Prophylactic Use Of Antimicrobial Agents Research Articles

High Serum miR-361-3p Predicts Early Postdischarge Infections after Autologous Stem Cell Transplantation.

Autologous hematopoietic stem cell transplantation (AHSCT) is currently the backbone of the treatment of multiple myeloma (MM) and relapsed and refractory lymphomas. Notably, infections contribute to over 25% of fatalities among AHSCT recipients within the initial 100 days following the procedure. In this study, we aimed to evaluate three selected miRNAs: hsa-miR-155-5p, hsa-miR-320c, and hsa-miR-361-3p, in identifying AHSCT recipients at high risk of infectious events up to 100 days post-transplantation after discharge. The study group consisted of 58 patients (43 with MM, 15 with lymphoma) treated with AHSCT. Blood samples were collected from all patients at the same time point: on day +14 after transplantation. Fifteen patients (25.9%) experienced infectious complications after post-transplant discharge within the initial +100 days post-transplantation. The median time to infection onset was 44 days (interquartile range, 25-78). Four patients required hospitalization due to severe infection. High expression of hsa-miR-361-3p (fold change [FC], 1.79; P=0.0139) in the patients experiencing infectious complications and overexpression of hsa-miR-320c (FC, 2.14; P<0.0001) in patients requiring hospitalization were observed. In the multivariate model, both lymphoma diagnosis (odds ratio [OR], 6.88; 95% confidence interval [CI], 1.55-30.56; P=0.0112) and high expression of hsa-miR-361-3p (OR, 3.00; 95% CI, 1.40-6.41; P=0.0047) were independent factors associated with post-discharge infectious complications occurrence. Our model in 10-fold cross-validation preserved its diagnostic potential with an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.64-0.92). Elevated serum hsa-miR-361-3p emerges as a promising biomarker for identifying patients at risk of infection during the early post-discharge period, potentially offering optimization of the prophylactic use of antimicrobial agents tailored to the specific risk profile of each AHSCT recipient.

MICROBIAL CAUSATIVE AGENTS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERNS IN CHRONIC RHINOSINUSITIS - IMPACT ON ANTIBIOTIC PROPHYLAXIS AND TREATMENT.

Chronic rhinosinusitis (CRS) is debilitating condition comprising inflammation of the mucosa of the nasal and paranasal sinuses, requiring conservative and often surgical treatment. Functional endoscopic sinus surgery (FESS) is a CRS treatment during which a microbiological diagnostic procedure may be conducted. Preoperative antibiotic prophylaxis is administrated before FESS. When indicated, the administered empiric antibiotic therapy must cover most common causing microbial agents. The aims of this study were to identify microbial pathogens isolated from sinonasal cavities in patients undergoing endoscopic sinus surgery, to determine bacterial antibiotic susceptibility patterns and compare them with guidelines for treatment and perioperative prophylactic use of antimicrobial agents. A retrospective cohort study on 456 samples collected between 2016 and 2019 was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Microbiology, Parasitology and Hospital Infections in the Clinical University Centre Sestre milordnice, Zagreb. The most common isolated pathogens were Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. and Haemophilus influenzae. According to antibiotic susceptibility patterns, empiric antibiotic treatment with amoxicillin-clavulanic acid was appropriate. Due to high rates of antibiotic resistance of anaerobic bacterial isolates to metronidazole, it cannot be recommended in empirical antibiotic treatment or preoperative surgical antibiotic prophylaxis.

A study of surgical site infections in a tertiary care hospital

Background: Health care-associated infections remain as an important public health concern. Surgical site infections (SSIs) are known to be one of the most common causes of nosocomial infections worldwide.Methods: A prospective observational study was conducted across 12 months (May 2018-April 2019) in a tertiary care hospital. The present study includes 223 patients who were undergoing clean and clean contaminated surgery in the hospital. Contaminated and dirty surgeries were excluded. The demographic data of the patient, diagnostic criteria used, associated risk factors, use of prophylactic antimicrobial agents, the type and duration of surgery, clinical evaluation of wound and laboratory data was collected. All the pus samples or wound swabs of clinically suspects of SSI cases received in the Department of Microbiology were inoculated and interpreted according to Centre for Disease Control and Infection guidelines.Results: The study included 223 patients who underwent surgery in the hospital. Amongst them 9 (4%) developed SSI. The incidence of SSI was 4.03%. There was a direct relationship observed between the occurrence of SSI and certain co-morbid conditions such as diabetes. It was also observed that prolonged surgeries above two hours and females were more predisposed to develop a surgical site infection.Conclusions: SSIs being one of the most common causes of nosocomial infections. It was also the most important factor responsible for significant morbidity, mortality, unwanted prolonged hospitalization and additional cost of treatment in surgical patients which can be reduced by strictly following the guidelines of infection control along with judicious and rational use of antibiotics.

Preoperative oral antibiotics and mechanical bowel preparation for left-sided colorectal surgery

Surgical site infection (SSI) is the most frequent postoperative morbidity in colorectal surgery. Once SSI occurs, hospital stay and medical cost increase, resulting in decreased quality of lives of patients. Therefore, controlling SSI has been recognized as the major challenge for surgeons. For this purpose, the use of prophylactic antimicrobial agents is now widely accepted in colorectal surgery.

Evaluation of Romyelocel-L Myeloid Progenitor Cells to Decrease Infections in De Novo AML Patients Receiving High-Dose Ara-C-Based Induction Therapy

Evaluation of Romyelocel-L Myeloid Progenitor Cells to Decrease Infections in De Novo AML Patients Receiving High-Dose Ara-C-Based Induction Therapy

Small Animal Review

Introduction: There is a need to minimise the use of prophylactic antimicrobial agents in the perioperative setting. With clean surgery the risk of a bacterial infection is very low, but the risk of microbial resistance developing is high. If prophylactic use is necessary it is essential that antimicrobial agents are used appropriately.

Can a galacto-oligosaccharide reduce the risk of traveller's diarrhoea? A placebo-controlled, randomized, double-blind study.

Diarrhoea is a common medical problem affecting travellers to Asia, Africa and Latin America. The use of prophylactic antimicrobial agents may increase the risk of contracting resistant bacteria. Findings indicate that oligosaccharides, i.e. carbohydrate chains of 3-10 monosaccharides, reduce the risk of diarrhoea. We performed a placebo-controlled, double-blind study of a galacto-oligosaccharide, B-GOS (Bimuno®, Clasado Ltd, Milton Keynes UK), vs placebo for participants travelling to countries with a high/intermediate risk of diarrhoea for 7-15 days. The participants ingested 2.7g of B-GOS daily from 5 days prior to departure throughout the travel period, and returned a questionnaire, with a diarrhoea log, after their return. The case definition of diarrhoea was three or more loose stools per day. Of 523 enrolled subjects, 334 travellers managed to comply per protocol (PP), 349 followed the protocol at least until the onset of diarrhoea (conditionally evaluable, CE), and 408 followed the protocol with fewer than 5 days of deviance from the protocol (intention to treat, ITT). There was a significant reduction of diarrhoea incidence in the PP group (odds ratio = 0.56, P = 0.03), while the effect in the CE group was non-significant (OR = 0.65, P = 0.08). No significant effect was found during the first 7 days after starting with B-GOS, but from day 8 there was a significant effect in both the PP and CE groups (OR = 0.47, P = 0.02 and OR = 0.53, P = 0.03, respectively). The entire effect was seen in 1-day (i.e. self-limiting) diarrhoea (PP: OR = 0.25, P = 0.004). There was no effect on duration or the number of bowel movements during diarrhoea. The severity of diarrhoea was not affected. B-GOS reduces the risk of diarrhoea lasting 1 day. The protection seemed to start after a week of treatment with B-GOS. Strict compliance is crucial. The treatment is environmentally friendly and without adverse effects.

Antimicrobial prophylaxis outside the operating theatre, an audit in a university hospital

BackgroundThe prophylactic use of antimicrobial agents to prevent infections in non-surgical situations has hardly been investigated. We investigate the extent, indications and appropriateness of antimicrobial prophylaxis given outside the operating room in a tertiary care hospital.MethodsFour point-prevalence surveys were conducted in which all inpatients on that day were screened for the use of prophylactic antimicrobials: medical prophylaxis, prophylaxis around non-surgical interventions and surgical prophylaxis given on the ward. The primary endpoint was the extent of prophylaxis relative to the total number of antimicrobial prescriptions. We also investigated per prescription the presence of a (local) protocol and adherence to these protocols.ResultsWe registered in total 1020 antimicrobial prescriptions, of which 317 (31.1%) were given as prophylaxis. 827/1020 were antibiotic prescriptions. Of these antibiotic prescriptions, 17.0% was medical prophylaxis, 2.7% prophylaxis around non-surgical interventions and 6.9% surgical prophylaxis administered on a ward. For medical antibiotic prophylaxis, a protocol was present in 125 of 141 prescriptions (88.7%); the protocol was followed in 118 cases (94.4%). For prophylaxis around non-surgical interventions and surgical prophylaxis on the wards, protocol presence and adherence rates were 59.1% and 92.3%, and 73.3% and 97.6% respectively. Of the 96 antiviral and 97 antifungal prescriptions, 42.7% and 57.8%, respectively, were medical prophylaxis, of which 95.1 and 96.3% were prescribed according to protocols respectively.ConclusionsAntimicrobial prophylaxis outside the operating theatre is responsible for a considerable part of total in-hospital antimicrobial use. For most prescriptions there was a protocol and adherence to the protocols was high. The main targets for improvement were prophylaxis around non-surgical interventions and surgical prophylaxis given on the ward.

Perioperative prophylactic use of antimicrobial agents after intensive management interventions

A total of 118 breast, thyroid and orthopedic physicians, pharmacists and nurses in operating room were selected as the intervention objects.After 8 cycles(2 years), the awareness rate increased from 6.78%(8/118)to 79.66%(94/118), the rationalization of indication increased from 36.52%(103/282)to 86.67%(247/285), the rationalization of kinds of antimicrobial agents increased from 8.57%(24/280)to 92.11%(140/152), the patients on antibiotics within 0.5-2 h pre-operation increased from 0.71%(2/280)to 96.05%(146/152), the average durations decreased from (6.3±3.9) to (2.9±0.7) days, the average hospitalization days declined from (10.3±5.5) to (7.6±3.1) days and the total rationalization increased from 1.06%(3/282)to 74.38%(212/285). No combined use was performed and there was no difference in nosocomial infection.Strengthening the management of antimicrobial agents is both feasible and effective. Key words: Anti-bacterial agents; Pharmacy administration

Drug abuse in paediatric dentistry: a cross-sectional study.

Compared to adult medicine, drug use in children is not extensively researched. The objective of present study is to find out drug prescribing pattern in the Department of Pedodontics and Preventive Dentistry and Orthodontics in teaching hospitals in Rajasthan, India. A prospective study was conducted in June 2011. A total of 619 prescriptions were collected randomly. Prescribing pattern was analyzed using WHO basic drug indicator. The average number of drugs and antimicrobial agent prescribed per prescription were 2.24 and 0.81 respectively. Antimicrobial agent contained 81.74% of all prescriptions. Most common groups of drugs prescribed by pedodontist were NSAIDS & Antipyretics (37.7%), Antimicrobial (36.4%) and Vitamins (12.3%). Prophylactic use of antimicrobial agents was 5.5 ± 0.5 days. Fixed dose combination (45.6%) frequently used by brand name. twelve percent generic drugs were used. Most of the drugs were from Essential Drug List especially a only one drug was prescribed. There is a need of mass awareness amongst dentists about good prescribing habit. Every institution must have Drugs and Therapeutic Committees. The five steps of WHO Program on Rational Use of Drugs (RUD) should be followed for rational prescribing of drugs.

Antiretroviral agents used by HIV-uninfected persons for prevention: pre- and postexposure prophylaxis.

Prophylactic use of antimicrobial agents and microbicides has been proven for many infections, including surgical, gastrointestinal, upper respiratory, and meningococcal infections. Antiretroviral therapy for pregnant women prevents mother-to-child transmission of human immunodeficiency virus (HIV), which has become rare in settings where access to therapy is widespread. Postexposure prophylaxis after needlestick injury or significant sexual exposure is recommended on the basis of animal studies and case-control observational studies, although use of these interventions is limited to those who recognize exposure, have access, and have the power to use the interventions. Clinical trials are evaluating whether regular or preexposure use of antiretroviral therapy provides additional protection for persons at high risk of infection who are also offered standard prevention care, including HIV testing, counseling, condoms, and management of sexually transmitted infections. Trials are evaluating topical or oral use. Concerns have arisen with regard to optimal dosing strategies, costs, access, drug resistance, risk behavior, and the role of communities. Future implementation, if warranted, will be guided by the results of clinical trials in progress and engagement of communities exposed to HIV.

Prevention of ventilator-associated pneumonia: possible role of antimicrobials administeredviathe respiratory tract

To the Editors: We read with interest the comprehensive and useful review of Lorente et al. 1 regarding the evidence concerning measures for prevention of ventilator-associated pneumonia (VAP). The authors did not comment on the prophylactic use of antimicrobial agents administered via the respiratory tract as a potential preventive strategy for VAP. Relevant guidelines of the Canadian Critical Care Trials Group and the Canadian Critical Care Society 2 recommend against the prophylactic use of oral …

Knowledge of prescribing antimicrobials among Yemeni general dentists

Objective. Overuse of antimicrobial agents is closely related to an increase in bacterial resistance. A sound knowledge of appropriate prescribing of antimicrobials among health professionals is thus critical in combating the resistance. The objectives of this study were to assess the rationale for and patterns of antimicrobial prescriptions by general dental practitioners in Yemen. Material andMethods. A questionnaire containing 65 closed questions was used for this cross-sectional study and distributed to 280 dentists in the three major governorates in Yemen. The anonymously completed questionnaires sought answers to demographic questions and to questions on the therapeutic and prophylactic use of antimicrobial agents in dentistry. Correct and incorrect answers were defined according to information available in the current authoritative literature. Each correct answer was given a score of 1 while an incorrect answer scored 0. Thus, the total score had an attainable range from 0 to 65. Frequencies, means, and associations were assessed statistically. Results. Out of 181 collected forms (response rate 64.6%), 150 were appropriately completed and used for data analyses. Penicillins were the most frequently prescribed drugs (72%), followed by spiramycin (10%). It was found that up to 84% of practitioners were likely to prescribe an antimicrobial agent when there was no clinical indication for such a medication. Many respondents (70%) would consider antibiotics for at least one of the given non-clinical factors. Conclusions. The results suggest that dental practitioners in Yemen lack uniformity in the rationale for appropriate prescribing of antimicrobials to their patients. Consequently, to reduce overuse, there is an urgent need for the dental community in the country to be informed about evidence-based guidelines and the appropriate use of antimicrobial agents in clinical dental practice.

Prophylactic antimicrobial agents in urologic laparoscopic surgery: 1-day versus 3-day treatments.

Although the incidence of surgical site infection (SSI) is generally low in laparoscopic urologic surgery, the standard protocol for prophylactic use of antimicrobial agents remains to be established. We retrospectively compared the incidence and severity of SSI after laparoscopic surgery between two different protocols for prophylactic use of antimicrobial agents. This study included 114 patients who underwent urologic laparoscopic surgery categorized as "clean" or "clean-contaminated" in Sapporo Medical University School Hospital between January 1996 and October 2002. As a prophylactic antimicrobial agent, one of the cephalosporins or penicillins was administered intravenously to all patients. For 46 consecutive patients between January 1996 and July 2000, an antimicrobial agent was given 30 min before operation and thereafter every 12 h on the same day and the next 2 days after operation (the 3-day group). For 68 consecutive patients from August 2000 to October 2002, an antimicrobial agent was given once 30 min before operation and was additionally given only in the evening or night of the day of operation (the 1-day group). The incidence of SSI was retrospectively investigated. There were two patients who developed SSI in each group (4.3% in the 3-day group and 2.9% in the 1-day group). The incidence of SSI was not significantly different between the two groups. The 1-day protocol has efficacy equal to that of the 3-day protocol in prophylaxis of SSI. The 1-day use of a prophylactic antimicrobial agent may be recommended for the clean or clean-contaminated urologic laparoscopic surgery described above.

Staphylococcus aureus nasal carriage and surgical-site infections

The current literature indicates that surgical-site infections significantly increase costs and length of stay. Nosocomial infections that are acquired after operative procedures increase mortality rates. Staphylococcus aureus is a major cause of surgical-site infections among patients, particularly patients who undergo cardiothoracic surgery. Patients who carry S aureus in their nares are at increased risk for surgical-site infections that are caused by this organism. Occasionally, health care workers who carry S aureus in their nares can cause outbreaks of surgical-site infections or other nosocomial infections. Persons who carry S aureus in their nares and have upper respiratory tract infections may spread this organism to numerous staff members and patients. Key measures for decreasing rates of these and other nosocomial infections include the appropriate use of prophylactic antimicrobial agents, surveillance and reporting of infections, and surveillance for clusters of infection caused by the same strain of S aureus and culture and surveys, when appropriate, to help identify infected health care workers. Additionally, surgical masks may prevent health care workers from inadvertent transmission of S aureus from their nares to patients' surgical sites.

Practical Food Safety Interventions for Dairy Production

Abstract Consumers are increasingly concerned about the safety of their food and uncertain about food production practices. Potential threats to human health related to dairy products and dairy farming include errors in pasteurization, consumption of raw milk products, contamination of milk products by emerging heat-resistant pathogens, emergence of antimicrobial resistance in zoonotic pathogens, chemical adulteration of milk, transmission of zoonotic pathogens to humans through animal contact, and foodborne disease related to cull dairy cows. Most dairy farmers feel responsible for the safety of milk and beef that originate on their farms, but linkage between farm production practices and the quality of processed products have been weak. The safety of dairy products can be enhanced by adoption of a number of management practices. Sources of microbial contamination of milk must be minimized by adoption of hygienic standards that can be easily evaluated. Uniform adoption of milking practices that reduce microbial contamination of milk should be emphasized. The diagnosis of salmonellosis or listeriosis on a dairy farm should be regarded as an indication that other potentially infected animals may be present in the herd. Coliform counts on bulk tank milk should be routinely performed as an indicator of fecal contamination. A reduction in the national regulatory limit for somatic cells in bulk tank milk should be considered based on potential enhancements in milk safety. Dairy farmers must take responsibility for the market cattle leaving their farms. The inappropriate or prophylactic use of antimicrobial agents must be minimized to ensure that antimicrobial resistance does not develop in animal pathogens. Consumers can have confidence in food safety programs on dairy farms that promote awareness and accountability for the products that are produced.

Current status of prophylactic use of antimicrobial agents for cesarean section in Thailand.

To evaluate actual practices and physician reasons for variation in prophylactic use of antimicrobial agents for cesarean section (CS). The study combined a survey of 2726 medical records and an interview of 50 practicing physicians at the obstetric departments of a university, a regional and a general hospital in Songkhla Province, Southern Thailand. Practices that were consistent with systematic reviews were use in 94%, prescription after cord clamping in 86%, and choosing ampicillin in 91%, because physicians believed in the advantages of these practices. Indications for prophylactic use ranged from routine use for all cases to selective use for indicated cases such as ruptured membranes, vaginal examinations, labor, maternal obesity, or unplanned CS. Single-dose practice was varied greatly across hospitals, from 9% to 84%. The reasons given by physicians for a multiple-dose regimen were personal experience in this regimen and belief in its superiority under their local conditions. This practice was less common where the hospital had practice recommendations. Not all evidence-based knowledge is adopted in practice. The prophylactic use of antimicrobial agents for CS varies among physicians. Past experience and personal beliefs in the limitation of research generalizability are the barriers to such adoption.

Aeromonas Infection After Medicinal Leech Therapy: Case Reports and Review of the Literature

Aeromonas Infection After Medicinal Leech Therapy: Case Reports and Review of the Literature

Gene therapy for chronic granulomatous disease

Recent progress in the development of gene therapy for chronic granulomatous disease (CGD), an inherited immunodeficiency syndrome, is reviewed. This disorder results from defects in any of the four genes encoding essential subunits of respiratory burst oxidase, the superoxide-generating enzyme complex in phagocytic leukocytes. The absence of respiratory burst oxidants results in recurrent bacterial and fungal infections and can also be complicated by the formation of inflammatory granulomas. Although current management, including prophylactic use of antimicrobial agents and interferon-γ, has significantly improved its prognosis, CGD continues to be associated with significant morbidity and mortality from life-threatening infections and complications. Allogeneic bone marrow transplantation can provide a life-long cure of the disease, but difficulty in finding suitable donors and risks associated with this procedure have limited its application. Recently CGD has emerged as a promising candidate for gene therapy targeted at the hematopoietic system. CGD mouse models have been developed with gene targeting technology, and preclinical studies in these animals with recombinant retroviral vectors have demonstrated the appearance of functionally normal neutrophils and increased resistance against pathogens such as Aspergillus. Although the murine studies have provided a promise of long-term cure of patients by gene transfer, phase I clinical studies in a limited number of patients with CGD with such vectors have yet to produce a clinically relevant number of corrected neutrophils for extended time periods. Efforts are ongoing to improve gene transfer efficiency into human hematopoietic stem/progenitor cells and to achieve better engraftment of the gene-corrected stem cells. (J Lab Clin Med 2000;135:122-8)

The use of prophylactic antimicrobial agents during and after hip arthroplasty.

An intravenous antibiotic, administered just before skin incision, effectively reduces the prevalence of deep wound infection. The optimal antimicrobial agent has not been determined definitively; however, a short duration of prophylaxis is recommended. Institutional compliance strategies are cost-effective and improve the timing of antibiotic administration. Also, published antimicrobial restriction recommendations are warranted because of the concern of emerging antibiotic-resistant bacteria. Specifically, restriction of vancomycin in orthopaedic surgery should be targeted critically. Supplemental antibiotic administration includes additional intra-operative antibiotic dosing, use of antibiotic-irrigant solutions, and admixture of antibiotics into acrylic bone cement or bone graft. There are no established standards or clinical guidelines for these supplemental antibiotic applications. Post-operatively, antimicrobial agents frequently are overused for various clinical scenarios and this pattern of antibiotic usage is potentially detrimental. A prophylaxis strategy for prevention of early and late hematogenous infection requires consideration of host risk factors, wound environment variables, and sources of potential bacteremia. This strategy should include deliberation of the cost-effectiveness, efficacy, and complications associated with routine use of antibiotics. Advisory statements for elective procedures, which potentially may cause bacteremia, are being developed and additional research is required for this area of antimicrobial agent prophylaxis.