Reduction In Antibiotic Use Research Articles

A study on the reduction of antibiotic use by introducing organic acids in broiler chicken feed in the district of Abidjan - Ivory Coast

The use of organic acids in the diet of animals is potentially beneficial for maintaining intestinal hemostasis and controlling the growth of pathogenic bacteria. The objective of this study was to experiment with organic acids as additives to antibiotics used by farmers. A total of 490 broilers were studied in this study and were divided into 5 lots of 98 subjects. The experimental core consisted of Fysal, Fysal-Selko, Selko, Patheryl (reference antibiotic) and Control. The experimental products were introduced in the drinking water (Selko pH) and in the feed (Fysal MP). A high feed consumption was noticed in the Fysal lot with 80.44±44g/chicken followed respectively by the Pteryl lots with 79.48 ± 42.25g/chicken, Fysal-Selko with 79.34 ± 43.62g/chicken, Selko with 77.27 ± 41.39g/chicken and finally Control with 76.01 ± 39.41g/chicken. The weight gain was high in the Fysal lot with 1770 ± 623.38g followed respectively by the Fysal-Selko lots with 1709 ± 606.05g, Pteryl with 1619 ± 577.70g, Selko with 1607 ± 567.90g against the Control lot with 1550 ± 544.41g. A mortality rate of 3.06% was recorded only in the Selko lot. Economically, the lots (Fysal, Fysal-Selko and Selko) that consumed the feed and water containing organic acids recorded higher profits compared to the Control and Pteryl batches. The organic acids such as Fysal MP and Selko pH could be used as alternatives to antibiotics in poultry farming.
 Keywords: Broiler, growth performance, organic acids, antibiotics

Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications

Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.

Responsible antibiotic use labeling and consumers' willingness to buy and pay for fluid milk.

Concerns about antibiotic resistant infections in the United States have called for reduction of antibiotic use in livestock, including dairy cattle. Although effective in curbing antibiotic use, universal organic dairy farming would be impractical and unattainable due to its high land and premium demands. The US Department of Agriculture's organic certification, which completely eliminates antibiotic use in milk production, also raises animal welfare concerns, as it could discourage the use of antibiotics even to treat indicated diseases. Therefore, a proposed alternative for US consumers is a label indicating the responsible antibiotic use (RAU) - not complete elimination - that would minimize antibiotics more than conventional (unlabeled) milk and maximize animal welfare more than organic milk. Our goal was to determine consumers' (1) self-reported preference and (2) willingness to pay for this hypothetical RAU label of milk relative to existing substitutes in organic and unlabeled fluid milk. We conducted (1) a nationally representative survey of US adults and (2) a randomized non-hypothetical experimental Becker-Degroot-Marschak auction with real money and real milk. Although almost half of the survey participants (48.5%) responded that they would buy a RAU-labeled milk, consumers in the experimental auction refused to pay a significant premium for the milk compared with unlabeled milk (mean willingness to pay (95% confidence interval) per half-gallon: $1.92 ($1.65-$2.19) for RAU-labeled milk versus $1.86 ($1.58-$2.13) for unlabeled milk). These results suggest that consumers' survey-identified preferences for RAU-labeled milk could reflect either social desirability bias or a genuine preference for which, however, consumers simply will not pay a significant premium. The study provides preliminary data for future exploration of marketability of the proposed RAU label in the United States and demonstrates the benefits of using complementary survey and experimental auction approaches to understand the potential market for a new dairy product.

SUSTAINABLE FOOD SYSTEMS IN THE LIGHT OF THE LEGAL AND ECONOMIC CONDITIONS OF THE COMMON AGRICULTURAL POLICY

The purpose of this paper is to formulate a preliminary assessment of the selected solutions of the Common Agricultural Policy as to whether they are adequate from the perspective of the objectives of the SFS. Sustainability of food systems has become a complex process, dependent on a number of environmental, economic, and social factors. The authors assess that the instruments for supporting Sustainable Food Systems included in the national strategic plan are adequate to the goals of these systems, but some reservations can be raised about them. In particular, in addition to measures that are certainly beneficial and consolidating (e.g., supporting the reduction of antibiotic use in livestock production and pesticide use in crop production), the national strategic plan lacks larger-scale instruments (important from the point of view of the big picture) to support, for example, the introduction of resource-efficient and climate-resilient production, the promotion of a healthy and sustainable diet, the wider introduction of quality food (not only organic), the reduction and combating of food waste, the proper storage of food, or the reduction and management of waste generated in the food chain. The relative nature of the conditionality mechanism remains a shortcoming.

1122. Early Infectious Diseases Consultation and Procalcitonin-Guided Therapy Limits Unnecessary Antibiotic Use in COVID-19

Abstract Background Antibiotic stewardship has been a central challenge of the COVID-19 pandemic. Empiric antibiotic therapy is offered in 56.6%-74.6% of inpatients with COVID-19, with microbiologically confirmed bacterial pneumonia reported in only 3.5%-16% of cases. Procalcitonin (PCT) as a biomarker for bacterial infection is of interest in improving antibiotic use. PCT-guided antibiotic stewardship initiatives have demonstrated reduction in the use of antibiotics in the COVID-19 pandemic. An Infectious Diseases (ID) consultation was obtained on most patients at our institution throughout the COVID-19 pandemic. We report a significant reduction in antibiotic use among COVID-19 patients in the setting of near-universal ID consultation in COVID-19 patients. Methods We evaluated the records of 1346 patients with COVID-19 from March 2020 – May 2021 at four hospitals with ID consultant availability. We assessed the inclusion of an ID consultant, antibiotic indication, initiation and discontinuation, PCT levels, radiologic images, and changes to therapy decisions. A chi-square test of independence and simple logistic regression were conducted to determine whether an association exists between the PCT level and the decision to discontinue antibiotics. Results Of 1346 patients with a confirmed COVID-19 diagnosis, 64.6% (870/1346) received antibiotics on admission. The most common diagnosis associated with initial antibiotic administration was bacterial pneumonia (692/870, 79.5%). An ID consultation was obtained on 97.8% (677/692) of the patients that received antibiotics for suspected bacterial pneumonia. In 48.1% (326/677) of these patients, antibiotics were discontinued within the first 48 hours of the ID consultation. A statistically significant difference was noted between the PCT level and continuation of antibiotics (Χ2= 67.02, p < .01). The odds of discontinuing antibiotics for the upper (PCT > 0.51) and middle (PCT = 0.26-0.50) groups were 0.22 and 0.37, respectively, when compared to the lower (PCT ≤ 0.25) group. Conclusion Early consultation of an ID specialist and evaluation of PCT levels leads to significant reductions in inappropriate antibiotic use. PCT may be a useful adjunct in assisting with the decision to discontinue antibiotics. Disclosures All Authors: No reported disclosures.

1658. Using remote Infectious Disease physician expertise to support inpatient antibiotic stewardship activities at three VA medical centers an implementation-effectiveness trial

Abstract Background Remote Infectious Disease (ID) physicians can provide stewardship support through telehealth. Using the RE-AIM framework, we assessed the implementation of telehealth-supported prospective-audit-and-feedback (tele-PAF) across 3 rural Veterans Administration medical centers (VAMC). Methods All 3 invited sites agreed to participate and lacked ID support for stewardship at baseline. During 2021, an ID physician met virtually 3 times/week with the stewardship pharmacist champion at each participating VAMC to review patients on antibiotics in acute-care (mean daily census 3/site) and nursing-homes (NHs; mean census 71/site); real-time feedback on antibiotic use was given to clinicians. The primary outcome of effectiveness was monthly antibiotic days of therapy (DOT) per 1,000 days-present aggregated across all sites; the secondary outcome was days of antibiotic spectrum coverage (DASC) per 1,000 days-present. An interrupted time-series analysis was performed to asses these outcomes during the 1-year intervention period vs. the 2-year prior baseline. Semi-structured interviews with 20 clinicians and pharmacists were conducted to assess implementation. Results RE-AIM elements are summarized in Table 1. Tele-PAF reviewed 502 unique patients and made 681 recommendations to 23 clinicians; 77% of recommendations were accepted. The most common recommendations were to stop antibiotics (28%) and change duration (20%). After the start of tele-PAF, antibiotic DOT and DASC immediately decreased in acute-care (-20%, p=0.01; -22%, p< 0.01) and NHs (-28%, p=0.03; -37%, p< 0.01). Both metrics began to rise again in acute-care (DOT: +2.5%/month, p=0.02; DASC: +2.7%/month, p=0.02) but were stable in NHs (Figure 1). Clinicians generally appreciated feedback, found it compatible with their workflow and responded favorably to collaborative discussions. Barriers included difficulty establishing rapport with some providers. Conclusion The implementation of tele-PAF was associated with sustained reductions in antibiotic use across 3 NHs but not in the studied small acute-care units. Overall, clinicians perceived the intervention as acceptable and appropriate. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use. Disclosures Daniel J. Livorsi, MD, Merck & Co.: Grant/Research Support.

1765. Antibiotic Consumption in a Healthcare System in Bolivia During the First Wave of COVID-19 Pandemic

Abstract Background Several countries in Latin America reported an increase in antibiotic use during the first wave of the COVID-19 Pandemic. Methods We retrospectively evaluated antibiotic use among 10,752 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-Dec 2019 (pre-pandemic) and Jan-Aug 2020 (pandemic). Antibiotic use was calculated as daily defined doses (DDD) per 1,000 member-days, per 100 ambulatory visits, and per 100 inpatient-days, and categorized using the World Health Organization classification (Access, Watch, and Reserve), based on the impact of different antibiotics on antimicrobial resistance. In April 2020, the antibiotic stewardship team developed COVID-19 treatment guidelines for ambulatory and hospitalized patients and provided recommendations on all patients hospitalized due to COVID-19. Due to the nature of the network, guideline use is usually high. During the pandemic period and due to local restrictions, patient interactions were mostly limited to COVID-19 presentations. Differences with 95% confidence intervals (CI) between groups were estimated. Results Pandemic and pre-pandemic antibiotic use in DDD/1,000 member-days was 8.48 and 18.37, respectively (diff. –8.89, 95%CI –10.11 to –9.67). Outpatient DDD/100 ambulatory visits was 67.68 vs. 86.20 (diff. –18.52, 95%CI –19.94 to –17.1), and hospital DDD/per 100 inpatient-days was 39.79 vs. 61.71 (diff. –21.92, 95%CI –26.2 to –17.68) for pandemic and pre-pandemic periods, respectively. During the pandemic period, an overall reduction in macrolides use was also observed (–3.13 DDD/100 ambulatory visits, 95%CI –3.84 to –2.44, and –2.05 DDD/per 100 inpatient-days, 95%CI –2.88 to –1.26). Additionally, an increase in Access antimicrobials (83.3% vs. 79.5%; diff. 3.8%, 95%CI 0.3% to 7.4%) and a reduction in the Watch group (16.7% vs. 20.5%; diff. –3.7%, 95%CI –7.4% to –0.1%) were observed for pandemic and pre-pandemic periods, respectively. Conclusion In this closed network, we observed a reduction in antibiotic use both in ambulatory and inpatient settings. Although, multifactorial, we believe the enhanced antibiotic stewardship approach on COVID-19 patients played a role in limiting antimicrobial use in this private healthcare system. Disclosures All Authors: No reported disclosures.

Vaccination against Bacterial Mastitis in Sheep.

The objective of this review is to discuss the application of vaccination for the prevention of bacterial mastitis in ewes, performed within the frame of health management schemes in sheep flocks. Mastitis is a multi-faceted infection, caused most often by staphylococci; hence, special emphasis is given to staphylococcal mastitis, also given that most relevant studies refer to vaccinations against that infection. Studies regarding various vaccines have been performed; most studies refer to vaccination by using a vaccine making use of cell-free surface polysaccharides in various vehicles, bacterial unbound cells or bacterial cells embedded in their biofilm matrix. Vaccination against mastitis should be better performed during the final stage of pregnancy to allow protection of ewes from lambing and should be considered as one of many control measures for the prevention of the disease. The expected benefits of mastitis vaccination in sheep flocks include the following: (a) reduced incidence risk of clinical and subclinical mastitis, (b) reduced somatic cell counts, optimum chemical composition, absence of staphylococci in milk, (c) increased milk production, (d) reduced dissemination of mastitis-causing pathogens and (e) reduction of antibiotic use in flocks.

Evaluating the impact of Respiratory Syncytial Virus immunisation strategies on antibiotic use and drug resistant bacterial infections in England

Background: Vaccines against viruses have been proposed as a novel means to reduce antibiotic use, which would, in turn, decrease selection for antibiotic resistant bacteria. However, the impact of this intervention is poorly quantified, and likely depends on setting-specific epidemiology. Therefore, with increasing confidence in a new vaccine against respiratory syncytial virus (RSV), it is important to quantify the impact of these vaccines on antibiotic prescribing and any downstream reduction in drug resistant bacterial infections. Methods: Here we integrate results from a dynamic transmission model of RSV and a statistical attribution framework to capture the impact of RSV vaccines on the reduction in antibiotic prescribing due to averted primary care visits in England. Results: Under base case assumptions, we find that the most impactful RSV vaccine strategy targets children aged 5–14 years, resulting in an annual reduction of 10.9 (8.0–14.2) antibiotic courses per 10,000 person years across the entire population, equivalent to reducing annual all-cause primary care prescribing by 0.23%. Our results suggest that this reduction in antibiotic use would gain 130 disability-adjusted life years and avert £51,000 associated with drug resistant bacterial infections. Seasonally administering monoclonal antibodies (mAbs) to high-risk infants under 6 months is the most efficient strategy, reducing per person year antibiotic prescribing by 2.6 (1.9–3.3) antibiotic courses per 1,000 mAb courses. Conclusions: Under optimistic conditions, the cost-effectiveness of RSV vaccine strategies in England would likely not be altered by integrating the benefits of preventing drug resistant infections in addition to RSV disease prevention.

Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China.

The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72h and for pneumonia was more than 7days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72h, treatment duration for culture-negative pneumonia less than 7days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72h for 47.48% patients with rule-out sepsis and within 7days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.

Decreased Antibiotic Exposure for Suspected Early-Onset Sepsis in the Neonatal Intensive Care Unit Through Implementation of an Antimicrobial Time-out.

Antimicrobials are among the most frequently prescribed drugs in the neonatal intensive care unit (NICU), although most neonates exposed lack a bacterial infection. Overuse of antimicrobials carries risk to the patient and fosters the development of resistant organisms. Strategic and systematic processes hold promise to limit the unnecessary use of these drugs in this population. This study reports a quality improvement initiative in which 2 antimicrobial stewardship strategies were implemented in a large, regional NICU setting: an automatic stop order and an antimicrobial time-out. Antimicrobial use was compared before and after implementation. These 2 simple strategies were associated with a nearly 30% reduction in antibiotic use (31 days per 1000 patient days).

Farm costs and benefits of antimicrobial use reduction on broiler farms in Dar es Salaam, Tanzania

Of all animal derived-food, the demand for poultry meat is the most dynamic. The poultry sector can meet this demand only by introducing intensive production where antimicrobial use is inevitable. Bacterial infection prevention and control is an important factor in intensive livestock production. Antibiotics are an effective and relatively inexpensive means of preventing and controlling infections, thus maintaining animal health and productivity. The aim of this study was to gain insight into the costs and benefits of various scenarios of antimicrobial use reduction at broiler farms in Dar es Salaam, Tanzania. This study focused on the economic impact of an average broiler farm. Costs and benefits for various scenarios of antimicrobial use reduction levels were projected by a partial budget framework using the Mclnerney model. The disease cost of the current situation was US$225. On reduction of antimicrobial use by 20% the avoidable disease cost was US$ 31, by 50% was US$ 83 and by 100% was US$ 147. A reduction in antibiotic use can only be achieved if better alternatives are available to combat disease. In conclusion, the model predicts that reducing antibiotic use increases production costs. Future studies on antimicrobial use reduction’s impact on morbidity and mortality and the efficiency of additional control and other measures of producing poultry meat without high concentrations of antibiotics are necessary.

Pharmacists under pressure to concede: Why pharmacists provide non-prescribed antibiotics in the Arab minority in Israel

BackgroundAntibiotics overuse has become a global health threat because of increased antimicrobial resistance. Consumption of non-prescribed antibiotics contributes to this problem and has been found particularly among minority populations. One source for non-prescribed antibiotics are pharmacists. This study focuses on perspective of Arab pharmacists working in the Arab society in Israel--a minority reported to overconsume antibiotics--in order to learn why Arab pharmacists might accede to customers’ requests for non-prescribed antibiotics. DesignFace-to-face interviews were conducted with 60 Arab pharmacists working in private pharmacies in different regions in Israel. Qualitative data were analyzed thematically by focusing on the characteristics of pharmacist-customer relations, conceptions of social norms, and perceived expectations to provide non-prescribed antibiotics. Key resultsThe findings highlight how perceived normative expectations associated with a collectivist orientation predispose pharmacists to concede to customers' requests. The analysis identified two inter-related factors serving to pressure pharmacists to dispense non-prescribed antibiotics: personal customer-pharmacist relationship and cultural collectivist values. Pharmacists faced dilemmas between obligation to comply with customers' requests and going against professional ethos and described strategies to resist customers’ requests. ConclusionsThis study illuminates the central role of sociocultural contexts and social norms in pharmacist-customer relations in a collectivist-oriented minority, resulting in pressuring pharmacists to go against regulations. The findings have implications to understanding reasons for dispensing prescription-only medications. Interventions to reduce antibiotics use could enlist the centrality of social ties and commitment in pharmacist-customer relationships to resist dispensing prescription-only medications without prescriptions and to strengthen pharmacists’ role in providing pro-health messages.

Financial incentives for infection prevention and antimicrobial stewardship to reduce antibiotic use: Japan's nationwide observational study

The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.

Antibiotic review kit for hospitals (ARK-Hospital): a stepped-wedge cluster-randomised controlled trial

Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical inpatients by increasing appropriate decisions to stop antibiotics at clinical review. We performed a stepped-wedge, cluster (hospital)-randomised controlled trial using computer-generated sequence randomisation of eligible hospitals in seven calendar-time blocks in the UK. Hospitals were eligible for inclusion if they admitted adult non-elective general or medical inpatients, had a local representative to champion the intervention, and could provide the required study data. Hospital clusters were randomised to an implementation date occurring at 1-2 week intervals, and the date was concealed until 12 weeks before implementation, when local preparations were designed to start. The intervention effect was assessed using data from pseudonymised routine electronic health records, ward-level antibiotic dispensing, Clostridioides difficile tests, prescription audits, and an implementation process evaluation. Co-primary outcomes were monthly antibiotic defined daily doses per adult acute general medical admission (hospital-level, superiority) and all-cause mortality within 30 days of admission (patient level, non-inferiority margin of 5%). Outcomes were assessed in the modified intention-to-treat population (ie, excluding sites that withdrew before implementation). Intervention effects were assessed by use of interrupted time series analyses within each site, estimating overall effects through random-effects meta-analysis, with heterogeneity across prespecified potential modifiers assessed by use of meta-regression. This trial is completed and is registered with ISRCTN, ISRCTN12674243. 58 hospital organisations expressed an interest in participating. Three pilot sites implemented the intervention between Sept 25 and Nov 20, 2017. 43 further sites were randomised to implement the intervention between Feb 12, 2018, and July 1, 2019, and seven sites withdrew before implementation. 39 sites were followed up for at least 14 months. Adjusted estimates showed reductions in total antibiotic defined daily doses per acute general medical admission (-4·8% per year, 95% CI -9·1 to -0·2) following the intervention. Among 7 160 421 acute general medical admissions, the ARK intervention was associated with an immediate change of -2·7% (95% CI -5·7 to 0·3) and sustained change of 3·0% (-0·1 to 6·2) in adjusted 30-day mortality. The antibiotic review kit intervention resulted in sustained reductions in antibiotic use among adult acute general medical inpatients. The weak, inconsistent intervention effects on mortality are probably explained by the onset of the COVID-19 pandemic. Hospitals should use the antibiotic review kit to reduce antibiotic overuse. UK National Institute for Health and Care Research.

Procalcitonin-guided reduction of antibiotic use in acute pancreatitis

Acute pancreatitis is a challenging disease to treat, representing a substantial clinical and economic burden. It is ranked among the top causes of acute emergency admission among gastrointestinal disorders and leads to substantial use of health-care resources and related costs.1 The recommended medical treatment of acute pancreatitis is conservative, but because evidence informing decision making is mostly of low quality and the outcomes are potentially severe, there is a tendency toward an excess in medical care.

Effects of Garlic Feed Inclusion on Experimental Salmonella gallinarum Infection in Broiler Chickens (Gallus gallus domesticus)

Garlic is a spice and herbal medicine with antibacterial, antioxidant and immunomodulatory effects. In view of global demand for reduction in antibiotic use in poultry production, the potential of garlic at controlling fowl typhoid was investigated. Day-old (75) broiler chicks were separated into groups A, B, C, D and E of fifteen each, placed in cages for brooding and administered 0.125%, 0.25%, 0.5%, 0% and 0.125% garlic-meal, respectively, in feed. At 9 week-old, each chick in groups A, B, C and D were inoculated with 8x106 cfu/ml PBS of Salmonella gallinarum, orally, while those in Group E were given PBS only. Up till 10 days post-infection (pi), clinical signs were scored from 1-3 based on degree of severity i.e. 1(mild), 2 (moderate) and 3 (severe). Mortality and gross pathology per group were recorded. Samples from liver and gall bladder were harvested for bacterial re-isolation. Groups A, B and C showed mild diarrhoea while group D showed in addition, anorexia, ruffled feathers and unthriftiness. Diarrhoea in groups A and B spanned days 2 -7 pi, group C on day 3 pi while in group D, days 1-10 pi with increasing degree of severity. Total diarrhoea scores were 6(A), 4(B), 1(C), 23(D) and 0(E) while mortalities were 2(A), 0(B), 2(C), 4(D) and 0(E). Enlarged and congested/bronze-coloured liver, engorged gall bladder and catarrhal enteritis were observed in carcasses. Colonial and cellular morphology of re-isolated bacteria were typical of S. Gallinarum. Garlic-meal ameliorated the effects of S. Gallinarum infection with the best result at 0.25%.
 Keywords: broiler chickens; antibacterial; fowl typhoid; Garlic; Salmonella gallinarum

Intramammary use of antibiotics in dairy farms in the canton of Ticino before, during and after Staphylococcus aureus genotype B elimination

The aim of the study was to evaluate the use of intramammary antibiotics before, during and after the elimination of Staphylococcus aureus genotype B (SAGTB). Data on intramammary antibiotic use was collected in 65 dairy farms as part of a pilot project for SAGTB elimination in the canton of Ticino from 2017 to 2019. The investigated farms were divided into 46 affected farms (with at least one SAGTB-positive animal) and 19 control farms (SAGTB-free farms). Data on antibiotic use were requested from veterinarians and treatment incidence, as a measure of antibiotic use, was calculated based on medical records and veterinary prescriptions. In addition, the treatment incidence was calculated for 47 farms during alpine farming period. In 2018 (elimination year), the mean incidence of treatment during lactation in the SAGTB-positive farms was significantly higher than in the control farms (p=0,003). In 2019 no significantly lower antibiotic use during lactation or dry period was detected between 2017 (before elimination) and 2019 (after elimination). Alpine farming places where only S. aureus genotype B-negative animals had access to had a significantly lower antibiotic use during lactation (p=0,004). The new federal database (Antibiotics Information System in Veterinary Medicine, IS ABV) should allow continuous monitoring and to confirm the reduction of antibiotic use in the coming years.

Effectiveness of Influenza Vaccination in Reducing Subsequent Antibiotic Prescribing in Young Children Attending Australian General Practices-A Case-Control Study.

Vaccination against influenza may reduce antibiotic use, but data are limited and imprecise. We conducted a case-control study using deidentified data from a large national primary care database to evaluate antibiotic prescribing changes following influenza vaccination in children 1-4 years old attending primary care in the Australian 2018 and 2019 influenza seasons. Cases were prescribed β-lactam or macrolide antibiotics during the influenza season and controls were not. Influenza vaccination was documented in the medical records. Adjusted odds ratios for antibiotic prescribing according to influenza vaccination status were estimated using generalized estimating equations, controlling for age, asthma diagnosis, other vaccinations, practice visit frequency, and attendance week. In 2018, 11282 cases and 32020 controls were eligible, and in 2019, 12705 cases and 36858 controls. Antibiotic prescriptions were less likely in vaccinated participants in 2018 (aOR, 0.65; 95% CI, 0.62-0.69) and 2019 (aOR, 0.78; 95% CI, 0.73-0.82) and did not vary by age, the number of GP visits, or prior prescribing of antibiotics. In the subgroup of children vaccinated in the preceding season, influenza vaccination was not associated with a reduction in antibiotic use (2018-aOR, 1.12; 95% CI, 0.90-1.39; 2019-aOR, 1.30; 95% CI, 1.16-1.46). From our estimates, potentially 100000 antibiotic prescriptions could be avoided annually in Australia if all children in this age range were vaccinated. Influenza vaccination may substantially reduce antibiotic prescribing among young children. This effect should be considered in the overall assessment of the costs and benefits of childhood influenza vaccination programs.

In vitro susceptibility of swine pathogens to feed additives and active ingredients with potential as antibiotic replacements.

The rise in antibiotic resistance requires the reduction of antibiotic use in all sectors. In animal production, many commercial alternatives to antibiotics have been developed for incorporation into feeds, but a lack of evidence on their antibacterial activity limits confidence in their application. We aim to compare the antibacterial activity of feed additives and active ingredients to better understand their usefulness. The antibacterial activity of 34 active ingredients and feed additives, including medium- and short-chain organic acids and essential oils, was tested against pure cultures of five bacterial swine pathogens. Antibacterial activity was observed using an agar plug diffusion method and quantified via broth microdilution. A diverse range of antibacterial activities were observed. The highest inhibitory activity against Staphylococcus aureus and Streptococcus suis was exhibited by the C12 monoglyceride (0.49mgml-1 ). The monoglyceride of C12 was more effective than C12:0 against Strep. suis, but neither C12:0 nor its monoglyceride showed efficacy against the gram-negative micro-organisms tested. The most active against Escherichia coli were the C6:0 medium-chain organic acids and potassium diformate (1.95mgml-1 ). For Salmonella Typhimurium, potassium diformate, sodium diformate, and a blend of C8:0/C10:0 (each 1.96mgml-1 ), and for Actinobacillus pleuropneumoniae, eugenol (0.49mgml-1 ) showed the most promising activity. We identified broad-spectrum antibacterial activity, such as the C6:0 MCOA, and those with interesting narrow-spectrum activity, notably the killing of Strep. suis by C12 monoglyceride. We have identified additives that show the most promising bioactivity against specific pathogens. We broadly compare a large collection of feed additives and active ingredients for their antibacterial activity against a diverse panel of bacterial swine pathogens. This provides a solid base of evidence which can drive the development of feed supplementation strategies with the aim of reducing dependency on antibiotic use in swine production.