Judicious Use Of Antibiotics Research Articles

TETRACYCLINE RESISTANCE AND DISCOLORATION OF TEETH: A COMPREHENSIVE STUDY ON DRUG RESISTANCE AND ITS IMPLICATIONS IN THE FEDERAL AREA OF PAKISTAN

Tetracycline antibiotics have been pivotal in managing bacterial infections in Pakistan and globally. However, the rampant misuse and overuse of tetracyclines have catalyzed the emergence of antibiotic resistance, presenting a pressing public health challenge. Additionally, the administration of tetracyclines during tooth development can result in tooth discoloration, exerting a profound impact on oral health and the overall quality of life. This research paper delves into assessing the prevalence of tetracycline resistance within the Federal Area of Pakistan, scrutinizes the interplay between tetracycline usage and tooth discoloration by enlisting 682 participants, and comprehensively evaluates the implications of antibiotic resistance on public health within the region. A rigorous examination of tetracycline resistance in the Federal Area of Pakistan comprised an extensive survey involving 682 individuals. The study encompassed diverse age groups and demographic characteristics to ensure a representative sample. The participants were interviewed, and their medical histories were scrutinized to establish the extent and patterns of tetracycline usage. Subsequently, dental examinations and assessments were carried out to identify cases of tooth discoloration associated with tetracycline exposure. Bacterial isolates from clinical specimens were subjected to susceptibility testing to determine the prevalence of tetracycline resistance in the region. The findings of this study revealed a substantial prevalence of tetracycline resistance among bacterial isolates in the Federal Area of Pakistan. Furthermore, the investigation demonstrated a significant correlation between tetracycline usage during tooth development and tooth discoloration in the surveyed population. The high incidence of tetracycline-induced tooth discoloration emphasized the need for increased awareness regarding the judicious use of antibiotics, especially in vulnerable populations. Tetracycline resistance in Pakistan's Federal Area is a pressing concern. Irresponsible use during tooth development can cause discoloration. To combat resistance, regulate use, educate the public, and promote alternative treatments. An integrated approach is urgently needed to protect public health.

Multi-drug Resistant Mannheimia hemolytica and Pasteurella multocida in Pneumonic Sheep in Bangladesh

Background: Pneumonia in sheep is a complicated multicausal disease which affects the respiratory system causing increased morbidity and herd mortality rate. The members of Pasteurellaceae family are one of the prime causes of bacterial pneumonia in ruminants. Once infected by these organisms, antimicrobial therapy becomes obligatory. In Bangladesh, causation of pneumonic pasteurellosis and their antibiogram is unknown in sheep which insists the veterinarians to choose empirical antimicrobial therapy. Objectives: This study was undertaken to identify multidrug resistant Pasteurella multocida and Mannheimia hemolytica in sheep suspected with pneumonia. Methodology: The samples of nasal swab and the lungs were collected aseptically. After overnight incubation in Brain Heart Infusion broth, the samples were streaked onto 5.0% sheep Blood Agar to obtain pure colony with characteristic features which were subjected to biochemical tests, polymerase chain reaction (PCR), and antibiogram study against eight antibiotics. Results: A total number of 140 samples were collected of which 120 nasal swabs and 20 lungs were collected aseptically. In total, 16.7% pneumonia cases in sheep were found to be caused by Pasteurella species. Out of 140 samples, 43.57% (61/140) were positive for Mannheimia hemolytica (68.85%) and 19.67% for Pasteurella multocida. The mixed infection by both organisms was 11.48%. The Mannheimia hemolytica (MH) was predominant in lungs (100.0%) and nasal swab samples (18.3%) than Pasteurella multocida (PM) which were 15% and 7.5% respectively. All the isolates were found to be multi-drug resistant where resistance against Penicillin and Ampicillin was 100% for all isolates. The resistance of Mannheimia hemolytica and Pasteurella multocida towards sulfonamide, ceftriaxone, oxytetracycline, gentamicin, and streptomycin were 63.33%, 49.44%, 44.44%. 16.67%, 11.11% and 78.22%, 45.46%, 45.45%, 36.36%, 27.27% respectively. Among all antibiotics tested, Chloramphenicol stands out to be the most effective one (100% sensitive). Conclusion: This study states the first molecular identification of Mannheimia hemolytica and Pasteurella multocida from sheep suspected with pneumonia in Bangladesh and their antibiogram pattern against commonly prescribed antimicrobials. Due to their commensalism nature and wide host coverage, these MDR pathogens warrant judicious use of antibiotics in small ruminants to reduce veterinary public health hazard. Bangladesh Journal of Infectious Diseases, June 2023;10(1):16-23

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness.

One of India's predominant public health issues is acute undifferentiated fever illness (AUFI), a typical response to an infectious agent. Diagnosisbecomes challenging when the disease has been reported with fever as the primary symptom. Among thecases presenting at a tertiary care hospitalin central India, 88% had an acute undifferentiated fever, the most common being dengue infection. In India, rural communities are at more risk from AUFI than cities. Most of those in danger are those who reside in remote areas, and one of the most significant risksis for those who reside close toforests. AUFI is a complex condition for physicians to deal with and is one of the most frequent clinical conditions for which empirical treatment is required. Nowadays, AUFI can be managed by a syndromic approach with the judicial use of antibiotics. Symptoms of AUFI, along with myalgia, headache, and anorexia, can be caused by various illnesses. Patients are recommended to undertake a battery of investigations, which may delay the therapy and increase expenses because many diseases may present with the same symptoms. In the developed world, viral illness is the primary cause of AUFI. However, in developing countries like India, it can also be brought on by potentially curable but life-threatening conditions such as malaria, leptospirosis, hantavirus infection, and Japanese encephalitis. Lack of knowledge of the locally prevalent illnesses, which might be the causeof AUFI, and lack of preliminary screening and diagnostics at the point of care to identify the etiologies make it difficult to control these generally curable causes of the burden of AUFI, especially in tropical and subtropical countries. A deeper understanding of AUFI is required to develop better diagnostics and cures for various etiologies, especially scrub typhus.

Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey

COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship. We performed a systematic survey which included a search using the concepts "antibiotic/antimicrobial" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc. Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n=52, 83%) and less commonly antibiotic selection (n=13, 21%), and duration of therapy (n=15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship. There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

Clostridioides difficile is a bacterium responsible for a healthcare-associated gastrointestinal infection, primarily affecting people who have undergone prolonged antibiotic treatment or who have compromised immune systems. The CD is of particular concern due to its high recurrence rates and the potential for serious outcomes, including life-threatening conditions such as pseudomembranous colitis, septic shock, and all associated conditions. Since this infection is a disease associated with other health conditions, a general vision of the problems is necessary which aims to obtain a general overview of the manifestations that generally correlate with care. Clinical reasoning following the disease-clustering method is able to produce a categorization process by grouping the possible correlations of the various conditions or factors underlying diseases on the basis of certain similarities or common models. The clustering process is performed using data analysis techniques which, by statically correlating each other, give an exact dimension of all the information related to a particular disease. In the case of CD, reasoning based on disease clustering has better clarified the practices, appropriateness in infection control, judicious use of antibiotics, and research into therapeutic and preventive strategies. This review, taking advantage of the clustering strategy, aimed to analyze the contingent conditions of the infection under examination, to reduce the incidence and impact of CD, having as its mission the improvement of the results deriving from the contrast of all those correlated pathological conditions to healthcare for the improvement of public health.

Antibiotic resistance pattern of aerobic bacterial isolates from patients with skin and soft tissue infections in Karaikal

Skin and Soft Tissue Infections (SSTIs) are considered as non-fatal burden with significant morbidity and disability. The important challenge of severe SSTIs is choosing a drug for empirical treatment. From this region, only limited local antibiogram data is available. To determine the frequency of different aerobic bacteria isolated from patients with SSTIs attending dermatology and surgery departments of GH, Karaikal and to study the antibiotic resistance pattern of the isolates. This is a prospective, cross-sectional study with 100 samples. Standard protocol was followed for collection, processing, identification and antibiotic susceptibility testing. All isolates of and were screened for methicillin resistance and subsequently subjected to Oxacillin E-strip and Vancomycin E-strip to know the minimum inhibitory concentration (MIC) value. Isolates of Gram negative bacilli resistant to one or more carbapenems were tested for carbapenemase production using Modified Carbapenem Inactivation Method (MCIM) and multi drug resistant (MDR) organisms were identified. Most effective antibiotic for methicillin sensitive (MSSA) are Clindamycin (82.75%), Gentamicin (80.95%) and Cotrimoxazole (75%). The methicillin resistant (MRSA) incidence is 6.89% (2/29). Around 66.67% (4/6) of was Cefoxitin resistant. The carbapenem resistance was found to be 13.88% (5/36). Around 43.13% (22/51) Gram negative bacilli were MDR. The presence of MRSA and carbapenemase producing Gram negative bacilli are worrisome. Further, routine surveillance is needed to monitor the trends in antibiotic resistant pattern. However, this data paves way for judicious use of antibiotics for treatment and to prevent development of resistance in future.

Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance.

The rapid growth of telehealth services has brought about direct-to-consumer telemedicine platforms, enabling patients to request antibiotics online without a virtual or face-to-face consultation. While telemedicine aims to enhance accessibility, this trend raises significant concerns regarding appropriate antimicrobial use and patient safety. In this viewpoint, we share our first-hand experience with 2 direct-to-consumer platforms, where we intentionally sought inappropriate antibiotic prescriptions for nonspecific symptoms strongly indicative of a viral upper respiratory infection. Despite the lack of clear necessity, requested antibiotic prescriptions were readily transmitted to our local pharmacy following a simple monetary transaction. The effortless acquisition of patient-selected antibiotics online, devoid of personal interactions or consultations, underscores the urgent imperative for intensified antimicrobial stewardship initiatives led by state and national public health organizations in telehealth settings. By augmenting oversight and regulation, we can ensure the responsible and judicious use of antibiotics, safeguard patient well-being, and preserve the efficacy of these vital medications.

DRESS Syndrome in ICU : A Diagnostic Dilemma.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome can be severe and life-threatening especially in critical care setting if not diagnosed and treated in time. DRESS syndrome is an idiosyncratic drug reaction characterized by rash, fever, eosinophilia, lymphadenopathy and internal organ. Regis CAR (European Registry of Severe Cutaneous Adverse Reaction) scoring system is used for its diagnosis. Diagnosis of this syndrome can be challenging in critical care setting due to nonspecific clinical features, multiple confounding factors, use of polypharmacy, and its resemblance with sepsis and septic shock of varied etiologies. We report a case of 15-year-old boy who developed this syndrome after starting sulfasalazine, HCQ and NSAIDS all together, one month back for treatment of ankylosing spondylitis. This case report focuses on early suspicion and identification of this syndrome in critical care setting. This in turn should help in effective treatment of the illness by stopping offending drugs and timely initiation of steroid therapy. Further it may help in judicious use of antibiotics by holding irrational use of these drugs.

Investigating the evolution and predicting the future outlook of antimicrobial resistance in sub-saharan Africa using phenotypic data for Klebsiella pneumoniae: a 12-year analysis

BackgroundAntimicrobial resistance (AMR) is a major public health challenge, particularly in sub-Saharan Africa (SSA). This study aimed to investigate the evolution and predict the future outlook of AMR in SSA over a 12-year period. By analysing the trends and patterns of AMR, the study sought to enhance our understanding of this pressing issue in the region and provide valuable insights for effective interventions and control measures to mitigate the impact of AMR on public health in SSA.ResultsThe study found that general medicine patients had the highest proportion of samples with AMR. Different types of samples showed varying levels of AMR. Across the studied locations, the highest resistance was consistently observed against ceftaroline (ranging from 68 to 84%), while the lowest resistance was consistently observed against ceftazidime avibactam, imipenem, meropenem, and meropenem vaborbactam (ranging from 92 to 93%). Notably, the predictive analysis showed a significant increasing trend in resistance to amoxicillin-clavulanate, cefepime, ceftazidime, ceftaroline, imipenem, meropenem, piperacillin-tazobactam, and aztreonam over time.ConclusionsThese findings suggest the need for coordinated efforts and interventions to control and prevent the spread of AMR in SSA. Targeted surveillance based on local resistance patterns, sample types, and patient populations is crucial for effective monitoring and control of AMR. The study also highlights the urgent need for action, including judicious use of antibiotics and the development of alternative treatment options to combat the growing problem of AMR in SSA.

Raman-Based Antimicrobial Susceptibility Testing on Antibiotics of Last Resort.

Antibiotic resistance represents a serious global health challenge, particularly with the emergence of strains resistant to last-resort antibiotics such as tigecycline, polymyxin B, and vancomycin. Urgent measures are required to alleviate this situation. To facilitate the judicious use of antibiotics, rapid and precise antimicrobial susceptibility testing (AST) is essential. Heavy water (deuterium oxide, D2O)-labeled Raman spectroscopy has emerged as a promising time-saving tool for microbiological testing. Deuterium incorporation and experimental conditions were examined to develop and apply a Raman-based AST method to evaluate the efficacy of last-resort antibiotics, including tigecycline, polymyxin B, and vancomycin, against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecium. Essential agreement and categorical agreement were used to assess the metabolism inactivation concentration based on Raman spectroscopy (R-MIC)-a new metric developed in this study-and minimum inhibitory concentration (MIC) determined via the traditional microdilution broth method. Spearman's rank correlation coefficient was employed to measure the association between R-MIC and MIC values. The Raman-based AST method achieved a 100% categorical agreement (92/92) with the traditional microdilution broth method within five hours, while the traditional method required approximately 24 h. The R-MIC values shared 68.5% (63/92) consistency with the MIC values. In addition, the R-MIC and MIC values were highly correlated (Spearman's r=0.96), resulting in an essential agreement of 100%. Our optimized experimental method and conditions indicate that Raman-based AST holds great promise as a solution to overcome the time-consuming challenges of traditional AST methods.

Sulfonamides and β-lactam antibiotic residues and human health risk assessment in commercial chicken meat sold in Nairobi City, Kenya

The use of antibiotic pharmaceuticals in chicken husbandry has risen steadily over time. Antibiotic residues in chicken meat poses risks to human health in addition to their contribution to the advancement of antibiotic resistance. Despite the increased use of antibiotics in chicken farming in Kenya, assessments of the residues and human exposure have not been conducted. In this study, the sulfonamides (SAs); sulfapyridine (SPD), sulfadiazine (SDZ) and sulfamethazine (SMZ) and the β-lactams (βLs); ampicillin (AMP), penicillin G (PEG) and amoxicillin (AMX) were determined in three chicken meat types; ex-layers, broilers, and indigenous meat marketed in Nairobi City, Kenya. Residual SAs ranged from 0.1 to 154.4 μg kg−1, with SPD recording the highest concentration in ex-layers’ chicken meat samples. A range of 19.7 to 309.0 μg kg−1of BLs was found, where the highest amount represented AMX in ex-layers. Mean AMX contents in all chicken types, and AMP in broilers were above the Maximum Residue Limits (MRLs). For SAs, only SPD mean content was above MRL in ex-layers. Human health risks from exposure to antibiotic-contaminated chicken meat was evaluated using % ADI. All tested βLs were of no risk (<1% ADI) to human health. SPD and SDZ posed considerable risk (1–5% ADI) in some chicken meat, whereas SPD in ex-layers’ chicken meat posed distinctive risk (>5% ADI) to children. Considering the co-occurrence of different types of antibiotics in same samples, obtained MRLs and % ADI (for some of the antibiotics) are indicative of potential human health risks. Information is valuable in provoking response from concerned agencies and fostering activities that advocate for judicious use of antibiotics.

One biomarker does not fit all: tailoring anti-infective therapy through utilization of procalcitonin and other specific biomarkers

ABSTRACT Introduction Considering the ongoing increase in antibiotic resistance, the importance of judicious use of antibiotics through reduction of exposure is crucial. Adding procalcitonin (PCT) and other biomarkers to pathogen-specific tests may help to further improve antibiotic therapy algorithms and advance antibiotic stewardship programs to achieve these goals. Areas covered In recent years, several trials have investigated the inclusion of biomarkers such as PCT into clinical decision-making algorithms. For adult patients, findings demonstrated improvements in the individualization of antibiotic treatment, particularly for patients with respiratory tract infections and sepsis. While most trials were performed in hospitals with central laboratories, point-of-care testing might further advance the field by providing a cost-effective and rapid diagnostic tool in upcoming years. Furthermore, novel biomarkers including CD-64, presepsin, Pancreatic stone and sTREM-1, have all shown promising results for increased accuracy of sepsis diagnosis. Availability of these markers however is currently still limited and there is insufficient evidence for their routine use in clinical care. Expert opinion In addition to new host-response markers, combining such biomarkers with pathogen-directed diagnostics present a promising strategy to increase algorithm accuracy in differentiating between bacterial and viral infections. Recent advances in microbiologic testing using PCR or nucleic amplification tests may further improve the diagnostic yield and promote more targeted pathogen-specific antibiotic therapy.

Antibiotic prescription among children with common cold at a district hospital in Uganda.

Most childhood infections are of viral origin making antibiotics unnecessary. They are, however, the most frequently prescribed drugs dispensed to children, resulting in inappropriate antibiotic prescriptions, which are one of the main drivers of antibiotic resistance. The study aimed to determine the prevalence of antibiotic prescriptions and identify its associated factors among children below 5 years with common cold who attend the outpatient department in Tororo General Hospital. The study was carried out in Tororo General Hospital, Eastern Uganda. A cross-sectional survey using consecutive sampling was performed among children below 5 years with common cold attending the outpatient department. Data were collected using an interviewer-administered, structured questionnaire and analysed using STATA version 14.0. Prevalence of antibiotic prescriptions was calculated. Bivariate analysis using chi-square test and multivariate analysis using logistic regression was performed to establish factors associated with antibiotic prescription. The prevalence of antibiotic prescriptions for common cold among children below 5 years was 23.3%. Factors associated with antibiotic prescription for common cold were duration of symptoms of more than 5 days (OR, 95% CI: 4.49; 1.16-17.23, p = 0.029) and being attended to by a clinical officer (OR, 95% CI: 0.19; 0.04-0.91, p = 0.038). There is inappropriate antibiotic prescription among children with common cold in Tororo General Hospital. There is need for antibiotic stewardship programmes to promote optimal antibiotic use in primary care facilities.Contribution: The study's findings can be used to develop context-specific antibiotic stewardship programmes tailored to promote judicious use of antibiotics in primary care.

Bacterial profile and antibiotic selection for pediatric appendicitis: A retrospective cohort study

ObjectiveThe objective of this study was to identify the predominant bacteria cultured from the surface of removed appendices in pediatric patients with acute appendicitis and determine the appropriate choice of antibiotics for preoperative and postoperative management. MethodsA 2-year retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, UAE. Patients under 14 years of age with diagnosed acute appendicitis who underwent laparoscopic appendectomy were included. Swab cultures, along with demographic, laboratory, and pathology data, were analyzed. ResultsOut of the 56 enrolled patients, 27 (48 %) exhibited bacterial growth on swab cultures, while 29 (52 %) showed no bacterial growth. Escherichia coli (E. coli) was the predominant isolated bacteria, present in 23/27 patients (85 %). Seven patients had co-infections involving E. coli and other bacteria, with Pseudomonas being the second most common bacteria identified in 7/27 patients (25 %). Antibiotic sensitivity testing indicated that 85 % of the isolated bacteria were sensitive to Gentamicin, 63 % to Amoxicillin/Clavulanic acid, 59 % to Trimethoprim + Sulfamethoxazole, and 27 % to Cefazolin. ConclusionE. coli was the most prevalent bacteria identified on swabs taken from inflamed appendices in pediatric patients. Amoxicillin/Clavulanic acid was determined to be an appropriate choice for preoperative prophylaxis. This study provides valuable insights for guiding the management of pediatric appendicitis and facilitating the appropriate and judicious use of antibiotics.

AEROBIC BACTERIAL PROFILE AND ANTIBIOGRAM OF BRONCHOALVEOLAR LAVAGES IN PULMONARY INFECTIONS AT A TERTIARY CARE HOSPITAL

Objective: Lower respiratory tract infections (LRTIs) are one of the common clinical problems in community and hospital settings and the commonest causes of morbidity and mortality. In pulmonary infections, BAL fluid sample has high sensitivity and reliability in diagnosis. To determine the distribution of bacterial isolates in BAL samples and antibiotic sensitivity patterns in most frequently isolated bacterial pathogens other than Mycobacterium tuberculosis.&#x0D; Methods: The study was conducted on 218 BAL samples received in the microbiology laboratory, Andhra Medical College from various wards of King George Hospital; Visakhapatnam; Andhra Pradesh, over a period of one year (from January 2022 to December 2022). All samples were processed according to standard microbiology protocols. Antimicrobial susceptibility was tested by the Kirby-Bauer disc diffusion method as per the CLSI guidelines 2022.&#x0D; Results: Total 218 BAL samples were studied. Among 218 BAL samples, 144(66%) samples were from male patients and 74(34%) samples from female patients. Out of 218 samples, 119(55%) were culture positive and 99(45%) were culture negative. Among 119 bacterial isolates, most predominant pathogen was Klebsiella pneumoniae 51(42.8%) followed by Pseudomonas aeruginosa 46(38.6%), Escherichia coli 11(9.2%), Enterobacter species 6(5.0%), Acinetobacter species 3(2.5%) and Staphylococcus aureus 2(1.68%). Out of these isolated pathogens, Gram-negative bacilli were more. These gram-negative isolates were most sensitive to Piperacillin-Tazobactam (74.3%) followed by Meropenem (71.7%), Amikacin (60.6%) and least sensitive to Ceftazidime (39.3%) and Cefotaxime (37.6%).&#x0D; Conclusion: The present study shows that gram-negative bacilli were more commonly isolated in BAL samples and the bacterial isolates were most sensitive to Piperacillin-Tazobactam and Meropenem and highly resistance to Cefotaxime and Ceftazidime. Hence, formulating a regular antibiogram in hospitals will help in developing local antibiotic policies, which may provide better patient management and judicious use of antibiotics by clinicians to prevent the risk of the emergence of multidrug-resistant pathogens.

Evaluation of uropathogens isolated in the outpatient department of a tertiary care hospital in south India

: Urinary tract infections constitute a large percentage of cases encountered in outpatient departments at tertiary care hospitals. These infections have been associated with a rise in antimicrobial resistance, leading to high morbidity and mortality. This rise in drug resistance has been linked to an increase in unauthorized, unregularized use of higher generations of antibiotics, leading to the prevalence of multi drug resistant organisms in the community.: The aim of this study is to analyze the prevalence of various uropathogens in the general population, along with their antibiotic susceptibility patterns. : The study has been carried out for a period of six months, during which a total of 872 urine samples were collected from the outpatient department at Kamineni Academy of Medical Sciences and Research Center, Hyderabad. Urine samples were subjected to bacterial culture and significant bacterial growth was identified using the colony count method. Identification and antimicrobial susceptibility testing was done using an automated VITEK 2 compact system. A total of 236 cases (27.1%) showed significant growth of uropathogens. The common organisms isolated were These organisms were seen more commonly in females. Multidrug resistance has been noted in multiple uropathogens, especially to fluoroquinolones and cephalosporins. This study documented an increase in antimicrobial resistance of the uropathogens isolated at the outpatient department. Judicious use of antibiotics may aid in prevention of spread of antimicrobial drug resistance in the general population.

Prescription Pattern of Antibiotics in Pulmonary Ward of a Tertiary Care Hospital, Jammu and Kashmir

BACKGROUND&#x0D; World population growth, pollution and overcrowding have all contributed to an increase in respiratory infections. Antibiotic resistant virulent bacteria are on the rise, and they're spreading quickly. As a general rule, lower respiratory tract infections cause only minor symptoms but can lead to significant morbidity and mortality. Improvements in public and professional awareness of the long-term nature of many LRTIs could lead to better antibiotic stewardship. The objective of the study was to assess the prescription pattern of antibiotics in patients in a pulmonary ward of a tertiary care hospital, Jammu and Kashmir.&#x0D; METHODS&#x0D; A six-month prospective observational study in a pulmonary ward of a tertiary care hospital in Jammu and Kashmir looked at antibiotic use patterns in a single location. According to the inclusion and exclusion criteria, a total of 355 patients were considered for evaluation. Asthma, bronchitis, pneumonia, chronic obstructive lung disease (COPD), and acute respiratory infections such as the common cold and pharyngitis were all included in the study.&#x0D; RESULTS&#x0D; In our study, 230 (64.79%) of the 355 patients were males, while 125 (35.21%) were females. Pulmonary Tuberculosis had the highest number of cases observed (157 patients, 44.22 percent), followed by COPD 91 patients (25.63 percent), pneumonia 46 patients (12.95 percent), Pleural effusion cases 43 patients (12.11 percent), and Bronchiectasis cases 18 patients (5.07 percent). The findings revealed that the most commonly prescribed antibiotics were Cephalosporins, Macrolides, Metronidazole, Penicillins, Aminoglycosides, Doxycycline, Fluoroquinolones, and finally Carbapenems.&#x0D; CONCLUSIONS&#x0D; Globally, respiratory illnesses are on the rise due to a growth in population, pollution, urbanization and overcrowding. There is a rapid increase in the number of multi-drug-resistant pathogenic bacteria. However, lower respiratory tract infections can cause severe morbidity and mortality if left untreated. Understanding and judicious use of antibiotics may be improved if more people are aware of the long-term nature of LRTIs. In order to understand the dangers and advantages of antibiotic treatment, further research is needed. There is a risk that the use of antibiotics for minor viral respiratory infections could lead to the development of antibiotic-resistant viruses in the community.

Previous Antibiotic Exposure Reshapes the Population Structure of Infecting Uropathogenic Escherichia coli Strains by Selecting for Antibiotic Resistance over Urovirulence.

Antibiotic therapy is the standard of care for urinary tract infections (UTIs) caused by uropathogenic Escherichia coli (UPEC). However, previous antibiotic therapy may impart a selective pressure that influences the population structure and pathogenic potential of infecting UPEC strains. Here, we conducted a 3-year study using whole-genome-sequencing analysis and retrospective medical record review to characterize how antibiotic exposure influenced the phenotypic antibiotic resistance, acquired resistome, virulome, and population structure of 88 UTI-causing E. coli strains from dogs. A majority of UTI-associated E. coli strains were from phylogroup B2 and clustered within sequence type 372. Previous antibiotic exposure was associated with a population shift toward UPEC from phylogroups other than the typical urovirulent phylogroup B2. The specific virulence profiles within the accessory virulome that were associated with antibiotic use were elicited by the effect of antibiotics on UPEC phylogenetic structure. Among phylogroup B2, antibiotic exposure increased the quantity of genes within the resistome and the odds of developing reduced susceptibility to at least one antibiotic. Non-B2 UPEC strains harbored a more diverse and greater resistome that conferred reduced susceptibility to multiple antibiotic classes following antibiotic exposure. Collectively, these data suggest that previous antibiotic exposure establishes an environment that provides a selective edge to non-B2 UPEC strains through their diverse and abundant antibiotic resistance genes, despite their lack of urovirulence genes. Our findings highlight the necessity for judicious use of antibiotics as we uncover another mechanism by which antibiotic exposure and resistance can influence the dynamics of bacterial infectious disease. IMPORTANCE Urinary tract infections (UTIs) are one of the most common infections of dogs and humans. While antibiotic therapy is the standard of care for UTIs and other infections, antibiotic exposure may influence the pathogenic profile of subsequent infections. We used whole-genome sequencing and retrospective medical record review to characterize the effect of systemic antibiotic therapy on the resistance, virulence, and population structure of 88 UTI-causing UPEC strains isolated from dogs. Our results indicate that antibiotic exposure alters the population structure of infecting UPEC strains, providing a selective edge for non-B2 phylogroups that harbor diverse and abundant resistance gene catalogues but fewer urovirulence genes. These findings highlight how antibiotic resistance can influence pathogen infection dynamics and have clinical implications for the judicious use of antibiotics for bacterial infections.

Pediatric antibiotic stewardship programs in Europe: a pilot survey among delegates of The European Academy of Pediatrics.

Antimicrobial resistance (AMR) is one of the leading causes of morbidity and mortality worldwide. Efforts to promote the judicious use of antibiotics and contain AMR are a priority of several medical organizations, including the WHO. One effective way to achieve this goal is the deployment of antibiotic stewardship programs (ASPs). This study aimed to survey the current situation of pediatric ASPs in European countries and establish a baseline for future attempts to harmonize pediatric ASPs and antibiotic use in Europe. A web-based survey was conducted among national delegates of the European Academy of Paediatrics (EAP). The survey assessed the presence of pediatric ASPs in the representatives' countries in the inpatient and outpatient settings, the staff included in the programs, and their detailed activities regarding antibiotic use. Of the 41 EAP delegates surveyed, 27 (66%) responded. Inpatient pediatric ASPs were reported in 74% (20/27) countries, and outpatient programs in 48% (13/27), with considerable variability in their composition and activities. Guidelines for managing pediatric infectious diseases were available in nearly all countries (96%), with those for neonatal infections (96%), pneumonia (93%), urinary tract (89%), peri-operative (82%), and soft tissue (70%) infections being the most common. Pediatric ASPs were reported at the national (63%), institutional (41%), and regional/local (<15%) levels. Pediatricians with infectious disease training (62%) and microbiologists (58%) were the most common members of the program personnel, followed by physician leaders (46%), infectious disease/infection control physicians (39%), pharmacists (31%), and medical director representatives (15%). Activities of the pediatric ASPs included educational programs (85%), monitoring and reporting of antibiotic use (70%) and resistance (67%), periodic audits with feedback (44%), prior approval (44%), and post-prescription review of selected antibiotic agents (33%). Although pediatric ASPs exist in most European countries, their composition and activities vary considerably across countries. Initiatives to harmonize comprehensive pediatric ASPs across Europe are needed.

Epidemiology of patients presenting to the emergency department with acute febrile illness in the summer months in Karachi, Pakistan: a cross-sectional study.

This was a cross-sectional surveillance study conducted in the summers of 2017 and 2018 in the EDs of four tertiary care hospitals in Karachi, Pakistan. Patients 18 years of age and older, both males and females, that presented with a fever within 48h were enrolled in the study. The study sample was 5034. Prior comorbidities, medication history, and treatment offered for the illness and diagnosis were noted. The data were stratified by years, that is, 2017-2018. A χ 2-test and a one-way analysis of variance test were applied to check the association between fever presentation in years and covariates. Of the 5034 patients, 3045 (60.5%) presented in 2017 and 1989 (39.5%) presented in 2018. Almost half of the patients who presented with fever to the ED were between 25 and 44 years of age [2383 (47.3%)]. A majority of those presenting were male [3049 (60.6%)]. Most of the patients had a fever recorded between 101 and 102°F [1038 (20.6%)]. The most common accompanying symptoms were headache [2636 (52.4%)] and nausea and vomiting [2274 (45.2%)]. The majority of the patients were diagnosed as viral fever [2390 (47.5%)]. Patients were managed with antibiotics [3342 (66.4%)] and intravenous fluids [2521 (50.1%)] and a majority of patients were discharged [4677 (93.8%)]. Fever is a common presentation in the ED. Understanding the frequency of the causative agent will help improve diagnosis and the judicious use of antibiotics.