli isolates were ESBL-producing strains, complicating treatment options. Conclusion: The study underscores the urgent need for judicious antibiotic use, guided by culture and sensitivity testing, to combat the rising threat of antibiotic-resistant UTIs. Tigecycline, Meropenem, and Ertapenem should be prioritized in treatment protocols for multidrug-resistant cases. Continuous surveillance and the development of new antimicrobial agents are essential to address this escalating public health challenge