Rational Use Of Antimicrobials Research Articles

Analysis of antimicrobial drug usage in psychiatric specialized hospitals during the pandemic in China

ABSTRACT Background This study aims to compare antimicrobial drug usage in our hospital to Jiangsu Province and China from 2020 to 2022. Research design and methods A detailed analysis was performed using data from the National Antimicrobial Drug Clinical Application Monitoring Network. Several parameters were studied: the rate of antimicrobial drug use, number and types of drugs used, the rate of combined use, rate of microbiological examinations, drug use intensity, and cumulative Defined Daily Doses (DDDs). Results From 2020 to 2022, our hospital’s antimicrobial drug usage rate was consistently lower than Jiangsu Province and China. The average number of drug types and the combined drug use rate were higher in 2020 but fell below those in Jiangsu Province and China in 2021 and 2022. Our microbiological examination rate consistently surpassed that of Jiangsu Province and China. Furthermore, our Antimicrobial Usage Density and cumulative DDDs were notably lower. While AUD remained stable, DDDs showed a decreasing trend. The most dominant drug in DDDs was cefditoren, a third-generation cephalosporin. Conclusions During the pandemic years, our hospital not only met the requirements for antimicrobial drug usage, microbiological examination, AUD, and cumulative DDDs but also demonstrated a consistent year-by-year decrease in drug usage and DDDs.

The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans.

Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically. Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model. A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. The rate of Escherichia coli resistance to ciprofloxacin increased (p < 0.05), while the resistance to amikacin decreased (p < 0.05). The resistance of Klebsiella pneumoniae to cephalosporins, carbapenems, β-lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased (p < 0.05), and the resistance of Pseudomonas aeruginosa to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly (p < 0.05). The resistance of Enterococcus faecium to tetracycline increased by year (p < 0.05), and the resistance of Enterococcus faecalis to erythromycin and high-concentration gentamicin declined (p < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially Escherichia coli, and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.

Prevalence and Antimicrobial Susceptibility Profile of Salmonella from Poultry Farms and In-Contact Humans and Associated Risk Factors in Addis Ababa, Ethiopia.

Poultry and poultry products are the common sources of Salmonella,which is one of the serious food-borne bacterial diseases in humans. Little is known about the status of Salmonella and their antimicrobial susceptibility in poultry farms in Addis Ababa. This study was conducted to estimate the prevalence and antimicrobial susceptibility of Salmonella isolates and to investigate possible risk factors for the occurrence of Salmonella in poultry farms in Addis Ababa. We recruited 58 poultry farms, from which 471 poultry-related samples and 44 stool samples from in-contact humans were collected. The isolates were tested for their susceptibility to 11 antimicrobials using the Kirby-Bauer disk diffusion assay. The farm-level prevalence of Salmonella was 36.2% and the sample-level prevalence was 6.4% for samples taken from poultry farms and 4.5% in human stool samples who have contact with poultry. On-farm waste disposal practices and chicken being purchased from different multiplication farms were significantly associated with Salmonella positivity of the farms (p < 0.05). Eleven (34.4%) Salmonella isolates were resistant to streptomycin, and nine (28.1%) were resistant to tetracycline. Thirteen (40.6%) Salmonella isolates were resistant to two or more antimicrobials tested in this study, whereas resistance to 3 or more antimicrobials was detected in seven (21.9%) isolates. In conclusion, a high prevalence of Salmonella and a high rate of resistance to multiple antimicrobials were detected in poultry farms in Addis Ababa. Hence, implementation of strong biosecurity measures and rational use of antimicrobials are recommended.

Antimicrobial utilization pattern in indoor patients of obstetrics and gynecology ward of a tertiary care hospital

Background: Rational prescribing of antimicrobials is fundamentally necessary to reduce incidence of antimicrobial resistance. To evaluate the rationality of antimicrobial prescribing practices in patients admitted to obstetrics and gynecology ward of a tertiary care hospital using ICMR guidelines and to check how many drugs were prescribed from NLEMI. Methods: It was a prospective observational study. Study included newly admitted patients in obstetrics and gynecology ward receiving antimicrobial therapy. Drugs prescribed to the patients during their hospital stay were noted from case sheets in case record form. WHO core and economic indicators were used to analyze prescribing patterns. Medguideindia.com was referred for prices of drugs. Results: Average number of drugs prescribed for a patient admitted in the obstetrics and gynecology ward were 3.22 and 4.31 respectively. Percentage of drugs prescribed by their generic name were 37.11% and 39.42% in obstetrics and gynecology ward respectively. 26.85% and 34.14% of patients received drugs through parenteral route in obstetrics and gynecology wards respectively. All antimicrobials were prescribed from NLEMI. Conclusions: WHO recommends prescribing all drugs by their generic names. Average duration of antimicrobial treatment was higher than recommended average duration suggested by ICMR. ICMR recommends use of 2nd generation cephalosporins but in the present study 3rd generation cephalosporins were used. For rational use of antimicrobials and to reduce their cost it is recommended to prescribe antimicrobials by their generic names and reduce treatment duration by referring to ICMR Guidelines and NLEMI.

Microorganisms isolated from blood cultures and resistance profile in children with cancer and high-risk febrile neutropenia. Red PINDA, Chile, 2016-2021

To identify the frequency of microorganisms isolated from blood cultures (BC) and their antimicrobial resistance (R) profile in children with HRFN, compared with the same data from previous studies of the same group. Prospective, multicenter, epidemiological surveillance study of microorganisms isolated from BC in patients under 18 years of age, from 7 PINDA network hospitals, between 2016 and 2021. 284 episodes of HRFN with positive BC were analyzed out of 1091 enrolled episodes (26%). Median age 7.2 years [3.0-12.3]. The main isolates were gram-negative bacilli (GNB) 49.2%, gram-positive cocci (GPC) 43.8%, and fungi 3.6%. The most frequently isolated microorganisms were viridans group Streptococci (VGS) (25.8%), Escherichia coli (19.8%), Pseudomonas spp. (11.2%), Klebsiella spp. (10.9%), and coagulase negative Staphylococci (CoNS) (10.9%). There was an increase in R to third-generation cephalosporins (p = 0.011) in GNB and to oxacillin in CoNS (p = 0.00), as well as a decrease in R to amikacin in non-fermenting GNB (p = 0.02) and to penicillin in VGS (p = 0.04). VGS is the main agent isolated in BC from pediatric patients with cancer and episodes of HRFN, followed by E. coli, Pseudomonas spp., and Klebsiella spp. Having epidemiological surveillance of microorganisms isolated from BC and their antimicrobial R profile is essential to favor the rational use of antimicrobials.

Assessment of knowledge, attitude, and practice of rational antibiotic use among medical students in a tertiary care teaching hospital of upper Assam – A cross-sectional study

Background: Antibiotics serve as wonder drug to combat against harmful microorganisms. Inappropriate and rampant antibiotics use is a major contributing factor for antibiotic resistance in the community. Insufficient knowledge about antibiotics usage and wrong prescribing pattern among the prescribers add to the magnitude of antibiotic resistance. Assessing the knowledge, attitude, and practices (KAP) of the future prescribers with regard to rational antibiotic use can help in planning and formulating suitable educational strategies for them during the course of study itself. Aims and Objectives: The primary objective of the present study was to evaluate the KAP of rational antibiotic usage among 3rd-year medical students in a tertiary care teaching hospital of Assam, India. Materials and Methods: A pre-validated and structured questionnaire was utilized to gather data on demographic profile and KAP of medical students pertaining to antibiotic usage. Data collected were subjected to descriptive analysis. Results were expressed as percentage under each response category. Results: A greater lot of the respondents (95.87%) had adequate knowledge about antibiotic use. The notion of antibiotic resistance was heard of but not clearly understood. The attitude results revealed that 79.34% of the respondents took antibiotics for common cold while 21.64% of respondents stopped taking antibiotic when they started feeling well. Approximately (25.77%) of participants admitted to have procured antibiotics without a valid prescription. Conclusion: The study provides baseline evidence and paucity in KAP regarding use of antibiotic among medical students in a tertiary care teaching hospital of Assam, India. Suitable educational interventions are a requisite to reinforce existent courses and instruction about rational use of antimicrobials with greater emphasis on antimicrobial stewardship.

Implementing Community Antimicrobial Stewardship Model in Nigeria: Lessons Learned from AMS Outpatient Setting among Community Pharmacists/Patent and Proprietary Medicine

Antimicrobial resistance (AMR) is a growing global concern primarily driven by the overuse and inappropriate utilization of antimicrobials. In Nigeria, AMR is exacerbated by the routine sale of prescription-only medicines, including antimicrobials, without proper monitoring. The National Action Plan for Antimicrobial Resistance (2017-2022) highlighted widespread inappropriate antibiotic use, with significant proportions obtained without prescriptions. Antimicrobial stewardship (AMS) in outpatient settings is a novel concept in Nigeria. This interventional study sought to contribute to the reduction of inappropriate antibiotic dispensing and use in community/outpatient settings in Nigeria, focusing on enhancing the skills and capacity of improved rational antibiotic therapy among community pharmacists and Patent and Proprietary Medicine Vendors (PPMVs), with the sole aim of improving patient health outcomes. The CAMS interventional study involves education, quality improvement capacity building, patient empowerment, and a multifaceted AMS strategy. Results from the CFID’s CAMS model indicated a significant improvement in the rational dispensing and use of antimicrobials within the intervention group, emphasizing the effectiveness of CAMS. Notable variations in post-visit actions between the intervention and monitoring groups further support the positive impact of the intervention. Variation in attitudes towards sharing of antibiotic to friends and relatives was reduced among the intervention group, offering clear understanding into the potential impact of CFID AMS outpatient setting (CAMS) intervention. The study’s conclusion underscores the pivotal role of implementing AMS in outpatient and community settings such as the CAMS interventional model in improving antibiotic-related practices in both urban and rural communities in Nigeria, emphasizing its relevance and impact.

Factors and challenges contributing to antimicrobial resistance in East African pastoral settings and importance of One Health approach

Abstract Antimicrobial resistance (AMR) is acknowledged as a One Health dilemma because resistant microbial and genes are swiftly appearing and spreading worldwide across humans, animals and the environment. Livestock owners in East African pastoral regions face significant financial and socio-economic challenges owing to animal diseases that can be particularly severe in remote areas, where communities rely solely on their livestock for subsistence. Unfortunately, providing veterinary services in these regions is challenging because of the inadequate infrastructure and limited resources. Consequently, pastoralists may resort to self-medicating their animals, often using antimicrobials in ways that can contribute to the emergence of AMR. Prolonged use, overuse, or misuse of antimicrobial drugs in both human and animal populations in low-income East African pastoral settings is a significant factor that contributes to the emergence of AMR in these regions. Similarly, a significant factor contributing to the spread of AMR in pastoral regions is the disregard for withdrawal periods by pastoralists, owing to a lack of awareness about AMR. Inadequate sanitation protocols and limited access to uncontaminated water sources are additional factors contributing to the dissemination of AMR pathogens in both animals and humans. This leads to critical public health concerns that hinder effective antimicrobial treatment, reduce animal productivity, and have economic consequences for pastoralists. Addressing the challenges associated with AMR requires a comprehensive, multi-sectoral approach that can facilitate the coordinated surveillance and monitoring of AMR, promote the rational use of antimicrobials, advocate for alternative disease prevention and management strategies, and raise awareness among communities and healthcare professionals in pastoral areas about the emergence of AMR. The challenges and factors contributing to AMR in pastoral settings are complex; however, the One Health approach offers a promising strategy for reducing the risk of AMR. This review aims to present a comprehensive overview of the factors and challenges associated with AMR in pastoral settings, and proposes the adoption of a One Health approach as a solution to this pressing issue. One Health impact statement The review highlights that antimicrobial resistance (AMR) in East African pastoral settings is a significant issue that contributes to the emergence and spread of AMR worldwide. Prolonged use, overuse, or misuse of antimicrobials in human and animal populations is a significant factor in the emergence of AMR in these settings. The challenges and factors contributing to AMR in pastoral settings are intricate and call for a multi-faceted approach that encourages rational use of antimicrobials, promotes alternative prevention and management methods, and enhances awareness among Eastern African pastoral communities. The article highlights the significance of adopting the One Health approach in mitigating the hazards of AMR in these settings.

A comprehensive point prevalence survey of the quality and quantity of antimicrobial use in Chinese general hospitals and clinical specialties

Antimicrobial resistance (AMR) is a serious, worldwide public health crisis. Surveillance of antimicrobial use forms part of an essential strategy to contain AMR. We aimed to conduct a national point prevalence survey (PPS) on antimicrobial use, and to compare this data with similar international surveillance programs to provide a reference for future AMR strategy development in China. Twenty general hospitals encompassing 10,881 beds and 10,209 inpatients around the country participated the survey using a standardized protocol, at 8am of someday from October 10th to November 31st, 2019. Of the patients, 37.00% (3777/10209) received antimicrobial agents, 31.30% (1630/5208) had surgical operations, and 76.63% (1249/1630) received prophylactic antibiotic. The prevalence of antimicrobial use in medical, surgical, and intensive care units (ICU) patients was 38.84% (1712/4408), 32.07% (1670/5208), and 66.61% (395/593), respectively. Of prescriptions, 5.79% (356/6151) were made in the absence of indication. The intensity of antimicrobial use was 61.25 DDDs/100 patient days, while the intensity of use in internal medicine, surgery, and ICU were 67.79, 45.81, 124.45 DDDs/100 patient days, respectively. Only 11.62% (715/6151) of prescriptions had a reason described in the patient record. Furthermore, 8.44% (210/2487), 14.19% (424/2989), and 12% (81/675) of the prescriptions in internal medicine, surgery, and ICU had a recorded indication, respectively. The review and stop date recorded for antimicrobial therapy was 43.73% (1976/4518). Of the patients, 38.07% (1438/3777) received combination therapy. The classes of antimicrobials prescribed were limited, and the proportion of prescriptions encompassed by the top 20 antimicrobial agents was 75.06% (4617/6151). The prevalence of antimicrobial use in China is close to that of Sweden, the UK, and Canada, but lower than that in India, and higher than that in Switzerland. The data described in this report indicate that the quality of antimicrobial prescriptions requires improvement in China. Further, hospitals should implement professional interventions to improve the rational use of antimicrobials.

Short communication: Circadian variations and day-to-day variability of clinical signs used for the early diagnosis of pneumonia within and between calves

For rational antimicrobial use, a timely and correct diagnosis of bovine respiratory disease, especially pneumonia, in calves is required. Current approaches often rely on clinical signs observed at a single time point, and do not take potential diurnal patterns in the manifestation of these clinical signs into account. Therefore, the aim of this pilot study was to investigate how clinical signs utilized for the (early) detection of pneumonia vary both within and between calves, throughout the day and across days. A longitudinal study was conducted in which 36 pre-weaned Holstein-Friesian calves were clinically examined eight times over the course of 48 h. The following parameters were considered: respiratory rate, type of respiration, dyspnea, stridor, induced cough (trachea reflex), spontaneous cough, eye and nasal discharge, ear positions, head tilt, rectal temperature, diarrhea, milk residue, body posture, Wisconsin and Davis BRD scorecard. The advent of thoracic ultrasonography (TUS) enables detection of (sub)clinical pneumonia in a more reliable way, compared to the diagnosis based solely on clinical signs. In this study, 14% (5/36) of the calves had an ultrasound confirmed pneumonia (consolidation ≥1 cm in depth). No variations were observed in the prevalence of clinical signs at the various time points of the day. However, we did observe a difference in the manifestation of clinical signs in individual calves (intra) and between (inter) them. Due to the significant intra-calf variability, diagnosing pneumonia based solely on a single observation of clinical signs, is likely to be insufficient. Hence, misdiagnosis might lead to incorrect use of antimicrobials.

Impact of an antimicrobial stewardship program in a medium-sized hospital

Problem consideredThe rational use of antimicrobials (ATMs) is a challenge for global health services. One strategy used to control the spread of multidrug-resistant (MDR) bacteria is antimicrobial management programs. This is a pre- and post-intervention study that assesses the impact of an antimicrobial stewardship program in a hospital through evaluating clinical and microbiological outcomes, usage measures and costs. MethodsThe sample comprised adult patients hospitalized for more than 24 h during a seven-month pre-intervention, and an eleven-month post-intervention period. Primary outcomes included length of therapy (LOT) and days of therapy (DOT) per 1000 patient-days (pd), the DOT/LOT ratio, the incidence of a number of the main multi-drug resistant bacteria, and the costs of therapy. Secondary outcomes were the use of antimicrobials and antimicrobial prescriptions by class, hospital length of stay rates, and mortality rates. Data were obtained from medical prescriptions, pre-authorization forms for restricted antibiotics, and microbiological tests. Non-critical and critical care units were compared, with a significance level of 0.05. ResultsA total of 2704 patients were evaluated and there was a significant post-intervention reduction of exposure to antimicrobials of 8.1% and of 90 days in respect of the LOT in non-critical units. There was a reduction of more than 50% in the costs of therapy and of 1.2 days in the length of hospital stay in non-critical units. There was no variation in bacterial resistance. ConclusionsAlthough the stewardship program and its interventions reduced antimicrobial consumption, costs and the length of hospital stay further studies are required to identify the components that can produce the impact on microbiological outcomes seen in other studies.

Letter to the editor: The challenge of carbapenem resistance

The global resistance of microorganisms to antimicrobials is one of the biggest public health challenges in recent decades however, among Gram-negative microorganisms, this problem has become very relevant, resulting in a shortage of medicines for the treatment of infections caused by these multi-resistant bacterial agents. Knowing the evolution of this resistance, among microorganisms in the hospital environment, is essential for: the projection of resistance in the coming decades, the rational use of antimicrobials and the adoption of measures to minimize their impact in this scenario. The most modern antimicrobial agents, which act on multi-resistant bacteria, are expensive, making their availability and use even more difficult, especially in the public health network in developing countries. However, new drugs for treating multidrug-resistant infections, due to their high cost, are often not available.

Determinants of implementing the ID ROLL OUT study's interventions: qualitative results

Abstract Issue Antimicrobial stewardship programmes (ASP) and infectious disease (ID) specialists aim to ensure the rational use of antimicrobials and to improve patient outcomes. Whilst ASPs are established to varying degrees, ID specialists are rarely available in secondary and tertiary care hospitals in Germany. Description of the problem With the ID ROLL OUT study, we implemented and evaluated an intervention, which comprises ASP with and without ID specialists’ consultation in ten hospitals (excl. university hospitals) in south-west Germany. Little has been reported on the medical and pharmaceutical staff's perspectives on the implementations. This study describes barriers, facilitators, and suggestions for improvement to successfully establish a large-scale multicentre intervention. The participants responsible for implementing the intervention were interviewed using semi-structured, guided interviews at two time-points (t1: n = 17; t2: n = 18). The recorded interviews were analysed for content, following Kuckartz. Results A high level of acceptance and a positive attitude towards the intervention are conducive to the intervention's successful implementation. The teams find extra time for the study and a close staff collaboration at a local team level to be helpful. The main barriers identified are a high workload, lack of acceptance by colleagues in key roles, and the Covid-19 pandemic. Lack of digitalisation and entrenched internal structures were identified as major barriers. To further improve implementation, more infectious disease training should be provided, along with support from superiors and extension of the intervention phase. Moreover, government-mandated ASP guidelines and quality management by the German Medical Association are desired and expected to contribute in the future. Lessons The identified determinants provide much-needed key information, which is important for the efficient, targeted and successful implementation of future similar interventions. Key messages • Acceptance, positive attitude and staff collaboration help to implement the intervention. • Heavy workloads and lack of support from key colleagues hinder the intervention’s implementation.

Effectiveness of antimicrobial interventions in animal production: systematic review &amp; meta-analysis

Abstract In animal production, the rational use of antimicrobials has been promoted to decrease antimicrobial resistance (AMR) in microorganisms. This systematic review evaluated the effectiveness of interventions to reduce/adequate antimicrobial use and decrease AMR. Articles were identified in PubMed, Scopus, The Cochrane Library, Web of Science, and grey literature in DANS EASY, WorldCat, RCAAP. Eligible studies included original studies, assessing broiler/pig populations, antimicrobial interventions, comparator with standard/no use of antimicrobials, outcomes related to AMR, farm level and analytical observational studies. Meta-analysis was conducted for combinations including type of intervention, bacterial species, production type, population. Interventions effectiveness was estimated using odds ratio of resistance to antimicrobial substances/classes by bacteria and populations with and without intervention. A total of 46 studies were eligible. For broilers, restrictions were all non-therapeutic use (46%), complete restriction (27%), prohibition on antimicrobials used for growth promotion (23%). For pigs, restrictions included: all non-therapeutic use (37%), complete restriction (37%), group treatments (22%). For meta-analysis (21 studies), combinations indicated a protective effect for most antimicrobial classes in E. coli, Campylobacter and Enterococcus and broilers, and Escherichia coli and Campylobacter and pigs, compared to conventional production or without intervention. An increased odds of resistance were observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones/quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. Our study revealed that organic, antimicrobial-free farms and group treatment restrictions in conventional production were mostly associated with AMR reduction, providing information on available options that may support decision-making to tackle AMR. Key messages • Organic/antimicrobial-free farms indicated a protective effect on resistance to most antimicrobials. • Fluoroquinolones resistant Campylobacter may persist in pigs raised without antimicrobials.

The Impact of Information Quality of Antimicrobial Susceptibility Test Report on the Rational Antimicrobial Use: A Retrospective Study.

Antimicrobial susceptibility test (AST) report was important for rational antimicrobial use. However, the reference value of AST report was sometimes limited due to poor information quality (IQ). This study aimed to measure the IQ of AST and evaluate the impact of IQ of AST report on rational antimicrobial use as a reference for antimicrobial therapy. The retrospective study included data of AST report, antimicrobials prescribed after reporting AST results and related inpatient information. The inclusion criteria of the AST report included three conditions: 1. The AST reports were from inpatients with diagnosis of infection. 2. The bacteria were extracted from a sterile-site specimen. 3. The interpretive categories (ie sensitive, intermediary or resistance) were firstly reported during one hospitalization. The IQ of AST report was measured by the total IQ and IQ of completeness, usefulness, accuracy and consistency. The rational antimicrobial use was measured by the antimicrobial adherence to the interpretive categories of AST report. Fractional logit regression model (FLRM) was chosen to evaluate the impact of IQ on the rational antimicrobial use. The median of the total IQ, completeness, usefulness, accuracy and consistency were 0.7345, 0.6082, 0.9167, 0.8966 and 1.0000, respectively. The results of FLRM showed that usefulness, accuracy and consistency had significant positive impacts on the rational antimicrobial use (β = 4.220, P < 0.001; β = 3.987, P < 0.001; β = 0.511, P = 0.001, respectively), while the total IQ and completeness had no statistically significant impacts on the rational antimicrobial use (β = -0.820, P = 0.35; β = -0.793, P = 0.20, respectively). This study confirmed that usefulness, accuracy and consistency performed well and had positive impacts on the rational antimicrobial use, which indicated that improving IQ especially usefulness, accuracy and consistency would make AST report play a greater role in promoting the rational antimicrobial use.

Clinical value of droplet digital PCR in the diagnosis and dynamic monitoring of suspected bacterial bloodstream infections

BackgroundBloodstream infections (BSIs) represent a significant public health challenge due to their high morbidity and mortality. The clinical prognosis of BSIs is closely related to the timely and accurate diagnosis and the rational use of initial antimicrobials. We aimed to evaluate the clinical value of droplet digital PCR (ddPCR) in rapid diagnosis and dynamic monitoring of BSIs. MethodsIn this prospective study, using a ddPCR-based approach which detects 18 common pathogens, we compared the detection results and clinical concordance rates of ddPCR with blood culture (BC) in 211 patients with suspected BSIs. Further, the inflammatory profile of BSIs with Gram-negative bacteria was analyzed by Olink proteomics platform. ResultsOur data showed that the positive detection rate of ddPCR was 48.82%, which was higher than that of BC (9.48%). For BC-validated BSIs, ddPCR had a sensitivity of 90.00% and a specificity of 55.50%. When considering clinically-validated BSIs, the diagnostic value of ddPCR improved with a sensitivity of 92.59% and a specificity of 78.46%.The bacterial load detected by ddPCR was correlated with traditional clinical inflammatory indicators such as interleukin-6 (IL-6) and C-reactive protein (CRP). In addition, using Olink proteomics platform, we revealed that serological osteoprotegerin (OPG), interleukin-8 (IL-8), interleukin-18 receptor 1 (IL-18R1), C–C motif chemokine 20 (CCL20) and IL-6 were substantially elevated in Gram-negative bacteria-associated BSIs, which could serve as novel auxiliary diagnostic indicators for Gram-negative bacteria BSIs. ConclusionddPCR has the potential to provide early pathogen diagnosis, dynamic monitoring, and treatment regimen optimization for patients with BSIs.

Bacteriological Profile of Surgical Site Infection Following Gastrointestinal Surgery and Their Antibiogram.

Surgical site infection is one of the common complication following abdominal surgery. It causes great morbidity and mortality, further increasing prevalence of multidrug resistant bacteria have made its management very challenging. The current study aims to identify causative agent responsible for surgical site infection and their antibiotic resistance patterns. This study was conducted among patients developing surgical site infection following gastrointestinal surgery in Tribhuvan university teaching hospital over a period of one year. The samples were collected and processed according to standard methods. The bacterial pathogens with their antimicrobial susceptibility were determined and resistant pattern like methicillin resistant Staphylococcus aureus and extended spectrum beta lactamase were further detected. A total of 832 patients had under gone gastrointestinal surgery during the study period. Among them, 162 cases (19.5%) developed surgical site infection and 125 cases showed growth in culture. A total of 160 aerobic bacteria were isolated; Escherichia coli (29.9%) was the commonest organism with 40.8% being extended spectrum beta lactamase producer and 47.4% of Staphylococcus aureus were methicillin resistant. About 75.9% (85/112) of gram negative bacteria and 60.4% (29/48) gram positive bacteria were multi drug resistant. The burden of multi drug resistant bacteria causing surgical site infection is high which needs to be addressed timely. Good surveillance of bacterial antibiogram and rational antimicrobial use is necessary to reduce emergence and spread of resistant bacteria.

Effectiveness of antimicrobial interventions directed at tackling antimicrobial resistance in animal production: A systematic review and meta-analysis.

In the last decades, a more prudent and rational use of antimicrobials has been progressively directed towards animal production to reduce antimicrobial selective pressure and antimicrobial resistance (AMR) in microorganisms and safeguard the antimicrobial efficacy of treatments in human medicine. This systematic review evaluated the effectiveness of interventions that have been applied to reduce or improve veterinary antimicrobial usage and aimed at decreasing resistant bacteria in chicken broiler and pig production contexts. Original articles were identified by searching PubMed™, Scopus™, The Cochrane Library™, and Web of Science™, and grey literature by searching DANS EASY™, WorldCat™ and RCAAP™. Inclusion criteria included: chicken broiler or pig populations (predestined for meat production), interventions intended to reduce/improve antimicrobial use, comparator with standard or no use of antimicrobials, outcomes related to prevalence of resistant bacteria, farm level studies, original data, and analytical observational studies. Data was extracted from eligible studies and meta-analysis using random or fixed effects models was conducted for combinations including type of intervention, bacterial species, production type and animal populations. Models were selected according to heterogeneity between studies. The effectiveness of interventions was assessed using pooled odds ratio of resistance to antimicrobial substances/classes by bacteria for associations between animal populations with and without intervention. A total of 46 studies were eligible for review. For chicken broilers, most interventions were identified as antimicrobial restrictions on all non-therapeutic use (46%), complete restriction (27%), and prohibition on antimicrobials used for growth promotion (23%). As for pig populations, restrictions were mainly observed on all non-therapeutic use (37%), complete restriction (37%) and group treatments (22%). For meta-analysis, 21 studies were pooled after assessment of existing combinations. These combinations demonstrated a protective effect for most antimicrobial classes in Escherichia coli, Campylobacter and Enterococcus isolates from samples of chicken broilers as well in Escherichia coli and Campylobacter spp. from samples of pigs, compared to animals raised under conventional production or without intervention. Increased odds of resistance were only observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones and quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. Our study indicates that organic production, antimicrobial-free farms, and group treatment restrictions are recommended for AMR reduction, providing information that may support decision-making to tackle AMR and better reporting to improve comparability of results between studies.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic.

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

Comparison between broth microdilution and agar disk diffusion methods for antimicrobial susceptibility testing of bovine mastitis pathogens

In order to counter the antibiotic resistance phenomenon, a prudent and rational use of antimicrobials should be driven by an accurate clinical diagnosis and, when possible, by the isolation of the etiological agent followed by susceptibility testing, with the aim to select the most suitable molecule for therapy. Cow mastitis is considered the main cause of antibiotic use in the cattle breeding sector. The purpose of this study was to compare the broth microdilution (BMD) method performed with Sensititre Custom Plates and the agar disk diffusion (ADD) method in determining antimicrobial susceptibility of 215 isolates from bovine mastitis, including contagious pathogens (Staphylococcus aureus, Streptococcus agalactiae) and environmental (Streptococcus uberis, Streptococcus dysgalactiae, Enterococcus spp., Escherichia coli, Serratia marcescens, Klebsiella pneumoniae). We compared results of the following antimicrobials: amoxicillin/clavulanic acid, ampicillin, cefazolin, ceftiofur, enrofloxacin, erythromycin, kanamycin, oxacillin, penicillin, pirlimycin, rifampicin and trimethoprim/sulphonamides. We applied MIC breakpoints and zone diameter breakpoints as recommended by CLSI and EUCAST. MIC and disk diffusion diameters were compared for 1839 microorganism/antimicrobial combination and discrepancies between the two methods were classified as very major discrepancy (VMD), major discrepancy (MD) and minor discrepancy (MiD). The overall agreement between the two methods was found to be 80.7% with a Cohen's kappa coefficient of 0.397, thus indicating a fair concordance. BMD method and ADD method demonstrated a satisfactory agreement (89 to 100%) for S. aureus and S. marcescens and all antimicrobial agents tested. Low agreement was observed for S. uberis and rifampicin (20%), enrofloxacin (49%), penicillin (51%) and pirlimycin (52%), E. coli and ampicillin (20%), S. dysgalactiae and enrofloxacin (44%), S. agalactiae and rifampicin (25%). A possible explanation for the discrepancies detected could be found in the breakpoints used which, sometimes, are not specific for the tissue-matrix of isolation/animal species/pathogen agent. The majority of the discrepancies found were MiD and MD, revealing a higher restrictiveness of the BMD method, while VMD represented only 0.2% of the total observations, a comforting fact since this type of error may result in treatment failure.