Judicious Use Of Antimicrobials Research Articles

Impact of untreated preoperative asymptomatic bacteriuria in patients undergoing holmium laser enucleation of prostate.

Treatment of preoperative asymptomatic bacteriuria (ASB) before endoscopic surgery is recommended by European Association of Urology (EAU) guidelines. United Kingdom (UK) practice varies, however, owing to the historical nature of the evidence behind the guidelines, risk of increased antimicrobial resistance, the paradoxical view that treatment of ASB leads to increased infection and inefficiencies in rescheduling. We do not routinely treat ASB in our practice before holmium enucleation of the prostate (HoLEP). To determine the safety of this, we examined our experience focusing on the infective complications. Retrospective data collection was performed on consecutive patients undergoing HoLEP between 2015 and 2020. Indication, preoperative urine cultures and infective complications were recorded. No patients were pretreated with oral antibiotics. All patients received intravenous antibiotics on induction and routine postoperative oral antibiotics at the surgeon's discretion. Some 443 patients were studied. No urosepsis occurred in the 125 patients with ASB compared with 2 of 318 patients (0.6%) with no growth on preoperative urine culture. Twenty-nine (7%) patients were treated with oral antibiotics for symptomatic postoperative complications (urinary tract infection without fever, epididymitis and haematuria). ASB did not predict for infective complications (urosepsis odds ratio [OR]: 0.50 p=0.66; oral antibiotics OR: 0.97 p=0.93). Not treating ASB before a HoLEP procedure is safe. This supports the judicious use of antimicrobials preoperatively. Other modalities of endoscopic surgery should be similarly assessed.

Barriers to recording calf health data on dairy farms in Ontario, Canada

Accurate data on illness and treatment rates in dairy calves are necessary for health management, yet calf health records are often incomplete. Due to the effects of illness in calves on future production, common use of antimicrobials in calf dis­ease, and concerns regarding judicious use of antimicrobials, we need to understand why calf health data are often poorly re­corded on dairy farms. Our objective was to investigate barriers for farmers for recording calf illnesses and treatments on dairy farms in Ontario, Canada.

Assessing bacterial prevalence and resistance in paediatric meningitis: safeguarding the central nervous system.

Paediatric bacterial meningitis (PBM) represents a major contributor to childhood morbidity and mortality globally, with heightened susceptibility in low- and middle-income nations where antimicrobial resistance (AMR) is highly prevalent. Pakistan exemplifies this setting, with widespread antibiotic overuse driving AMR expansion. Thus, expediting PBM diagnosis and targeted antibiotic therapy is imperative yet challenged by the dynamic local epidemiology. This study aimed to delineate the recent bacterial etiologies and AMR profiles of PBM from a major Pakistani diagnostics laboratory to inform empirical treatment. This prospective observational investigation evaluated PBM epidemiology in patients under 18 years old admitted to the study hospital. Standard cerebrospinal fluid analysis identified bacterial pathogens and antibiotic susceptibility patterns. Among 171 PBM cases, 152 (88.9%) had bacterial isolates confirmed via culture. The cohort was 42.7% male with a mean age of 3 months. The most prevalent pathogens among infants younger than 3 months were Escherichia coli, Enterococcus faecium, and Staphylococcus epidermidis, contrasting with S. epidermidis, Streptococcus pneumoniae, and Staphylococcus hominis predominating in older children. Staphylococcal isolates exhibited considerable penicillin and erythromycin resistance but maintained vancomycin and linezolid susceptibility. Other resistance patterns varied. These findings highlight the pressing threat of paediatric AMR in Pakistan, underscoring the need for vigilant AMR surveillance and judicious antimicrobial use. This study provides a reference to current PBM epidemiology to guide context-specific empirical therapy.

The prevelance of multidrug resistance in uropathogens of patients admitted in the intensive care unit of a tertiary care hospital.

Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50-65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings.

Prescribing antimicrobials effectively in Dentistry; Resources to support the role of the dentist in antimicrobial stewardship

Background The discovery of antibiotics revolutionised modern medicine and extended the average human lifespan by 23 years.1 Antimicrobial resistance threatens to reverse the progress that has been made. In 2019, there were 4.95 million deaths globally associated with drug-resistant bacterial infections.2 That figure may rise to as many as 50 million by 2050, making this an unprecedented global public health problem.3 The threat of a post-antibiotic era has prompted the publication of Ireland’s One Health National Action Plan on Antimicrobial Resistance (2021-2025).4 This National Action Plan advocates for the judicious use of antimicrobials to limit any unintended consequences and antimicrobial resistance. This is commonly known as Antimicrobial Stewardship. Antibiotic resistance is largely driven by the overuse and misuse of antibiotics in people, animals and in the environment.4 Dentists are responsible for approximately 10% of antibiotic prescribing in humans globally.5 With several international studies of dental antibiotic prescribing demonstrating that overprescribing occurs frequently5, dentists have an opportunity to contribute significantly to slowing the development and spread of antibiotic resistance by optimising prescribing. This article aims to show how dentists can support good antimicrobial stewardship in their practice.

Antimicrobial use and appropriateness in neutropenic fever: a study of the Hospital National Antimicrobial Prescribing Survey data.

Neutropenic fever (NF) is a common complication in patients receiving chemotherapy. Judicious antimicrobial use is paramount to minimize morbidity and mortality and to avoid antimicrobial-related harms. To use an Australian national dataset of antimicrobial prescriptions for the treatment of NF to describe antimicrobial use, prescription guideline compliance and appropriateness; and to compare these findings across different healthcare settings and patient demographics. We also aimed to identify trends and practice changes over time. Data were extracted from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) database from August 2013 to May 2022. Antimicrobial prescriptions with a NF indication were analysed for antimicrobial use, guideline compliance and appropriateness according to the Hospital NAPS methodology. Demographic factors, hospital classifications and disease characteristics were compared. A total of 2887 (n = 2441 adults, n = 441 paediatric) NF prescriptions from 254 health facilities were included. Piperacillin-tazobactam was the most prescribed antimicrobial. Overall, 87.4% of prescriptions were appropriate. Piperacillin-tazobactam and cefepime had the highest appropriateness though incorrect piperacillin-tazobactam dosing was observed. Lower appropriateness was identified for meropenem, vancomycin, and gentamicin prescribing particularly in the private hospital and paediatric cohorts. The most common reasons for inappropriate prescribing were spectrum too broad, incorrect dosing or frequency, and incorrect duration. This study provides insights into antimicrobial prescribing practices for NF in Australia. We have identified three key areas for improvement: piperacillin-tazobactam dosing, paediatric NF prescribing and private hospital NF prescribing. Findings from this study will inform the updated Australian and New Zealand consensus guidelines for the management of neutropenic fever in patients with cancer.

Clonal and plasmidic dissemination of critical antimicrobial resistance genes through clinically relevant ExPEC and APEC-like lineages (ST) in the dairy cattle population of Québec, Canada.

Antimicrobial resistance can be effectively limited by improving the judicious use of antimicrobials in food production. However, its effect on the spread of AMR genes in animal populations is not well described. In the province of Québec, Canada, a new legislation implemented in 2019 has led to an unprecedented reduction in the use of critical antimicrobials in dairy production. We aimed to investigate the potential link between ESBL/AmpC E. coli isolated before and after legislation and to determine the presence of plasmids carrying genes responsible for critical AMR. We collected fecal samples from calves, cows, and manure pit from 87 Québec dairy farms approximately 2 years before and 2 years after the legislation came into effect. The whole genomes of 183 presumptive ESBL/AmpC E. coli isolated after cefotaxime enrichment were sequenced. Their phylogenetic characteristics (MLST, serogroup, cgMLST) and the presence of virulence and resistance genes and replicons were examined. A maximum likelihood phylogenetic tree was constructed based on single nucleotide polymorphism (SNPs). We identified 10 clonal lineages (same cgMLST) and 7 clones (SNPs ≤ 52). Isolates belonging to these clones could be found on different farms before and after the legislation, strongly suggesting a clonal spread of AMR genes in the population during this 4-year period. All isolates were multidrug resistant (MDR), with clone 2 being notable for the presence of macrolide, fluoroquinolone, and third-generation cephalosporin resistance genes. We also identified clinically relevant ExPEC (ST10) and APEC-like lineages (ST117, ST58, ST88) associated with the presence of ExPEC and APEC virulence genes, respectively. Our data also suggests the presence of one epidemic plasmid belonging to the IncY incompatibility group and carrying qnrs1 and blaCTX-M-15. We demonstrated that AMR genes spread through farms and can persist over a 4-year period in the dairy cattle population through both plasmids and E. coli clones, despite the restriction of critical antimicrobial use. MDR ExPEC and APEC-like STs are present in the normal microbiota of cattle (more frequently in calves). These data increase our knowledge on gene dissemination dynamics and highlight the fact that biosecurity measures should be enhanced in this industry to limit such dissemination.

Salmonella enterica Serovar Dublin from Cattle in California from 1993 to 2019: Characterization and Analysis of Antimicrobial Resistance Diversity.

For this study, antimicrobial susceptibility data for Salmonella enterica subsp. enterica serovar Dublin (S. Dublin)-a well-known cattle-adapted pathogen with current concerns for multidrug resistance-were recovered from cattle at the California Animal Health and Food Safety Laboratory System (CAHFS) over the last three decades (1993-2019) and were evaluated using tools to capture diversity in antimicrobial resistance. For this purpose, minimum inhibitory concentration (MIC) testing was conducted for 247 clinical S. Dublin isolates. Antimicrobial resistance (AMR) profiles revealed a predominant core multidrug-resistant pattern in the three most common AMR profiles observed. Antimicrobial resistance richness, diversity, and similarity analysis revealed patterns for changes in AMR profiles for different age groups. Discriminant analysis using MIC log2-transformed data revealed changes in MIC for year groups, with a time-sequence pattern observed. Drivers for reduced susceptibility were observed for 3rd generation cephalosporins and quinolones observed for more recent year groups (2011-2015 and 2016-2019) when compared to older year groups (1993-1999 and 2000-2005). Together, these results highlight the changes in the diversity of AMR profiles, as well as changes in susceptibility of S. Dublin over time for critical antimicrobials of importance to both animals and humans, and support the need for continued monitoring and efforts that will support judicious use of antimicrobials, especially for these two drug classes.

Prevalence, extended-spectrum β-lactamase and biofilm production ability ofEscherichia coli isolated from buffalo mastitis

This study aimed to determine the prevalence, antibiotic resistance pattern, extended-spectrum, beta-lactamase production and biofilm forming ability of isolated E. coli strains from buffaloes mastitis milk. Out of 549 bacterial isolates from mastitis milk of buffaloes (n, animal level= 472) between 2019 and 2022, a total of 43 E. coli strains were isolated with an overall prevalence of 9.11% at animal level. Prevalence of E coli was high in unorganised buffalo herd (11.36%) from villages of Farmer FIRST project (ICAR-FFP) compared with organised buffalo farms (6.73%). The highest resistance was against Penicillin 43 (100%) followed by Ceftriaxone 18 (41.86%), Amoxycillin/Sulbactam 8 (18.60%) and Enrofloxacin 7 (16.27%). Additionally, all were sensitive to gentamycin 43 (100%) followed by Cefoperazone/Sulbactam 34 (79.06%). Cephalosporins are frequently used antibiotics to treat bovine mastitis. However, their therapeutic effectiveness is being compromised by bacterial resistant to β-lactams. In present study, a total of 32 (6.78% %) extended-spectrum β-lactamase (ESBL) producing E coli were isolated from mastitic buffalo milk (n=43/472). In total, 17 (39.5%) isolates were biofilm producers by microtiter-plate method. There was statistically non-significant relationship between biofilm production and antibiotic resistance as well as between ESBL production and biofilm formation in E coli strains. Present study demonstrated a high occurrence of ESBL and biofilm producing E. coli in buffalo mastitis milk, implementing a significant challenge to treat mastitis in buffaloes, necessitates judicious use of antimicrobials and to explore potential therapeutic agents as substitutes forantibiotics to treat bovine mastitis effectively.

1263. The Experience of an Antimicrobial Stewardship Program at a Tertiary Referral Hospital in a Low/Middle Income Country

Abstract Background Antimicrobial Stewardship Programs (ASP) play a crucial role in optimizing antimicrobial utilization and limiting the use of broad-spectrum antibiotics, to reduce antimicrobial resistance. During the COVID-19 pandemic, there was a noticeable increase in antimicrobial consumption globally. The ASP at the American University of Beirut Medical Center (AUBMC) began formal operations in January 2019. In this study, our aim is to evaluate the activities of the ASP -since implementation and during the pandemic- at our institution, a tertiary referral hospital in Beirut. Methods The ASP team performed handshake stewardship rounds and daily reviews of antimicrobial use. It provided educational activities in a multi-disciplinary approach in addition to implementing a carbapenem sparing strategy and ongoing monitoring of antibiotic consumption. This study is a retrospective review of those activities. We compiled the ASP recommendations from January 2019 until December 2021. Data collected included the number of ASP recommendations and their sub-categories in addition to acceptance rates. Results We recorded a total of 9922 recommendations during this three-year period. Recommendations aiming at reducing antimicrobial consumption were the most common (42%), and included: duration of therapy, de-escalation, and duplicate coverage (Figure 1). Rates of acceptance of these recommendations were 88%, 92% and 95% in 2019, 2020 and 2021 respectively. The number of recommendations increased during the pandemic and coincided with COVID-19 surges in Lebanon (figure 2). There was also an increase in the acceptance rate of recommendations to reduce antibiotic consumption (Figure 3) over this period.Figure 1.Distribution of ASP Interventions per sub-CategoryFigure 2.Number of ASP Recommendations pre- and During COVID-19Figure 3.ASP recommendations to Reduce Antibiotic Consumption and Acceptance Rate Conclusion Despite the challenges imposed by the pandemic and the involvement of the ASP in the COVID-19 response, the team maintained its efforts and involvement to mitigate antibiotic misuse. The results are encouraging and attest to the important role of ASP in driving culture change regarding the judicious use of antimicrobials even during a pandemic. Disclosures Souha S Kanj, MD, Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant

1017. Impact of a Multifaceted Approach to Audit-and-Feedback Antimicrobial Stewardship Intervention in Acute Leukemia Patients Using Measures of Appropriateness

Abstract Background Prospective audit-and-feedback (PAF) for hospitalized leukemia patients is resource-intensive, while data on stadardized assessment of the quality, i.e. appropriateness, of antimicrobial prescribing are scarce. We implemented a multifaceted program combining patient-level PAF with unit-level appropriateness reports generated by serial point-prevalence surveys using the web-based Canadian National Antimicrobial Prescribing Survey (NAPSTM) platform. Quality of prescribing was assessed based on local guidelines and clinical justification using published definitions (Fig. 1). The objective of the study was to evaluate the impact of PAF+NAPS interventions on antibiotic use (AU) in acute leukemia patients at an academic cancer center, compared to PAF-only. Methods In this retrospective cohort study, during the PAF-only period (Jun 1 2017-May 31 2019), the AMS team led 30-minute PAF rounds with prescribers 2x/week. After implementating PAF+NAPS (Jun 1 2019-Mar 31 2020), we met 2x/month for 30 minutes. At each meeting we presented an automated NAPS dashboard report (Fig. 2) of aggregate appropriateness adjudication of antibiotic prescriptions, followed by targeted PAF on select patients with complex antimicrobial needs. We analyzed the impact of the two-step approach on the primary outcome of AU (defined daily dose [DDD]/100 patient-days [PD]) using interrupted time series models. Secondary outcomes were appropriateness of AU during PAF+NAPS, lenght of stay and in-hospital mortality. Target appropriatenesss was at least 90%. Categorical variables were compared using chi-square test and continuous variable using Mann Whitney U test.Fig. 2Sample Canadian NAPS Dashboard Report From a Point-Prevalence Survey Results Patient characteristics and outcomes were presented in Table 1. AU data were presented in Table 2. AU of piperacillin-tazobactam and vancomycin decreased significantly after implementation of 2x/month PAF+NAPS, compared to 2x/week PAF-only interventions (Fig. 3). Overall appropriateness was 91.4% (1757/1921 prescriptions). Conclusion Despite reducing frequency of interventions from 2x/week to 2x/month, PAF+NAPS was an efficient and sustainable AMS model that promoted appropriate and judicious antimicrobial use in hematology-oncology patients (Fig. 4), allowing the AMS team to expand to other specialized areas. Disclosures Shahid Husain, MD, Astellas: Grant/Research Support|Avir: Grant/Research Support|F2G: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Pulmocide: Grant/Research Support|Synexis: Grant/Research Support|Takeda: Honoraria

Trends of feline Escherichia coli minimum inhibitory concentrations over 14 years illustrate the need for judicious antimicrobial use in cats.

This study aims to assess the antimicrobial resistance (AMR) trends among Escherichia coli isolated from cats between 2008 and 2022, utilizing MIC data, within a one-health framework. The study analyzed MIC results from 1,477 feline E coli isolates that were obtained from samples submitted to the Cornell University Animal Health Diagnostic Center, primarily from the northeastern US. MIC values were categorized as susceptible or not susceptible using the Clinical and Laboratory Standards Institute breakpoints. Multidrug resistance (MDR) was analyzed using a Poisson regression model. Additionally, accelerated failure time models were employed to analyze MIC values. Out of the 1,477 E coli isolates examined, 739 (50%) showed susceptibility to all tested antimicrobials. Among the tested antimicrobials, cefazolin (69%) and ampicillin (74% for urinary tract isolates) exhibited the lowest susceptibility. Overall, 15% of isolates were not susceptible to cefovecin. E coli isolates were highly susceptible (> 95%) to antibiotics typically reserved for human use. Almost one-third of the isolates were classified as MDR, with nonurinary isolates more likely to exhibit an MDR pattern. A decrease in MICs for fluoroquinolones and gentamicin in recent years was identified. However, MICs for cephalexin increased from 2016 to 2022 and cefovecin from 2012 to 2019. This study highlights the challenge of AMR in feline medicine, emphasizing the importance of responsible antimicrobial use and surveillance to address E coli AMR. The related Currents in One Health by Cazer et al, JAVMA, December 2023, addresses additional feline antimicrobial stewardship topics.

Effect of Sampling Method on Detection of the Equine Uterine Microbiome during Estrus.

Bacterial endometritis is among the most common causes of subfertility in mares. It has a major economic impact on the equine breeding industry. The sensitivity of detecting uterine microbes using culture-based methods, irrespective of the sample collection method, double-guarded endometrial swab, endometrial biopsy, or uterine low-volume lavage (LVL), is low. Therefore, equine bacterial endometritis often goes undiagnosed. Sixteen individual mares were enrolled, and an endometrial sample was obtained using each method from all mares. After trimming, quality control and decontamination, 3824 amplicon sequence variants were detected in the dataset. We found using 16S rRNA sequencing that the equine uterus harbors a distinct resident microbiome during estrus. All three sampling methods used yielded similar results in composition as well as relative abundance at phyla (Proteobacteria, Firmicutes, and Bacteroidota) and genus (Klebsiella, Mycoplasma, and Aeromonas) levels. A significant difference was found in alpha diversity (Chao1) between LVL and endometrial biopsy, suggesting that LVL is superior at detecting the low-abundant (rare) taxa. These new data could pave the way for innovative treatment methods for endometrial disease and subfertility in mares. This, in turn, could lead to more judicious antimicrobial use in the equine breeding industry.

Detection of virulence genes and multidrug resistance in Pseudomonas aeruginosa clinical isolates from a public hospital in Lagos, Nigeria

Pseudomonas aeruginosa is a main cause of nosocomial infections and is classified as a priority critical pathogen of global concern. Multidrug resistance and virulence genes attributed to the pathogenicity of the organism has resulted in failed therapies, linked to increased morbidity and mortality in infected patients. The aim of this study was to determine the virulence genes and multidrug resistant P.aeruginosa in clinical specimens from a secondary health care center laboratory in Lagos, Nigeria. MethodologyA total of three hundred and sixty-seven clinical samples were examined with conventional methods and Microbact GNB12A. Forty- seven (47) P. aeruginosa strains were identified. Antimicrobial susceptibility test was performed by the standard disk diffusion method following CLSI guidelines. Identification of P. aeruginosa was done by amplification of oprL and oprI genes. Monoplex and multiplex PCR assays were used for detecting virulence genes (lasB, toxA, exoU and nan1). Descriptive statistical methods were used to analyze the distribution of P. aeruginosa by sample sources, MDR patterns by number of isolates and virulence gene carriage by MDR (≥3classes of antibiotics). ResultsA total of forty-seven (47) isolates were confirmed as P. aeruginosa. The isolates showed pan-resistance to cefuroxime and ceftazidime. An elevated level of resistance was also seen in amoxycillin-clavulanic acid, ceftriaxone, cefixime and meropenem. Susceptibility to Amikacin was 95.7 %. Multidrug resistance was seen in forty (85.1 %) of the isolates. P. aeruginosa (100 %) were confirmed with oprL and 74.5 % oprI genes. All isolates (100 %) had lasB, toxA and exoS virulence genes while nan1 was detected in 19.1 % isolates. ConclusionsDiverse and multiple virulence genes were distributed among the multidrug resistant isolates. Understanding the factors contributing to pathogenicity and antibiotic resistance will aid in the treatment of infection. It will also promote judicious use of antimicrobials.

The Essential Role of Senior Care Pharmacists in Antimicrobial Stewardship: An Updated Position Statement on Behalf of the American Society of Consultant Pharmacists and the Society of Infectious Diseases Pharmacists.

Senior care pharmacists are well-positioned to lead and drive antimicrobial stewardship (AMS) initiatives, not only through audit and data collection, but also through communication, collaboration, and cooperation with prescribers and nurses to influence prescribing behaviors. Senior care pharmacists are in a unique position to take a leadership role within the interprofessional team to achieve AMS goals. They should engage with the interprofessional team to promote the judicious and appropriate use of antimicrobials at their practice sites. This position statement is an update of the 2017 version by the American Society of Consultant Pharmacists (ASCP) Antimicrobial Stewardship and Infection and Prevention Control Committee and the Society of Infectious Diseases Pharmacists (SIDP).

A survey of antimicrobial use practices on veal farms in the United States.

Neonatal veal calves are highly susceptible to bacterial diseases. Occasional sub-optimal early-life care and long-distance transportation result in high disease burden and antimicrobial treatment incidence. Nonetheless, judicious use of antimicrobials is necessary to mitigate the animal and human health impacts of antimicrobial resistance. The objective of this cross-sectional study was to use a clinical vignette-based survey approach to evaluate the potential for reduced group or individual therapeutic antimicrobial use. The survey included items probing the adherence to veterinary-written protocols, antimicrobial use (AMU) at the calf- and group-level, and the treatment actions to case vignettes of calf diarrhoea, pneumonia, and navel infection. The survey was mailed to all veal calf producers within two U.S. production companies (n = 32 producers in Company 1; n = 70 producers in Company 2) in February and December 2019, respectively. The overall survey response rate was 36% (21/59). Although 95% of producers reported having veterinary-written treatment protocols for diarrhoea, pneumonia, and navel infection, veal producers infrequently (<50% of the time) referenced these protocols. Veal producers were primarily trained for disease identification and treatment by observing other personnel "on-the-job" (81%). Veal producers reported a high incidence of calf diarrhoea relative to pneumonia and naval infection, a lower percentage (≤40%) of diarrhoea cases being treated individually with antimicrobials. Using clinical vignettes, our results suggest that AMU decisions among veal producers depend on the severity of clinical signs for diarrhoea and pneumonia, while navel infections are often treated with antimicrobials regardless of sign severity. Nearly two-thirds of veal producers reported treating uncomplicated cases of diarrhoea (watery stool with normal body temperature, activity, and appetite), more than previously reported from dairy producers (37.1%). Findings from this survey suggest that calf producer-focused training to guide antimicrobial treatment decisions and improve producer adherence to veterinary-written treatment protocols may have important impacts on judicious antimicrobial use.

Salmonella infection among the pediatric population at a tertiary care children's hospital in central Nepal: a retrospective study.

Typhoid fever, an infective bacterial disease, is capable of causing fatal systemic infection in humans, and in an era of antimicrobial resistance, it has become of public health importance. This study aimed to investigate the laboratory diagnosis of Salmonella bloodstream infection, its serotype, antimicrobial resistance pattern, and seasonal variation at a tertiary care children's hospital. We undertook a retrospective, cross-sectional study by reviewing hospital-based laboratory records of patients whose blood culture samples were submitted from the outpatient department to the laboratory of a tertiary care children's hospital in Kathmandu, Nepal, from January 2017 to January 2019. Among the total blood culture samples obtained (n = 39,771), bacterial isolates (n = 1,055, 2.65%) belonged either to the Genus Enterobacteriaceae or Genus Acinetobacter. Altogether (n = 91, 8.63%), isolates were positive for Salmonella spp., which were further identified as Salmonella enterica subsp. enterica ser. Typhi (n = 79, 7.49%), Salmonella enterica subsp. enterica ser. Paratyphi A (n = 11, 1.04%), and Salmonella enterica subsp. enterica ser. Paratyphi B (n = 1, 0.1%). The median age of patients was 6 years (IQR: 4-9), with male and female patients constituting (n = 53, 58.24%; OR, 1.0; 95% CI, 0.60-1.67) and (n = 38, 41.76%; OR, 0.98; 95% CI, 0.49-2.05) cases, respectively. The disease was observed throughout the year, with a high prevalence toward the spring season (March-May). An antibiogram showed resistance more toward nalidixic acid with S. Typhi, comprising half the isolates (n = 52, 65.82%; p = 0.11). Resistance toward β-lactams with β-lactamase inhibitors (amoxicillin/clavulanate; 1.27%) was seen in a single isolate of S. Typhi. The multidrug resistance pattern was not pronounced. The multiple antibiotic resistance (MAR) index was in the range between 0.14 and 0.22 in S. Typhi and 0.22 and 0.23 in S. Paratyphi. Salmonella Typhi was the predominant ser. Infection was common among children between 1 and 5 years of age, showing male predominance and with the spring season contributing to a fairly higher number of cases. Antimicrobial susceptibility testing of S. Typhi showed more resistance toward nalidixic acid, with only a single isolate resistant to β-lactamase inhibitors (amoxicillin/clavulanate). Alarming multidrug resistance patterns were not observed. The MAR index in this study indicates the importance of the judicious use of antimicrobials and hospital infection prevention and control practices.

Adoption and decision factors regarding selective treatment of clinical mastitis on Canadian dairy farms

As clinical mastitis (CM) treatments are responsible for a large portion of antimicrobial use on dairy farms, many selective CM treatment protocols have been developed and evaluated against a blanket treatment approach of CM cases. Selective treatment protocols use outcomes of diagnostic tests to exclude CM cases from antimicrobial treatment when they are unlikely to benefit. To tailor interventions to increase uptake of selective treatment strategies, a comprehension of current on-farm treatment practices and factors affecting treatment decisions is vital. Two questionnaires were conducted among 142 farms across 5 provinces participating in the Canadian Dairy Network for Antimicrobial Stewardship and Resistance in this cross-sectional study. Self-reported adoption of selective CM treatments by dairy farmers was 64%, with median of 82% of cows treated in those herds using selective treatment. Using logistic regression models, the odds to implement a selective CM treatment protocol increased with a decreasing average cow somatic cell count. No other associations were identified between use of a selective CM treatment protocol and farm characteristics (herd size, CM incidence, province, milking system, and housing system). Three subsets of farmers making cow-level CM treatment decisions were identified using a cluster analysis approach: those who based decisions almost exclusively on severity of clinical signs, those who used various udder health indicators, and farmers who also incorporated more general cow information such as production, age, and genetics. When somatic cell count was considered, the median threshold used for treating was >300,000 cells/mL at the last Dairy Herd Improvement test. Various thresholds were present among those considering CM case history. Veterinary laboratories were most frequently used for bacteriological testing. Test results were used to start, change, and stop treatments. Regardless of protocol, reasons for antimicrobial treatment withheld included cow being on a cull list, having a chronic intramammary infection, or being at end of lactation (i.e., close to dry off). If clinical signs persisted after treatment, farmers indicated that they would ask veterinarians for advice, stop treatment, or continue with the same or different antibiotics. Results of this study can be used to design interventions targeting judicious mastitis-related antimicrobial use, and aid discussions between veterinarians and dairy producers regarding CM-related antimicrobial use.

Antimicrobials in patients with hematologic malignancies and recipients of hematopoietic cell transplantation and other cellular therapies.

Appropriate use of antimicrobials for hematologic malignancy, hematopoietic stem cell transplant recipients, and other cellular therapies is vital, with infection causing significant morbidity and mortality in this unique population of immunocompromised hosts. However, often in this population the choice and management of antimicrobial therapy is complex. When selecting an antimicrobial agent, key considerations include the need for dose adjustments due to renal or hepatic impairment, managing drug interactions, the potential for additive drug toxicity among those receiving polypharmacy and therapeutic drug monitoring. Other factors include leveraging pharmacodynamic principles to enable optimization of directed therapy against challenging pathogens, as well as judicious use of antimicrobials to limit drug resistance and adverse drug reactions. This review summarizes the clinical considerations for commonly used antimicrobials in this setting, including antibacterial, antiviral, and antifungal agents.

Occurrence of Sub-clinical mastitis and Associated Risk Factors in Lactating Goats in Selected Areas of Eastern Harerghe Zone, Oromia, Ethiopia

Subclinical mastitis reduces the quality and quantity of milk and is a disease of great economic and public health importance. A cross-sectional study was conducted to estimate the occurrence of subclinical mastitis, associated risk factors, and isolate of Staphylococcus aureus in lactating goats in the Eastern Hararghe zone, Ethiopia. A total of 384 lactating goats were sampled and screened by White Side test (WST) to detect subclinical mastitis. The study results revealed that animal and udder/halve level prevalence was 23.2% and 21.8% respectively, while 30 teats were found to be blind. Univariate analysis of the potential risk factors has depicted that mastitis was more prevalent in does with medium age, poor body condition, late lactation stage, does sample from Aweday, does mixing with others, closed housed goat, weakly manure removal and previous history of mastitis showed a statistically significant association with the proportion of subclinical mastitis (p &lt; 0.05). With multivariable analysis, age, lactation stage, and origin of sampled animals showed significant association with subclinical mastitis prevalence, and these factors continued significant in the multivariable logistic regression model after stepwise elimination (p &lt; 0.05). As a result, does in mid-age (OR=9.06, 2.24-36.60, late stage of lactation (OR=2.52, 1.21-5.24), and does sample from Aweday (OR=4.43, 1.37-14.38) were at higher risk of udder infections than younger age, early lactation and does sampled from Haramaya separately. In the present study, S. aureus has been isolated from 37.1% of goat milk. Antibiogram study results indicated that gentamicin and erythromycin were found to be the most effective drug against S. aureus. The present study has also demonstrated the existence of alarmingly high levels of antimicrobial resistance of S. aureus against chloramphenicol (100%), Vancomycin (87.5%), and Ampenciline (81.8%). The results of this study deep-rooted the importance of S. aureus as a possible cause of subclinical mastitis in goats and the spread of multiple drug-resistant S. aureus. It is therefore, recommended to prevent subclinical mastitis in the study area by considering potential risk factors, regular screening and microbiological examination of udder of lactating goats as well as judicious use of antimicrobials to treat subclinical mastitis.