Use Of Antibiotics For Prevention Research Articles

The effect of information provision on consumers’ risk perceptions of, support for a ban, and behavioral intention towards the preventive use of antibiotics in food animals

BackgroundAntibiotics have been widely used in feed and drinking water for food animals to prevent them from getting sick. Such preventive use of antibiotics has become a contributor to increasing antibiotic resistance and thus poses threats to human health. However, consumers have little knowledge about this practice and the associated health risks of increasing transmission of antibiotic residues and antibiotic resistant bacteria. This study aimed to examine the effect of information provision on consumers’ risk perceptions, support for a ban, and behavioral intention regarding the preventive use of antibiotics in food animals. Especially, the study sought to test two competing hypotheses which were informed by two theoretical perspectives of fear appeal theory — the linear model and the plateau effect model. The former suggested that providing information on the health risks of both antibiotic residues and antibiotic resistant bacteria would have a stronger effect compared to providing information on only one of them, while the latter posited that providing information on both risks might not have additional influence, as the effect of information on either risk could reach the plateau.MethodsAn experimental study with four conditions was conducted where participants read different information on the health risks associated with the preventive use first and then answered questions regarding consumers’ risk perceptions, support for a ban, and behavioral intention regarding the preventive use. Condition 1 was the control condition, where basic information about antibiotics, antibiotic resistance, and the preventive use was provided. Condition 2 and Condition 3 further added information on the health risk of antibiotic residues (Condition 2) and antibiotic resistant bacteria (Condition 3) due to the preventive use, respectively. Condition 4 provided all information contained in the first three conditions.ResultsThe results showed that compared to participants in the control condition, participants in Conditions 2-4 reported higher risk perceptions, stronger support for a ban on the preventive use, and a higher intention to buy meat produced without the preventive use of antibiotics. However, there were no significant differences in these factors between Conditions 2-4, indicating that providing information on the health risk of either antibiotic residues, or antibiotic resistant bacteria, or both, has similar effect on these variables. That is, the hypothesis based on the plateau effect model was supported.ConclusionsThe findings suggested that informing the public with the health risk of either antibiotic residues or antibiotic resistant bacteria associated with the preventive use is effective enough to reach plateau effect in increasing risk perceptions, support for a ban, and behavioral intention, which has important implications for policymakers and livestock industries to develop effective communication strategies to promote responsible antibiotic use in food animals.

Computer-assisted decision support for the usage of preventive antibacterial therapy in children with febrile pyelonephritis: A preliminary study

Urinary tract infection (UTI) is one of the most common infectious diseases among children, but there is controversy regarding the use of preventive antibiotics for children first diagnosed with febrile pyelonephritis. To the best of our knowledge, no studies have addressed this issue by the deep learning technology. Therefore, in the current study, we conducted a study using Tc99m−DMSA renal static imaging data to investigate the need for preventive antibiotics on children first diagnosed with febrile pyelonephritis under 2 years old. The self-collected dataset comprised 64 children who did not require preventive antibiotic treatments and 112 children who did. Using several classic deep learning models, we verified that it is feasible to screen whether the first diagnosed children with febrile pyelonephritis require preventive antibacterial therapy, achieving a graded diagnosis. With the AlexNet model, we obtained accuracy of 84.05%, sensitivity of 81.71% and specificity of 86.70%, respectively. The experimental results indicate that deep learning technology could provide a new avenue to implement computer-assisted decision support for the diagnosis of the febrile pyelonephritis.

The Management of Intussusception: A Systematic Review.

Intussusception (ISN) is adangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study.Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention.

Biomarkers of Neonatal Sepsis: Where We Are and Where We Are Going.

Neonatal sepsis is a bacterial bloodstream infection leading to severe clinical manifestations frequently associated with death or irreversible long-term deficits. Antibiotics are the drug of choice to treat sepsis, regardless of age. In neonates, the lack of reliable criteria for a definite diagnosis and the supposition that an early antibiotic administration could reduce sepsis development in children at risk have led to a relevant antibiotic overuse for both prevention and therapy. The availability of biomarkers of neonatal sepsis that could alert the physician to an early diagnosis of neonatal sepsis could improve the short and long-term outcomes of true sepsis cases and reduce the indiscriminate and deleterious use of preventive antibiotics. The main aim of this narrative review is to summarize the main results in this regard and to detail the accuracy of currently used biomarkers for the early diagnosis of neonatal sepsis. Literature analysis showed that, despite intense research, the diagnosis of neonatal sepsis and the conduct of antibiotic therapy cannot be at present decided on the basis of a single biomarker. Given the importance of the problem and the need to reduce the abuse of antibiotics, further studies are urgently required. However, instead of looking for new biomarkers, it seems easier and more productive to test combinations of two or more of the presently available biomarkers. Moreover, studies based on omics technologies should be strongly boosted. However, while waiting for new information, the use of the clinical scores prepared by some scientific institutions could be suggested. Based on maternal risk factors and infant clinical indicators, sepsis risk can be calculated, and a significant reduction in antibiotic consumption can be obtained.

Risk factors for infections after arthroscopic rotator cuff repair

To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection. Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair. In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05). Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

BACTERIAL PROFILE AND ANTIBIOGRAM OF MICROORGANISMS ISOLATED FROM DIFFERENT BODY SITE INFECTIONS AMONG PATIENTS OF A PRIVATE HOSPITAL, KARACHI

Objective:It is crucial to keep an eye on current patterns of multi-drug resistance and extensively drug resistance at local level to facilitate physicians in making justified decision regarding empirical therapy during this era of rising superbugs. Material and Methods: This antibiogram was made up according to CLSI (Clinical Laboratory Standard Institute) M100 guidelines. Samples were received for a period of 2-years from June 2019-June 2021 at National Medical Center Karachi. These samples were urine, blood, pus, cerebrospinal fluid (CSF), central venous pressure (CVP) tip, sputum and tracheal aspirates. Results: Out of 10564 samples received, 4582 were positive for growth of microorganisms. Sample distribution patterns according to the frequency of positive growth of isolates were predominantly urine (58%) and blood (17%) followed by pus (8%) and pus swab (6%) 2% fluid and 2% tracheal secretions, and 7% others like tips growth. Blood cultures were mainly received from Intensive care unit (50%) followed by out-patients departments (34%). The pattern of resistance observed in Escherichia coli (E. coli) revealed ampicillin as the most resistant among all antibiotics (93%) followed by cefixime (77%). Most sensitive antibiotic was amikacin (99%). The Staphylococcus aureus isolates were highly susceptible to vancomycin and linezolid (100%) followed by gentamicin (89%) and chloramphenicol (85%). Vancomycin resistance was observed in Enterococcus faecium (8%). Conclusion: Antimicrobial resistance among gram negative and gram-positive bacteria is increasing. This has left us with fewer therapeutic options which in turn highlights the issue of antimicrobial resistance being a global health concern. This emphasizes the significance of surveillance of antimicrobial patterns, development of antibiograms and implementation of antibiotic stewardship programs by judicious use of antibiotics for prevention of further spread of antimicrobial resistance. Key Words: Antibiogram, Antimicrobial resistance, Multidrug resistance, Extensively drug resistance

The Soaring Increase of Resistant Microorganisms Demands Immediate Action Solutions are Available

Clinical environments provide an ideal reservoir for the growth, proliferation, and transmission of pathogenic organisms. Surfaces in hospitals e.g. hospital furniture, ECG lead wires and other cables, push buttons of infusion pumps, control knobs of ventilation machines, textiles as well as implantable biomaterials like central venous catheters, urologic catheters, endotracheal tubes are contaminated increasingly frequent with multiresistant microorganisms. These microorganisms are distributed by the hands of the nursing personnel throughout the hospital with serious, life threatening consequences. 1.8 million patients suffer from a nosocomial infection per year in Europe; approximately 180,000 deaths are attributed to these infections. The Centers for Disease Control (CDC) estimates that 2 million U.S. patients per year acquire a hospital-related infection. These infections cause 90,000 deaths each year and cost an average of $47,000 per patient to treat. The added cost to hospitals is $4.8 billion anually for extended care treatment. Microorganisms show an increasing rate of resistance against the majority of antibiotics including carbapenems as last available antibiotic. 700,000 deaths have been rеρorted worldwide, 30 000 deaths alone in Europe during the last year due to infections where no effective antimicrobial substance was available. The use of disinfectants is ostensibly intended to remove/kill pathogens on surfaces. However studies have shown that more than one-half the time, surfaces are not adequately cleaned or are re-contaminated within minutes. Much emphasis has been put therefore on hand disinfection. However there are also rеρorts of the emergence of alcohol tolerant/insensitive microorganisms e.g., vancomycin resistant enterococci. This phenomenon has the potential to undermine the effectiveness of alcohol based disinfectant standard precautions. The reason for this dramatic development of resistant microorganisms is still in debate. The indiscriminate use of antibiotics for prevention of a bacterial superinfections e.g. sinusitis, otitis media after a viral infections is frequently incriminated, however this seems to have little impact on the occurrence of multi-resistant hospital pathogens in general. However individual patients are seriously affected by the selection of multi-resistant pathogens. In contrast there is increasing evidence that the widespread use of disinfectants is responsible: disinfectants - analogous to antibiotics - must be incorporated into the metabolism of microorganisms. This is inevitably associated with induction of resistance by transfer of resistance plasmids e.g. induction of efflux pumps. 10 167 рublications (PUBMed Jan. 2023) are available in the international literature which document the resistance of microorganisms against disinfectants; 649 рublications describe the cross resistance with antibiotics, at the same time there are 11 237 publications on the toxicity of disinfectants.

Impact of a Statewide Livestock Antibiotic Use Policy on Resistance in Human Urine Escherichia coli Isolates: A Synthetic Control Analysis.

On 1 January 2018, California implemented Senate Bill 27 (SB27), banning, for the first time in the United States, routine preventive use of antibiotics in food-animal production and any antibiotic use without a veterinarian's prescription. Our objective was to assess whether SB27 was associated with decreased antimicrobial resistance among E. coli isolated from human urine. We used U.S. nationwide monthly state-level data from BD Insights Research Database (Becton, Dickinson, and Co.) spanning 1 January 2013 to 30 June 2021 on antibiotic-resistance patterns of 30-d nonduplicate E. coli isolated from urine. Tested antibiotic classes included aminoglycosides, extended-spectrum cephalosporins (ESC), fluoroquinolones, and tetracyclines. Counts of tested and not-susceptible (resistant and intermediate, hereafter resistant) urine isolates were available by sex, age group (, year), month, and state. We applied a synthetic control approach to estimate the causal effect of SB27 on resistance patterns. Our approach created a synthetic California based on a composite of other states without the policy change and contrasted its counterfactual postpolicy trends with the observed postpolicy trends in California. We included E. coli urine isolates, 90% among women, across 33 states. From 2013 to 2017, the median (interquartile range) resistance percentages in California were 11.9% (7.4, 17.6), 13.8% (5.8, 20.0), 24.6% (9.6, 36.4), 7.9% (2.1, 13.1), for aminoglycosides, ESC, fluoroquinolones, and tetracyclines, respectively. SB27 was associated with a 7.1% reduction in ESC resistance (p-value for joint null: ), but no change in resistance to aminoglycosides, fluoroquinolones, or tetracyclines. Further research is needed to determine the role of SB27 in the observed reduction in ESC resistance E. coli in human populations, particularly as additional states implement similar legislation. https://doi.org/10.1289/EHP11221.

Antibiotic resistance genes and molecular typing of Streptococcus agalactiae isolated from pregnant women

BackgroundThe antibiotic resistance of genital tract colonizing Streptococcus agalactiae in pregnant women is increasing. We aimed to determine the antibiotic resistance genes of different clonal types of this bacterium in pregnant women.MethodsFour hundred twenty non-repeated vaginal and rectal specimens were collected from pregnant women and were transferred to the laboratory using Todd Hewitt Broth. The samples were cultured on a selective medium, and the grown bacteria were identified by standard microbiological and biochemical tests. Antimicrobial resistance pattern and inducible clindamycin resistance of the isolates were determined using the disk agar diffusion method. The genomic DNAs of S. agalactiae strains were extracted using an extraction kit, and the antibiotic resistance genes and RAPD types were detected using the PCR method.ResultsThe average age of the participants was 30.74 ± 5.25 years. There was a significant relationship between the weeks of pregnancy and the number of positive bacterial cultures (P-value < 0.05). Moreover, 31 pregnant women had a history of abortion, and 18 had a history of membrane rupture. Among 420 specimens, 106 S. agalactiae isolates were detected. The highest antibiotic resistance rate was found against tetracycline (94.33%), and all isolates were susceptible to linezolid. Moreover, 15, 15, 42, and 7 isolates showed an iMLSB, M-, cMLSB, and L-phenotype. The ermB was the most prevalent resistance gene in the present study, while 38 (35.84%), 8 (7.54%), 79 (74.52%), 37 (34.9%), and 20 (18.86%) isolates were contained the ermTR, mefA/E, tetM, tetO, and aphA3 gene, respectively.ConclusionsThe high-level antibiotic resistance and prevalence of resistance genes may be due to the arbitrarily use, livestock industry consumption, and the preventive use of antibiotics in pregnant women. Thus, the need to re-considering this problem seems to be necessary.

Use of Prophylactic Antibiotics in Third and Fourth Degree of Perineal Rupture

Numerous studies have demonstrated how routine episiotomies can cause additional problems like poor postpartum sexual function, ongoing perineal pain, and increased anal sphincter damage resulting in flatus or fecal incontinence. To combat the high frequency of maternal labor morbidity, antibiotic prophylaxis is recognized as a method of intervention that can be applied. . On the other hand, several studies seem to support the use of preventive antibiotics in situations of severe perineal rupture. It is not advised to use antibiotics excessively due to the rising prevalence of their use, which increases the danger of antibiotic resistance. As a result, following a serious perineal tear, the use of prophylactic antibiotics is crucial to preventing infection and determining whether a side effect is present in the mother or infant. Therefore it is necessary to assess the effectiveness of antibiotic prophylaxis to reduce maternal morbidity and side effects of third and fourth-degree perineal rupture during vaginal delivery.

Ensuring food safety in use antimicrobial veterinary drugs in agriculture

Currently, the problem of antibiotic resistance is acute at the world level. As a result of unsystematic and uncontrolled intake of antimicrobial drugs into the human body, pathogenic and opportunistic microorganisms acquire resistance to the action of drugs, and therapy is ineffective. Antibiotic resistance develops as a result of non-compliance with the course of treatment, dosage of drugs, as well as when antibiotics enter the body, residual amounts of which circulate in the external environment and are found in food. The use of antimicrobial agents in agriculture is of great importance. In 2017, Decree of the Government of the Russian Federation No. 2045-r On approval of the Strategy for preventing the spread of antimicrobial resistance in the Russian Federation for the period up to 2030 and the action plan for its implementation came into force, in accordance with which the SCAMP program was developed - a system for monitoring antimicrobial drugs. This program is currently being implemented within the framework of voluntary certification and provides for the achievement of the therapeutic efficacy of antibiotic therapy; reduction in the use of antibiotics; rejection of unsystematic and uncontrolled use of antibiotics for prevention, stimulation of growth and productivity; obtaining raw materials of animal origin and products that do not contain residual amounts of antimicrobial drugs; ensuring food security. A high role in the control system of antimicrobial drugs is played by digitalization in the circulation of food products on the territory of the Russian Federation, which makes it possible to control the turnover from farm to table and to nullify the cases of circulation of unsafe counterfeit products, and the registration of manufacturers in electronic systems and the assignment of a unique digital labeling of products will oblige manufacturers to comply with the requirements of regulatory and technical documentation, including when using medicines.

Antibiotic prescription in Morocco, national data: Meta-analysis

Antibiotics are the most prescribed medication and the misprescribing of antibiotics is a public health problem worldwide.Objective: Conduct a meta-analysis to determine the prevalence of antibiotic prescribing, assess the quality of prescribing and identify factors of inappropriate prescribing in Morocco.Materials and Methods: 92 articles found in databases (35, 42, 55 and 50, in Elsevier, PubMed, Google Scholar and Other engines respectively).Results: In studies carried out in 2009 and 2011, on the evaluation of the use of antibiotics by dermatologists we noticed that beta-lactams were the most commonly prescribed: 53%. A survey on the use of generic antibiotics or pediatric service used beta-lactam, 63%. The prescription of antibiotics in the department of burns and plastic surgery was 65%. These results are important to explain a resistance of betalactamins to different offences and the constitution of beta-lactamase should be searched. A study conducted in 2018 in Rabat, 90 physicians and surgeon’s specialists, 91.7% of them prescribed antibiotics. Through previous studies from 2014 to 2022, a children’s under 5 years of age with severe clinical pneumonia, 86.5% received antibiotics. In another study on the evaluation of antibiotic prescriptions in the emergency department, amoxicillin was used in 31.4%. Also in a study on the evaluation of antibiotic prescriptions in pediatric emergency departments, 3rd generation cephalosporins were used in 69% of cases. A study of antibiotic self-medication parents knew that antibiotics are subject to a prescription and 72.1% knew that antibiotics had side effects on children, and in this study amoxicillin was used the most at 46.6%, and it is one of the most widely used antibiotics in Morocco, despite the development of numerous resistances. In studies conducted in 2009, 2016, and 2017 on preventive antibiotic use is still prescribed (22%, 17.7% and 7.14%). Antibiotic prescriptions were not limited only to physicians, but studies indicated that 10.9% of them were prescribed by pharmacists and in 2022 the percentage increased to 42%.Conclusion: This meta-analysis on studies and research of antibiotic prescribing: national data in the last 13 years in Morocco, the deficiencies found in antibiotic prescribing require the establishment of national recommendations to reduce misprescribing.

ASSESSMENT OF RATIONAL USE OF ANTIMICROBIAL IN ORTHOPAEDIC PROCEDURE

Background: From a clinical perspective, proper use of antimicrobial experts is essential. Current anti-microbial drugs play a vital role in both the prevention and treatment of irresistible illnesses, making them one of the most important agents for therapeutic evaluation. Without a doubt, there is a problem with their abuse globally, with underdeveloped countries experiencing it to a greater extent.Objective: evaluation of the therapeutic and preventive use of antibiotics in patients who have had orthopaedic surgery.Methodology: On 150 clinical records of orthopaedic patients who underwent medical procedure, an immediate and observational review was done.Result: This study included information from 150 people, including 80 men and 70 women who had orthopaedic surgery. Cephalosporins (73.36%) and cefuroxime (62.62%) were found to be the antimicrobial classes most frequently utilised for prophylaxis and therapy, respectively. Nearly 50% of prophylactic cases were found to be unsuitable, whilst approximately 70% of antibiotic treatments failed to adhere to recommendations.Conclusion: This study includes the maximum number of patients from total hip replacement surgery and open reduction internal fixation (ORIF), respectively. The study's findings showed that some surgical prophylaxis during orthopedic operations was somewhat improper.

Assessing farm biosecurity and farmers' knowledge and practices concerning antibiotics and antibiotic resistance in poultry and pig farms in Southern Togo.

Background and Aim:Several factors contribute to the unusual incidence of antibiotic resistance, which is now a primary public health concern. However, failure in managing preventive and therapeutic antibiotic use on farms is one of the most crucial factors. Therefore, this study aimed to evaluate the biosecurity of farms, farmers’ competence, and practices related to antibiotics and their resistance in poultry and pig rearing in Togo.Materials and Methods:Through a cross-sectional survey, 121 commercial poultry farmers and 97 commercial pig farmers were questioned to evaluate the biosecurity of farms and farmers’ competence and practices related to antibiotics and antibiotic resistance. Descriptive analyses, including the evaluation of proportions, were carried out. In addition, results from qualitative factors were evaluated in a defined grid and totaled up to assess cleanliness measures, awareness, and behavior regarding antibiotics and their resistance.Results:The results demonstrated that most farmers working on poultry farms had a university education, while most working on pig farms had secondary education. Most poultry (69%) and pig (44%) farms were of small sizes (<1000 animals in poultry and <10 animals in pig farming). The footbaths were used in just 51% of poultry farms and 4% of pig farms, respectively, with 37% and 82% of poultry and pig farms having inadequate levels of hygiene. In poultry farms, respiratory issues and periodic decline in egg-laying were the main problems. Simultaneously, skin disorders (scabies) and plagues (African swine fever) were the primary health constraints in pig farming. Tetracycline is the most commonly used antibiotic by farmers. However, in poultry and pig farms, 21% and 67% of farmers were unaware of antibiotics. In addition, 39% and 57% were unaware of antibiotic resistance. Poultry and pig farmers’ competence were substantially linked to their education level. Poultry farmers demonstrated better practices, including procuring antibiotics based on veterinary prescriptions (63%) and they knew where antibiotics should be bought (90%). Nevertheless, 43% of farmers asserted unpleasant activities – no application for laboratory testing (93%) and use of antibiotics for prevention (82%). In pig farming, most farmers (69%) reported inadequate incidents of the use of antibiotics.Conclusion:This study identified a crucial non-compliance with biosecurity measures and good practices toward antibiotic use on many farms. Therefore, training of farmers is mandatory for safe livestock products.

Novel Predictors of Stroke-Associated Pneumonia: A Single Center Analysis.

Stroke-associated pneumonia (SAP) is a common cause of disability or death. Although the researches on SAP have been relatively mature, the method that can predict SAP with great accuracy has not yet been determined. It is necessary to discover new predictors to construct a more accurate predictive model for SAP. We continuously collected 2,366 patients with acute ischemic stroke, and then divided them into the SAP group and non-SAP group. Data were recorded at admission. Through univariate analyses and multivariate regression analyses of the data, the new predictive factors and the predictive model of SAP were determined. The receiver operating characteristic (ROC) curve and the corresponding area under the curve (AUC) were used to measure their predictive accuracy. Of the 2,366 patients, 459 were diagnosed with SAP. International normalized ratio (INR) (odds ratio = 37.981; 95% confidence interval, 7.487–192.665; P < 0.001), age and dysphagia were independent risk factors of SAP. However, walking ability within 48 h of admission (WA) (odds ratio = 0.395; 95% confidence interval, 0.287–0.543; P < 0.001) was a protective factor of SAP. Different predictors and the predictive model all could predict SAP (P < 0.001). The predictive power of the model (AUC: 0.851) which included age, homocysteine, INR, history of chronic obstructive pulmonary disease (COPD), dysphagia, and WA was greater than that of age (AUC: 0.738) and INR (AUC: 0.685). Finally, we found that a higher INR and no WA could predict SAP in patients with acute ischemic stroke. In addition, we designed a simple and practical predictive model for SAP, which showed relatively good accuracy. These findings might help identify high-risk patients with SAP and provide a reference for the timely use of preventive antibiotics.

Putative antigenic proteins identified by comparative and subtractive reverse vaccinology in necrotic enteritis-causing Clostridium perfringens isolated from broiler chickens

BackgroundAvian necrotic enteritis (NE) caused by Clostridium perfringens is a disease with a major economic impact, generating losses estimated to 6 billion of dollars annually for the poultry industry worldwide. The incidence of the disease is particularly on the rise in broiler chicken flocks eliminating the preventive use of antibiotics. To date, no alternative allows for the efficient prevention of NE and a control of the disease using a vaccinal strategy would be mostly prized. For this purpose, comparative and subtractive reverse vaccinology identifying putative immunogenic bacterial surface proteins is one of the most promising approaches.ResultsA comparative genomic study was performed on 16 C. perfringens strains isolated from healthy broiler chickens and from broilers affected with necrotic enteritis. Results showed that the analyzed genomes were composed of 155,700 distinct proteins from which 13% were identified as extracellular, 65% as cytoplasmic and 22% as part of the bacterial membrane. The evaluation of the immunogenicity of these proteins was determined using the prediction software VaxiJen®.ConclusionsFor the most part, proteins with the highest scores were associated with an extracellular localisation. For all the proteins analyzed, the combination of both the immunogenicity score and the localisation prediction led to the selection of 12 candidate proteins that were mostly annotated as hypothetical proteins. We describe 6 potential candidates of higher interest due to their antigenic potential, their extracellular localisation, and their possible role in virulence of C. perfringens.

The practices of antibiotics application in neurosurgical patients in Ukraine: a cohort study

Introduction. The outcomes of potential complications of surgical interventions in neurosurgical patients can cause a death. Efficient antibiotic prophylaxis decreases the risks of infection and improves the quality of health care.&#x0D; Purpose. To estimate the appropriateness of prescribing antibiotics in a neurosurgical ward from the perspective of evidence-based medicine.&#x0D; Material and method. A retrospective cohort study has been carried out in a neurosurgical ward of multidisciplinary healthcare setting of Ukraine. Data from 131 in-patient medical cards (MC) of neurosurgical patients has been analyzed. Descriptive statistics methods have been used for data analysis. The relative risk (RR) with the 95% confidence interval (95% CI) has been calculated.&#x0D; Results. We found that among the patients, females prevailed (n = 81 / 61.8%). The patients’ mean age was 49.83 ± 13.90 years. The frequency of antibiotics prescriptions was higher significant in patients, who received surgical procedures in comparison with patients, who did not receive surgical procedures (RR = 1.827; 95% CI: 1,137 – 2.935). Antibiotics were prescribed mostly during the postoperative period. The use of interchangeable antibiotics of the same group has been occurred. The use of antibiotics for prevention in the most cases was of unreasonably long duration.&#x0D; Conclusion. The practice of the use of antibiotics in neurosurgical ward does not correspond to scientifically founded recommendations. It is needed to clearly define the indications for prescribing antibiotics. Duration of antibiotic use should depend on specialization of wards in multidisciplinary healthcare setting. It is expedient to conduct an audit on the use of antibiotics at healthcare settings on a regular basis with involving a specialist in infection control, a clinical pharmacist, and a clinical microbiologist.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

Mandated restrictions on the use of medically important antibiotics in broiler chicken production in Canada: implications, emerging challenges, and opportunities for bolstering gastrointestinal function and health — a review

Chicken Farmers of Canada has been progressively phasing out prophylactic use of antibiotics in broiler chicken production. Consequently, hatcheries, veterinarians, and nutritionists have been mandated to contend with less reliance on the use of preventive antibiotics. A topical concern is the increased risk of proliferation of enteric pathogens leading to poor performance, increased mortality, and compromised welfare. Moreover, the gut harbors several taxa such as Campylobacter and Salmonella capable of causing significant illnesses in humans via contaminated poultry products. This has created an opportunity for research and development of dietary strategies designed to modulate gastrointestinal environment for enhanced performance and food safety. Albeit with inconsistent responses, literature data suggest that dietary strategies such as feed enzymes, probiotics/prebiotics, and phytogenic feed additives can bolster gut health and function in broiler chickens. However, much of the efficacy data were generated at controlled research settings that vary significantly with the complex commercial broiler production operations due to variation in dietary, health, and environmental conditions. This review will summarize implications of mandated restrictions on the preventative use of antibiotics and emerging Canadian broiler production programs to meet processor specifications. Challenges and opportunities for integrating alternative dietary strategies in commercial broiler production settings will be highlighted.

Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics.

Self-medication with antibiotics is a major contributing factor to antimicrobial resistance. Prior research examining factors associated with antibiotic self-medication has focused on an individual’s knowledge about antibiotics, antibiotic usage practices, accessibility to antibiotic medication, and demographic characteristics. The role of psychological distress associated with perceived health risks in explaining antibiotic self-medication is less understood. This study was designed to address this knowledge gap in the context of the COVID-19 pandemic in Australia. An online survey of 2217 participants was conducted at the height of the initial outbreak and revealed that 19.5% of participants took antibiotics to protect themselves from COVID-19. Multivariate logistic analysis examined the predictors of taking antibiotics for protection against COVID-19. An integrative framework developed from the results illustrates potential pathways and facilitating factors that may contribute to prophylactic self-medication with antibiotics. Specifically, COVID-19 pandemic-induced psychological distress was significantly positively related to self-medication. Preventive use of antibiotics was also facilitated by a lack of understanding about antibiotics, inappropriate antibiotics usage practices, the nature of the patient-doctor relationship, and demographic characteristics. The findings highlight that to combat antimicrobial resistance due to self-medication, interventions need to focus on interrupting entrenched behavioural responses and addressing emotional responses to perceived health risks.