Overuse Of Antimicrobials Research Articles

Evaluation of the Knowledge, Attitudes and Practice of Veterinary Professionals and Senior Animal Health Students in Central Gondar Zone, Gondar, Ethiopia: Antimicrobial Use and Resistance Perspectives.

Antimicrobial resistance (AMR) poses a worldwide challenge to the well-being of animals and humans. The emergence of AMR is largely attributed to the improper utilization and overuse of antimicrobials. In order to combat this issue and promote responsible antimicrobial use (AMU), it is imperative for veterinary professionals and graduating students to possess extensive knowledge, maintain positive attitudes, and adhere to good practices regarding AMU and AMR. To assess the knowledge, attitude and practices (KAPs) of veterinary professionals and senior animal health students' towards veterinary AMU and AMR. A cross-sectional study design was conducted on purposefully selected 200 participants (60 of them were veterinary professionals from the districts and towns, and the remaining 140 were senior animal health university students). A self-administered, structured questionnaire was used to collect the necessary data, and descriptive statistics were used to summarize the data. The study revealed that, overall, study participants' KAP were not satisfactory. From veterinary professionals, about 56.7% of respondents scored average knowledge, whereas 66.7% and 61.66% of them had negative attitudes and poor practices, respectively, on AMU and AMR. The study found that 56% of the participants' think the previous knowledge they acquired regarding AMU and AMR was not sufficient, and the internet was used as a source of drug information by the majority of participants. The majority (72%) of them were not taking special training on AMU and AMR. Regarding senior animal health students, this study indicated that 52% and 69.2% of the respondents had poor knowledge and a negative attitude, respectively, towards AMU and AMR. Overall, veterinary professionals in the central Gondar zone have average knowledge, a negative attitude and poor practices. Poor knowledge and a negative attitude were also observed among senior animal health students towards AMU and AMR. Therefore, to fill the observed gaps, activities that enhance the skills of veterinary professionals and students should be implemented. Ingreted measures with animicrobial stewardship program and Nationwide studies are highly suggested to evaluate the overall status of veterinary professionals towards AMU and AMR.

An antimicrobial resistance gene situationer in the backyard swine industry of a Philippine City

Antimicrobial resistance (AMR) as a result of antimicrobial overuse and misuse in agriculture is a growing concern, especially in the predominant but poorly regulated backyard or smallholder swine farms of the Philippines. A city-scale surveillance of antimicrobial resistance genes (ARGs) was conducted through selected backyard swine farms to obtain a comprehensive understanding of the AMR situation in the backyard sector of Davao City, Philippines. The ARGs encoding resistance to four antimicrobial classes (β-lactams: blaCTX−M, blaOXA, blaSHV, blaTEM, mecA; quinolones: qnrS and qnr-A2; macrolides: ermA and ermB; tetracycline: tetM) were quantified in swine feces via real-time PCR, and point maps were generated to visualize the ARG geographic distribution. The ARGs bla-TEM, ermB, qnrS, and tetM were detected in all farms at relatively intermediate to high levels, consistently representing the four most used antimicrobial classes in Philippine farms. All the investigated ARGs were present in some local barangay units, indicating potential emergence of AMR hotspots. A 0.5 quantile regression analysis identified specific backyard farm attributes associated with ARG occurrence and diversity, which may influence the ecological spread of the ARGs. These findings provide support for evidence-based guidelines to reinforce a One Health framework for the Philippine National Action Plan to Combat AMR.

Detection of Antibacterial Susceptible Salmonella spp. in Cured Beef with Different Shelf-Life Expectancy

Meat is currently one of the food products with the highest demand ever since 1980, where demand has reached 24.8 kg per year per person as of 2020. With high demand comes intensive farming which causes overuse of antimicrobials for both therapeutic and non-therapeutic reasons, allowing more antimicrobial resistant (AMR) strains of bacteria to occur. In the case of meat products, salmonella is considered one of the more commonly occurring bacteria found in raw meat products. However, with meat’s short shelf-life expectancy, the likeliness of consumers suffering from salmonellosis increases. Thus, preservation methods have been implemented to reduce this likeliness, primarily through curing beef. Although curing may reduce the likeliness of excessive microbial growth, AMR salmonella has been detected in cured beef samples. The scope of this research determines whether there is Salmonella spp. within the cured beef samples, conduct AMR (azithromycin, ciprofloxacin, and ceftriaxone) analysis of the Salmonella spp. isolated from the cured beef samples and enumeration was conducted. The longer the shelf-life expectancy of cured beef samples, the lower the overall CFU/mL per sample was (control: 17,800,000 CFU/mL, >1 year: 0 CFU/mL). It was also discovered that Salmonella spp. has potential resistance towards ciprofloxacin (33.33% intermediate) and susceptibility towards azithromycin and ceftriaxone (100.00% sensitive). This research implies the agricultural industry and safety for consumers of cured beef products with different shelf-life expectancies.

“Antimicrobial utilization in a paediatric intensive care unit in India: A step towards strengthening antimicrobial stewardship practices"

Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1–12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.

Antimicrobial use in hospitalized patients: a point prevalence survey across four tertiary hospitals in Niger.

Antimicrobial resistance (AMR) is a global threat to public health. Misuse or overuse of antimicrobials contributes to the emergence of AMR. Data on antimicrobial prescribing represent the cornerstone for guiding antimicrobial stewardship strategies. This study aimed to assess the use, indications, classification, and quality indicators of antimicrobials prescribed to patients in four tertiary hospitals in Niger. This cross-sectional study used the methodology for Global Point Prevalence Surveys in tertiary hospitals between January and April 2024. Hospital records of all inpatients on admission at 08:00 hours on a specific day were reviewed for antimicrobial use during the survey. The overall prevalence of antibiotic use across hospitals was 54.5% (n = 470/862), ranging between 66.2% (n = 149/234) and 44.3% (n = 183/258). Most antibiotics used were antibacterials (89.0%, n = 637). Third-generation cephalosporins (48.2%, 307/637), imidazole derivatives (14.7%, 105/716), penicillins with extended spectrum (9.6%, 69/716), and fluoroquinolones (6.1%, 44/716) were the most commonly prescribed classes of antibiotics. Most antibiotics (84.9%, n = 608) were prescribed to treat community-acquired infections, while surgical prophylaxis accounted for 6.4% (n = 47/716). Most antibiotics (96.1%; n = 688/716) were used empirically, and less than a quarter (20.7%) of antibiotics prescribed had a documented stop/review date recorded. Only, 4.2% (n = 31/716) of prescribed antibiotics had cultures and susceptibility testing requested. This study shows that antibiotic prescription rates are high in tertiary hospitals, with relatively high use of third-generation cephalosporins. Most antibiotics were empirically used and not guided by culture and susceptibility testing. These results could be the subject of key interventions for hospital antibiotic stewardship strategies in Niger.

Vaccines in the fight against antimicrobial resistance - perspectives from South Africa.

Antimicrobial resistance (AMR), in which microbes adapt to and resist current therapies, is a well-recognised global problem that threatens to reverse gains made by modern medicine in the last decades. AMR is a complex issue; however, at its core, it is driven by the overuse and inappropriate use of antimicrobials. Socioeconomic factors have been identified as significant contributors to the emergence and exacerbation of AMR, especially in populations facing inadequate access to healthcare, poor sanitation services and high morbidity and mortality rates. Weak healthcare systems and water, sanitation and hygiene have been highlighted as fundamental risk factors for AMR emergence and transmission. Behavioural factors, such as purchasing antibiotics without a prescription from a registered healthcare professional, not completing the prescribed course or overly prolonged courses of antibiotics, using antibiotics to treat viral infections, lack of access to quality antibiotics, and the proliferation of substandard or falsified (SF) drugs, have also been identified as significant contributors to AMR. Low- and middle-income countries have a higher incidence of antibiotics being dispensed without a prescription than higher-income countries.

Coverage of policies to improve antimicrobial stewardship in human medicine in low and middle income countries: results from the Global Survey of Experts on Antimicrobial Resistance

BackgroundAntimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs).MethodsTo assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS).ResultsA total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR.ConclusionsIn many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally.

Exploring the Role of the Environment as a Reservoir of Antimicrobial-Resistant Campylobacter: Insights from Wild Birds and Surface Waters.

Antimicrobial resistance (AMR) is a growing global health challenge, compromising bacterial infection treatments and necessitating robust surveillance and mitigation strategies. The overuse of antimicrobials in humans and farm animals has made them hotspots for AMR. However, the spread of AMR genes in wildlife and the environment represents an additional challenge, turning these areas into new AMR hotspots. Among the AMR bacteria considered to be of high concern for public health, Campylobacter has been the leading cause of foodborne infections in the European Union since 2005. This study examines the prevalence of AMR genes and virulence factors in Campylobacter isolates from wild birds and surface waters in Luxembourg. The findings reveal a significant prevalence of resistant Campylobacter strains, with 12% of C. jejuni from wild birds and 37% of C. coli from surface waters carrying resistance genes, mainly against key antibiotics like quinolones and tetracycline. This study underscores the crucial role of the environment in the spread of AMR bacteria and genes, highlighting the urgent need for enhanced surveillance and control measures to curb AMR in wildlife and environmental reservoirs and reduce transmission risks to humans. This research supports One Health approaches to tackling antimicrobial resistance and protecting human, animal, and environmental health.

Burden assessment of antimicrobial use and resistance in livestock in data-scarce contexts.

Misuse and overuse of antimicrobials in livestock production are identified as drivers for antimicrobial resistance (AMR). To improve decision-making concerning livestock health, it is important to understand the impact of AMR in livestock and aquaculture, within and beyond farm level, as well as expenditure on antimicrobial use (AMU). Such understanding provides grounds for systematic disease prioritisation and establishes a baseline for understanding the value of different strategies to mitigate animal health problems and for the monitoring and evaluation of the impact of those strategies. Yet limited data availability and quality surrounding AMU and AMR create barriers to furthering the knowledge of such impact. These data constraints are also more prevalent in contexts that lack the necessary resources to develop and maintain systematic and centralised data collection and collation systems. Even in regions with robust AMU and AMR monitoring systems in place, data limitations remain, such that the expenditure on antimicrobials and impacts of AMR remain unclear. Additionally, the current research funding strategies have been less focused on primary data collection, adding further barriers to filling the data void and reducing the global AMU/AMR knowledge gap. To work around the data scarcity and leverage previous and ongoing research efforts, it is vital to gain comprehensive knowledge of the people, projects and research consortia dedicated to the topic of AMU/AMR.

Prevalence and antimicrobial resistance trends among vaginal bacteria isolates from pregnant bitches.

Many of the reproductive tract infections in the bitches are caused by bacteria that can normally be present on the vaginal mucosa. These bacteria also might have an important role as the cause responsible for pregnancy loss and fetal deaths. The choice of antibiotic therapy for the pregnant animal is narrow and represents a severe problem in veterinary practice, especially due to increased antimicrobial resistance. Due to incorrect antimicrobials use in breeding kennels, the aim of the present study was to assess the occurrence of the bacterial flora isolated from the pregnant bitches and their antibiotic sensitivity. The study was carried out at the private Veterinary clinic in Novi Sad, Serbia. The vaginal swabs were taken from 60 bitches diagnosed with pregnancy and were sent to be laboratory tested. Based on the results, the most common isolated pathogens were Staphylococcus pseudintermedius (20%) and beta-hemolytic streptococci (18.33%). Furthermore, significant resistance to antibiotics from beta-lactams group was detected. It is of particular importance that antimicrobial treatment be evidence based in order to reduce the overuse of antimicrobials due to increased concern regarding antimicrobial resistance.

Antimicrobial Resistance in Equines: A Growing Threat to Horse Health and Beyond-A Comprehensive Review.

The equine industry holds substantial economic importance not only in the USA but worldwide. The occurrence of various infectious bacterial diseases in horses can lead to severe health issues, economic losses, and restrictions on horse movement and trade. Effective management and control of these diseases are therefore crucial for the growth and sustainability of the equine industry. While antibiotics constitute the primary treatment strategy for any bacterial infections in horses, developing resistance to clinically important antibiotics poses significant challenges to equine health and welfare. The adverse effects of antimicrobial overuse and the escalating threat of resistance underscore the critical importance of antimicrobial stewardship within the equine industry. There is limited information on the epidemiology of antimicrobial-resistant bacterial infections in horses. In this comprehensive review, we focus on the history and types of antimicrobials used in horses and provide recommendations for combating drug-resistant bacterial infections in horses. This review also highlights the epidemiology of antimicrobial resistance (AMR) in horses, emphasizing the public health significance and transmission dynamics between horses and other animals within a One Health framework. By fostering responsible practices and innovative control measures, we can better help the equine industry combat the pressing threat of AMR and thus safeguard equine as well as public health.

The swine waste resistome: Spreading and transfer of antibiotic resistance genes in Escherichia coli strains and the associated microbial communities

The overuse of antimicrobials in livestock farming has led to the development of resistant bacteria and the spread of antibiotic-resistant genes (ARGs) among animals. When manure containing these antibiotics is applied to agricultural fields, it creates a selective pressure that promotes the acquisition of ARGs by bacteria, primarily through horizontal gene transfer. Most research on ARGs focuses on their role in clinical antibiotic resistance and their transfer from environmental sources to bacteria associated with humans, such as Escherichia coli. The study investigates the spread of antibiotic-resistant genes (ARGs) through class 1 integrons in 27 Escherichia coli strains from pig manure. It focuses on six common ARGs (ermB, cmlA, floR, qnrS, tetA, and TEM) and the class 1 integron gene, assessing their prevalence in manure samples from three pig farms. The study found correlations and anticorrelations among these genes, indicating a predisposition of the integron in spreading certain ARGs. Specifically, cmlA and tetA genes were positively correlated with each other and negatively with int1, suggesting they are not transferred via Int1. Farm B had the highest int1 counts and a higher abundance of the TEM gene, but lower levels of cmlA and tetA genes. The results underscore the complexity of predicting ARG spread in agricultural environments and the associated health risks to humans through the food chain. The study's results offer valuable insights into the antibiotic-resistant genes (ARGs) profile in swine livestock, potentially aiding in the development of methods to trace ARGs in the environment.

Contract governance to reduce antimicrobial overuse in hog farms in China

Antimicrobial resistance caused by the overuse of antimicrobials by farmers is an essential health issue. Currently, signing contracts between farmers and cooperatives has become crucial for small farmers to integrate into the modern agricultural industry chain. Unlike vertical government governance, which aims to intervene in the overuse of antimicrobials by farmers through many mandatory or incentive measures, contract governance refers to the social governance model that clarifies rights and obligations between farmers and cooperatives to ensure the adequate performance of contracts, which is especially beneficial to regulate farmers' safe production behavior such as the standard use of antimicrobials. However, there is a research gap concerning the effectiveness of contract governance in inhibiting farmers' overuse of animal antimicrobials. This study applies propensity score matching and mediation analysis method to assess how contract governance affects the overuse of antimicrobials by hog farmers. The paper uses data from 498 hog farmers of China's Hebei, Henan, and Hubei provinces to explore the impact and underlying mechanisms of contract governance on antimicrobial overuse in agriculture. The results showed that contract governance was found to inhibit the overuse of antimicrobials, with the amount paid for antimicrobials reduced by 118 yuan/household. We found evidence that this effect is exerted through three mechanisms: cooperative supervision (CS), technical guidance (TG), and product premium perception (PP). The CS, TG, and PP mediation effects accounted for 19.94%, 27.90%, and 26.93% of the total impact, respectively. Therefore, policy implications of these results include strengthening the standard of contract signing procedures and the integrity of executing contracts, increasing the market premium for products that meet the antimicrobial residue standards, and enhancing farmers' knowledge and contracting ability.

Understanding Antimicrobial Prescription Practices: Insights from Small Animal Veterinarians in North Macedonia

Abstract Antimicrobial resistance (AMR) is an increasing global concern in small animal veterinary practices. The overuse and misuse of antimicrobials in companion animals can contribute to the spread of AMR between animals and humans. This study aimed to assess small animal veterinarians’ knowledge, attitudes, and behaviors towards antimicrobial use (AMU) and AMR in North Macedonia. A web-based questionnaire was developed, including questions addressing demographics, owner influence on antibiotic prescription and prescribing practices. The response rate of the small animal veterinarians was 47.50% (57/120), with most of them (84.20%) having 1-15 years of work experience. Pearson’s chi-square test of independence was used for contingency tables that met the chi-square assumption, and Fisher’s exact test was conducted for contingency tables that did not. Most veterinarians responded that they had perceived pressure and direct demands from pet owners to prescribe antimicrobials (35.09% frequently, 45.61% occasionally). In the survey, 50.77% of the veterinarians reported frequently administering antibiotics without conducting bacteriological or antimicrobial susceptibility testing. They typically resorted to these tests in cases with recurrent infections, such as skin infections (19.63%), or when empirical therapy is ineffective (14.72%). Based on the findings, it can be concluded that veterinarians play a crucial role in tackling the AMR in North Macedonia. The lack of stewardship programs or guidelines for responsible antimicrobial use in companion animals is a critical issue that requires urgent attention, emphasizing the vital role of veterinarians in combating AMR.

Genomic Insights into Bacterial Antimicrobial Resistance Transmission and Mitigation Strategies.

The rapid emergence and global spread of antimicrobial resistance in recent years have raised significant concerns about the future of modern medicine. Superbugs and multidrugresistant bacteria have become endemic in many parts of the world, raising the specter of untreatable infections. The overuse and misuse of antimicrobials over the past 80 years have undoubtedly contributed to the development of antimicrobial resistance, placing immense pressure on healthcare systems worldwide. Nonetheless, the molecular mechanisms underlying antimicrobial resistance in bacteria have existed since ancient times. Some of these mechanisms and processes have served as the precursors of current resistance determinants, highlighting the ongoing arms race between bacteria and their antimicrobial adversaries. Moreover, the environment harbors many putative resistance genes, yet we cannot still predict which of these genes will emerge and manifest as pathogenic resistance phenotypes. The presence of antibiotics in natural habitats, even at sub-inhibitory concentrations, may provide selective pressures that favor the emergence of novel antimicrobial resistance apparatus and, thus, underscores the need for a comprehensive understanding of the factors driving the persistence and spread of antimicrobial resistance. As the development of antimicrobial strategies that evade resistance is urgently needed, a clear perception of these critical factors could ultimately pave the way for the design of innovative therapeutic targets.

Clinical Impact of Plasma Metagenomic Next-Generation Sequencing on Infection Diagnosis and Antimicrobial Therapy in Immunocompromised Patients.

Clinical impact of plasma metagenomic next-generation sequencing (mNGS) on infection diagnosis and antimicrobial therapy in immunocompromised patients with suspected infection remains unclear. Between March and December 2022, 424 cases with fever, infection history, mechanical ventilation, or imaging abnormalities underwent plasma mNGS testing at a single center. Eleven patients have received solid organ transplantation, and the remaining patients were categorised into febrile neutropenia (FN), non-neutropenia (NN), and non-haematologic disease (NTHD) groups based on immunosuppression severity. The diagnostic rate of infection and the utilisation of antimicrobial agents based on mNGS were assessed. The use of mNGS significantly improved the diagnostic rates for fungi in the FN (56.1%, P = 0.003) and NN (58.8%, P = 0.008) groups versus the NHD group (33.3%). Positive impacts associated with therapy were significantly greater than negative impacts across all three groups (all P < 0.001), and the utilisation of escalation therapy was significantly more frequent in the FN group than in the NN groups (P = 0.006). Over 70% of cases with negative mNGS results across the three groups underwent de-escalation therapy, with >1/3 being discontinued, preventing antimicrobial overuse. Plasma mNGS has a clinically confirmed positive impact in immunocompromised patients with neutropenia, improving the diagnosis of fungal infections and antimicrobial therapy.

Gut colonization by extended-spectrum β-lactamase-producing Escherichia coli in dairy herd in Brazil: successful dissemination of a One Health clone.

The overuse of antimicrobials in livestock has contributed to the emergence and selection of clinically relevant multidrug-resistant bacteria. In Brazil, there is no conclusive information on the occurrence of Escherichia coli producing extended-spectrum β-lactamase (ESβL) in cattle breeding, which is an important sector of agribusiness in this country. Herein, we investigated the presence of ESβL-positive E. coli strains in dairy cattle from a commercial farm with routine practice of therapeutic cephalosporins. Ninety-five rectal swab samples were collected from healthy dairy calves and cows under treatment with ceftiofur. Samples were screened for the presence of ESβL producers, and positive isolates were identified by MALDI-TOF, with subsequent screening for genes encoding ESβL variants by PCR and sequencing. The presence of ESβL (CTX-M-15)-producing E. coli was confirmed in calves, and lactating and dry cows. Most ESβL strains with genetic homologies ≥ 90% were grouped into two major PFGE clusters, confirming the suscessful expansion of clonally related lineages in animals from different lactating cycles, on the same property. Four representatives CTX-M-15-positive E. coli strains had their genomes sequenced, belonging to the clonal complex (CC) 23 and sequence type (ST) 90. A phylogeographical landscape of ST90 was performed revealing a global One Health linkage. Our results highlight the intestinal microbiota of dairy cattle as a hotspot for the spread of critical priority ESβL-producing E. coli and demonstrate that ST90 is an international clone genomically adapted to human and animal hosts, which deserve additional investigation to determine its zoonotic potential and impact in food chain.

A Stepwise Diagnostic Stewardship Approach to Reduce Unnecessary Urine Cultures, Asymptomatic Bacteriuria, and CAUTI Rate

Background: Clinically non-indicated asymptomatic bacteriuria (ASB) identification precipitates higher reported catheter-associated urinary tract infection (CAUTI) rates and urinary tract infection (UTI)-directed antimicrobial overuse. Published diagnostic stewardship interventions to reduce ASB were mostly tested individually and heterogeneously; hence the optimal bundle approach is yet to be defined. Methods: We performed a single-center sequential quasi-experimental study involving hospitalized, emergency, and long-term care patients at a VA healthcare facility, retrospectively comparing standard of care (period 1: 1/1/2022-6/30/2022) to adding dedicated provider education on facility-approved urine-culturing indications (period 2: 7/1/2022-1/19/2023), then adding an electronic clinical decision support (CDS) tool (Figure 1) mandating urine-culturing indications selections (period 3: 1/20/2023-6/30/2023), then prospectively adding real-time case-based physician-generated audit/feedback emails on ordering appropriateness (period 4: 7/1/2023-12/31/2023). We randomly sampled approximately 500 orders from each period and measured the impact on the rate of urine reflex/culture orders, the percentage of non-indicated orders and ASB, UTI-directed antimicrobial usage, and facility-wide CAUTI rates. Results: We analyzed 2140 urine reflex/culture orders (Table 1 and Figure 2). The mean monthly orders per 1000 bed-days and percentage of non-indicated orders decreased with each intervention to one-fourth of the initial values by period 4 (p=0.0002). The ASB rate among positive cultures was unchanged from periods 1 to 2 but started to decrease in period 3 with the biggest impact in period 4 (p=0.01). Non-indicated and ASB-directed antimicrobial courses both followed the previous pattern, dropping from 28% and 26% baseline to 6% and 4% by the study conclusion (p=0.015 and 0.008), respectively. Estimated UTI-directed antimicrobials decreased by 34% (363/551) with antimicrobial-days saved from 4093 to 2846 per 6-month period. CAUTI rate relatively declined with each intervention, along with a reduction in ASB-attributed CAUTI’s from 45% (5/11) initially to 20% (1/5) in period 4. Conclusion: A stepwise urine-culturing diagnostic stewardship approach of clinical education, electronic CDS tool, plus real-time audit/feedback decreased overall urine reflex/cultures, non-indicated ordering, ASB identification, unnecessary antimicrobials, and CAUTI rates, with the greatest impact after bundling all interventions including order appropriateness audit/feedback.

Polyvalent Bacterial Lysate with Potential Use to Treatment and Control of Recurrent Urinary Tract Infections.

Overuse of antimicrobials has greatly contributed to the increase in the emergence of multidrug-resistant bacteria, a situation that hinders the control and treatment of infectious diseases. This is the case with urinary tract infections (UTIs), which represent a substantial percentage of worldwide public health problems, thus the need to look for alternatives for their control and treatment. Previous studies have shown the usefulness of autologous bacterial lysates as an alternative for the treatment and control of UTIs. However, a limitation is the high cost of producing individual immunogens. At the same time, an important aspect of vaccines is their immunogenic amplitude, which is the reason why they must be constituted of diverse antigenic components. In the case of UTIs, the etiology of the disease is associated with different bacteria, and even Escherichia coli, the main causal agent of the disease, is made up of several antigenic variants. In this work, we present results on the study of a bacterial lysate composed of 10 serotypes of Escherichia coli and by Klebsiella pneumoniae, Klebsiella aerogenes, Enterococcus faecalis, Proteus mirabilis, Citrobacter freundii, and Staphylococcus haemolyticus. The safety of the compound was tested on cells in culture and in an animal model, and its immunogenic capacity by analysing in vitro human and murine macrophages (cell line J774 A1). The results show that the polyvalent lysate did not cause damage to the cells in culture or alterations in the animal model used. The immunostimulatory activity assay showed that it activates the secretion of TNF-α and IL-6 in human macrophages and TNF-α in murine cells. The obtained results suggest that the polyvalent lysate evaluated can be an alternative for the treatment and control of chronic urinary tract infections, which will reduce the use of antimicrobials.

Exploring bacterial diversity and antimicrobial resistance gene on a southern Brazilian swine farm

The bacterial composition of and the circulation of antimicrobial resistance genes (ARGs) in waste from Brazilian swine farms are still poorly understood. Considering that antimicrobial resistance (AMR) is one of the main threats to human, animal, and environmental health, the need to accurately assess the load of ARGs released into the environment is urgent. Therefore, this study aimed to characterize the microbiota in a swine farm in southern Brazil and the resistome in swine farm wastewater treated in a series of waste stabilization ponds (WSPs). Samples were collected from farm facilities and the surrounding environment, representing all levels of swine manure within the treatment system. Total metagenomic sequencing was performed on samples from WSPs, and 16S-rDNA sequencing was performed on all the collected samples. The results showed increased bacterial diversity in WSPs, characterized by the presence of Caldatribacteriota, Cloacimonadota, Desulfobacterota, Spirochaetota, Synergistota, and Verrucomicrobiota. Furthermore, resistance genes to tetracyclines, lincosamides, macrolides, rifamycin, phenicol, and genes conferring multidrug resistance were detected in WSPs samples. Interestingly, the most abundant ARG was linG, which confers resistance to the lincosamides. Notably, genes conferring macrolide (mphG and mefC) and rifamycin (rpoB_RIF) resistance appeared in greater numbers in the late WSPs. These drugs are among the high-priority antibiotic classes for human health. Moreover, certain mobile genetic elements (MGEs) were identified in the samples, notably tnpA, which was found in high abundance. These elements are of particular concern due to their potential to facilitate the dissemination of ARGs among bacteria. In summary, the results indicate that, in the studied farm, the swine manure treatment system could not eliminate ARGs and MGEs. Our results validate concerns about Brazil's swine production system. The misuse and overuse of antimicrobials during animal production must be avoided to mitigate AMR.