Risk Factors For Antimicrobial Resistance Research Articles

Antimicrobial infusion practices within intensive care units: Carbapenem infusion preparation and administration process errors

ObjectiveTo describe nurse preparation and administration of intermittent carbapenem infusions. Research methodology/designThis observational study documented the carbapenem infusion process to adult patients in three general intensive care units. Main outcome measuresTiming and duration of infusions were observed. Volumetric analysis of infusion items was conducted to determine loss of reconstituted carbapenem during preparation and administration phases. ResultsCarbapenem infusions (n = 223) administered to twenty adult patients were observed. Infusion duration guidance was variable, with two ICUs following current literature recommendations, and one ICU referring to medication package insert information. Within these parameters, only 60 % of infusions complied with infusion duration. Non-compliance with planned time of administration impacted on desired dosing intervals. Incomplete delivery of intended dose was found during: sub-optimal reconstitution of vials, incorrect number of vials reconstituted, failure to administer a dose (missed dose), and discarding antibiotic residue in infusion items. Volumetric analysis of infusion items showed mean dose losses of 4.9 % and 1.2 % in discarded vials and syringes. Mean drug losses of 6.3 % and 30.8 % occurred in discarded infusion bags and infusion lines respectively. No flushing guidance or practice was observed. ConclusionIncorrect nurse administration of antibiotics resulted in varying durations of infusions and the non-delivery of prescribed dose. Under-dosing has the potential to contribute to selection pressure for bacterial antibiotic resistance. The increasing frequency of intravenous delivery of antimicrobial agents through infusions requires an understanding of the required duration of administration and how to manage residual drug remaining in the intravenous line once the infusion is completed. Implications for clinical practiceFlushing of administration lines is not common practice following intermittent antimicrobial infusions. Although there are multi-factorial risk factors for antimicrobial resistance in the critical care arena, nurse infusion practice must ensure that patients receive intended antimicrobial treatment. Attention must be given to the potential for antimicrobial resistance from environmental contamination with the disposal of infusion items containing undelivered antimicrobial medication.

Prevalence and Risk Factors for Antimicrobial Resistance of Mycoplasma genitalium Infections in a High-Risk Population.

Background/Objectives:Mycoplasma genitalium (MG) infections and antibiotic resistance are increasing in prevalence while treatment options are limited. Limited data exist regarding MG resistance in Israel. Our aim was to study the prevalence of MG resistance in a sexually transmitted infection (STI) clinic in Israel. Methods: We performed a single-center retrospective study among patients attending an STI clinic during 2019-2020. MG isolates were tested to detect their resistance to azithromycin and fluoroquinolones (FQs) using commercial kits (Allplex™ MG & AziR Assay, Allplex™ MG & MoxiR Assay). We collected patient data regarding the risk factors for STIs and resistance. A multivariate logistic regression model was used to identify the risk factors for resistance. Results: Of the 142 patients who tested positive for MG, 50 (35.2%) and 22 (15.5%) had resistant mutations to azithromycin and FQ, respectively, and 13 (9.2%) showed resistance to both agents. In a multivariate logistic regression model, men who have sex with men (RR 7.01 95% CI 3.00-16.33) and past STIs (RR 2.33 95% CI 1.01-5.34) were independent risk factors for azithromycin resistance. Conclusions: We found a high prevalence of azithromycin resistance and, to a lesser degree, FQ resistance. These findings may help design the treatment guidelines and support routine resistance testing in high-risk populations.

Conventional and unsupervised artificial intelligence analyses identified risk factors for antimicrobial resistance on dairy farms in the province of Québec, Canada

Antimicrobial resistance (AMR) is one of the greatest threats to global health worldwide and is threatening not only humans, but also animal production systems, including dairy farms. The objective of this paper was to describe risks factors associated with AMR on dairy farms in Québec, Canada. This observational cross-sectional study included 101 commercial dairy farms and took place between the springs of 2017 and 2018 for a one-year period. We explored risk factors such as farm practices and producer's knowledge (measured using a questionnaire), antimicrobial use (quantified using veterinary invoices), and the presence of Salmonella Dublin (tested by serology). We evaluated AMR with fecal Escherichia coli retrieved from pre-weaned calves and lactating cows using the following outcomes: the presence of extended-spectrum-β-lactamase/AmpC resistance and the number of resistances to antimicrobial classes. We used logistic regression models to evaluate the association between each risk factor and the 2 outcomes for the 2 types of samples (pre-weaned calves and lactating cows). Furthermore, we explored the relationships between these risk factors utilizing data dimensionality reduction and hierarchical clustering. Outputs of these analyses were used as regressors for AMR in regression models. While the results for univariate analyses were ambiguous, the unsupervised analysis naturally categorized the sample of farms according to their health/treatment status (dimension 1, explaining 12.9% of the variance) and herd size (dimension 2, explaining 7.8%). Three clusters of farms were identified (cluster 1: mainly healthy herds and low ceftiofur users, cluster 2: relatively high ceftiofur users, cluster 3: farms with a higher incidence of diseases and higher antimicrobial treatment rates). Dimension 1 and cluster membership were statistically associated with the presence of extended-spectrum-β-lactamase/AmpC resistance in lactating cows and in pre-weaned calves. Dimension 1 was also statistically associated with the number of resistances in lactating cows and in pre-weaned calves. This study highlights the complexity of analyzing risk factors associated with AMR. Our results suggest that the herd health status and the AMU-related practices used are associated with AMR in dairy farms. However, prospective studies are needed to confirm a causal relation.

Assessment of Knowledge and Attitude toward Antibiotic Misuse and Resistant among Selected Group of Sudanese University Students, 2022

Background: Globally, antimicrobial resistance is a serious public health concern. The World Health Organization (WHO) has highlighted improper antibiotic usage as a key risk factor for antimicrobial resistance. Aims: Assessing the knowledge and attitudes of students regarding antibiotic misuse and resistance could lead to better management and eventually a good quality of life. Methodology: This study is a descriptive cross-sectional study conducted on 150 students in a selected group of Sudanese university students, randomly selected from students by self-administering that was conducted using a structured questionnaire. These variables were assessed using a ten-point scale, whose responses ranged from ``YES`` to ``NO``. Results: The current study demonstrates that the highest percentage (47.3%) was in the age group (21-23), and more than half of participants had good knowledge and attitudes regarding antibiotic misuse and resistance. This study reflects that most of the participants were male, with a total of 108 (72.0%), and several females, with a total of 42 (28.0%). The study shows that most of the students at the second level are 55 (36.7%), single (144 (96.0%), and married (4.0%). Conclusion: The research conclusion is that students have good knowledge of antibiotics and good knowledge of antibiotic resistance. The majority of these students have a mediocre attitude toward the use of antibiotics, which is insufficient for a group of students enrolled in health-related programs.

Occurrence and management of lower respiratory tract infections in children at a Nigerian tertiary hospital

Objectives Infectious diseases such as pneumonia, diarrhea, and malaria are the major causes of child mortality, with pneumonia, a lower respiratory tract infection (LRTI), being the foremost of the three. Antimicrobial agents are required to treat LRTIs, such as pneumonia caused by bacteria, while those commonly caused by viruses, such as bronchiolitis, do not benefit from antimicrobial therapy unless laboratory tests indicate otherwise. When not shown, empirical management of patients using antimicrobials remains a risk factor for antimicrobial resistance in the management of LRTIs. This study aimed to determine the occurrence of LRTIs in children who presented with acute respiratory tract infections (RTIs) and evaluate their management in comparison with the guidelines. Material and Methods The study was a descriptive retrospective review of prescribing records for respiratory tract infections (RTIs) presented at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA), Ebonyi State, Nigeria. Data were collected through systematic sampling of the case folders of children aged five years and below who presented with RTIs from January to December 2021, using a data collection proforma. Collected data were cleaned and coded, and Statistical Package for Social Sciences (SPSS) Version 28 was used for analysis. Results There were 422 case folders containing diagnoses of RTIs. Of these, 36 (8.5%) were diagnosed with LRTIs and 28 (6.6%) had no comorbidity. Of the 28 cases without comorbidities, pneumonia (20;71.4%) and bronchiolitis (8;28.6%) were the only two LRTIs. Antibiotics were the most prescribed medications, followed by vitamins (8;28.6%) and antihistamines (7;25.0%). There were seven types and three combinations of antibiotic medications, the most being cefuroxime (10;35.7%) followed by amoxicillin/clavulanic acid (7; 25.0%). One case of pneumonia did not receive an antibiotic. Laboratory investigations were not conducted for the majority (25;89.3%) of the cases presented. Conclusion This study showed that the LRTIs presented were mostly managed using the recommended antibiotics for pneumonia. Antibiotics for bronchiolitis without confirmation by laboratory tests may not have been justified as most of them are of viral origin. Deviations from guidelines may be reduced if national protocols are developed in managing LRTIs.

Resistance to first-line antibiotic therapy among patients with uncomplicated acute cystitis in Melbourne, Australia: prevalence, predictors and clinical impact.

Australian guidelines recommend trimethoprim or nitrofurantoin as first-line agents for uncomplicated urinary tract infections (UTIs). Laboratory surveillance indicates high rates of trimethoprim resistance among urinary bacterial isolates, but there are scant local clinical data about risk factors and impact of trimethoprim resistance. To determine the prevalence, risk factors, mechanism and impact of resistance to first-line antibiotic therapy for uncomplicated UTIs in the community setting. A prospective observational study from October 2019 to November 2021 in four general practices in Melbourne, Australia. Female adult patients prescribed an antibiotic for suspected or confirmed uncomplicated acute cystitis were eligible. Primary outcome was urine isolates with resistance to trimethoprim and/or nitrofurantoin. We recruited 87 participants across 102 UTI episodes with median (IQR) age of 63 (47-76) years. Escherichia coli was the most common uropathogen cultured (48/62; 77%); 27% (13/48) were resistant to trimethoprim (mediated by a dfrA gene) and none were resistant to nitrofurantoin. Isolates with resistance to a first-line therapy were more common among patients reporting a history of recurrent UTIs [risk ratio (RR): 2.08 (95% CI: 1.24-3.51)] and antibiotic use in the previous 6 months [RR: 1.89 (95% CI: 1.36-2.62)]. Uropathogen resistance to empirical therapy was not associated with worse clinical outcomes. Resistance to trimethoprim is common in uncomplicated UTIs in Australia but may not impact clinical outcomes. Further research is warranted on the appropriateness of trimethoprim as empirical therapy, particularly for patients with antimicrobial resistance risk factors.

COMPARATIVE STUDY TO DETECT ANTIBIOTIC RESIDUES IN PROCESSED AND RAW MILK IN LAHORE

Antibiotics help animals and human beings live longer and healthier lives. But if antibiotics are used carelessly or inappropriately, or if the required withdrawal period is not understood, it's possible that treated animals' products will include unintended antibiotic residues. Many of these life-saving drugs are losing their efficacy as formerly vulnerable microorganisms (bacteria, viruses, fungi and microscopic-parasites) develop resistance. This phenomenon is called “antimicrobial resistance” or AMR. Antimicrobial usage (AMU) is a significant risk factor for antimicrobial resistance (AMR) development. The aim of this study was to investigate the presence of β-lactam and tetracyclines antibiotic residues in raw (cow and buffalo) milk and processed (UHT and pasteurized) milk in District Lahore. For that purpose, a total of 200 milk samples, containing 100 raw milk samples and 100 processed milk samples were collected from 5 zones of Lahore. The samples were processed using Milk Antibiotic Residues Rapid Test (Bioeasy) for β-lactams and tetracyclines in the milk kit method which is based upon colloidal gold immunochromatography technology also known as lateral flow dipstick immunoassay. Among total of 200 milk samples, the results showed as 6.5% of milk samples were positive for only beta-lactams, 1.5% milk samples were positive for only tetracyclines, 9.5% milk samples exhibited dual positivity for both beta-lactams and tetracyclines, 8.5% milk samples demonstrated weak positive results for both antibiotics, and 74% milk samples were negative for beta-lactams and tetracyclines both. The calculated p-value (0.0004998) indicates a significant difference between the observed samples in terms of antibiotic residue presence by Fisher's exact test. These residues were more in the raw milk as compared to the processed milk. Regulatory authorities should ensure proper withdrawal period before milking the animals and definite supervisions are necessary on application of these drugs as this is the serious healthcare concern in Lahore.

Pharmacological management of upper respiratory tract infections in children: An assessment of a tertiary institution practice in Nigeria

Objectives: Upper respiratory tract infections (URTIs) are the most common acute RTIs that occur in children. Therapy addressing symptoms is recommended for URTI management. The use of antibiotics without culture and sensitivity tests is a risk factor for antimicrobial resistance. Materials and Methods: This study was set to assess the pharmacological management of URTIs in children from a tertiary institution practice. This study was conducted in Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria. It was a retrospective review of 275 prescriptions of medicines for URTIs in children, from January to December 2021. A systematic sampling technique was used to collect data. Data were analyzed using the Statistical Package for the Social Sciences version 28.0. Results: Of the 275 sampled URTI cases, 157 (57.1%) occurred in male children. No laboratory test was conducted for 265 (96.4%) cases. The majority (207; 75.3%) were diagnosed as non-specific URTI. Other diagnoses include tonsillitis (46; 16.7%), otitis media (8; 2.9%), and rhinitis (6; 2.2%) among others. Antibiotics were the most prescribed medications, (212; 77.1%) followed by antihistamines, (110; 40.0%), vitamins (75; 27.3%), and antimalarials (55; 20.0%). The most prescribed antibiotic was amoxicillin-clavulanic acid (79; 28.7%). There was no statistically significant association between the age category of children and the number of medicines prescribed, whether antibiotics were prescribed, and the number of antibiotics prescribed (P > 0.05). Conclusion: Antibiotics were the mainstay for the management of URTIs in the study center. This mode of therapy could lead to antimicrobial resistance since culture and sensitivity tests were not done before the initiation of antibiotic therapy.

Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study.

A novel 'subscription-type' funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model. An online survey was sent to all infection consultants in NHS acute hospitals in England. The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both 'subscription-type' model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia. The 'subscription-type' model was viewed favourably by infection consultants in England.

Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy.

Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that is frequent, as more than half of antibiotics prescriptions in ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred to in different settings. The estimated attributable mortality of VAP can go up to 50%, which is higher in cases of antimicrobial-resistant VAP. When the diagnosis of pneumonia in a mechanically ventilated patient is made, initiation of effective antimicrobial therapy must be prompt. Microbiological diagnosis of VAP is required to optimize timely therapy since effective early treatment is fundamental for better outcomes, with controversy continuing regarding optimal sampling and testing. Understanding the role of antimicrobial resistance in the context of VAP is crucial in the era of continuously evolving antimicrobial-resistant clones that represent an urgent threat to global health. This review is focused on the risk factors for antimicrobial resistance in adult VAP and its novel microbiological tools. It aims to summarize the current evidence-based knowledge about the mechanisms of resistance in VAP caused by multidrug-resistant bacteria in clinical settings with focus on Gram-negative pathogens. It highlights the evidence-based antimicrobial management and prevention of drug-resistant VAP. It also addresses emerging concepts related to predictive microbiology in VAP and sheds lights on VAP in the context of coronavirus disease 2019 (COVID-19).

Empirical treatment and mortality in bacteremia due to extended spectrum β-lactamase producing Enterobacterales (ESβL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia

BackgroundInfections caused by extended spectrum β-lactamase (ESβL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality.MethodsA retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum β-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established.ResultsThe prevalence of bacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC).Conclusionsbacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.

P23 The SMASH survey: Subscription Models for Antibiotics in Hospital—preliminary results

Abstract Objectives On 1 July 2022 NHS England launched a novel delinked ‘subscription-type’ payment model for two new antimicrobials, ceftazidime/avibactam and cefiderocol. The SMASH survey (Subscription Models for AntibioticS in Hospitals) aims to capture the views of Infectious Diseases and Microbiology Consultants on key knowledge gaps around the implementation and impact of this model in the NHS. Methods A novel questionnaire was developed and piloted for this survey (https://www.surveymonkey.co.uk/r/SMASHsurvey). The target audience included Consultants in Infectious Diseases and/or Medical Microbiology working at least 1 day per week (2 Programmed activities or equivalent) in an NHS acute hospital in England. The questionnaire was distributed to all eligible Consultants in England using a network of local investigators in 35 key locations around the country. The SMASH survey was sponsored by the London School of Hygiene and Tropical Medicine (REC Reference No 28161/RR/29296) and funded by an independent research grant from Shionogi B.V. Results A total of 111 complete responses were received within the first 21 days of the survey launch. Most responders (55.9%, 62/111) had a CCT in Microbiology or Infectious Diseases and Medical Microbiology (26.1%, 29/111). Only 57.6% (64/111) reported having heard of the new funding model before completing the survey, yet the majority (72.1%, 80/111) agreed that it is a welcome development in the management of drug-resistant infections. Some Consultants reported that cost is a significant consideration when using specific antimicrobials (46.8% Agree or Strongly Agree), while other Consultants were unsure (19.8% Neither Agree or Disagree) or disagreed with this statement (33.4% Disagree or Strongly Disagree). Using a 5-point scoring system and other antimicrobials for carbapenem-resistant infections as comparators, responders indicated that they believed ceftazidime/avibactam and cefiderocol had high insurance (4.28/5 and 4.16/5 respectively) and diversity value (4.11/5 and 4.07/5), moderate enablement (3.37/5 and 3.15/5) and transmission value (3.12/5 and 3.00/5) and low spectrum value (2.13/5 and 2.16/5). Meropenem recorded the highest score for enablement value (3.77/5) and transmission value (3.31/5), while Fosfomycin the highest score for spectrum value (3.06/5). With regards to antimicrobial stewardship, only 20.7% (23/111) of Consultants agreed that the new funding model will lead to reduced use of carbapenems. 46% of responders (51/111) would consider using the two newly introduced antibiotics empirically, when risk factors for antimicrobial resistance are present, while the rest would only use them in microbiologically confirmed carbapenem-resistant infections. The most important resistance risk factors that would justify empirical use were previous infection with carbapenem-resistant bacteria (81.1%), current colonisation with carbapenem-resistant bacteria (73.9%), ward outbreak of carbapenem-resistant bacteria (68.5%), clinical treatment failure of carbapenems (63.1%) and recent admission to high prevalence hospital for carbapenem-resistant bacteria (46.9%). Conclusions The ‘subscription type’ payment model for antimicrobials was introduced in England 5 months ago, yet many infection specialists have not been informed about it. Its effect on stewardship is currently uncertain and introduced antimicrobials are likely to be used empirically. Infection specialists in England agree that new antimicrobials have benefits beyond the treatment of an individual patient, especially in terms of insurance and diversity value.

Awareness and knowledge of antimicrobial resistance and factors associated with knowledge among adults in Dessie City, Northeast Ethiopia: Community-based cross-sectional study.

Antimicrobial resistance is an important global health challenge. The current study aimed to assess the level of awareness and knowledge of antimicrobial resistance and factors associated with knowledge among adults in Dessie City, Ethiopia. A community-based cross-sectional study was conducted among 407 adults in Dessie City from June to July 2021. A systematic random sampling technique was used to select respondents, and Google Form was used to collect data online. The data was analyzed by SPSS Version 26. The associated factors of knowledge of antimicrobial resistance were identified by using bivariate and multivariable logistic regression. Independent variables with a P-value <0.2 were selected as candidate variables for multivariable logistic regression. Those variables with a P-value <0.05 were declared statistically significant factors. Out of the required sample sizes, four hundred and seven participants were enrolled, giving a response rate of 99.3%. One hundred and fifty-two (37.3%) respondents were females. Nearly one-third of the respondents (28.3%) have taken antibiotics in the last 6 months. In this study, 73.7% of study participants were aware of the existence of germs; 58.2% were aware of the existence of antibiotic resistance to bacteria; 47.7% were aware of the existence of drug resistance; 39.8% were aware of the existence of antimicrobial resistance; and 36.6% were aware of the existence of antibiotic resistance. Sixty-four (15.7%) respondents were not aware of any of the above terms. Sixty (14.7%) of the respondents were not aware of any risk factor for antimicrobial resistance. About 63 (15.5%) of the respondents did not know the consequences of antimicrobial resistance. Two hundred and thirty-eight (58.5%) respondents had good knowledge of antimicrobial resistance. In this study, being male (AOR = 1.99; 95% CI: 1.23,3.20), college and above educational level (AOR = 3.50; 95% CI: 1.08,11.39), grade 11-12 educational level (AOR = 3.73; 95% CI: 1.20,11.61), getting advice from health professionals about how to take antibiotics (AOR = 1.84; 95% CI:1.07,3.17), using health professionals as a source of information on antibiotics (AOR = 2.51; 95% CI: 1.48,4.25), and taking antibiotics without prescription (AOR = 1.86; 95% CI: 1.04,3.30) were significantly associated with good knowledge of antimicrobial resistance. The study identified low awareness and knowledge of antimicrobial resistance among adults. Being male, higher educational level, getting advice from health professionals about how to take antibiotics, using health professionals as a source of information on antibiotics, and taking antibiotics without a prescription were significantly associated with good knowledge of antimicrobial resistance. Educational campaigns would be highly desirable for the public to improve their awareness and knowledge of antimicrobial resistance.

Chronic Kidney Disease-An Underestimated Risk Factor for Antimicrobial Resistance in Patients with Urinary Tract Infections.

(1) Background: Chronic kidney disease (CKD), as well as antimicrobial resistance (AMR) represent major global health problems, with important social and economic implications. It was reported that CKD is a risk factor for antimicrobial resistance, but evidence is scarce. In addition, CKD is recognized to be a risk factor for complicated urinary tract infections (UTIs). (2) Methods: We conducted an observational study on 564 adult in-hospital patients diagnosed with urinary tract infections. The aim of the study was to identify the risk factors for AMR, as well as multiple drug resistance (MDR) and the implicated resistance patterns. (3) Results: The mean age was 68.63 ± 17.2 years. The most frequently isolated uropathogens were Escherichia coli strains (68.3%) followed by Klebsiella species (spp. (11.2%). In 307 cases (54.4%)), the UTIs were determined by antibiotic-resistant bacteria (ARBs) and 169 cases (30%) were UTIs with MDR strains. Increased age (≥65) OR 2.156 (95% CI: 1.404–3.311), upper urinary tract obstruction OR 1.666 (1.083–2.564), indwelling urinary catheters OR 6.066 (3.919–9.390), chronic kidney disease OR 2.696 (1.832–3.969), chronic hemodialysis OR 4.955 (1.828–13.435) and active malignancies OR 1.962 (1.087–3.540) were independent risk factors for MDR UTIs. In a multivariate logistic regression model, only indwelling urinary catheters (OR 5.388, 95% CI: 3.294–8.814, p < 0.001), CKD (OR 1.779, 95% CI: 1.153–2.745, p = 0.009) and chronic hemodialysis (OR 4.068, 95% 1.413–11.715, p = 0.009) were risk factors for UTIs caused by MDR uropathogens. (4) Conclusions: CKD is an important risk factor for overall antimicrobial resistance, but also for multiple-drug resistance.

Waiting for markets to change me-High-stakeholders' views of antibiotic use and antibiotic resistance in pig production in Brazil.

Overuse of veterinary antibiotics is a risk factor for antimicrobial resistance (AMR), which is a global public health emergency. More than 70% of the antibiotics consumed worldwide are used in farm animals, mainly in poultry and pig herds. Brazil is the fourth largest pork producer globally and the second-largest user of antibiotics in animals. Qualitative research can help understand the complexities around antibiotic use (AMU) in Brazilian pig herds and identify stakeholders' attitudes concerning the rational AMU and AMR in the production chain. This study aimed to explore the knowledge and attitudes of high-level professionals in the animal production chain about AMU and AMR in pig farming, the relationship with pig welfare and AMU in Brazil. We conducted 32 in-depth interviews with individuals active in the pig industry. The majority of the participants considered AMU excessive and inappropriate in pig farms in Brazil. However, attitudes toward a restrictive AMU scenario in Brazilian pig farms were predominantly negative, justified by economic, sanitary and social barriers. These included unsatisfactory management and biosecurity conditions in pig farms that, in their opinion, justify AMU to prevent diseases; issues surrounding prescription and acquisition of veterinary drugs; and employment and income relationships arising from the sale of antibiotics. The views of high-level professionals in the Brazilian livestock chain reveal antibiotics as a structural element that enables pig production. Antibiotics were viewed as essential resources for producing cheap food. Foreign markets were considered the most relevant driver of change in AMU practices rather than pressure from Brazilian consumers. A common belief expressed was that AMR is more associated with the inappropriate AMU in human medicine than in the livestock sector. Resistance to change in these stakeholders may hinder the implementation of future public policies to restrict the use of antibiotics in Brazil. Our findings suggest that successful measures to deal with the AMU/AMR challenges in the pig chain shall not be rooted in personal behavior change. Instead, honest interdisciplinary dialogues and structural changes are needed to define common grounds and a way forward to break the cycle perpetuating antibiotics as structural commodities.

Risk factors for antimicrobial resistance in patients with Escherichia coli bacteraemia related to urinary tract infection

NHS Lothian policy has recently changed to avoid first-line use of trimethoprim for uncomplicated urinary tract infections (UTI) in patients with risk factors for trimethoprim resistance, in line with national guidance. This study aimed to identify risk factors for antimicrobial resistance in Escherichia coli bacteraemia related to UTI. A retrospective cohort study of 687 patients with E.coli bacteraemia related to UTI in NHS Lothian from 01/02/18 to 29/02/20 was undertaken. Demographics and comorbidities were collected from electronic patient records. Community prescribing and microbiology data were collected from the prescribing information system and Apex. Univariate and multivariate analysis was undertaken using RStudio to analyse trimethoprim, gentamicin and multi-drug resistance (MDR). Trimethoprim resistance was present in 282/687(41%) of blood culture isolates. MDR was present in 278/687(40.5%) isolates. Previous urinary trimethoprim resistant E.coli was a significant risk factor for both trimethoprim resistance (OR 9.44, 95%CI 5.83-15.9) and MDR (OR 4.81, 95%CI 3.17-7.43) on multivariate modelling. Trimethoprim prescription (OR 2.10, 95% CI 1.33-3.34) and the number of community antibiotic courses (OR 1.19, 95%CI 1.06-1.35) were additional risk factors for trimethoprim resistance. Multiple independent risk factors were also identified for trimethoprim resistance, MDR and gentamicin resistance. This study showed a high prevalence of trimethoprim resistance and MDR in patients with E.coli bacteraemia related to UTI. This supports the withdrawal of trimethoprim from first-line treatment of UTIs in patients with risk factors for trimethoprim resistance. It has also identified risk factors for MDR in E.coli bacteraemia.

Evaluation of Antibiotics Use and its Predictors at Pediatrics Ward of Jimma Medical Center: Hospital Based Prospective Cross-sectional Study.

BackgroundOne of the biggest emerging public health issues is the alarming increase in the prevelance of antibiotic resistance across the globe, which is linked to significant morbidity and mortality and demands special attention. The most significant risk factor for antimicrobial resistance (AMR), which is increasing considerably in Ethiopia and is responsible for increased adverse effects, treatment failure, and rising health-care costs, is inappropriate antibiotic usage. The purpose of this study was to assess the use of antibiotics in inpatient settings at an Ethiopian teaching hospital providing tertiary care.MethodsThe hospital-based prospective cross-sectional study was undertaken at JMC in southwest Ethiopia. Data were collected by using structured checklist which contains patient’s sociodemographic characteristics and pattern of antimicrobial use. All cards of patients which fulfill the inclusion criteria were selected by using a systematic random sampling technique. Bivariate analysis was done to know the association between independent variable and the outcome variable.ResultsThe medical records of 402 pediatric patients who had taken at least one systemic antibiotic were examined. The most frequently prescribed combination antibiotics were ampicillin+gentamycin (43.33%) followed by ceftriaxone+gentamycin (15.23%). Gentamycin 116 (24.11%) was the most frequently used antimicrobial. Overall 19.29% of antibiotic use was improper. A higher percentage of participants 149 (22.41%) experienced inappropriate antibiotic usage as a result of inappropriate frequency. Pediatric patients stay in hospital ≥7 days (AOR; 2.45, 95%CI: 2.32–5.34), prescribed antibiotics ≥2 3.12 (AOR: 3.12, 95%CI: 6.32–13.37) and prescribed empirical treatment types (AOR; 2.65, 95%CI: 4.23–8.87) were independent predictors of inappropriate antibiotics use.ConclusionAntibiotics were generally used inappropriately at high rates. Gentamycin and crystalline penicillin were the most prescribed antibiotics. Longer hospital stay, antibiotics prescription ≥2, and empirical treatments were the independent predictors of inappropriate antibiotic use.

A study of the 20-year evolution of antimicrobial resistance patterns of pediatric urinary tract infections in a single center.

Febrile urinary tract infections (UTIs) are important bacterial infections in children but increasingly difficult to treat due to antimicrobial resistance. We performed a retrospective analysis of the prevalence of uropathogens in hospitalized children with a febrile UTI between 2000 and 2019 in our university hospital to get more insight into trend and determinants of antimicrobial resistance over time. There were 1010 hospitalizations in children with a median age of 1.1years. Thirty-six percent had an abnormal ultrasound and/or the presence of vesico-ureteral reflux, defined as CAKUT. Escherichia coli was the most prevalent pathogen (76%). However, there was an increasing prevalence towards other gram-negative organisms over time, and these pathogens were more common in children with congenital anomalies of kidney and urinary tract (CAKUT) (OR 4.26 (3.14-5.78), p < 0.001). E. coli strains demonstrated an increase in resistance against amoxicillin clavulanic acid (AMC) over time from 16% (2000-2004) to 36% (2015-2019) with an average increase of 2.0%/year; this was + 1.1%/year for third-generation cephalosporin. Multivariate analysis demonstrated that prior antibiotic use was an additional risk factor for antimicrobial resistance in E. coli. Nevertheless, increasing resistance was also observed in children without reported previous antibiotic treatment (+ 1.9%/year, p = 0.04). Conclusion: We observed a significant pattern of increasing antimicrobial resistance of E. coli within a relatively short period of time, making it increasingly difficult to treat pediatric UTIs. This pattern was also seen in children without underlying risk factors (recent antibiotic treatment or structural urological disease). This is indicative for a larger problem in the general population and an important threat to our current standard of health care. What is Known: •Escherichia coli is the most frequent pathogen in pediatric urinary tract infections. •There is an increasing antimicrobial resistance against commonly used antibiotics in urinary tract infections. What is New: •The first 20-year retrospective, longitudinal study on characteristics of the microorganisms of pediatric urinary tract infections in a single center. •A 1-2% yearly increase in antimicrobial resistance, not only in children with congenital anomalies of the kidneys or recent antibiotic treatment but also in children without risk factors.

Risk Factors for Antimicrobial Resistance of Staphylococcus Species Isolated from Dogs with Superficial Pyoderma and Their Owners

The microbial communities on the skin of dogs include several species of bacteria, which contribute to skin health and disease. Staphylococcus pseudintermedius, cultured at high frequency from the skin of dogs, is an opportunistic pathogen causing superficial pyoderma. Effective treatment against S. pseudintermedius infections is an important issue in veterinary medicine. However, multiple antibiotic-resistant mechanisms gradually developed by bacteria make treatment more challenging nowadays. Drug-resistant genes may have the chance to be transferred from infected dogs to other staphylococci in humans. The objective of this survey is to investigate the bacterial species that cause canine superficial pyoderma and characterize the antibiotic-resistant profiles and drug-resistant genes of isolated S. pseudintermedius. In addition, the possible risk factors causing S. pseudintermedius colonizing owners were also evaluated by a questionnaire survey. Sixty-five bacteria were isolated from dogs with superficial pyoderma, which included 47 S. pseudintermedius (72.3%), 12 other staphylococci (18.5%), 4 other Gram-positive bacteria (6.2%) and 2 Gram-negative bacteria (3.1%). Strains containing mecA and blaZ genes showed multiple-drug resistance characteristics. Dogs that received antimicrobial treatment within a recent month were at significantly higher risk of MRSP infections. Only five S. pseudintermedius strains (8.33%) were isolated from 60 samples of owners. Risk factor analysis indicated there was no significant association between S. pseudintermedius isolated from dogs and owners, but the “Keeping three or more dogs” and “Dogs can lick the owner’s face” have high odds ratios of 3.503 and 5.712, respectively. MRSP isolates belonged to three different dru types, including dt11y (29.41%), dt11a (47.06%) and dt10cp (23.53%). In conclusion, the major pathogen of canine superficial pyoderma is found to be S. pseudintermedius in Taiwan, and isolates which are mecA- or blaZ-positive are generally more resistant to commonly used antibiotics. Although S. pseudintermedius isolated from the owners might be transferred from their dogs, definite risk factors should be examined in the future study.

Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.

Clostridioides difficile infection (CDI) is the most common cause of gastroenteritis, and community-acquired pneumonia (CAP) is the most common infection treated in hospitals. American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) CAP guidelines recommend empiric therapy with a respiratory fluoroquinolone or cephalosporin plus macrolide combination, but the CDI risk of these regimens is unknown. We examined the association between each antibiotic regimen and the development of hospital-onset CDI. We conducted a retrospective cohort study using data from 638 US hospitals contributing administrative including 177 also contributing microbiologic data to Premier, Inc. We included adults admitted with pneumonia and discharged from July 2010 through June 2015 with a pneumonia diagnosis code who received ≥3 days of either empiric regimen. Hospital-onset CDI was defined by a diagnosis code not present on admission and positive laboratory test on day 4 or later or readmission for CDI. Mixed propensity-weighted multiple logistic regression was used to estimate the associations of CDI with antibiotic regimens. Our sample included 58,060 patients treated with either cephalosporin plus macrolide (36,796 patients) or a fluoroquinolone alone (21,264 patients) and with microbiological data; 127 (0.35%) patients who received cephalosporin plus macrolide and 65 (0.31%) who received a fluoroquinolone developed CDI. After adjustment for patient demographics, comorbidities, risk factors for antimicrobial resistance, and hospital characteristics, CDI risks were similar for fluoroquinolones versus cephalosporin plus macrolide (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.70-1.38). Among patients with CAP at US hospitals, CDI was uncommon, occurring in ∼0.33% of patients. We did not detect a significant association between the choice of empiric guideline recommended antibiotic therapy and the development of CDI.