Proportion Of Antibiotics Research Articles

Dynamics of antibiotic resistance agents during sludge alkalinization treatment

This study aimed to assess the removal of antimicrobial resistance agents (antibiotics, antibiotic-resistant bacteria - ARB, and antimicrobial resistance genes - ARGs) from aerobic and anaerobic sludges treated with quicklime (chemical alkalinization). Different mixing ratios (25%, 35%, and 45%) and contact times (2 h and 72 h) were evaluated. The findings revealed that anaerobic sludge responded more effectively to alkaline treatment, achieving better removal rates of antibiotics, ARB, and ARGs compared to aerobic sludge. The 45% lime treatment yielded the highest antibiotic removal rates, with average reductions of 19% in aerobic sludge and 28% in anaerobic sludge. The 35% lime treatment was the most effective in reducing ARGs across both types of sludge (average removal of 2 logs). The 25% lime treatment proved most efficient for removing ARB, with average reductions of 4 logs (aerobic) and 5 logs (anaerobic). The contact time between the sludge and quicklime also influenced the removal of resistance agents. An increase in the proportion of antibiotics and the absolute concentration of ARB and ARGs was observed after 72 h compared to the samples analyzed after 2 h of contact. This increase was more pronounced in aerobic sludge samples treated with 35% and 45% lime. Despite the overall reduction, none of the monitored resistant genes or bacteria were completely eradicated in both sludge samples, raising concerns about their potential dissemination into the environment.

The Impact of SARS-CoV-2 Pandemic on Antibiotic Prescriptions and Resistance in a University Hospital from Romania.

This paper aimed to evaluate the effects of the COVID-19 pandemic on prescription rates and antibiotic resistance in a university hospital. A retrospective study was conducted on the medical records of patients admitted to the Bihor Emergency Clinical County Hospital in Romania in 2019 (pre-pandemic) and 2021 (during the pandemic period). We evaluated the antibiotic consumption index (ACI) and susceptibility rates. The overall percentage of antibiotic prescribing increased in 2021, while the total number of patients decreased. Genito-urinary, digestive, respiratory infections, heart diseases and wounds were the most common conditions for antibiotic prescriptions, but the number of them decreased in 2021. There was a decrease in the proportion of antibiotics from the Watch and Reserve class and an increase in the proportion of antibiotics from the Access class. Antibiotic use has been reduced despite an increase in the number of patients, with a high consumption in the Watch group in the ICU wards. By contrast, surgical wards had the highest rate of antibiotic prescriptions, but a decrease in the number of patients. The patients who were administered antibiotics were hospitalized for diagnoses other than COVID-19. Almost all prescribed antibiotics displayed decreasing sensitivity rates. The number of isolated ESKAPE pathogens, except for Staphylococcus aureus methicillin-resistant strains, were increased. Strategies to control antibiotic prescriptions and the spread of resistant pathogens should be improved.

Analysis of risk factors and short-term prognostic factors of arrhythmia in patients infected with mild/moderate SARS-CoV-2 Omicron variant.

Complications, including arrhythmia, following severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection continue to be of concern. Omicron is the mainstream SARS-CoV-2 mutant circulating in mainland China. At present, there are few epidemiological studies concerning the relationship between arrhythmia and Omicron variant infection in mainland China. To investigate the risk factors of arrhythmia in patients infected with the SARS-CoV-2 Omicron variant and the factors influencing prognosis. Data from 192 Omicron infected patients with symptoms of arrhythmia (AH group) and 100 Omicron infected patients without arrhythmia (Control group) were collected. Patients in the AH group were divided into the good and poor prognosis groups, according to the follow-up results 4-6 weeks after infection. The general and clinical data between the AH and Control groups, and between the good and poor prognosis groups were compared. The variables with differences between the groups were included in the multivariate logistic regression analysis, and the quantitative variables were analyzed by receiver operating characteristic curve to obtain their cut-off values. Compared with the control group, the body mass index (BMI), proportion of patients with a history of arrhythmia, proportion of antibiotics taken, heart rate, moderate disease severity, white blood cell (WBC) count, and the aspartate aminotransferase, creatine kinase (CK), CK isoenzyme (CK-MB), myoglobin (Mb), high-sensitive troponin I (hs-cTnI), lymphocyte ratio and high sensitivity C-reactive protein (hs-CRP) levels in the AH group were significantly higher (p < 0.05). In addition, obesity (BMI ≥24 kg/m2), fast heart rate (≥100 times/min), moderate disease severity, and WBC, CK-MB and hs-cTnI levels were independent risk factors of arrhythmia for patients with Omicron infection (p < 0.05), and hs-CRP was a protective factor (p < 0.05). Compared with the good prognosis group, the age, proportion of patients with a history of arrhythmia, heart rate, proportion of moderate disease severity, and hs-CRP, CK, Mb and hs-cTnI levels were significantly higher in the poor prognosis group, while the proportion of vaccination was lower in the poor prognosis group (p < 0.05). Advanced age (≥65 years old), proportion of history of arrhythmia, moderate disease severity, vaccination, and hs-CRP, Mb and cTnI levels were independent factors for poor prognosis of patients with arrhythmia (p < 0.05). The factors that affect arrhythmia and the prognosis of patients infected with Omicron include obesity, high heart rate, severity of the disease, age. history of arrhythmia, WBC, hs-CRP, and myocardial injury indexes, which could be used to evaluate and prevent arrhythmia complications in patients in the future.

Drug prescription pattern in primary healthcare centers in southwest Nigeria. A cohort analysis of primary health workers prescription records

Introduction: Rational use of Drugs is the prescription and dispensation of drugs to the appropriate patients in appropriate doses, for required period and at lowest cost to them and their community. Irrational use refers to inappropriate use of drugs which include prescription and dispensation of too many drugs (polypharmacy), unnecessary and overuse of antibiotics and use of injection where oral drug suffices. A step towards preventing irrational drug use is to document it in a study such as this, so that appropriate corrective steps can be taken. Methods: This was a cross sectional cohort analysis of the prescribing records of primary health care workers from eight primary health care facilities. Result &amp; Discussion: There were 513 prescriptions of 2, 590 drugs from the eight facilities;206 (40%) from a cohort of two comprehensive health centres and 307(60%) from a cohort of six basic health clinics. 206(40%) was diagnosis-based prescriptions, while 307(60%) was not based on diagnosis. About 426(83%) contain antibiotics prescriptions, while 87(17%) had no antibiotic prescriptions. About 395(77%) prescriptions contained injectable drugs while 118(23%) did not contain any injectable drug. Conclusion: The average of number drugs per prescription and the proportions of antibiotics and injectables prescriptions in this study were higher than the WHO recommendations. These values were equally higher than values in many studies. Healthcare workers at the basic health clinics did more diagnosis-based prescriptions, prescribed more antibiotics and more injectable than their counterparts at the comprehensive health centers.

Efficacy and safety of PEG-rhG-CSF versus rhG-CSF in preventing granulocytopenia in sarcoma patients receiving doxorubicin combined with ifosfamide: A prospective, randomized, non-inferiority phase II study.

e24173 Background: Prophylactic use of rhG-CSF is routinely recommended in patients with a high risk of febrile neutropenia (FN) after chemotherapy. Currently, rhG-CSF is mostly used in clinical practice. However, PEG-rhG-CSF tends to be a substitute due to its convenience and long-acting effect. Regarding concerns about its efficacy and safety, whether PEG-rhG-CSF could be prophylactically used after these regimens with a high risk of FN is still in doubt. Doxorubicin combined with ifosfamide is commonly applied in sarcoma patients and is one of the most serious myelosuppressive chemotherapy regimens in solid tumors. We compared the efficacy and safety of PEG-rhG-CSF with rhG-CSF in the prevention of severe granulocytopenia and FN, in patients receiving this representative regimen. Methods: This was a single-center, prospective, randomized, crossover, non-inferiority phase II trial. Patients with sarcoma suitable for doxorubicin combined with ifosfamide treatment were enrolled. All patients received 2 cycles of chemotherapy and were randomly assigned to either the AOB group (PEG-rhG-CSF used in 1st cycle and rhG-CSF in 2nd cycle) or BOA group (rhG-CSF used in 1st cycle and PEG-rhG-CSF in 2nd cycle). Blood monitoring every other day until ANC ≥ 2×109/L in two consecutive tests. The primary endpoints were the frequency and duration of grade 4 granulocytopenia after prophylactic use of PEG-rhG-CSF and rhG-CSF respectively, the secondary endpoints were the frequency and duration of febrile neutropenia, and proportion of antibiotic use. Results: From Jan 1, 2018 to Aug 31, 2021, 70 patients were enrolled, 35 each in AOB and BOA. There were no statistical differences in the incidence and duration of grade 4 granulocytopenia (85.7% vs. 77.0%, p = 0.1; 1.34d vs. 1.41d, p = 0.70), the proportion and duration of febrile neutropenia (12.8% vs. 8.2%, p = 0.77; 0.6d vs. 0.8d, p = 0.74), and the proportion of antibiotics used (19.1% vs. 14.9%, p = 0.79) when comparing PEG-rhG-CSF vs. rhG-CSF in prophylactical use. The incidence of grade 4 granulocytopenia in both groups was comparable in 1st cycle (90.9% vs. 96.0%, p = 0.47), but in 2nd cycle it was significantly lower in AOB than that in BOA (54.5% vs. 88.0%, p = 0.01). The lowest value of ANC was higher in AOB in 2nd cycle (0.32G/L vs. 0.12G/L, p = 0.03). Conclusions: This study demonstrated PEG-rhG-CSF could prevent granulocytopenia and FN in sarcoma patients receiving doxorubicin combined with ifosfamide, with comparable efficacy and toxicities as rhG-CSF. Considering the convenience in use and patient compliance, PEG-rhG-CSF could be an effective and reasonable alternative to rhG-CSF. Clinical trial information: ChiCTR1900021945 .

Modern aspects of Helicobacter pylori infection

A systematic review of current data on the structure and functions of Helicobacter pylori (Hp), pathogenesis, diagnosis and treatment of Hp-infection is presented. The relevance of the topic of helicobacteriosis is due to the proven connection of this infection with chronic, widespread diseases of the digestive organs among the population. The review used materials from the databases including PubМed, Medline, EMBASE, Scopus, Google Scholar, RSCI. A systematic review based on studies with a high degree of evidence has shown significant progress in the diagnosis and treatment of Hp-infection in recent years in adults and children. Coordination of the scientific search for the regularities of the formation of Hp-associated forms of pathology, continuous improvement of diagnostic technologies and the search for new therapies, periodic well-organized international revisions of standard methods of Hp diagnosis and treatment contribute to the creation of effective methods of Hp eradication, preservation of the optimal composition of the microbiota of the gastrointestinal tract and prevention of antibiotic resistance. Of particular importance for the prevention of complications of Hp-infection are original diagnostic algorithms using specialized endoscopic and molecular technologies before and after Hp eradication with long-term follow-up and the determination of the leading factors correlating with a high risk of stomach cancer. The review indicates the emergence of potentially effective and promising areas for the diagnosis and treatment of Hp-infection, including genetic modification of the Hp genome to ensure its existence as a human symbiont and a significant reduction in its pathogenic properties. At the same time, sequencing of a new generation reveals mutations in Hp genes associated with its pathogenicity and antibiotic resistance, which contributes to the creation of new classes of drugs to increase the effectiveness of Hp eradication with a decrease in the proportion of antibiotics and an increase in pathogenetically significant inhibitors of its pathogenic factors for the prevention of side effects, a significant reduction in the empirical use of several antibiotics and increased compliance to treatment.

Antimicrobial prescribing for children in China: data from point prevalence surveys in 18 tertiary centres in China in 2016–2017

ObjectivesThe reports on evaluating the classification of antibiotic agents prescribed for Chinese children by combining WHO’s and China’s administrative categories were rare. This study aimed to investigate the pattern of...

156. Evaluation of Trends in Antimicrobial Use and Proportion of Culture Positive Gram-Negative/Gram-Positive Pathogens Comparing Prior to and During the SARS-CoV-2 Pandemic: A Multicenter Evaluation

BackgroundIncreased risk for bacterial co-infections has been described in the pathogenesis of primary viral infections. We evaluated trends in incidence of antibiotic use (abx) and culture positive Gram negative/Gram positive (GN/GP) pathogens in US hospitalized patients prior to and quarterly during the SARS-CoV-2 pandemic.Table. Trends in antimicrobial use, duration, and positive GN/GP pathogen results. MethodsWe conducted a multi-center, retrospective cohort analysis of all hospitalized patients from 241 US acute care facilities with >1-day inpatient admission between 7/1/19-5/15/21 in the BD Insights Research Database (Franklin Lakes, NJ USA). SARS-CoV-2 infection was defined as a positive PCR during or ≤7 days prior to hospitalization. Admissions with abx prescribed ≥24 hrs and a GN/GP non-contaminant, positive culture were evaluated.ResultsDuring the pre-pandemic period (7/19 – 2/20) 30% (600,116/2,001,793) admissions were prescribed abx ≥ 24 hrs and 5.3% were positive for a GN/GP pathogen (Table 1). During the SARS-CoV-2 pandemic, abx use ≥ 24 hrs (66.2%) and positive GN/GP culture (8.4%) was highest in SARS-CoV-2 positive patients followed by patients negative for SARS-CoV-2 (abx ≥ 24 hrs 36.7%; GN/GP pathogens 6.8%), and SARS-CoV-2 not tested (abx ≥ 24 hrs 27.5%; GN/GP pathogens 4.5%). GN/GP positive culture was consistent by quarter during the pandemic for SARS-CoV-2 positive patients, whereas SARS-CoV-2 negative and not tested patients had the highest proportion of antibiotics received and positive pathogens in the first three months of pandemic. SARS-CoV-2 positive patients with positive GN/GP culture had the longest median abx duration. (Table 1) The prevalence of abx usage was highest in all groups for all abx during the early pandemic and then declined over time with the largest declines in SARS-CoV-2 positive patients. (Table 2)ConclusionThis study highlights the impact of viral infections on both prescribing practices and prevalence of bacterial pathogens. Approximately two-thirds of SARS-CoV-2 positive patients received an antibiotic despite a low percentage of positive cultures, however aggregate antimicrobial use overall was similar prior to compared to during the SARS-CoV-2 pandemic. These data may inform opportunities for stewardship programs and antibiotic prescribing in the current and future viral pandemics.Disclosures Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)

THE REASONABLENESS OF USING DRUGS TO TREAT PNEUMONIA

Objective: To investigate the reasonableness of using drugs to treat pneumonia at Can Tho Children’s Hospital. Subjects and methods: a retrospective-descriptive study on 384 inpatient medical records at Can Tho Children’s Hospital from January 2019 to December 2019 was diagnosed pneumonia. Results: The percentage of the initial treatment regimen that was not reasonable with the recommended antibiotic regimen was relatively high at 84.11%. The proportion of antibiotics with inappropriate dose was only 1.71% of the total number of surveyed cases. The appropriate rate of antibiotic dose was 98.29%. The proportion of adjuvants with high appropriate doses such as Salbutamol, Hydrocortison and Prednisolon accounted for 100%. The rate of taking antibiotics in accordance with recommendations accounted for 94.67%. The rate of adjuvanvt drug delivery was very high, there were only a few cases that did not comply with recommendations such as Ibuprofen with 14 cases, accounting for 37.84%, Acetylcysteine ​​and Hydrocortison accounted for 14.58% with 7 cases, and Prednisolon and Budesonid accounted for the very low percentage. Conclusion: The proportion of the initial treatment regimen that was not compatible with the antibiotic regimen was relatively high. The appropriate rate of antibiotic dose was high. The proportion of adjuvants with suitable doses was high such as Salbutamol, Hydrocortison and Prednisolon. The antibiotic delivery rate was consistent with recommendations. The rate of adjuvant delivery was very high.

Estimating the Proportion of Antibiotics Attributable to Common Paediatric Respiratory Viruses: An Example Leveraging Unique Population-Based Prescribing and Laboratory Data

IntroductionInappropriate antibiotic prescribing, such as that for viral illness, is common in primary care. This is of growing interest given concerns around antimicrobial resistance and harms associated with unnecessary treatment; however, current data limitations have hindered population-based estimates of the proportion of community-prescribed antibiotics attributable to common respiratory viruses.&#x0D; Objectives and ApproachTo estimate the proportion of antibiotics prescribed in primary care to young children attributable to common respiratory viruses, including respiratory syncytial virus (RSV), influenza, human metapneumovirus (HuMPV) and parainfluenza. We leveraged two unique sources of comprehensive, linked population-based administrative data on dispensed antibiotic prescriptions and laboratory tests for respiratory viruses for all Scottish children (&lt;5 years). We fit time series negative binomial models to predict weekly antibiotic prescribing rates from positive viral tests rates for the period April 1, 2009 through Dec 27, 2017. Using linked demographic and hospitalization data, we stratified our analysis by age, presence of high-risk chronic medical conditions, and antibiotic class.&#x0D; ResultsWe included data on over 6 million antibiotic prescriptions among nearly 800,000 children. An estimated 6.9% (95% CI: 5.6,8.3), 2.4% (1.7,3.1), and 2.3% (0.8,3.9) of prescribed antibiotics were attributable to RSV, influenza and HuMPV, respectively. RSV was consistently associated with the highest proportion of antibiotics prescribed across all analyses but particularly among children without chronic conditions [4.30% (3.19, 5.41)] and for amoxicillin [8.10% (6.43, 9.76)] and macrolide prescriptions [7.65% (6.14, 9.16)].&#x0D; Conclusion / ImplicationsNearly 14% of antibiotics prescribed to Scottish children in this study were attributable to common viral pathogens such as RSV for which antibiotics are not recommended. This highlights clear targets for antibiotic stewardship programs and suggests antibiotic prescribing could be reduced once an RSV vaccine is introduced.

Effect of early intervention bundle on clinical prognosis of patients with latent/overt septic shock in emergency department

To observe the effect of early intervention bundle on clinical prognosis of patients with latent/overt septic shock in emergency department and analyze the risk factors for mortality. Patients with latent and overt septic shock admitted to the North Hospital of Huashan Hospital Affiliated to Fudan University from January 2018 to December 2019 were retrospectively analyzed and divided into latent shock group and overt shock group. The gender, age, main infection site, the time of shock diagnosis, the indicators of early (3-hour) intervention bundle, 6-hour compliance rate of intervention bundle, the remission time and 28-day prognosis were observed. Logistic regression analysis was used to identify risk factors for 28-day mortality. Receiver operating characteristic (ROC) curve was used to analyze its prognostic value. Totally 181 patients were included in the analysis. There were 102 cases in the latent shock group, and 28-day mortality was 15.69% (16 cases); 79 cases in the overt shock group, and 28-day mortality was 31.65% (25 cases). Compared with the latent shock group, patients in overt shock group had higher compliance rate of early intervention bundle (93.67% vs. 58.82%), higher blood lactate acid at admission [Lac (mmol/L): 7.09±2.08 vs. 5.69±1.27], higher compliance rate of blood culture before antibiotics (93.67% vs. 63.73%), higher proportion of antibiotics use at the first and second hours (45.57% vs. 31.37%, 54.43% vs. 33.33%), higher proportion of rapid fluid resuscitation at the first hour (crystal liquid: 59.49% vs. 11.76%, crystal fluid combined with human serum albumin: 40.51% vs. 0%), and higher proportion of vasoactive use at the first hour (100% vs. 9.80%). The stable time was significantly prolonged (days: 4.40±1.35 vs. 1.49±0.55), while the onset time (days: 1.47±0.97 vs. 2.95±1.61), the time of diagnosis (minutes: 31.30±12.54 vs. 79.15±13.81), 6-hour lactate clearance [(50.27±21.53)% vs. (61.82±13.12)%], the proportion of antibiotics use at the third hour (0% vs. 35.29%), the proportion of rapid fluid resuscitation at the second and third hour (second hour crystal liquid: 0% vs. 60.78%, second hour crystal fluid combined with human serum albumin: 0% vs. 14.71%, third hour crystal liquid: 0% vs. 12.75%), 6-hour compliance rate of the standard of central venous blood saturation (ScvO2, 60.76% vs. 78.43%) and the success rate of treatment (28-day mortality: 31.65% vs. 15.69%) were lower than those of the latent shock group (all P < 0.05). Ten patients with latent shock developed into overt shock within 24 hours after admission. All patients with overt shock needed vasoactive drugs to maintain mean arterial pressure (MAP) ≥ 65 mmHg (1 mmHg = 0.133 kPa). Compared with the survival patients, the Lac (mmol/L: 7.59±2.27 vs. 5.92±1.24) and the proportion of vasoactive drugs use (65.85% vs. 44.29%) were significantly increased in the death patients, while the 6-hour lactate clearance [(46.58±15.83)% vs. (59.60±17.92)%], the proportion of antibiotics use in the third hour (4.88% vs. 24.29%), and 6-hour compliance rate of urine volume and ScvO2 (56.10% vs. 82.86%, 43.90% vs. 78.57%) were significantly decreased (all P < 0.05). Binary Logistic regression analysis showed that Lac at admission, 6-hour lactate clearance, the use of antibiotics at the third hour, rapid fluid resuscitation at the first hour, and 6-hour compliance rate of ScvO2 were independent risk factors for 28-day mortality [odds ratio (OR) was 1.618, 0.021, 0.100, 0.307 and 3.018, all P < 0.05]. ROC curve analysis showed that the Lac at admission had the highest predictive value for 28-day mortality, the area under the ROC curve (AUC) was 0.706; followed by 6-hour compliance rate of ScvO2 (AUC was 0.673). Patients with latent/overt septic shock need early diagnosis and intervention bundle to improve the 6-hour blood lactate clearance and 6-hour compliance rate of ScvO2 and reduce the mortality.

Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): Amulticentreobservational study.

The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.

Traceability of Pediatric Antibiotic Purchasing Pathways in Italy: A Nationwide Real-World Drug Utilization Analysis.

PurposeThe aim of the present study was to describe the purchasing patterns of a set of antibiotics used exclusively in an out-patient pediatric setting in Italy using the Farma360 wholesale drug database (IQVIA Solutions Italy), identifying the proportion of medications which are not captured by Italian National Health Service (NHS) pharmacy claims databases and examining the implications of such findings from a public health and pharmaceutical policy perspective.MethodsUsing a systematic approach, sixty-six antibiotic pediatric formulations were selected for the 5 most commonly used antibiotics in Italy in children and adolescents: amoxicillin in combination with clavulanic acid, amoxicillin, azithromycin, clarithromycin and cefixime. The Farma360 wholesale drug purchasing database was used to identify the yearly proportion of antibiotics not purchased based on NHS reimbursement in primary care from 2015–2017 at the national level. The relationship between product cost and purchase outside the NHS was assessed by a scatterplot. All analyses were stratified by geographic area: Northwest, Northeast, Central and Southern Italy.ResultsThe proportion of antibiotics not reimbursed by the NHS increased nationally from 24% in 2015 to 29% in 2017. The antibiotic with the highest proportion of purchases outside the NHS was amoxicillin, with almost two-thirds of all amoxicillin purchases in Southern Italy being made in this way in 2017. The relationship between antibiotic price and antibiotic purchase outside the NHS was almost linear for many geographic areas.ConclusionsThis study showed that a large proportion of antibiotics with a pediatric formulation is purchased outside the NHS drug purchasing pathway, especially in Southern Italy, indicating that it is not possible to fully monitor drug utilization, including appropriateness, for these antibiotics. A better strategy is needed to improve drug utilization monitoring, such as better data collection or data linkage.

Efficacy and safety of antibiotic agents in children with COVID-19: a rapid review.

BackgroundThe aim of this review was to evaluate the efficacy and safety of antibiotic agents in children with COVID-19, as well as to introduce the present situation of antibiotics use and bacterial coinfections in COVID-19 patients.MethodsWe searched Cochrane library, Medline, Embase, Web of Science, CBM, Wanfang Data and CNKI from their inception to March 31, 2020. In addition, we searched related studies on COVID-19 published before March 31, 2020 through Google Scholar. We evaluated the risk of bias of included studies, and synthesized the results using a qualitative synthesis.ResultsSix studies met our inclusion criteria. Five studies on SARS showed an overall risk of death of 7.2% to 20.0%. One study of SARS patients who used macrolides, quinolones or beta lactamases showed that the mean duration of hospital stay was 14.2, 13.8 and 16.2 days, respectively, and their average duration of fever was 14.3, 14.0 and 16.2 days, respectively. One cohort study on MERS indicated that macrolide therapy was not associated with a significant reduction in 90-day mortality (adjusted OR 0.84, 95% CI: 0.47–1.51, P=0.56) and improvement in MERS-CoV RNA clearance (adjusted HR 0.88, 95% CI: 0.47–1.64, P=0.68). According to the findings of 33 studies, the proportion of antibiotics use ranged from 19.4% to 100.0% in children and 13.2% to 100.0% in adults, despite the lack of etiological evidence. The most commonly used antibiotics in adults were quinolones, cephalosporins and macrolides and in children meropenem and linezolid.ConclusionsThe benefits of antibiotic agents for adults with SARS or MERS were questionable in the absence of bacterial coinfections. There is no evidence to support the use of antibiotic agents for children with COVID-19 in the absence of bacterial coinfection.

Prevalence of antibiotic use in a tertiary care hospital in Italy, 2008\u20132016

BackgroundFew data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008–2016 in the largest children’s hospital in Italy.MethodsAnnual point prevalence surveys of antibiotic use were conducted by reviewing medical charts of 0–17 year-old children hospitalized for ≥48 h. Prevalence of antibiotic use was computed by year, type of ward and indication. Trends in prevalence over time were evaluated using the Cochrane-Armitage test. Possibile determinants of antibiotic use were assessed at univariate analysis and through a logistic regression model.ResultsOut of 3015 children, 1516 (50.3%) received antibiotics, 58.1% of which for medical/surgical prophylaxis. Prevalence of antibiotic use increased from 42.0% in 2008 to 56.2% in 2016 (p = 0.001). The prevalence of patients receiving antibiotics for medical prophylaxis increased from 6.1% in 2008 to 24.2% in 2016 (p < 0.001), whereas the prevalence of patients receiving antibiotics for surgical prophylaxis significantly decreased (from 13.7 to 11.8%; p = 0.04); no significant temporal trends were found in antibiotic use for treating infections.The administration of third-generation cephalosporins for surgical and medical prophylaxis significantly decreased over time, while the proportion of antibiotics prescribed to treat infections after microbiological investigations significantly increased. Year (ORadj: 1.8 in 2016 compared to 2008, p < 0.001), age (ORadj ≥1.5 in children ≥1 year, compared to infants ≤2 months, p < 0.001), length of stay (LOS) (ORadj: 1.4 in case of LOS between 8 and 30 days compared to LOS ≤ 7 days, p < 0.001), and type of ward (ORadj: ≥1.3 in intensive-care, surgical and medical-subspecialty units compared to medical units, p < 0.001) were significantly and independently associated with antibiotic use.ConclusionsComparing prevalence rates of antibiotic use among hospitals and over time should consider differences in patient characteristics, such as age, ward of hospitalization and length of stay. Over the years, we documented an improvement in the choice of antibiotics prescribed for medical and surgical prophylaxis. However, further efforts are needed to avoid antibiotic misuse for medical prophylaxis, and to reduce the empirical use of broad spectrum antibiotics.

Do Different Proportions of Antibiotics in the CTZ Paste Interfere with the Antimicrobial Action? In Vitro Study

Objective: To evaluate the antimicrobial action of the CTZ paste in three different proportions by diffusion in agar with the microorganisms: Enterococcus faecalis , Escherichia coli , and Candida albicans . Material and Methods: Three different proportions of antibiotics were tested: GROUP A - CTZ paste in the ratio of 33.33% chloramphenicol + 33.33% tetracycline + 33.33% zinc oxide, mixed with 2 drops of eugenol (1:1:1 ratio); GROUP B - CTZ paste in the proportion of 25% chloramphenicol + 25% tetracycline + 50% zinc oxide, mixed with 2 drops of eugenol (1: 1: 2 ratio); GROUP C - CTZ paste with 13% chloramphenicol + 13% tetracycline + 74% Zinc Oxide, mixed with 2 drops of eugenol (1:1:6 ratio); PC GROUP - Positive Control (0.12% Chlorhexidine); and NC GROUP - Negative Control (0.9% Saline solution). Data were analyzed through descriptive statistics (means and standard deviation). The one-way ANOVA and Tukey’s test were used, with a significance level of 5%. Results: No statistical differences for Enterococcus faecalis between groups A, B, and C (p = 0.1986) were found. There were statistical differences for Escherichia coli between groups B and C (p = 0.029), and for Candida albicans between groups A and C (p = 0.006). Groups A, B, and C had significant differences with both Positive and Negative Controls for all the microorganisms . Conclusion: The three different ratios of CTZ paste showed antimicrobial efficacy against Enterococcus faecalis , Escherichia coli, and Candida albicans microorganisms.

Variability in antibiotic use across Ontario acute care hospitals.

Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts.

Antibiotic use before chlamydia and gonorrhea genital and extragenital screening in the sexually transmitted infection clinical setting.

Background antibiotic use (i.e., administration of antibiotics not directly related to Chlamydia trachomatis or Neisseria gonorrhoeae infections) has been associated with a lower prevalence of genital C. trachomatis infection in a clinical setting. Associations with specific antibiotic types or with N. gonorrhoeae are lacking. Here, we assessed the prevalence of antibiotic use, the different classes and agents used, and their association with a subsequent sexually transmitted infection (STI) clinic C. trachomatis and N. gonorrhoeae test result. At our STI clinic, we systematically registered whether antibiotics were used in the past month (in 29% of the cases, the specific antibiotic agent was named). Patients were screened for urogenital C. trachomatis and N. gonorrhoeae; a third of them were also screened for anorectal and oropharyngeal C. trachomatis and N. gonorrhoeae. The proportion of antibiotics used and their association with C. trachomatis and N. gonorrhoeae prevalence were assessed for heterosexual men, men who have sex with men (MSM), and women. During 14,775 clinic consultations, antibiotic use was reported by 12.2% (95% confidence interval [CI], 11.7% to 12.7%), i.e., 14.8% of women, 8.6% of heterosexual men, and 11.6% of MSM. The most reported antibiotics were penicillins, tetracyclines, and macrolides, respectively. The prevalence was 11.0% (95% CI, 10.3% to 11.3%) for C. trachomatis and 1.9% (95% CI, 1.7% to 2.1%) for N. gonorrhoeae. Only tetracycline use was associated with a lower C. trachomatis prevalence (3%). Overall antibiotic use was associated with lower anorectal C. trachomatis prevalence in MSM only (odds ratio, 0.4; 95% CI, 0.2 to 0.8). STI clinic visitors commonly report recent antibiotic use. Even in a country with low antibiotic consumption, tetracycline use impacted C. trachomatis prevalence, while there was a notable absence of association with azithromycin.

Retrospective Assessment of Irrational use of Antibiotics to Children Attending in Mekelle General Hospital

Background: In the last decades, there has been an escalating consumption of antibiotics with the number of antibiotic prescriptions increasing worldwide. Since children are more vulnerable to infectious disease than adults, more antibiotics are prescribed for them. Inappropriate use of antibiotics has resulted in a major increase in the development of multi-drug resistant pathogens with great implication in terms of morbidity, mortality and costs. The objective of this study was to determine the irrational use of antibiotics prescribed for children under the age of 15 years in Mekelle general hospital. Methods: A retrospective cross sectional study was conducted. Four hundred three children’s prescriptions and corresponding cards which were recorded by the year 2012 were selected by systematic random sampling proportionally from each month in the year. Results: Of all antibiotic prescriptions reviewed, the numbers of outpatient antibiotic prescriptions were 222 (55.1%) while inpatient prescriptions were 181 (44.9%).The predefined antibiotics indicators like percentage of antibiotics prescribed, frequency of route of administration, antibiotics prescribed from Standard treatment guideline, proportion of antibiotics, cost of antibiotics per antibiotics days, incidence and antibiotics utilization ratio were determined and 141(35.1%) were treated with different antibiotics irrationally. Conclusion: The finding of this study indicated that antibiotics were prescribed irrationally. Prescriptions containing one or more antibiotics constituted 73.68% of all prescriptions and around 5.9% of encounters were treated without any diagnosis. T he study has revealed that third generation cephalosporin (ceftriaxone) has been highly prescribed in the study hospital.

Point prevalence survey on antibiotic use in a Croatian Infectious Disease Hospital

Antibiotic use is the driving force for increasing antibiotic resistance. A large proportion of antibiotics in hospitals are used inadequately. The objective of this study was to evaluate antibiotic use at the Hospital for Infectious Diseases through point-prevalence surveys conducted in 2006, 2008, and 2009. Point prevalence surveys were part of the European Surveillance on Antimicrobial Consumption (ESAC) Hospital Care Subproject and patients’ data were collected following ESAC protocol. Additionally, the adequacy of antimicrobial therapy and administration of the first line antibiotic according to the local guidelines were assessed by an infectious disease doctor and a clinical microbiologist. In the study period among the 599 patients admitted to hospital, 352 (58·8%) received antibiotics. Out of 448 antimicrobial treatments, 313 (69·9%) were administered parenterally and 135 (30·1%) orally. Altogether in years 2006, 2008, and 2009 the most commonly prescribed antibiotics were ceftriaxone (19·9%), co-amoxiclav (15·4%), ciprofloxacin (12·3%), narrow spectrum penicillins (6·5%), and penicillinase resistant penicillins (5·6%). Most (82·6%) of the treated infections were community acquired infections. The predominating diagnoses were urinary tract infections and infections with no primary site defined, followed by skin, soft tissue and bone and joint infections. The overall adequacy of antimicrobial therapy was 82% and the first line antibiotic according to the local guidelines was administered with high frequency for central nervous system and cardiovascular infections (100%), and low for ear, nose, and throat infections, urinary tract infections, lower respiratory tract and bone and joint infections (23·0%, 51·6%, 52·5%, 65·0%, respectively) which indicates a significant overuse of antibiotics for diagnoses listed. The results of an individual point prevalence survey provided reliable and representative data for the hospital. Point-prevalence surveys proved to be a valuable method for detecting targets for antibiotic prescribing improvement and they clearly showed that our local hospital guidelines offered too many choices of antibiotic treatment for each clinical indication and needed revision.