Level Of Antibiotic Use Research Articles

Self-Reported Antibiotics Usage, Allergies and Resistance of Albanian Patients from a Dental Perspective: A Preliminary Questionnaire-Based Survey.

The paper aims to assess the level of antibiotic use and the antibiotic types used generally in dentistry and identify self-reported allergies and resistance related to them. The data were collected between March and May 2024 via an electronic questionnaire on self-reported antibiotic usage, antibiotic allergies and resistances among individual in Albania. A total of 477 individuals (83% females, 17% males) with a mean 33 ± 13 (min 17; max 73) years of age completed the questionnaire. Overall, 88% of the population reported having used antibiotics before the questionnaire, among whom 56% used them for dental reasons. An average of 5% reported being allergic, mainly to the penicillin group, while 5% claimed to have undergone an antibiogram analysis before taking the prescribed antibiotics, with most of them showing resistance to the penicillin group. Based on the findings of this study, the high prevalence of antibiotics usage in dentistry encourages further deepening studies and training adapting global guidelines for antibiotics indications in dentistry to the level of antibiotics allergies and resistances of this specific country.

Identification of Antimicrobial-Resistant Zoonotic Bacteria in Swine Production: Implications from the One Health Perspective.

Antimicrobial resistance poses a major threat to global health and food security and is primarily driven by antimicrobial use in human and veterinary medicine. Understanding its epidemiology at farm level is crucial for effective control measures. Despite the significant reduction in antibiotic use in conventional livestock production, the swine sector traditionally has a higher level of antibiotic use in veterinary medicine. Consequently, multidrug resistance (MDR) among microbial isolates of swine origin has been relatively frequent. The aim of this study was to assess the presence of multidrug-resistant (MDR) bacteria, enteric pathogens and resistance genes to the main antibiotics used in clinical practice, both within the environment and in animals across pig farms characterized by varying degrees of sanitary status. A total of 274 samples were collected. Of these, 34 samples were collected from the environment (wall swabs, slat swabs and slurry pit), and 240 samples were collected from animals (sows' and piglets' rectal faeces). All samples were analysed for MDR bacteria and enteric pathogens. The study revealed a high frequency of extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales and Campylobacter spp., with ESBL-producing Enterobacterales predominating in high health status farms (environment and animals) and Campylobacter spp. in both high health status and low health status environments. Additionally, a high percentage of methicillin-resistant Staphylococcus aureus (MRSA) was found, mainly in environmental samples from high health status farms, and Clostridioides difficile was distributed ubiquitously among farms and samples. Furthermore, though less frequently, vancomycin-resistant Enterococcus faecium (VRE) was isolated only in high health status farms, and Gram-negative bacilli resistant to carbapenems were isolated only in environmental samples of high health status and low health status farms. This study underscores the importance of surveillance for MDR bacteria in farm animals and their environment, including their waste. Such ecosystems serve as crucial reservoirs of bacteria, requiring national-level surveillance to promote responsible antibiotic use and pandemic control.

Evaluation of banana peel extract (Musa sapientum L.) as a natural antimicrobial for livestock farming

AbstractIntroductionOne of the primary objectives of managing microbial content in livestock farming is to control diseases in the respective animals. Nevertheless, the pervasive development of drug‐resistant bacteria is a consequence of the high levels of antibiotic use that are necessary to achieve this objective. This situation exacerbates animal disease and poses a threat to human health. The purpose of this study was to investigate alternative microbial control methods in livestock farming using banana peel extract.Materials & MethodsThe antioxidant and antimicrobial activities of peel extracts from unripe and ripe cultivated bananas were examined and compared.ResultsThe results are notable because they show that the unripe banana peel extracts exhibited significantly better antioxidant activity than the ripe banana peel extracts in 2,2‐diphenyl‐1‐picrylhydrazyl (DPPH), 2,2′‐azino‐bis(3‐ethylbenzothiazoline‐6‐sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP) tests. Furthermore, the unripe banana peels showed significant antimicrobial activity in vitro against four bacteria that are commonly found in swine and poultry houses, including Staphylococcus epidermidis, Exiguobacterium indicum, Bacillus cereus, Bacillus siamensis, Bacillus altitudinis, Pantoea ananatis, and Bacillus megaterium. This activity was probably due to their high levels of total phenolic content and total flavonoid content. Then, the spray formulation loaded with the concentrated unripe banana peel extract that was five times higher than the minimum bactericidal concentration was developed and tested. Ethanol, sodium benzoate, tween 80, and glycerine were applied as additives in the spray formulation to increase the extract's solubility and stability. It was found that the developed spray formulation effectively inhibited the growth of S. epidermidis.ConclusionThese research outcomes show that the possible application of banana peel extract is an excellent approach because it is an eco‐friendly alternative to control microorganisms undesired microbial growth in farm animals.

The contribution of animal antibiotic use to antibiotic resistance in human infections: Panel evidence from Denmark

Antibiotic use (ABU) in animals is postulated to be a major contributor to selection of antibiotic resistance (ABR) which subsequently causes infections in human populations. However, there are few quantifications of the size of this association. Denmark, as a country with high levels of pig production and strong ABR surveillance data, is an ideal case study for exploring this association.This study compiles a dataset on ABU across several animal species and antibiotic classes, and data on the rate of antibiotic resistance (ABR) in humans across key pathogens, in Denmark over time (2010−2020). Panel data regressions (fixed effects, random effects, first difference and pooled ordinary least squares) were used to test the association between the level of ABR in human isolates and the level of ABU in animals.A positive relationship was identified between ABR in humans and ABU in cattle, with some evidence of a positive relationship for poultry and companion animals, and a negative relationship for fish, although the latter is likely driven by confounding factors. When lagging ABU by one year, the effect of ABU in cattle and companion animals remained similar, the effect of ABU in poultry fell in size, and ABU in fish was no longer significant, perhaps due to differences in life cycle length among animal species. Additional covariates were explored, including pet populations, agricultural production and GDP per capita (at purchasing power parity), but these results were limited by the statistical power of the dataset. Under all models, animal ABU determined only a minority of the change in human ABR levels in this context with adjusted R2 ranging from 0.19 to 0.44.This paper supports the role of animal ABU in determining human ABR levels but suggests that, despite comprising a large portion of systemwide ABU, it only explains a minority of the variation. This is likely driven in part by data limitations, and could also be due to a persistence of ABR once resistance has emerged, suggesting a significant role for socioeconomic and transmission factors in bringing ABR down to desirable levels.

Antimicrobial use before and during COVID-19: data from 108 Veterans Affairs medical centers

Abstract Objective: Inpatient antibiotic use increased during the early phases of the COVID-19 pandemic. We sought to determine whether these changes persisted in persons with and without COVID-19 infection. Design: Retrospective cohort analysis. Setting: 108 Veterans Affairs (VA) facilities. Patients: Persons receiving acute inpatient care from January 2016 to October 2022. Methods: Data on antibacterial use, patient days present, and COVID-19 care were extracted from the VA Corporate Data Warehouse. Days of therapy (DOT) per 1000 days present (DP) were calculated and stratified by Centers for Disease Control and Prevention-defined antibiotic classes. Results: Antibiotic use increased from 534 DOT/1000 DP in 11/2019–2/2020 to 588 DOT/1000 DP in 3/2020–4/2020. Subsequently, antibiotic use decreased such that total DOT/1000 DP was 2% less in 2020 as a whole than in 2019. Driven by treatment for community acquired pneumonia, antibiotic use was 30% higher in persons with COVID-19 than in uninfected persons in 3/2020–4/2020, but only 4% higher for the remainder of 2020. In 2022 system-wide antibiotic use was 9% less in persons with COVID-19; however, antibiotic use remained higher in persons with COVID-19 in 25% of facilities. Discussion: Although antibiotic use increased during the early phases of the COVID-19 pandemic, overall use subsequently decreased to below previous baseline levels and, in 2022, was less in persons with COVID-19 than in persons without COVID-19. However, further work needs to be done to address variances across facilities and to determine whether current levels of antibiotic use in persons with COVID-19 are justified.

Association between quality of governance, antibiotic consumption, and antimicrobial resistance: an analysis of Italian regions

BackgroundEmerging research has provided evidence suggesting the potential influence of governance on the development and spread of antimicrobial resistance (AMR), accounting for significant disparities observed both between and within countries. In our study, we conducted an ecological analysis to investigate the relationship between governance quality, antibiotic consumption, and AMR across Italian regions.MethodsBy leveraging data from three distinct sources at the regional level, we compiled a comprehensive dataset comprising: AMR proportions for three specific pathogen-antibiotic combinations in the year 2021, antibiotic consumption data for systemic use in the year 2020, and the 2021 European Quality of Government Index (EQI) and its corresponding pillars. Employing mediation analysis, we investigated the potential mediating role of antibiotic consumption in the association between the EQI and an average measure of AMR.ResultsOur analysis revealed substantial variation in the percentages of AMR across different regions in Italy, demonstrating a discernible North-to-South gradient concerning both antibiotic usage and governance quality. The EQI exhibited a statistically significant negative correlation with both antibiotic consumption and AMR percentages, encompassing both specific combinations and their average value. Regions characterized by higher levels of governance quality consistently displayed lower values of antibiotic consumption and AMR, while regions with lower governance quality tended to exhibit higher levels of antibiotic use and AMR. Furthermore, we observed a significant total effect of the EQI on average AMR (β = − 0.97; CI − 1.51; − 0.43). Notably, this effect was found to be mediated by antibiotic consumption, as evidenced by a significant indirect effect (β = − 0.89; CI − 1.45; − 0.32).ConclusionsThese findings draw attention to the regional disparities observed in AMR levels, antibiotic consumption patterns, and governance quality in Italy. Our study also highlights the mediating role of antibiotic consumption in the relationship between governance quality and AMR. This underscores the significance of implementing focused interventions and policies aimed at improving governance quality and promoting responsible antibiotic use.

The Level of Use of Antibiotics as Self-medication in Taman Bumyara Housing, Mustikajaya District Bekasi

Background: Antibiotics are drugs that used to treat bacterial infections. Irrational use of antibiotics can lead to resistance. The use of antibiotics must be through a doctor’s prescription because use without a prescription is very likely to couse irrational use. Using of antibiotics Inappropriate self-medication is one of the causes of antibiotic resistance. The purpose of this study was to determine the level of use of antibiotics as self-medication in Taman Bumyagara Housing, Mustikajaya District.Method: The type of research used is descriptive observational with a cross sectional research design. The sample in this study amounted to 140 people. The data used are primary data using a google form questionnaire and analyzed by univariate analysis presented in tabular and narrative form.Result: Based on the research that has been done, the results of measuring the level of antibiotic use, respondents had a level of infrequent use (89.3%). For the types and preparations of drugs for self-medication, 94.3% of respondents used Amoxicillin and 94.3% who chose tablets. Based on the indications for use, there are 77.9% of respondents using antibiotics for fever. Profile of self-medication use of antibiotics, respondents using drugs orally (100%) with frequency of use (98.6%), interval of use (97.9%), dose of use (97.9%) according to the brochure, and duration of use was not according to needs (32.9%).Conclusion: The use of antibiotics as self-medication in Taman Bumyagara Housing, Mustikajaya District is low level.

Antibiotics Misuse in Children KAP Survey of Parents at Benghazi-Libya 2021

Introduction: Children are known to receive antibiotics more often than any other type of drug, as they are frequent subjects of infections of various etiologies. The improper use of antibiotics is the most important cause of the modern expansion of antibiotic resistance. The development of antibiotic resistance, with its clinical and economic consequences. Increased bacterial resistance is threatening the therapeutic effectiveness of antibiotics. High level of antibiotic use is probably the main factor driving the emergence of resistant. Objectives of the Study: To determine the level of awareness of antibiotic use in Benghazi 2021 among parents of children and to identify factors associated with parent’s decision regarding use of antibiotics. Materials and Methods: A convenient sample of 2000 questionnaires was distributed among parents of their children aged from 6moths to 6 years. By direct an interview to the parents at Benghazi city during the period from September to December –2021 who agreed for an interview survey. The questionnaire was developed by the researcher, and the data collected by well- trained interviewer team (the researcher and his colleagues, including doctors, medical students and pharmacists). The questionnaire contains were focused on the knowledge and attitude and practice of parents including the general knowledge on antibiotics, side effects of antibiotics use, the ideal mechanism of action of antibiotics and if antibiotics can cause allergy. If the parents use antibiotics to their children without a doctor's prescription, the reasons for use antibiotics without doctor's prescription. A score technique was chosen as suitable method to identify the level of awareness among parents regarding antibiotics use. A Scoring for questions knowledge five questions, every question gives 2 marks. We Categorize Score as: Deficient (poor), intermediate (average), Optimum (good) marks. The participants responded to the questionnaire without any .......

COVID-19 and antimicrobial therapy

BACKGROUND: One of the problems with managing patients with a new coronavirus infection is the irrational use of antibiotics. Antibacterial drugs are not active against viral infection, including COVID-19. Unfortunately, in actual clinical practice, the level of antibiotic use remains extremely high, reaching 7080%. Unwanted antibacterial therapy leads to a number of undesirable phenomena that can significantly worsen the patients condition, and sometimes lead to life-threatening consequences. In this context, the most important question is the formulation of the diagnosis. In particular, the reference to the term pneumonia, in the case of COVID-19, is neither scientifically or clinically feasible. The most correct would be to call this process viral or virus-associated lung damage. This term will allow you to set priorities in the choice of tactics leading the patient. That is, viral lesion (not pneumonia!) will induce the practical doctor to analyze the situation requiring prescription in the presence of indications of anti-inflammatory (monoclonal antibodies, glucocorticosteroids) and anticoagulation therapy, and will avoid unnecessary in the overwhelming number of antimicrobial prescription situations.
 AIM: Formulate criteria for prescribing antibacterial therapy in patients with COVID-19.
 MATERIALS AND METHODS: The study is based on a review and analysis of the literature on new coronavirus infection, drawing conclusions and recommendations.
 RESULTS: In actual Russian practice, the level of use of antibiotics remains extremely high, reaching 7080%.
 CONCLUSION: The prescription of antibacterial therapy in patients with COVID-19 is justified only if there are convincing signs of bacterial infection the appearance of purulent sputum, increased procalcitonin of blood more than 0,250.5 ng/ml, an increase in blood white count of more than 10 thousand/mcl with an increase in the number band neutrophils more than 10%.

ANTIMICROBIAL RESISTANCE (AMR) CAMPAIGN FOR MOTHERS OF DASA WISMA KWARASAN, SLEMAN

Antimicrobial Resistance (AMR) is a serious problem and is still widely ignored by the wider community, including in the community of Kwarasan Hamlet, Gamping District, Sleman Regency, Yogyakarta. AMR is a condition in which the drugs given are ineffective and even unable to eradicate microbes as disease agents such as bacteria. AMR can be caused by the unwise use of antibiotics. The state of AMR makes infectious diseases such as tuberculosis difficult to cure. Knowledge about AMR is important to be disseminated and understood to the public. It is proven in the records of the Gamping I Health Center for the last 5 years that the level of antibiotic use in Kwarasan Hamlet has reached 90%. Besides that, there have also been 116 cases of tuberculosis, some of which ended in death. The women of Dasa Wisma Melati Dusun Kwarasan are very enthusiastic about understanding and campaigning for knowledge about AMR to the wider community. Based on this potential, Dusun Kwarasan can become a pioneer in health care through the Antimicrobial Resistance (AMR) campaign program. This program is structured with the flow of counseling program deliberation, preparation of extension programs, counseling on AMR, formation of AMR cadres, upgrading of AMR cadres, action plans for AMR cadres and program evaluation. The program will support the realization of a community that cares about AMR, prevents infectious diseases caused by microbes that are difficult to cure and becomes a pioneer in AMR care.

Identifying Antibiotic Use Targets for the Management of Antibiotic Resistance Using an Extended-Spectrum β-Lactamase-Producing Escherichia coli Case: A Threshold Logistic Modeling Approach.

The aim of this study was to develop a logistic modeling concept to improve understanding of the relationship between antibiotic use thresholds and the incidence of resistant pathogens. A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-level incidence rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli). Threshold logistic models identified thresholds for fluoroquinolones (61.1 DDD/1000 occupied bed days (OBD)) and third-generation cephalosporins (9.2 DDD/1000 OBD) to control hospital ESBL-producing E. coli incidence. The 60th percentile of ESBL-producing E. coli was determined as the cutoff for defining high incidence rates. Threshold logistic analysis showed that for every one-unit increase in fluoroquinolones and third-generation cephalosporins above 61.1 and 9.2 DDD/1000 OBD levels, the average odds of the ESBL-producing E. coli incidence rate being ≥60th percentile of historical levels increased by 4.5% and 12%, respectively. Threshold logistic models estimated the risk scores of exceeding the 60th percentile of a historical ESBL-producing E. coli incidence rate. Threshold logistic models can help hospitals in defining critical levels of antibiotic use and resistant pathogen incidence and provide targets for antibiotic consumption and a near real-time performance monitoring feedback system.

The Levels of Antibiotic Use in Tyfoid Fever Patients in Interna Wards at the Hospital Makassar City

Typhoid fever is an acute infectious disease of the small intestine caused by the bacterium Salmonella typhi (S.typhi) which is an endemic systemic infectious disease, which is transmitted through the food or drink consumed. Antibiotics are a group of drugs that are often used today to treat typhoid fever. The purpose of this study was to find out the most antibiotics used for the treatment of typhoid fever in internal care at the Makassar City Hospital, to find out the rational use of antibiotics which includes, the right drug, the right indication, and the right patient. This research is an observational study conducted retrospectively (non-experimentally) and analyzed using descriptive methods. Sampling by purposive sampling method. The study sample was typhoid fever patients who met the inclusion criteria, had no complications and had complete medical record data. The data is compared with the standard of medical treatment at Makassar City Hospital. The results showed that the most use of antibiotics in typhoid fever patients at the Makassar City Hospital's Internal Care for the period January-February 2022 consisted of Ciprofloxacin (50.8%), Ceftriaxone (19.6%), Cefixime (9.8%), Chloramphenicol (6.5%), Cotrimoxazole (6.5%) Levofloxacin (4.9%) cefotaxim (1.6). Evaluation of the use of antibiotics is known to be the right indication (100%), the right drug (100%), the right patient (100%). The high accuracy of the drug, the right indication and the patient's accuracy is because the hospital has used antibiotics that are in accordance with existing guidelines.

Consumers’ willingness to pay for pork produced with different levels of antibiotics

Abstract Compared with the EU, regulations on antibiotic use in livestock are less stringent in the USA. If consumers prefer non-antibiotic or minimal antibiotic-use meat, labeling different levels of antibiotic use in the USA could have the potential to mitigate the development of antibiotic-resistant livestock. This study used a survey of 660 US consumers to estimate willingness to pay (WTP) for pork chops from pigs raised with different levels of antibiotic use. Results show that WTP for antibiotic-free pork chops is higher compared with WTP for pork chops produced with minimal use of antibiotics for disease treatment and conventional use of antibiotics for growth promotion. These findings suggest that it could be beneficial to differentiate usage levels of antibiotics when labeling pork products rather than stating ‘use’ or ‘no use’.

301. Detection of Pneumococcal Pneumonia During SARS-CoV-2 Infection

Background Streptococcus pneumoniae (pneumococcus) is a common colonizer of the upper respiratory tract and can progress to cause invasive and mucosal disease. Additionally, infection with pneumococcus can complicate respiratory viral infections (influenza, respiratory syncytial virus, etc.) by exacerbating the initial disease. Limited data exist describing the potential relationship of SARS-CoV-2 infection with pneumococcus and the role of co-infection in influencing COVID-19 severity.MethodsInpatients and healthcare workers testing positive for SARS-CoV-2 during March-August 2020 were tested for pneumococcus through culture-enrichment of saliva followed by RT-qPCR (to identify carriage) and for inpatients only, serotype-specific urine antigen detection (UAD) assays (to identify pneumococcal pneumonia). A multinomial multivariate regression model was used to examine the relationship between pneumococcal detection and COVID-19 severity.ResultsAmong the 126 subjects who tested positive for SARS-CoV-2, the median age was 62 years; 54.9% of subjects were male; 88.89% were inpatients; 23.5% had an ICU stay; and 13.5% died. Pneumococcus was detected in 17 subjects (13.5%) by any method, including 5 subjects (4.0%) by RT-qPCR and 12 subjects (13.6%) by UAD. Little to no bacterial growth was observed on 21/235 culture plates. Detection by UAD was associated with both moderate and severe COVID-19 disease while RT-qPCR detection in saliva was not associated with severity. None of the 12 individuals who were UAD-positive died.ConclusionPneumococcal pneumonia (as determined by UAD) continues to occur during the ongoing pandemic and may be associated with more serious COVID-19 outcomes. Detection of pneumococcal carriage may be masked by high levels of antibiotic use. Future studies should better characterize the relationship between pneumococcus and SARS-CoV-2 across all disease severity levels.Disclosures Akiko Iwasaki, PhD, 4Bio (Consultant, Advisor or Review Panel member)Adaptive Biotechnologies (Consultant, Advisor or Review Panel member)Blavatnik (Grant/Research Support)HHMI (Grant/Research Support)Mathers (Grant/Research Support)NIH (Grant/Research Support)Spring Discovery (Grant/Research Support)Spring Discovery (Consultant, Advisor or Review Panel member)Vedanta InProTher (Consultant, Advisor or Review Panel member)Yale School of Medicine (Grant/Research Support) Nathan D. Grubaugh, PhD, Tempus Labs (Consultant) Ronika Alexander-Parrish, RN, MAEd, Pfizer (Employee, Shareholder) Adriano Arguedas, MD, Pfizer (Employee) Bradford D. Gessner, MD, MPH, Pfizer Inc. (Employee) Daniel Weinberger, PhD, Affinivax (Consultant)Merck (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support) Anne Wyllie, PhD, Global Diagnostic Systems (Consultant)Pfizer (Advisor or Review Panel member, Research Grant or Support)PPS Health (Consultant)Tempus Labs, Inc (Research Grant or Support)

Prevalence and antimicrobial susceptibility pattern of coagulase-negative staphylococci obtained from nares of adult patients admitted to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria

Coagulase-negative staphylococci (CoNS) are part of the normal microbial flora of the skin and mucous membranes. Nasal colonization with antibiotic-resistant CoNS represents both a risk factor for the colonized individual and their immediate contacts. This study determines the antibiotics susceptibility pattern and resistance phenotypes to a specific group of antimicrobial agents in CoNS isolate from the nares of adult patients from Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Kaduna State, Nigeria. One hundred and twenty-three presumptive staphylococci isolate from nasal colonization surveillance cultures of adult patients were collected from the diagnostic medical microbiology laboratory of ABUTH, Zaria and were characterized using standard microbiological procedures and their susceptibility to commonly used antimicrobial agents determined using the guideline of European committee on antimicrobial susceptibility testing (EUCAST). A total of 60 of the 123 (49%) staphylococcal isolate were CoNS. Characterization of the sixty CoNS isolate showed that the most predominant species were S. chromogenes (30.0%), S xylosus (15.0%) and S. schleiferi subsp. coagulans (13.3%). The highest level of resistance was observed to Cefoxitin (95.0%) and the lowest to Tigecycline (1.7%). S. epidermidis isolates were observed to show ≥60% resistance to all tested antibiotics with the exception of Tigecycline (0%) and Gentamicin (20%). Analysis of the multiple antibiotic resistance index (MARI) showed that majority (96.7%) of the isolates were resistant to 3 or more of the antimicrobial agents. No isolate was resistant to all the tested antimicrobial agents. A very high proportion of the CoNS isolates were resistant to cefoxitin, penicillin, tetracycline, amoxicillin-clavulanate, and vancomycin. In conclusion, the high proportion of isolates with MARI of 0.3 and above indicates a high level of antibiotic use or exposure in the study area. These findings revealed the need for continued surveillance for resistant phenotype to inform clinical therapy decisions

Antibiotic use and colorectal neoplasia: a systematic review and meta-analysis

Background and aimsColorectal cancer (CRC) is the third most common cancer for women and men and the second leading cause of cancer death in the USA. There is emerging evidence...

Antimicrobial resistance profile and multidrug resistance patterns of Streptococcus pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia

BackgroundAntimicrobial-resistant strains of Streptococcus pneumoniae have become one of the greatest challenges to global public health today and inappropriate use of antibiotics and high level of antibiotic use is probably the main factor driving the emergence of resistance worldwide. The aim of this study is, therefore, to assess the antimicrobial resistance profiles and multidrug resistance patterns of S. pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia.MethodsA hospital-based prospective study was conducted from January 2018 to December 2019 at Addis Ababa city and Amhara National Region State Referral Hospitals. Antimicrobial resistance tests were performed from isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal fluid, blood, sputum, eye discharge, ear discharge, and pleural and peritoneal fluids) from all collection sites were initially cultured on 5% sheep blood agar plates and incubated overnight at 37 °C in a 5% CO2 atmosphere. Streptococcus pneumoniae was identified and confirmed by typical colony morphology, alpha-hemolysis, Gram staining, optochin susceptibility, and bile solubility test. Drug resistance testing was performed using the E-test method according to recommendations of the Clinical and Laboratory Standards Institute.ResultsOf the 57 isolates, 17.5% were fully resistant to penicillin. The corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5 and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was co-resistance to penicillin, erythromycin, clindamycin, and tetracycline.ConclusionsMost S. pneumoniae isolates were susceptible to ceftriaxone and cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to several commonly used antibiotics including penicillin. Hence, it is important to periodically monitor the antimicrobial resistance patterns to select empirical treatments for better management of pneumococcal infection.

Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan.

To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.

Antibiotic Utilization Trends in Two State Hospitals of Mongolia from 2013 to 2017

Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospital and State Third Hospital in Mongolia, using the WHO developed and standardized ATC/DDD methodology. Methods. Data were collected from the State Second Hospital and State Third Hospital which are major public hospitals that provide health care for approximately one fifth of the Mongolian population. Antibiotic utilization was monitored retrospectively for five years (2013–2017) using the ATC/DDD methodology and data were presented in DDD/ admission and DDD/100 bed days. Statistical analysis was performed using a Student’s t-test for parametric data. A P value of ≤0.05 was considered to be statistically significant. Results. The annual consumption rates in the State Second Hospital were stable over time while in the State Third Hospital consumption rates varied considerately between years. Overall, the total antibiotic consumption rate was very high, but has decreased in both hospitals. The rate of consumption of all antibiotics was approximately twice that in the State Third Hospital (421.7 DDD/100 bed days) between 2013 and 2017 when compared with the State Second Hospital (199.7 DDD/ 100 bed days), P<0.001). The seven most frequently used antibiotics comprised approximately 75% of all DDDs in both hospitals, in the period 2013–2017; being: amoxicillin, cefazolin, cefotaxime, ceftriaxone, clarithromycin, ciprofloxacin, and nitroxoline. However, this was not consistent when considering the individual years, since in 2015 and 2016, these seven active agents represented approximately 50%. Conclusion. This is the first hospital-based study of antibiotic consumption rates reported in Mongolia. In addition to very high consumption rates, large differences occurred between the hospitals investigated. Inappropriate and high levels of antibiotic use lead to increased costs and also increased nosocomial infection rates with potentially resistant species. The Government and health professionals need to take more active roles in improving and promoting quality antibiotic use among inpatients.

Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review

BackgroundMany low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses.MethodsBoth PubMed and Embase were systematically searched for studies reporting on impact measurement in moving towards prescription only access to antibiotics in LMICs. The PRISMA methodological review framework was used to ensure systematic data collection and analysis of literature. Narrative data synthesis was used due to heterogeneity of study designs.ResultsIn total, 15 studies were included that assessed policy impact in 10 different countries. Strategies employed to enforce regulations prohibiting OTC sales of systemic antibiotics included retention of prescriptions for antibiotics by pharmacies, government inspections, engaging pharmacists in the design of interventions, media campaigns for the general public and educational activities for health care workers. A variety of outcomes was used to assess the policy impact; changes in antimicrobial resistance rates, changes in levels of antibiotic use, changes in trends of antibiotic use, changes in OTC supply of antibiotics, and changes in reported practices and knowledge of pharmacists, medicine sellers and the general public. Differences in methodological approaches and outcome assessment made it difficult to compare the effectiveness of law enforcement activities. Most effective appeared to be multifaceted approaches that involved all stakeholders. Monitoring of the impact on total sales of antibiotics by means of an interrupted time series (ITS) analysis and analysis of pharmacies selling antibiotics OTC using mystery clients were the methodologically strongest designs used.ConclusionsThe published literature describing activities to enforce prescription-only access to antibiotics in LMICs is sparse and offers limited guidance. Most likely to be effective are comprehensive multifaceted interventions targeting all stakeholders with regular reinforcement of messages. Policy evaluation should be planned as part of implementation to assess the impact and effectiveness of intervention strategies and to identify targets for further activities. Robust study designs such as ITS analyses and mystery client surveys should be used to monitor policy impact.